{"id":697,"date":"2008-11-18T08:11:23","date_gmt":"2008-11-18T13:11:23","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=697"},"modified":"2010-09-09T15:53:56","modified_gmt":"2010-09-09T20:53:56","slug":"lies-damn-lies-and-statistics-collective-statistical-illiteracy","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2008\/11\/lies-damn-lies-and-statistics-collective-statistical-illiteracy.html","title":{"rendered":"Lies, Damn Lies And Statistics: Collective Statistical Illiteracy"},"content":{"rendered":"<p>Everyone knows the supposed origin of the phrase. But as you can see\u00a0<a href=\"http:\/\/www.york.ac.uk\/depts\/maths\/histstat\/lies.htm\">here<\/a> it goes back to Medicine:<\/p>\n<blockquote><p>&#8220;Look at the dozens of operations by me this year without a death,&#8221; says the operator. His less enthusiastic neighbor thinks of the proverbial kinds of falsehoods, &#8220;lies, damned lies and statistics&#8221; and replies &#8220;reports of large number of cases subjected to operations seldom fail to beget a suspicion of unjustifiable risk&#8221;.<\/p>\n<p>In &#8220;Some Surgical Sins&#8221;, John B. Robert A.M, \u00a0M.D., \u00a0<a href=\"http:\/\/books.google.com\/books?id=e_0SAAAAYAAJ&amp;pg=PA971&amp;lpg=PA971&amp;dq=Look+at+the+dozens+of+operations+by+me+this+year+without+a+death,&amp;source=web&amp;ots=bIMQNMPCr5&amp;sig=jyUoiuD5FD0ErHJbwtRiY0sMYDs&amp;hl=en&amp;sa=X&amp;oi=book_result&amp;resnum=1&amp;ct=result\" target=\"_blank\">Chairman&#8217;s Address on Surgery and Anatomy<\/a>, 45th Meeting of the AMA, June 1894.<\/p><\/blockquote>\n<p>It looks like not much has changed since then.<\/p>\n<p><!--more--><\/p>\n<p>A new\u00a0<a href=\"http:\/\/www.psychologicalscience.org\/journals\/pspi\/pspi_8_2_article.pdf\" target=\"_blank\">international report<\/a> shows how little statistical literacy doctors have. It connects directly to rational ignorance, a topic <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2008\/06\/participatory-medicine-an-end-to-rational-ignorance-in-medicine.html\" target=\"_blank\">I wrote about<\/a> not long ago. The new report demonstrates that many\u00a0doctors, patients, journalists, and politicians\u00a0alike do not understand what health statistics mean\u00a0or draw wrong conclusions without always noticing.<\/p>\n<p>Collective\u00a0statistical illiteracy refers to the widespread inability to\u00a0understand the meaning of numbers. [Note: Numeracy\u00a0is a prerequisite to being statistically literate.]<\/p>\n<p>The report comes just in time to be read before you can turn to &#8220;Its Great! Oops, No It Isn&#8217;t: Why Clinical Research Can&#8217;t Guarantee The Right Medical Answers&#8221;, a new book by Ronald Gauch, dissecting\u00a0medical research methodology and explaining why correct answers in clinical research are so hard to achieve. In the book\u00a0the author challenges the notion that medical research is too complex for the average citizen to comprehend. He is right. But that comprehension first requires statistical fluency!<\/p>\n<p>The report provides evidence\u00a0that statistical illiteracy:<\/p>\n<ul>\n<li>is common to patients, journalists,\u00a0and physicians;<\/li>\n<li>is created by the nontransparent\u00a0framing of the statistical information, either because of lack of understanding or intentionally to manipulate or persuade people; and<\/li>\n<li>can have serious consequences for health.<\/li>\n<\/ul>\n<p>As e-Patient Dave <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2008\/11\/making-sense-of-health-statistics.html\">wrote yesterday<\/a> the report is directly relevant to e-patients and shows how statistical illiteracy of the public perpetuates the old paradigm of medicine:<\/p>\n<blockquote><p>The causes of statistical illiteracy should not be attributed\u00a0to cognitive biases alone, but to the emotional nature\u00a0of the doctor\u2013patient relationship and conflicts of interest\u00a0in the healthcare system. The classic doctor\u2013patient relation\u00a0is based on (the physician\u2019s) paternalism and (the\u00a0patient\u2019s) trust in authority, which make statistical literacy\u00a0seem unnecessary; so does the traditional combination of\u00a0determinism (physicians who seek causes, not chances)\u00a0and the illusion of certainty (patients who seek certainty\u00a0when there is none).<\/p><\/blockquote>\n<p>The authors show that information pamphlets,\u00a0Web sites, leaflets distributed to doctors by the pharmaceutical\u00a0industry, and even medical journals often report\u00a0evidence in nontransparent forms that suggest big benefits\u00a0of featured interventions and small harms. Because of \u00a0statistical illiteracy the public is susceptible\u00a0to political and commercial manipulation of their anxieties\u00a0and hopes, which undermines the goals of informed consent\u00a0and shared decision making.<\/p>\n<p><strong>What can be done?<\/strong> The authors advocate for teaching, starting in primary and secondary education and continuing in\u00a0medical school,\u00a0the methods of statistical thinking and transparent representations. This early teaching first requires familiarizing children with the concept of probability. It also requires transforming the meaning of statistical\u00a0literacy as the art of solving real-world problems. The authors also note that a\u00a0major precondition for statistical literacy is\u00a0transparent risk communication. To change the current situation the authors recommend using:<\/p>\n<ul>\n<li><a href=\"http:\/\/apha.confex.com\/apha\/128am\/techprogram\/paper_2882.htm\" target=\"_blank\">frequency statements<\/a> instead of <a href=\"http:\/\/www.bun.kyoto-u.ac.jp\/~suchii\/WS.html\" target=\"_blank\">single-event probabilities<\/a>,\u00a0<a href=\"http:\/\/www.bmj.com\/cgi\/content\/full\/333\/7581\/1248\" target=\"_blank\"><\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/cgi\/content\/full\/333\/7581\/1248\" target=\"_blank\">absolute risks<\/a> instead of <a href=\"http:\/\/www.patient.co.uk\/showdoc\/27000849\/\" target=\"_blank\">relative risks<\/a>,<\/li>\n<li>mortality rates instead\u00a0of survival rates, and\u00a0<a href=\"http:\/\/www.medicine.ox.ac.uk\/bandolier\/booth\/glossary\/freq.html\" target=\"_blank\"><\/a><\/li>\n<li><a href=\"http:\/\/www.medicine.ox.ac.uk\/bandolier\/booth\/glossary\/freq.html\" target=\"_blank\">natural frequencies<\/a> instead of\u00a0<a href=\"http:\/\/davidmlane.com\/hyperstat\/A129710.html\" target=\"_blank\">conditional probabilities<\/a>.<\/li>\n<\/ul>\n<p>They also note that<strong> <\/strong><\/p>\n<blockquote><p><strong>Statistical literacy is a necessary precondition for an\u00a0educated citizenship in a technological democracy. <\/strong>Understanding\u00a0risks and asking critical questions can also\u00a0shape the emotional climate in a society so that hopes and\u00a0anxieties are no longer as easily manipulated from outside\u00a0and citizens can develop a better-informed and more relaxed\u00a0attitude toward their health.&#8221;<\/p><\/blockquote>\n<p>This last point is worth expanding. It doesn&#8217;t apply just to health statistics. For example the NetGen people have had a completely different experience than their parents had with playing outdoors. Thanks to the abuse of crime statistics by many media, a large percentage of parents (the Baby Boomers) have kept their children indoors due to the perceived risk of letting their children play freely outside. \u00a0In turn, this has helped shape the NetGeners who are completely used to communicate with others from their computers, in a perceived safe environment.  Since statistics are used all the time, here is a good example of clear statistics, using all the prescribed tools from the report:<\/p>\n<blockquote><p>As of 2006, it is estimated that at least 9.25 million people are currently imprisoned worldwide.<\/p>\n<p>In absolute terms, the USA\u00a0currently has the largest inmate population in the world, with more than 2\u00bd million\u00a0or more than 1 in 100 adults\u00a0in prison and jails. Although the United States represents about 3% of the world&#8217;s population, over 25% of the people incarcerated around the world are housed in the American prison system. Pulitzer Prize winning author Joseph T. Hallinan wrote in his book\u00a0<em>Going Up the River: Travels in a Prison Nation<\/em>, &#8220;so common is the prison experience that the federal government predicts 1 in 11 men will be incarcerated in his lifetime, 1 in 4 if he is black.&#8221;<\/p>\n<p>Prison population per 100,000 inhabitants:<\/p>\n<p>USA: 756 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0France: 85<\/p><\/blockquote>\n<p>I wish medical statistics were always presented in such a concise and clear manner.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Everyone knows the supposed origin of the phrase. But as you can see\u00a0here it goes back to Medicine: &#8220;Look at the dozens of operations by me this year without a [&hellip;]<\/p>\n","protected":false},"author":33,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1,226],"tags":[],"coauthors":[8259],"class_list":["post-697","post","type-post","status-publish","format-standard","hentry","category-general","category-understanding-statistics"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lies, Damn Lies And Statistics: Collective Statistical Illiteracy - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2008\/11\/lies-damn-lies-and-statistics-collective-statistical-illiteracy.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Lies, Damn Lies And Statistics: Collective Statistical Illiteracy - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"Everyone knows the supposed origin of the phrase. 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