TE
科技回声
首页24小时热榜最新最佳问答展示工作
GitHubTwitter
首页

科技回声

基于 Next.js 构建的科技新闻平台,提供全球科技新闻和讨论内容。

GitHubTwitter

首页

首页最新最佳问答展示工作

资源链接

HackerNews API原版 HackerNewsNext.js

© 2025 科技回声. 版权所有。

How Well Do We Understand Probabilities in Medicine? (2016)

53 点作者 bladecatcher超过 6 年前

8 条评论

rcdmd超过 6 年前
Reading some comments in this thread you might think physicians are unable to apply Bayesian statistics to medical care. As a physician myself, I&#x27;d encourage a more considered line of thinking.<p>Clearly, physicians here failed to calculate an exact positive predictive value in the example. The question is does that inability affect their 1) medical care delivered and 2) communication with the patient and the patient&#x27;s own informed decision-making.<p>In speaking to 1-- there are many examples to choose from from probably any medical specialty but let&#x27;s stick to breast cancer screening since that&#x27;s the example from the article. USPSTF presents their recommendations[1]. I&#x27;d encourage anyone with interest to at least skim the rationale presented on the page below those recommendations. They very well consider prevalence as well as efficacy of specific tests given the presence of different risk factors in a patient (age, family history, etc). Importantly, those and many other screening guidelines are applied by primary care physicians who may not otherwise be able to calculate exacting probabilities.<p>[1] <a href="https:&#x2F;&#x2F;www.uspreventiveservicestaskforce.org&#x2F;Page&#x2F;Document&#x2F;RecommendationStatementFinal&#x2F;breast-cancer-screening1" rel="nofollow">https:&#x2F;&#x2F;www.uspreventiveservicestaskforce.org&#x2F;Page&#x2F;Document&#x2F;...</a><p>In speaking to 2-- patient autonomy of course requires an appropriate understanding of the tests they receive, any risk to those tests and the benefits and harms of true positives, false negatives, etc. The associated frequencies, albeit with some degree of imprecision are avaialble by reference and I&#x27;d suspect they&#x27;re memorized by most radiologists reading mammograms and the breast surgeons involved in tested positives-- even if they may not be able to calculate them. If the doctor doesn&#x27;t have them memorized-- they should be available by referencing the relevant guideline.
评论 #18802830 未加载
iheartpotatoes超过 6 年前
BSEE and MSEE with 8 years of heavy math and the fact that I still have to read the solution slowly and not really get it scares the bejeezers out of me.
评论 #18801697 未加载
评论 #18801973 未加载
DanBC超过 6 年前
Bit annoying that this article hat-tips Taleb, when Gerd Gigerenzer has been doing this better and for longer.<p>This book is a good introduction, includes a lot of anecdote from different health care professionals across a range of different testing (including cancer and HIV), and mentions the research across different health care professionals.<p><a href="https:&#x2F;&#x2F;www.amazon.com&#x2F;Reckoning-Risk-Learning-Live-Uncertainty&#x2F;dp&#x2F;0140297863&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.amazon.com&#x2F;Reckoning-Risk-Learning-Live-Uncertai...</a><p>Here&#x27;s an extract: <a href="https:&#x2F;&#x2F;imgur.com&#x2F;zO4zkl4" rel="nofollow">https:&#x2F;&#x2F;imgur.com&#x2F;zO4zkl4</a>
fred_and_fred超过 6 年前
This topic comes up here periodically, and I&#x27;ve linked to these articles before, but it&#x27;s probably worth doing so again for those interested. I am a physician who was also puzzled by these matters, and wound up inventing a simple diagram that I use as a mental &quot;widget&quot; to manipulate the ideas of the 2x2 table in my head. The full text articles can be found at: <a href="https:&#x2F;&#x2F;www.researchgate.net&#x2F;profile&#x2F;Kevin_Johnson40" rel="nofollow">https:&#x2F;&#x2F;www.researchgate.net&#x2F;profile&#x2F;Kevin_Johnson40</a><p>P.S. I&#x27;d love to have someone animate this in Javascript!
评论 #18816795 未加载
mrnobody_67超过 6 年前
I always wonder the pros&#x2F;cons of getting tested for no specific symptom... anxiety.stress.costs of false positives could be enormous.<p>There&#x27;s even a book &amp; several articles out there arguing that getting tested for cancer might be a bad idea: <a href="https:&#x2F;&#x2F;www.theatlantic.com&#x2F;health&#x2F;archive&#x2F;2015&#x2F;06&#x2F;should-I-get-tested-screened-for-cancer&#x2F;397100&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.theatlantic.com&#x2F;health&#x2F;archive&#x2F;2015&#x2F;06&#x2F;should-I-...</a>
known超过 6 年前
Science, Statistics and Lies <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Lies,_damned_lies,_and_statistics" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Lies,_damned_lies,_and_statist...</a>
progval超过 6 年前
Sadly unsurprising. I remember reading a conversation on Twitter where a psychologist wrote openly &quot;I don&#x27;t use statistics because I have an analytical orientation&quot;.
tcj_phx超过 6 年前
I find it ironic that this article is posted on a website aimed at the mental health industry. The actual challenge faced by mental health practitioners is with the futility of their approach.<p>I met a young man (early 20&#x27;s) who&#x27;d recently arrived in town for the purposes of &quot;recovery&quot;. Having learned something about people&#x27;s problems with self-medicating I asked, &quot;People usually know when their problems with substances started. When did it start for you?&quot;<p>He instantly said that when he was in third grade his teacher thought he was disruptive. Parents took him to the doctor, who prescribed medication. When he got to 9th grade he gave his parents an ultimatum: &quot;if you don&#x27;t take me off these drugs, <i>I&#x27;m going to kill myself.</i>&quot; His parents promptly took him off the drugs that didn&#x27;t address the boredom he&#x27;d experienced in his suffocating 3rd grade classroom, and that&#x27;s when he started self-medicating with whatever he could get his hands on.<p>The DSM is the mental health industry&#x27;s guide to help practitioners precisely diagnose symptoms. The problem is the industry frequently jumps to treatment without concern as to the cause of the patients&#x27; symptoms.<p>Court-ordered treatment (aka &quot;assisted outpatient treatment&quot;) is where the mental health industry decides to force a patient to take the drugs they think they need. I have the affidavits that were filed against my friend. They say, essentially, &quot;Patient expects us to believe that her symptoms are related to consuming 2 bottles of liquor a day. She is clearly in need of court-ordered treatment because she does not believe that she has a chronic condition. We know that she has a chronic condition because she&#x27;s had two previous orders for treatment. She took herself off our forced services 4 years ago, and here she is again.&quot;<p>Before this went down, I&#x27;d decided that my friend&#x27;s substance abuse problems were related to her having been adopted, exposed to meth amphetamine as a pre-teen, having &quot;lost her future&quot; at 16 years old when she was expelled for self-medicating with what is now approved as a breakthrough therapy for PTSD (MDMA), and having been injected with a prescription endocrine disruptor [0] with the black-box warning of &quot;cortisol deficiency&quot; at 18 or 19 years old. This &quot;birth control&quot; drug is known to make some women suicidally-depressed. Cortisol deficiency is now associated with psychosis. My friend allowed that maybe the injections took her from &quot;drug abuser&quot; to &quot;drug addict&quot;.<p>[0] <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Depo-Provera" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Depo-Provera</a><p>In the world where mental health professionals address causes rather than symptoms and treat conservatively when the causes of a condition are unknown, those doctors would have recognized my friend&#x27;s presentation as a form of substance-induced psychosis [1], and provided support to help her sober up.<p>[1] <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Substance-induced_psychosis" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Substance-induced_psychosis</a><p>Rather than provide rational treatment, they just force her to take &quot;anti-psychotics&quot; in the delusional belief that their drugs (rather than sobriety) are what allows my friend to be functional. At one point they thought she needed two different drugs. My friend explained her presentation as, &quot;I&#x27;m sorry, these drugs make us slow&quot;.<p>Every medical specialty has practices that aren&#x27;t actually justified by the findings of science. I believe Psychiatry is the most important of the medical specialties, but the path &quot;mainstream&quot; practitioners has taken since the 1950&#x27;s has been a mistake: most psychiatric drugs are just modern FDA-approved &quot;patent medicines&quot; [2] that don&#x27;t actually address the causes of the patient&#x27;s symptoms. While some people like their psych drugs, they&#x27;d probably do much better with more scientific approach to their complaints.<p>[2] <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Patent_medicine" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Patent_medicine</a>
评论 #18801529 未加载