Know Your Chances: Understanding Health Statistics Paperback – Nov 30 2008
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From the Inside Flap
"We have a deluge of medical information coming from caregivers, drug companies, and the media. Some of this is accurate and important, some misleading and irrelevant. This concise and clearly written primer gives us a strategy to navigate through these data and arrive at an intelligent understanding of what we need for our health and what we can forgo."Jerome Groopman, MD, author of How Doctors Think
"Valuable to any patient or prospective patient, from junior high schoolers to senior citizens."Joel Best, author of Stat-Spotting: A Field Guide to Identifying Dubious Data
"Many people have an interest in making you unnecessarily afraid about diseases you're not likely to get or cause you to have unrealistic expectations about the benefits of treatment. This book gives you the skills to make your own judgments about these claims. It provides a roadmap for deciphering the kinds of statistics that keep us from making truly informed decisions."Maryann Napoli, Associate Director of Center for Medical Consumers
"The authors have done a remarkable job of dispelling the clouds that often separate people from the medical information that they need. Know Your Chances reflects the authors' confidence that, with a little help, people can make sound decisions about their own health."Baruch Fischhoff, author of Acceptable Risk
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Often these messages are accompanied by numbers intended to cast an amplifying light onto the message or simply parroted by "health reporters" too lazy to interpret data into a less misleading or alarmist form.
Know Your Chances: Understanding Health Statistics is a fast read, only 113 pages, that takes the reader step by step through what it takes to put these numbers into perspective. Why, for example is it true that the risk for being struck with colon cancer is both 5 out of 10000 and 1 out of 19. The difference between the two is time frame which is often omitted from the message.
Naked percentages are another abuse of numbers often appearing in messages. Activists will often use large percentages of small populations to suggest a big change while a corporation might use a small percentage of a large population to play down danger. Both are misleading but common.
The authors define risk in the first chapter and show the reader how to put it into perspective in chapters 2 and 3. This foundation is important as it shows how the oft cited lifetime population or annual population risk is not the same as individual risk. Lifestyle, family and medical history greatly influence individual risk.
The benefits of "health intervention" are tackled in chapters 4 and 5. Aside from weighing the benefits of intervention against the risk of doing nothing side effects must be considered. Also the outcome of an intervention must be distinguished from a treatment's benefit. They're not the same.
Think reducing risk is always good? Think again. Reducing a minor risk with a treatment that has dangerous side effects is hardly desirable. Think about a sleeping pill that might gain you 30 minutes more sleep during an eight hour night but leave you feeling drowsy during your morning commute. Chapters 6 and 7 educate the reader about the downsides of risk reduction and how to balance benefit against side effects. The remaining chapters show help the reader recognize exaggerated claims and how to become a healthy skeptic.
Each chapter includes simple but illustrative quizzes that help the reader ensure they have grasped the concepts discussed.
This book will likely be read by few patients. Few know about the book and most simply follow their doctor's advice. However this book should be a must read for any health reporter. Policy makers and influencers hoping to improve the quality of health care would also benefit reading this book.Primary care doctors would also benefit with a gentle reminder of what the learned or should have learned in medical especially in an era of soaring health care costs and exaggerated claims by for profit health care suppliers.
The authors walk us through a discussion of risk with detailed examples and illustrations. Sure, it's a little simple, but not everyone has studied statistics. I've had graduate-level stats courses and I found the discussions helpful and enlightening.
What's really scary is that we're exposed to hype in news reports, which often seem to come directly from press releases of the pharmaceutical companies. I wonder how many MDs read these statistics without understanding what's going on.
Even worse, we're getting propaganda from medical institutions. The authors show a misleading flyer from the prestigious M.D. Anderson Health Center in Houston.
My favorite part of the book is the discussion on survival rates. If you're diagnosed early you may not get an extra day of life. You just live with the knowledge longer.
I can't help wondering if the millions of dollars we're spending on drugs claiming to lower cholesterol and reduce hypertension might not be better spent on healthy food, exercise and stress reduction. As the authors point out, we need evidence that people with better "numbers" really live longer and experience less suffering. We also need evidence that these drugs really contribute to meaningful outcomes, not just lower numbers.
Just this morning the Wall Street Journal solemnly reported a drug that promised to lower "prostate cancer risk" by 23% among a large sample of high-risk men. Following the guidelines of this book, it was easy to spot flaws. The difference between the placebo group and the drug group was just 6.5%, not 23%. In other words, out of 1000 men, 65 seem to have been spared the diagnosis - not 230. Is that a big number? The authors advise, "It's up to you."
The authors warn us to look with skepticism at promised outcomes. For instance, "shrink the tumor" doesn't always mean "reduce risk death by cancer." "Increase bone density" doesn't mean "avoid hip-fracturing falls."
In this article, the outcome was "diagnosed with prostate cancer," not "death from prostate cancer." If many of the men were 70 or over, it's possible that they would end up dying *with* prostate cancer, as opposed to dying *from* prostate cancer.
The only point I'd add (and I may have missed it in the book) is that extremely large samples can lead to misleading results. When you have huge samples, you can get significant correlations by chance. A study of hundreds of thousands sounds impressive but you need to look more closely.
Everyone needs to read this book, especially consumers of the medical system, legislators and regulators.
and when patient advocacy organizations are often funded by the pharmaceutical industry, it's hard to know what medical information to trust. "Know Your Chances" is a clearly-written and easy-to-understand guide that helps the reader to figure out fact from fiction in medical information.
The authors are well-known doctors from Dartmouth Medical School who have spent many years analyzing and teaching about risk analysis in medicine. They bring their teaching ability to this book - presenting engaging examples and easy to learn tools for deciphering medical statistics.
This is a book everyone should read to ensure that they are getting the best health information possible.
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