Re: Canadian doctors coming to the US

From: George Conklin (nilknoc_at_earthlink.net)
Date: 09/04/04 

Date: Sat, 04 Sep 2004 20:40:29 GMT

"Herman Rubin" <hrubin@odds.stat.purdue.edu> wrote in message
news:chd8ce$4e60@odds.stat.purdue.edu...
> In article <I2KZc.1615$Vl5.1292@newsread2.news.atl.earthlink.net>,
> George Conklin <nilknoc@earthlink.net> wrote:
>
> >"Herman Rubin" <hrubin@odds.stat.purdue.edu> wrote in message
> >news:ch7bd2$4eqk@odds.stat.purdue.edu...
> >> In article <mqEYc.4785$JT3.18@newsread3.news.atl.earthlink.net>,
> >> George Conklin <nilknoc@earthlink.net> wrote:
>
> >> >"Orac" <orac@mac.com> wrote in message
> >> >news:orac-EF355F.16333529082004@news4-ge1.srv.hcvlny.cv.net...
> >> >> In article <cgt8fn$22fi@odds.stat.purdue.edu>,
> >> >> hrubin@odds.stat.purdue.edu (Herman Rubin) wrote:
>
> >> >> > In article
<orac-A727DC.21270928082004@news4-ge1.srv.hcvlny.cv.net>,
> >> >> > Orac <orac@mac.com> wrote:
> >> >> > >In article <cgra53$4a0m@odds.stat.purdue.edu>,
> >> >> > > hrubin@odds.stat.purdue.edu (Herman Rubin) wrote:
>
> >> >> > >> In article
<41309b16$0$18253$79c14f64@nan-newsreader-05.noos.net>,
> >> >> > >> Lictor <ghostmlNOSPAM-REMOVE@online.fr> wrote:
>
> ....................
>
> >> > Herman denies that the usual test of statistical significance is a
vaid
> >> >test of how effective medicine is. Thus anything the government posts
> >would
> >> >automatically be invalid in his mind. I have never really understood
why
> >he
> >> >insists that only Bayesian analysis be used, since he has never shown
> >that
> >> >the results would be changed if you change the test. Anyway......
>
> >> A test of statistical significance tests whether the
> >> observations would be "sufficiently unlikely" if the
> >> null hypothesis is EXACTLY true, and NOTHING else.
>
>
> > Based on this comment, we could never do any medical research since
all
> >variables cannot be controlled.
>
> This is NOT what I said. One can do research with NO
> variables controlled; this is what happens in astronomy,
> meteorology, and economics, for example. To a large
> extent, it is what is done in ecology and geology. We
> need to use these techniques in biology (it is, to a
> small extent) and medicine.
>

   In UK, for example, social class remains a very strong predictor of
health, even with nationalized health care. It is in the USA, with
free-enterprise medicine. It is a crime not to control for the social
variables (see below for stress). By the way, people high in social class
have LESS stress, despite their complaints. The same is true in the animal
world.

> > Having said that, self-selection, social class and a whole lot of
other
> >variables have fouled medical findings now for many years. They also
ignore
> >things like stress, since it is not something a BENCH scientist does.
>
> I have seen studies taking into account stress.
>

  Some do. But my comment came from the latest cross-national heart study.
The investigators stated what I said, but were very surprised that stress
was I think #3 in predicting heart attacks. We sure do know that stress
works in animal models.

> >> It does not take into account how effective the
> >> procedure is under the alternatives, nor the magnitude
> >> of the effect under the null, and hence does not balance
> >> the various components of risk. If 50% of the people
> >> exposed to a disease without treatment died, and 51%
> >> of 1,000,000 people given a treatment survived, this
> >> would be HIGHLY significant.
>
> > So? People would see from the figures what the effect was and the risk
> >too.
>
> One can see this from the FULL figures, but NOT from the
> significance levels. It does take calculation; the
> original problem from which the above extremization was
> made was 3 out of 3 versus 7 out of 8. The results were
> approximately that if treatments of this type, if they
> worked, worked more than 90% of the time, take the 3 out of
> 3, else the 7 out of 8. The prior information, usually
> involving lots of subjectivity, MUST be used. Even in
> science, statistical theory shows that objectivity is not
> even desirable, in that there are better non-objective
> procedures than the best objective ones.
>
  A very unclear statement Herman. I saw one study which claimed 'massively
significant' results when the advantage was 3 months in 9 years. Is that
what you mean? Significant but unimportant at the individual level? (I'm
trying Herman.....)

> >If there was a new
> >> treatment given to 4, and they all survived, this
> >> would not meet the customary significance level.
> >> Which treatment would YOU choose?
>
> > False choice too Herman. Today we are wondering if common treatments
> >might make things worse, like HRT.
>
> And for complications like the ones occurring with HRT,
> it can take years to accumulate enough data. What do
> you do in the many years for this to happen?
>

   Why should it? If self-selection were controlled for from the start, we
would not have subjected women to years of harm. My wife asked her
cardiologist about the HRT studies...and she (the cardiologist) used to do
family medicine too. When women really asked her, she told them NO to HRT,
but other physicians (mostly ob/gyns) were pushing it.

> In medicine, we are concerned with decision making under
> uncertainty. We have to balance the components of risk;
> this is prior Bayesian behavior. One way to do it is
> to look at the posterior distributions, but it is not
> always possible to reasonably approximate this, even
> when one can approximate prior Bayes risk well.
>

   No technique of analysis will overcome self-selection Herman. Crap in,
crap out.

Relevant Pages

  • Re: Canadian doctors coming to the US
    ... we could never do any medical research since ... It is a crime not to control for the social ... have LESS stress, despite their complaints. ... > And for complications like the ones occurring with HRT, ...
    (sci.med.cardiology)
  • Re: Canadian doctors coming to the US
    ... we could never do any medical research since ... It is a crime not to control for the social ... have LESS stress, despite their complaints. ... > And for complications like the ones occurring with HRT, ...
    (sci.med)
  • OTP kind of - long whine - chronic cough
    ... For those of you who know me on the arthritis support newsgroup, ... I think most of it is stress. ... I decided to retire on the first of May. ... and keep the paperwork under control. ...
    (alt.support.arthritis)
  • OTP kind of - long whine - chronic cough
    ... For those of you who know me on the arthritis support newsgroup, ... I think most of it is stress. ... I decided to retire on the first of May. ... and keep the paperwork under control. ...
    (alt.support.arthritis)