Health Care

“Do doctors understand test results?”

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The short answer in many cases is “no”:

In one session, almost half the group of 160 gynaecologists responded that the woman’s chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 – which is the correct answer. That’s a worse result than if the doctors had been answering at random.
 
The fact that 90% of women with breast cancer get a positive result from a mammogram doesn’t mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease’s prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don’t actually have breast cancer.
 
It’s a maths puzzle many of us would struggle with. That’s because, Gigerenzer says, setting probabilities out as percentages, although standard practice, is confusing. He campaigns for risks to be expressed using numbers of people instead, and if possible diagrams.
 
Graphic showing “false positives” in mammogram tests
Even so, Gigerenzer says, it’s surprising how few specialists understand the risk a woman with a positive mammogram result is facing – and worrying too. “We can only imagine how much anxiety those innumerate doctors instil in women,” he says. Research suggests that months after a mammogram false alarm, up to a quarter of women are still affected by the process on a daily basis.
 
Survival rates are another source of confusion for doctors, not to mention journalists, politicians and patients. These are not, as you might assume, simply the opposite of mortality rates – the proportion of the general population who die from a disease. They describe the health outcomes of people who have been diagnosed with a disease, over a period of time – often five years from the point of diagnosis. They don’t tell us about whether patients die from the disease afterwards.

The linked article is worth reading despite its implicit pro-NHS boosterism. See also this. The poor education in statistical analysis of doctors, lawyers, journalists and members of other influential groups in our society is a significant problem.

(Via Mangan RT by heartiste on Twitter.)

UPDATE: Gerd Gigerenzer’s Books

Prediction: Romney 2016.

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I have been predicting this, especially since these polls.

Even the Washington Post has second thoughts.

Romney would hold a slight lead on President Obama if the 2012 election were replayed today, according to a new Washington Post-ABC News poll.

The poll of registered voters shows Romney at 49 percent and Obama at 45 percent in the rematch, a mirror image of Romney’s four-point (51-47) popular-vote loss in 2012.

Now, we have this.

What can I say except I told you so.

Will Romney be different from these other failed nominees? Could he defy the odds and make a comeback presidential bid capturing the GOP nomination after all the doubt, second-guessing and blame that accompany such a loss? According to the latest Quinnipiac poll, many Americans seem to think so—45 percent of voters said the United States would be better off today with Romney as president.

I donated more to the Romney campaign than I have in any other election and I was a volunteer for McCain in 2000.

I told you so. I think there is a case that the 2012 election was stolen.

The knowledge that the 1960 election was probably stolen helped Nixon in 1968. That and the failure of the Johnson Administration in Vietnam. Anyway, I have been predicting this for a while at Althouse and I can’t remember if I have posted this opinion here. Obama, with the time he has left, will make this more and more attractive. I thought we were doomed after 2012. I still think so but maybe I was wrong. The Megyn Kelly interviews with Bill Ayers might even help although she never got into the Ayers-Obama relationship.

I just hope we avoid the worst of the blowback from inept foreign policy before 2016.

More. This is amazing.

All this is weird, unprecedented. The president shows no sign—none—of being overwhelmingly concerned and anxious at his predicaments or challenges. Every president before him would have been. They’d be questioning what they’re doing wrong, changing tack. They’d be ordering frantic aides to meet and come up with what to change, how to change it, how to find find common ground not only with Congress but with the electorate.

Instead he seems disinterested, disengaged almost to the point of disembodied. He is fatalistic, passive, minimalist. He talks about hitting “singles” and “doubles” in foreign policy.

“The world seems to disappoint him,” says The New Yorker’s liberal and sympathetic editor, David Remnick.

Just weird.

A Compendium of Useful Reminders to be Consulted in Moments of Confusion

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Judging by what I see communicated by many of my longtime friends, there are a whole lot of confused people out there these days. Here is a helpful list for them:

  1. Only a small minority of projects, even in relatively successful organizations in highly competitive industries, deliver their promised scope, on time, within budget. A large majority are drastically scaled back, incur huge cost overruns, deliver years later than intended, or are canceled outright. Anything nefarious either fails or is publicized by whistle-blowers or investigators. There are no secret, vast criminal enterprises pulling the wool over the eyes of the populace, and the best-known entities in society, both public and private, can be astonishingly inept.
  2. Large publicly-funded initiatives, other than those intimately connected to the physical survival of the societies in which they are undertaken, are quite likely to be mainly for show, irrespective of their supposedly spectacular significance. The current American example is the ACA, which has not resulted (and almost certainly will not result) in either greater insurance coverage or lower costs, is notoriously not a fully government-operated, “single-payer” system, and has no pathway to lead to one. None of this matters; indeed, many of its provisions, if they ever go into effect, will do so only after the current Administration has departed from the scene. All that matters is that its perpetrators get to claim to have passed “historic” legislation ostensibly providing “universal” health care. For an example from an earlier generation, see the Space Shuttle, which was supposed to fly 50-60 times per year at $5.5 million per launch. The actual flight rate hovered around a tenth of what was promised, and each launch cost nearly a hundred times the original projection. Hilariously, President Obama is now being criticized for ending this, even though it was collapsing from its own weight and consisted mainly of workfare jobs in Republican congressional districts.
  3. Notwithstanding phenomena like the above, the United States is probably the most successful large-population country in the world due to its sheer realism, in particular the relative openness and process orientation of English common law, which (to quote myself) “rather than construct elegant theories and then shoehorn (or bludgeon) societies into an unchanging mold,” exhibits “a willingness to work with the world and human nature as it is.”
  4. Even ignoring the fantastic technological advances, quality of life in the US has improved immensely in the past two decades. Social pathologies have plummeted. The rates of some categories of crime are down 90%, to all-time recorded lows. There are now fewer abortions per capita than at the time of Roe v Wade. Probably three-quarters of Americans live in neighborhoods where violent crime is effectively nonexistent. And the worst labor market in 80 years has done nothing to reverse these trends.
  5. Large-scale, institutionalized technologies range from the very safe (electric-power generation [including nuclear] and transmission) to the so-safe-there-is-no-instance-of-recorded-harm (agricultural genetic engineering). The problem is that in much of the real (that is, Third) world, they are insufficiently available to provide the thoughtless, comfortable existence that pervades most of the West. Living “off the grid” / following a soidisant “natural” lifestyle is a plaything of rich people who can slink away into town whenever they get tired of hewing wood and drawing water. Especially water with enterotoxigenic E. coli in it.
  6. Pharmaceutical companies are not trying to kill you, nor to provoke health crises to sell new drugs. They may in some instances be trying to convince you that your life depends on continuing to purchase their products, whether it actually does or not. Then again, so is the “health food” store down the street, and in all likelihood, what it’s pushing is far more dangerous.
  7. All religions are not equal. The general heuristic is to judge them by their effects, or at least by their efforts. Those prescribing global expansion through conquest and coercive displacement, and those (especially if they don’t refer to themselves as religions) prescribing the extermination of followers of other religions, are particularly problematic.
  8. Any conspiracy theory that mentions the Mossad, Rothschilds, etc, is every bit as viciously anti-Semitic as Mein Kampf and should be treated as such. Anyone expressing admiration for Marxist notions and personages is no better. Conspiracy theories involving the CIA quaintly ignore the NSA (which is ~6x larger) and, in any case, descend from Stalinist and Maoist propaganda during the early Cold War and the Korean War. Facile anger about the NSA, however, ignores its well-publicized activities with the analog wireline telecommunications of 30-40 years ago, as amply documented in Bamford’s The Puzzle Palace. The phenomena of Wikileaks and Snowden’s massive data theft are an existence proof that such activities can neither be kept secret nor have much influence on real-world events; as someone who read through the supposedly devastating Wikileaks cables remarked, “[American diplomats] sound like Canadians with better access.”
  9. No amount of “smart diplomacy” or supposed avoidance of provocation will protect a country from attack. Only a convincing ability to make an attack more trouble than it could possibly be worth can do that, and even such an ability may be insufficient to deter non-state actors and small groups. In combination with steadily declining costs of dual-use technologies, a more-or-less freelance WMD attack somewhere in the world seems inevitable. When it occurs, the greatest hazards to the immediate survivors will be 1) official overreaction, as by ordering the evacuation of a far larger area than was actually affected and 2) popular derangement, which in the worst-case scenario may create a conspiracy theory popular enough to put an extremist political movement in power, even in a large, democratic nation.

Commenters are encouraged to provide additional examples and corollaries.

Is the United States becoming a corrupt enterprise ?

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The activities of the Obama administration have progressed into Mafia territory the past five years. I never thought things could change this fast but it seems I was wrong. The latest example ?

Soon after the US Government sold the last of its stake in General Motors, the company began to announce a huge number of recalls. These safety defects were known for years but unreported until the federal government sold its interests, at a huge loss of course.

Taxpayers, drivers, and investors who assumed the government would never fail to disclose rampant safety problems in a company it owned can rest easy, though. Instead of investigating fatally flawed GM components while the U.S. government was the company’s largest single owner, the NHTSA was busy harassing Toyota — one of GM’s top competitors — for an alleged malfunction that led to “unintended acceleration” in Toyota vehicles. Toyota was fined and eventually bullied into recalling 8 million vehicles over the issue.

Toyota is probably the safest, highest quality auto maker in the world. I drive one and have bought Toyotas for my daughter.

And what was the final result of the NHTSA investigation?

Many drivers may have confused the gas and brake pedals a problem that may account for “the vast majority” of the unintended acceleration incidents the agency investigated, NHTSA deputy administrator Ron Medford said at Tuesday’s NHTSA press briefing.

“What mostly happened was pedal misapplication where the driver stepped on the gas instead of the brake or in addition to the brake,” Medford said.

The Toyota cases were always about driver error, not safety of the auto. Only the trial lawyers and a complacent government permitted this raid on a company to proceed.

Is that the only case ?

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