Medical Decisions in the Face of Uncertainty (Revised)

Healthcare in the US is a mess: quality is wanting and cost is out of control. Nearly one out of every five dollars earned is spent on healthcare, and the number keeps climbing. Our per-capita outlay in this realm is far greater than that of any other industrialized nation, and yet we have worse patient outcomes to show for it. This in spite of the fact that U.S. medical research remains the primary global source for new discoveries, drugs, medical devices, and clinical procedures. The US system is rife with over-treatment, ineffective and harmful treatment, and unnecessary medical tests. Many of our citizens get shoddy care or no care at all.

The problem is not new. We've been talking about it for years: "We need to reform the system. We need a new paradigm for health care. We need more transparency. We need medical care that has better justification. We need true evidence-based medicine." It all seems so obvious. But what exactly do we mean by "true evidence-based medicine"? How do we get it?

True evidence-based medicine is the product of rigorous statistics, a data-gathering and data-analysis methodology built on incontrovertible mathematics. Not only can it estimate the likelihood that a treatment will work for you, but it offers a guarantee on the reliability of that estimate. This kind of information enables you to compare treatment options in an objective, quantitative way, so as to help you make the best treatment decision; it's the kind of information you ignore at your own peril.

Rigorous statistics provides an objective, unbiased way of understanding the world, and reports its results in a transparent manner. The audience knows how the numbers were arrived at and how reliable they are. It's a far cry from the numbers typically thrown at us in the media in a brazen effort to sell stuff or distort opinion, thrown at us without explaining their origin and without any guarantee of reliability. It's that kind of stuff that we call flimflam stats. Making a medical decision based on flimflam stats is reckless, if not utterly foolish.

This book explains the fundamentals of rigorous statistics, and will leave the reader with no doubt that it's backed by rock-solid, irrefutable mathematics.

Rigorous statistics has been around for a long time, and has been used extensively in fields outside medicine. But it hasn't been adopted as the primary guide for making medical decisions on a daily basis. That's mainly because most doctors have not been trained in statistics, and most patients are unaware that such a methodology exists. But also because, until recently, the requisite computer systems and necessary stores of standardized historical patient data have not been available to make true patient-centric, clinical care a reality.

We are poised for a new age in clinical practice, in which patient-centric, rigorous statistics are used as the primary advice for medical decisions. Compared to the archaic way medical decisions are made today, the new paradigm well-deserves to be called revolutionary.

This book is for patients, healthcare professionals, and healthcare policymakers, as well as journalists who report on medical issues.