Tuesday, March 6, 2012


I have spent many a typing session ranting about soundbites and skewed statistics..... I've bitched and moaned about the manner in which the words survive and cure are used interchangeably.  And now, let's just further add to the confusion.

The opposite of survive within the framework of a conversation about disease would be, in my mind, death.  Death and mortality, again, in my layman chemo-BRAIN mean the same thing.  HOWever, when those words are used in tandem with statistics, like that ever so popular 98% five year survival rate that gets bantered about like a victory flag, a PINK victory flag, they have different meanings.

For those of you whose brains fire on all cylinders whenever you summon your grey &/or white matter into action, I am reprinting the Medscape article in its entirety.  For the rest of us, read it slowly.  I got it after a couple of attempts and the insistence that every dripping faucet be tightened, all ticking clocks have batteries removed, phones silenced and my surroundings were plunged into complete monastery-like silence.

The take away if you don't feel like putting yourself into the same fortress of No Distractions?  I Call: Stop with the nonsense.  Stop Stop Stop.  Everyone stop quoting things unless you can fully explain what the hell you are saying. Apparently, this includes some doctors, too.  You have to love an article that has subtitles like these, particularly when referring to some of the doctors from whom we are taking medical direction:

  • Confusing Survival with Mortality
  • Statistical Confusion
  • Survival in Screening Misinterpreted
  • Education Needed
It's time to cut through the crap already.  Speak plainly.  Start using words like "alive"  "dead"  "alive and in treatment" "alive but on a death bed"   "living in constant pain" ......  I know I'm oversimplifying this.  Or maybe, just maybe, somewhere along the way, we LOST our way and just overcomplicated everything in a grand effort to make things sound more palatable.  To make things look better.  Personally, I don't care for the rose colored lenses.  I'm not a pessimist. I'm not an optimist, either.  I choose the simplest statement of all:  Reality Is.  Period.

And the biggest reality of all:  Be your own advocate.  Understand your own specific circumstances.   It's your life.  You are making decisions about your life.  And sometimes, you're getting sketchy info.  That's just gotta stop.  GOT TO STOP.  I'd like to get back to the way of The KISS.  Keep It Simple Stupid.

Option B:  Hire a statistician who has impeccable qualifications and charges a ginormous fee to put those skills to use for you.

This is the link directly to Medscape Today.  Since the link may require login information, below is the article as it appears in its entirety.

Cancer Screening Data Often Misunderstood By Doctors

Roxanne Nelson
Read this article on Medscape's
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March 5, 2012 — Many primary care physicians appear to be misinterpreting cancer screening data. According to research published in the March 5 issue of the Annals of Internal Medicine, they often mistakenly interpret improved survival and increased detection with screening as evidence that screening can save lives.
In their study, the authors, led by Odette Wegwarth, PhD, senior research scientist at the Max Planck Institute for Human Development, Berlin, Germany, found that few primary care physicians were able to correctly recognize that decreased mortality in a randomized trial demonstrates evidence of the benefits of cancer screening.
Primary care physicians were more likely to recommend a screening test "supported by irrelevant evidence," such as an increased 5-year survival rate, than a screening test supported by the "relevant evidence — reduction in cancer mortality," the authors note.
"It is natural to assume that survival is the same as mortality; that is what the words imply in common language," said Dr. Wegwarth. "And it is what the statistics imply in medical settings besides screening."
Survival in the context of screening is different from survival in the context of a treatment trial.
Dr. Wegwarth explained to Medscape Medical News that in a randomized trial of a treatment, survival is based on the starting trial population. "If 10% of the patients die in 1 year, 90% survive," she said. "However, in the context of screening, the term survival takes on a different meaning, because the calculation of survival, in contrast to mortality, is based only on people diagnosed with cancer, not on the whole study population."
"We believe that many physicians are not aware that survival in the context of screening is different from survival in the context of a treatment trial," she added.
Confusing Survival With Mortality
In the survey, physicians were presented with information about 2 hypothetical screening tests. For the first test, they were told that the 5-year survival rate improved from 68% to 99%; for the second, they were told that the mortality rate decreased from 2.0 to 1.6 deaths per 1000 people.
Physicians were 3 times more likely to report that they would "definitely recommend" the test with improved 5-year survival than the one with lower mortality (69% vs 23%). In reality, the data were for the same test and the same disease — prostate-specific antigen screening for prostate cancer.
In addition, the majority of respondents (80%) stated that the screening test supported by irrelevant evidence (5-year survival) "saves lives from cancer," whereas only 60% felt the same way about the test supported by relevant evidence (decreased cancer mortality) (P < .001).
Statistical Confusion
Screening for disease, especially cancer, is enthusiastically supported by patients, the public, and even health professionals," notes Virginia A. Moyer, MD, MPH, from the Baylor College of Medicine, Houston, Texas, in anaccompanying editorial. However, many do not appreciate the fact that for a number of tests, there is not only no evidence of benefit, there is evidence of potential harm.
Information is available to patients about screening and treatment, but simply "providing patients with the statistical data about screening tests does little to improve their decision making," Dr. Moyer explains.
She points out that numeracy — the ability to perform basic quantitative calculations — is an important component of health literacy, but a number of studies have shown an alarmingly low skill level among patients. "The result is poor understanding of the benefits and risks of screening," Dr. Moyer writes.
Healthcare providers are usually the most highly rated sources of health information, so the responsibility for helping patients understand the potential benefits and risks of screening falls largely to primary care physicians, she notes. The question is: Can they do it?
"The news on that front is not good," says Dr. Moyer. Medical students do not understand statistical concepts well, and this study suggests that fully trained physicians do not either.
Physicians clearly do not understand how to interpret cancer screening statistics.
"Physicians clearly do not understand how to interpret cancer screening statistics themselves — expecting them to communicate this information to patients is a stretch," she writes.
Dr. Wegwarth and colleagues offer potential solutions, Dr. Moyer points out, but to "temper the unbridled enthusiasm of patients for screening tests, and especially for cancer screening, we need to reach beyond medicine to the public, which of course gets a substantial amount of medical information from the media."
Thus, educational efforts need to focus not just on physicians and medical students, but also on journalists," she explains.
"The need for high-quality, evidence-based guidelines for preventive services is widely recognized," adds Dr. Moyer. "Patients and physicians are most likely to believe and follow the resulting recommendations if they understand the statistics on which recommendations are based."
Survival in Screening Misinterpreted
Dr. Wegwarth and colleagues conducted their survey to learn whether primary care physicians in the United States understand which statistics provide evidence that screening saves lives.
In 2010, 297 physicians who practiced both inpatient and outpatient medicine responded to the survey; in 2011, 115 physicians who practiced exclusively outpatient medicine responded.
The majority incorrectly equated improved survival and early detection with lives saved by screening. About one half (47%) incorrectly reported that discovering cancer in screened, as opposed to unscreened, populations is evidence that screening saves lives.
Almost the same number of physicians believed that survival data prove that screening saves lives as believed that mortality data prove this (76% vs 81%; = .39).
Many of the physicians appear to have mistakenly interpreted survival in screening as if it were survival in the context of a treatment trial, note the authors. After reviewing only the 5-year survival rates in the scenario provided (99% vs 68%), almost half the respondents who thought that "lives were saved" stated that there would be 300 to 310 fewer cancer deaths per 1000 people screened.
The actual reduction in cancer mortality demonstrated in the European Randomized Study of Screening for Prostate Cancer was about 0.4 in 1000 within 5 years. More than 50% of physicians correctly identified this when presented with cancer mortality rates.
Education Needed
"There are medical organizations, physicians, and students who still tend to see statistics as inherently mathematical and clinically irrelevant for the individual patient," said Dr. Wegwarth. This attitude is reinforced at medical schools, "which mainly focus on analysis-of-variance and multiple-regression techniques. Indeed, these kind of statistics are not necessarily needed in doctors' practices."
However, other statistics are considered highly practical and relevant for an informative doctor–patient communication — statistics such as survival vs mortality, relative vs absolute risk, and the predictive values of screening tests, she continued. "Excellent work has been done that shows how the simple techniques of these statistics can be easily taught to doctors and patients. If medical schools would pick up on these techniques, the biggest part of the problem might be solved."
It is imperative that physicians be aware that they are misinterpreting these data in the first place; research such as ours might help raise awareness, explained Dr. Wegwarth.
"However, as long as the survival statistics in the context of screening are published in high-ranked medical journals, many physicians may believe that this statistic is meaningful in that context," she added. "Medical journal editors can play an important part in preventing confusion about health statistics by carefully limiting inferences about the value of screening based on statistics other than mortality. Journals could provide explicit guidance to readers — perhaps in editors' notes — about what can and cannot be inferred from changes in survival, early-stage detection, and incidence with screening."
This study was funded by the Max Planck Institute for Human Development and the National Cancer Institute.

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