First, a confession—I’m a mathphobe, traumatized by growing up in a family skewed with an overabundance of math genes for whom math skills came as naturally as breathing. I always got confused, and thought it was "sadistics," not "statistics." So it was with a bit of hesitation that I tentatively began Between the Lines (BTL), doing so because I thought it would be good for me, like eating broccoli.
My hesitation was misplaced. Between the Lines is a very readable, informative book, that I highly recommend to others.
Early on, my major education in statistics was Darryl Huff’s “How to Lie with Statistics,” a humorous and understandable introduction. We were taught no statistics in med school or subsequent training, nor how to critically evaluate medical literature. We had to study calculus and physics, which amount to wasted pre-medical education since most physicians never subsequently use them in their practices, but not statistics, which would have been invaluable.
Several years ago, I had tried Studying a Study and Testing a Test. This home study course seemed thorough but proved too daunting to me for light, after work recreation. Perhaps I’ll try again now that I have a better basic understanding from BTL.
BTL has already paid off—it helped me understand the implications of the sensitivity and specificity data on Orasure’s new HIV test, OraQuick, which I discussed in my last post.
The text is broken down into bite-size, more readily digestible chapters, which also makes it easy to turn back to as a reference. I found the studies cited to be helpful in illustrating each point. There were only a couple of places where I stumbled, but was able to recoup and move on.
I particularly appreciated Dr. Zilberberg’s understanding and explicit acknowledgement that our patients are individuals, “It is one thing for a clinician to ignore evidence willfully; it is entirely another to be a conscientious objector to what is known but not applicable to the individual in the office…Doctors need time, intellectual curiosity, and skills to conduct these individual-patient (also known as ‘n of 1’) trials in their offices.” I was comforted by “When someone brings an evidence-based guideline to you and insists that, unless you comply 95% of the time, you are providing less than great quality of care and you say, ‘This guideline does not represent my patients,’ you are actually not crazy.” After caring for patients for more than 30 years, I am well aware that not everyone patient follows the textbooks or responds to “standard” treatments.
Zilberberg’s section on the limited thinking that has been instilled in us by false dichotomies is valuable, too. Our thinking and insight would be far richer if we focused on the possibility of their being more than a “right” or a “wrong” answer, a spectrum of possibilities.
For patients—excuse me, “consumers” in the current favored jargon of administrators—there is a valuable section on context and a list of questions that should be considered before jumping into testing and invasive treatments. These questions are often glossed over by physicians, especially surgeons, in their discussions with patients.
Just as businesses can profit by consumers being hopelessly “illiterate” at math, we can become better consumers of medical care by increasing our literacy in that area. In the area of financial literacy, fortunately we have Michelle Singletary, Jane Bryant Quinn and Elizabeth Warren to help us. (Wow! They’re all women. I wonder what the correlation is between gender and writing clearly about numbers?) Lately, I've been particularly impressed by Elizabeth Warren’s plain-speaking way of explaining the financial fiascos to mere mortals. Zilberberg’s Between the Lines does for statistics what Warren does for money.
And as those women's lucid offerings help us to understand our finances, BTL provides a number of useful tools to help make statistics and understanding newspaper and journal articles accessible to lay and medical people alike. You don’t have to be a rocket scientist to gain from this book. Zilberberg’s approach is conversational, accessible, and quite humorous at times. Pick up a copy, and sharpen your understanding of medical news and consumer skills.
Between the Lines cover courtesy Marya Zilberberg, MD, MPH
Between the Lines bookmarked copy cover courtesy Elaine Schattner, MD
How to Lie with Statistics by Darrell Huff, 31st printing, published by W.W. Norton & Company Inc, New York. Scan by Andrew Alder of the cover of the copy in my own collection. (same edition I grew up on!) via Wikipedia
"Molecules to Medicine" banner Michelle Banks