Things I Learned in Yale
Okay, in Yale Alumni Magazine, that is. Glenn is an alumni of the law school and yesterday, while rather bored, I picked up the magazine and thumbed through it. Here is what I learned. First, most doctors can't do stats:
Funny, talk to most doctors and they will tell you that only MDs can prescribe because they "know all that calculus, stats and stuff." Really? I've never seen a doctor do any calculations to write a prescription. Now, I've learned that many of them them don't know how to interpret a piece of research thoroughly. That really breeds confidence.
Next, I found out in the magazine that:
Uhmm, okay, but I am not sure I buy this theory for the population at large. Undergrads are notorious for partying at night and sleeping during the day. When they have kids or get older and have to be at a job, I wonder if this still holds true? Can't researchers ever get away from studying undergraduates, who are such a peculiar type of cohort that findings may not carry over to other people at different points of life or in different environments?
Finally, I learned that working at Starbucks can save your life. There was an interesting book reviewed in the magazine with the intriguing title, How Starbucks Saved My Life: A Son of Privilege Learns to Live Like Everyone Else.
Apparently, the author, who is a member of the Yale class of 63, got a plum job with J. Walter Thompson ad agency only to lose it at the age of 53. Then he goes on to have a number of misfortunes including impregnating a mistress, getting kicked out by his wife, a brain tumor etc. He loses his job and ends up working at a Starbucks in Manhattan and loves it. Naturally, the book review makes fun of this fact, describing the author as a "Starbucks sycophant" but whatever.
The book sounds fun and interesting enough to consider for my collection of reading material that I can never get to since I am too busy reading magazines such as the one described for no other reason than it was sitting beside me on the coffee table.
Almost every medical school student takes a course or two in biostatistics to learn how to understand research data. But Donna Windish, an assistant professor at the School of Medicine, has shown that the information often doesn't stick. "A significant percentage of physicians-in-training do not understand the statistics they encounter in the medical literature," she says.
In her own teaching, Windish had seen that trainees often read only the abstracts, or "ignored the statistics and skipped right to the results." This practice turns out to be common throughout the medical profession -- and potentially troubling. "An abstract usually says little about methods of design, conduct, and analysis," says Windish, citing an earlier study that showed frequent data mismatches between the abstract and the paper.
"Doctors don't necessarily need to know how to do the mathematical calculations," Windish says. "They need to understand the concepts and how to use them."
Funny, talk to most doctors and they will tell you that only MDs can prescribe because they "know all that calculus, stats and stuff." Really? I've never seen a doctor do any calculations to write a prescription. Now, I've learned that many of them them don't know how to interpret a piece of research thoroughly. That really breeds confidence.
Next, I found out in the magazine that:
Morning people are more likely to be emotionally stable than their "night owl" counterparts. Yale psychology postdoctoral researcher Colin DeYoung and his colleagues studied 279 students in an introductory psychology class at the University of Toronto and found a moderately strong correlation between "morningness" and character traits associated with stability.
Uhmm, okay, but I am not sure I buy this theory for the population at large. Undergrads are notorious for partying at night and sleeping during the day. When they have kids or get older and have to be at a job, I wonder if this still holds true? Can't researchers ever get away from studying undergraduates, who are such a peculiar type of cohort that findings may not carry over to other people at different points of life or in different environments?
Finally, I learned that working at Starbucks can save your life. There was an interesting book reviewed in the magazine with the intriguing title, How Starbucks Saved My Life: A Son of Privilege Learns to Live Like Everyone Else.
The book sounds fun and interesting enough to consider for my collection of reading material that I can never get to since I am too busy reading magazines such as the one described for no other reason than it was sitting beside me on the coffee table.
29 Comments:
Speaking of calculations and doctors - I've never gotten the impression that medications, either prescribed or over the counter, take things like body mass, age, and gender into account in any significant way.
Or does a given dose of ibuprofen really affect a 95 pound teenage girl the same way it does a 215 pound middle age male?
The directions on the bottle would make it seem so...
From the few things I've read on the topic, expert systems do a much better job at diagnosing people and prescribing medicine than do doctors...but doctors are quite jealous of their professional privilege and the "unquantifiable" art to it, and so resist these tools.
Parker Smith,
Yes, I found that after I had my heart attack, docs gave me the same meds they were giving 200 pound men. Needless to say, I was sick as a dog from them and they had to be cut out or back. I do think size, gender and general body chemistry have a lot to do with how we process medication.
I once had a psychiatrist lecture me on how doctors understood statistics that laymen couldn't. I took a little more than the required statistics in college. Plus, working in marketing research, I've become more familar and have co-workers that can make your statistical head spin. None are MD's.
The statistic that the psychiatrist was lecturing about? That the FDA had not approved Zoloft for use with kids. He was asserting that he knew better than the FDA.
Yes, I have seen a doctor do calculations, once, only once. And that was at my last doctor visit at Target. The good doc got out her calculator and several reference books to make sure the prescription was correct for my body type. I was confused as to what she was doing so she showed me.
The inability to do simple statistical reasoning is pretty common. One of the networks (CBS, I think) recently ran a series on the "high suicide rate" among Iraq veterans. Problem is, if you use comparable age and gender groups, the rate among these veterans isn't really atypical.
Parker Smith,
Depends on the medication. Barring any kidney or liver problems, most OTC medications have a very large Therapeutic Window. This is the range where you are taking enough medication to get an effect, but not enough to cause toxicity (95% CI I believe).
Now with prescription drugs, few doctors actually look through all the data as Dr. Helen was pointing out. Your best bet is to be nice to the pharmacist, maybe even ask for a consult, to see if you have any reason to be concerned.
When it comes to drugs, the pharmacists know the ins and outs.
"Or does a given dose of ibuprofen really affect a 95 pound teenage girl the same way it does a 215 pound middle age male?"
LOL.....
On describing to my Doc a pain I no longer recall and that I take 'an' Ibuprofen for relief he asked 'Just one?' and his face screwed up the likes of which I wouldn't suspect a Doctor to show and said... 'that's enough for... a twelve year old.'
So now, when necessary, I just pop 'em by the handful.
'Life is good'
After quite a few years of teaching statistics to polisci grads and undergrads, I have come to the conclusion that if I can get them to accept the statement that, "descriptive statistics should *NEVER* be used to drive policy" I have been moderately successful, since fewer than 10% will ever remember even the baby stat of crosstabs.
A few learn multiple regression and a bit more. They may well run things someday.
You know that's funny because in Hospital Corps school (10 Weeks long) in every Hospital Med orientation program, in Independent Duty Corpsman School and in various follow on training we had to learn how to calculate med dosages by weight and in some cases age. If Drs. cant do it we have a lot of problems.
Some abstracts are bad? Who writes them? Maybe better qualified people should.
Helen -
I am a biostatistician at a Medical School and I can personally attest to MDs being undereducated in the areas of study design and analysis of clinical research. In general, they are also unwilling to admit it.
The med students that I teach generally treat stats as a nuisance and roll their eyes at the nuances of study design. I haven't found a way to convince them that it is equal on par with the anatomy lessons or biochemistry lessons.
Terri in Texas
"A significant percentage of physicians-in-training do not understand the statistics they encounter in the medical literature," she says.
As Bill Clinton said, it depends on what the meaning of 'understand' is. If it mens understanding that 'p < 0.05' means the result has a less than 1 in 20 chance of occuring by chance alone then they understand. If you mean understanding why the Archives of General Psychiatry went from accepting Analyis of Varaince to whatever it is they want now and how to perform the statistical calculation well no. It is more important to understand that when the FDA says a drug is indicated for a disorder that means it is statistically effective and the side effects are generally reasonable relative to the burden of the illness. If you understood that then you woudn't prescribe Wellbutrin, Buspar and Cymbalta successively for panic disorder, something I encountered in recent weeks. We should be so fortunate however that if they were going to prescibe something other than that having an indication, they 'would encounter the medical literature' through Pubmed to see if thre are any published articles on the subject. Happy everybody is into knowledge though. It's going to make my morning drive easier everybody learning how automatic transmission works before they hit the road tomorrow. I'll be driving 'standard' which is intellectually easier.
Glenn may be an alumnus (male singular) of Yale Law, but he is not an alumni (plural).
Dosage of drugs has NEVER made sense to me. How can my 4'8" 90 lbs wife and I (6'1" 205 lbs) get the same dosage? It is weird!
I'd say that very few people know enough statistics to use statistics. This appears to be worst of all in the media where it appears that they do not know anything about statistics.
An example of poor statistical reasoning is the common argument that "your chances of being killed by a terrorist are much lower than your chances of being killed in a car wreck; therefore, we should spend less $ on counterterrorism and more $ on highway safety." One example of such an argument (by someone who should know better), and my response, here.
I've always thought it amusing that pediatricians dose by the kg of weight for their patients (kids), but other doctors dose the same for all adults. I'm sure that some drugs are more weight dependent than others, but I've never had a doctor dose me by weight (and I'm quite a bit above average).
The biggest problem I see is the resistance to collecting data on performance by doctors for fear that it might be used against them in a lawsuit... while I understand their fear, it seems like a bit like covering your eyes to avoid seeing the scary monster that's about to eat you...
EI
I agree that doctors should know if a study is legitimate before endorsing it. Somebody needs to be checking on these studies. I definitely prefer to sleep in, but I'm not sure how this translates to my emotional state. I do seem to feel physically better when I wake up earlier.
Well, Dr. H, you sort of have a point, in the same way that the hooligans over at /. have a point when they laugh at some ruling by a judge that was profoundly ignorant of the nature of Internet mail protocol. We could all do better jobs if we were better informed about each and every branch of human knowledge. Perhaps law schools should teach more about how computers and the Internet works, these days, and medical schools should teach more about epidemiology, or least statistics.
But...medical training is already brutally intense and enormously long and expensive. Just what would you have them drop, so they can spend much more time on the subtlety of statistics? Less time dissecting? Less time reading up on infectious diseases and how to control them? Less time in the clinic figuring out how to cope with real patients in the real world (with all its distractions and routine screw-ups)?
One of the problems with folks from an academic background is that they are a little fuzzy on real-world economics. There's a tendency to just prescribe the best conceivable solution to any problem -- regardless of whether it's at all practical or economical. Medical education is not designed to give students all possible useful knowledge: it's designed to select the maximally useful set given the constraints of time and human stamina. If you don't like the priorities, that's fine, but realistically you can't propose adding something without proposing subtracting something, because there's just no wasted time left to exploit.
Medical education has historically been very heavy on the investment in clinical training, because, let's face it, no one wants to be a new doctor's very first case of [insert your medical condition here]. Hence the emphasis on getting the protodoctor the maximum amount of clinical experience under supervision as fast as possible.
Recently we've added more and more 'theoretical' background knowledge, on the grounds that pure clinical experience and knowing the standard care in your medical textbooks isn't enough: with more rapidly changing medical tech, and more options in how you treat complex diseases, you need to know enough about the 'concepts' behind the tech to be able to make independent judgments. What you're saying is to add on to this burden, make doctors more independent judges of the results of clinical drug trials, etc., instead of relying on standards of care.
Well, fair enough, but realize something has to give, and it will probably be that clinical experience. You'll be having doctors who know more statistics concepts, but who have less 'real-world' experience with your disease. You sure that's a trade-off you like? Think long and carefully. I realize your personal situation is kind of a statistical outlier, but for most people the major determiner of outcome is the clinical experience of the initial diagnoser, the ability to match real-world symptoms with a relatively small range of typical medical conditions. That is, from a purely public-health perspective, it matters more that doctors have the clinical experience to recognize COPD in all its wide variety of clinical presentations than that they are first-rate critics of a Phase III trial reported in JAMA.
Yesterday I went to a clinic and was given a presciption of a protopic ointment for eczema. I picked it up from the pharmacy and in the instructions it also included an a statistical analysis of the study. Perhaps the pharmacists know this stuff better. I know a little about statistics since I took a class in highschool and college.
Birth. Education enough to contribute to the tax base after school - paid for by others' taxes. A life of paying taxes. Death. More taxes after death.
Who needs any more stats than that?
情趣用品,
性感睡衣,
免費視訊聊天,
視訊交友網,
美姬圖影,
情境坊歡愉用品,
花美姬情趣用品,
成人圖片,
臺灣情色網,
嘟嘟情人色網,
色情網站,
情境坊歡愉用品,
徵信,
徵信公司,
徵信,
外遇,
徵信,
徵信,
抓姦,
徵信,
外遇,
徵信,
徵信社,
徵信社,
抓姦,
徵信社,
徵信社,
徵信社,
趣,
趣,
整型,
視訊聊天,
視訊交友,
AV女優,
色情,
A片,
A片,
情趣用品,
情色,
A片,
色情影片,
情趣用品,
A片,
AV女優,
視訊聊天室,
聊天,
情趣用品,
情惑用品性易購,
情侶歡愉用品,
A片,
情趣,
情惑用品性易購,
辣妹視訊,
自慰套,
情侶歡愉用品,
寄情築園小遊戲,
aio交友愛情館,
美女視訊,
色情A片,
情趣用品,
徵信社,
情趣用品,
A片,
美女視訊,
色情A片,
AV女優,
A片,
辣妹視訊,
自慰套,
情侶歡愉用品,
2008真情寫真aa片免費看捷克論壇微風論壇大眾論壇plus論壇080視訊聊天室情色視訊交友90739美女交友-成人聊天室色情小說做愛成人圖片區豆豆色情聊天室080豆豆聊天室 小辣妹影音交友網台中情人聊天室桃園星願聊天室高雄網友聊天室新中台灣聊天室中部網友聊天室嘉義之光聊天室基隆海岸聊天室中壢網友聊天室南台灣聊天室南部聊坊聊天室台南不夜城聊天室南部網友聊天室屏東網友聊天室台南網友聊天室屏東聊坊聊天室雲林網友聊天室大學生BBS聊天室網路學院聊天室屏東夜語聊天室孤男寡女聊天室一網情深聊天室心靈饗宴聊天室流星花園聊天室食色男女色情聊天室真愛宣言交友聊天室情人皇朝聊天室上班族成人聊天室上班族f1影音視訊聊天室哈雷視訊聊天室080影音視訊聊天室38不夜城聊天室援交聊天室080080哈啦聊天室台北已婚聊天室已婚廣場聊天室 夢幻家族聊天室摸摸扣扣同學會聊天室520情色聊天室QQ成人交友聊天室免費視訊網愛聊天室愛情公寓免費聊天室拉子性愛聊天室柔情網友聊天室哈啦影音交友網哈啦影音視訊聊天室櫻井莉亞三點全露寫真集123上班族聊天室尋夢園上班族聊天室成人聊天室上班族080上班族聊天室6k聊天室粉紅豆豆聊天室080豆豆聊天網新豆豆聊天室080聊天室免費音樂試聽流行音樂試聽免費aa片試看免費a長片線上看色情貼影片免費a長片
85cc免費影城 愛情公寓正妹牆川藏第一美女 成人影片 情色交友網 美女視訊 美女視訊 視訊情人高雄網 JP成人影城 383成人影城 aa片免費a片下載 a片線上看aa片免費看 ※a片線上試看※sex520免費影片※ aa片免費看 BT成人論壇 金瓶影片交流區 自拍美女聊天室 aa片免費a片下載 SEX520免費影片 免費a片 日本美女寫真集 sex520aa免費影片 sex520aa免費影片 BT成人網 Hotsee免費視訊交友 百分百貼影片區 SEX520免費影片 免費視訊聊天室 情人視訊高雄網 星光情色討論版 正妹牆 383成人影城 線上85cc免費影城 85cc免費影城 85cc免費影城 85cc免費影城 ※免費視訊聊天室※ ※免費視訊聊天室※ 免費視訊聊天室 85cc免費影片 85cc免費影片 080苗栗人聊天室 080苗栗人聊天室 080中部人聊天室 080中部人聊天室 免費a片下載 免費a片 AA片免費看 aa片免費看 aa片免費看 aa片免費看 aa片免費看 日本av女優影片 av女優 av女優無碼影城 av女優 av女優 百分百成人圖片 百分百成人圖片 視訊情人高雄網 電話交友 影音電話交友 絕色影城 絕色影城 夜未眠成人影城 夜未眠成人影城 色咪咪影片網 色咪咪影片網 色咪咪影片網 色咪咪影片網 色咪咪影片網 免費色咪咪貼影片 免費色咪咪貼影片 色情遊戲 色情遊戲 色情遊戲 色情遊戲 影音視訊交友網 視訊交友網 080視訊聊天室 ※免費視訊聊天室※ ※免費視訊聊天室※ 視訊聊天室 成人影音視訊聊天室 ut影音視訊聊天室 ※免費視訊聊天室※ 視訊ukiss聊天室視訊ukiss聊天室 視訊交友90739 視訊交友90739 情人視訊網 168視訊美女 168視訊美女 168視訊美女 視訊美女館 視訊美女館 免費視訊美女網 小高聊天室 小高聊天室 aio交友聊天室 aio交友聊天室 交友聊天室 交友聊天室 線上a片 線上a片 線上a片 線上a片 線上a片 免費線上a片 免費線上a片 嘟嘟成人網站 成人漫畫 情色文學 嘟嘟成人網 成人貼圖區 情色文學成人小說 微風成人區 情色貼圖區 免費視訊聊天 免費成人圖片區 愛情公寓 愛情公寓聊天室 寄情築園小遊戲 免費aa片線上看 aa片免費看 情色SXE聊天室 SEX情色遊戲 色情A片 免費下載 av女優 俱樂部 情色論壇 辣妹視訊 情色貼圖網 免費色情 聊天室 情人視訊聊天室 免費a片成人影城 免費a片-aa片免費看 0204貼圖區 SEX情色 交友聊天-線上免費 女優天堂 成人交友網 成人情色貼圖區 18禁 -女優王國 080視訊美女聊天室 080視訊聊天室 視訊交友90739 免費a片 aio 視訊交友網 成人影城-免費a片※免費視訊聊天※85cc免費影片日本線上免費a片 免費色咪咪影片免費色咪咪影片aaa片免費看影片aaa片免費看成人影城免費色咪咪影片
广州托盘复合托盘食品托盘天津木托盘胶合板托盘蜂窝纸托盘塑木托盘熏蒸木托盘木制托盘广东塑料托盘钢托盘钢制托盘栈板塑料栈板木栈板垫仓板托盘包装求购托盘天津托盘温州托盘山东托盘北京托盘上海木托盘塑胶托盘卡板纸卡板塑料卡板手推车推车机场手推车好孩子手推车液压手推车超市手推车医用手推车康贝手推车不锈钢手推车平板车电动平板车老虎车静音手推车平板手推车小推车模具架置物架堆垛架巧固架整理架物料整理架挂板架整理柜零件柜零件整理柜文件整理柜仓储笼仓库笼料箱塑料箱钢制料箱货箱整理箱塑料整理箱周转箱塑料周转箱防静电周转箱求购周转箱物流箱物料盒零件盒塑料零件盒卡板箱周转筐塑料周转筐周转箩登高车物流台车台车密集架档案密集架文件柜办公文件柜北京文件柜广州文件柜上海文件柜南京文件柜深圳文件柜钢制文件柜铁皮文件柜档案柜文件柜厂底图柜档案柜鞋柜储物柜更衣柜防火防磁柜防磁柜防火防磁文件柜图书架资料柜工具柜
免費視訊聊天 ut聊天室辣妹視訊UT影音視訊聊天室 吉澤明步QQ美女視訊秀 85cc免費影片aa影片下載城sex免費成人影片aaa片免費看短片美女視訊 sex383線上娛樂場av969 免費短片日本免費視訊aa影片下載城視訊網愛聊天室影音視訊交友 咆哮小老鼠分享論壇sex520免費影片aa免費影片下載城aio辣妺視訊 aio辣妹交友愛情館 jp成人影片aio交友愛情館馬子免費影片免費線上a片18成人85cc影城0204movie免費色咪咪視訊網pc交友s383視訊玩美女人34c高雄視訊聊天jp成人免費視訊辣妹 kk777視訊俱樂部xxxpandalive173影音視訊聊天室 sex520-卡通影片成人免費視訊 完美女人13060 免費視訊聊天sexy girl video movie辣妹妹影音視訊聊天室UT視訊美女交友視訊情色網百事無碼a片dvd線上aa片免費看18禁成人網ut聊天室kk俱樂部視訊激情網愛聊天 情人小魔女自拍卡通aa片免費看夜未眠成人影城aio性愛dvd辣妹影片直播拓網視訊交友視訊聊天室ggoo168論壇視訊辣妹love104影音live秀 美女show-live視訊情色yam交友辣妹妹影音視訊聊天室s383情色大網咖視訊aaa俱樂部台灣情色網無碼avdvdsexy diamond sex888入口Show-live視訊聊天室
免費 a 片aaaaa片俱樂部影片aaaaa片俱樂部dodo豆豆聊天室sex520網路自拍美女聊天室天堂免費線上avdvd援交av080影片aa影片下載城aaa片免費看短片成人圖片區18成人avooogo2av免費影片sexdiy影城免費線上成人影片bonbonsex0951影片下載日本av女優sex888免費看影片免費視訊78論壇辣妹有約辣妹no31314視訊dudu sex免費影片avdvd情色影片免費色咪咪影片網av080免費試看日本美女寫真集辣妹脫衣麻將視訊聊天室性福免費影片分享日本美女寫真集,kk視訊aio交友愛情館免費成人美女視訊bt論壇色情自拍免費a片卡通tw 18 net卡通18美少女圖色情漫畫777美女小護士免費 aa 片試看百分百成人情色圖片a片免費觀賞sexy girls get fuckedsexy girl video movie情色文學成人小說sex888免費看eyny 伊莉論壇sexdiy影城自拍情色0204movie免費影片aio免費aa片試看s383情色大網咖sexy girl video movie草莓牛奶AV論壇台灣論壇18禁遊戲區環球辣妹聊天室 90691拓網aio交友愛情館拓網學生族視訊777美女 sex888影片分享區hi5 tv免費影片aa的滿18歲卡通影片sex383線上娛樂場sexdiy影城免費a片線上觀看真人美女辣妹鋼管脫衣秀比基尼辣妹一夜情視訊aio交友愛情館
視訊做愛視訊美女無碼A片情色影劇kyo成人動漫tt1069同志交友網ut同志交友網微風成人論壇6k聊天室日本 avdvd 介紹免費觀賞UT視訊美女交友..........................
情色交友色情遊戲情色視訊色情色情網站非常好色天下第一色站免費視訊辣妹色色辣妺視訊免費線上a片85cc免費影片絕色影城hinet遊戲網嘟嘟成人網h漫avhello成人電影院h大奶妹做愛影片視訊做愛百分百成人av圖片aa片免費看影片
Post a Comment
<< Home