tag:blogger.com,1999:blog-1474751880645498536.post7034757990582464431..comments2023-10-10T10:14:36.340-04:00Comments on Medical Evidence Blog: Absolute Confusion: How Researchers Mislead the Public with Relative RiskScott K. Aberegg, M.D., M.P.H.http://www.blogger.com/profile/17564774546019869201noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-1474751880645498536.post-51013843278433353502020-12-29T16:12:57.133-05:002020-12-29T16:12:57.133-05:00and in one of my own specialty journals by one of ...and in one of my own specialty journals by one of my favorite decision authors, GR Norman: https://pubmed.ncbi.nlm.nih.gov/22396560/<br />Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-53692519306526179252017-09-24T15:37:10.060-04:002017-09-24T15:37:10.060-04:00http://www.annualreviews.org/doi/full/10.1146/annu...http://www.annualreviews.org/doi/full/10.1146/annurev-statistics-010814-020148Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-19333970979237963292017-07-17T15:05:13.525-04:002017-07-17T15:05:13.525-04:00Thanks for your comments. I will admit that I don...Thanks for your comments. I will admit that I don't totally follow. One issue is whether absolute vs relative risks have primacy for decision making and I think it's clear that absolute ones are the ones that matter. Whether the decision is one of necessity versus luxury does not matter regarding the absolute/relative distinction. And yes, the luxury necessity distinction is one of values.<br /><br />I agree that things are additive, but that is also irrelevant to a decision. What matters is whether the "net utility" of each little thing you do is positive for you when you figure the positive value * its probability minus/less the costs of doing it is has net positive utility. If it is easy for you to avoid red meat, then surely do it. If it is a big struggle, you may carefully review the probability*value of avoiding red meat and conclude that it is so small that it is not worth the effort for you. <br /><br />We should have called it the normalization fallacy. I can apply the same logic there - I think the probability that replacing potassium helps people is very small and I opine that on balance the effort of doing it exceeds the positive value and we should not do it.<br /><br />I think you may wish to consider that incremental gains in ICU outcomes have to do with other things, such as less illness severity and cohort effects, and the fact that much/most of the improvement *may* be due to the fact that we have stopped doing harmful stuff in the past 20 years.<br /><br />Your may also be interested in the prevention/therapeutic paradox: http://www.medicalevidenceblog.com/2015/01/the-therapeutic-paradox-whats-right-for.html<br /><br />Thanks for your interest!Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-73366658939651828372017-07-17T08:12:28.829-04:002017-07-17T08:12:28.829-04:00Absolutely correct for healthcare decisions. I thi...Absolutely correct for healthcare decisions. I think. I didn't resonate with your shopping analogy, though. We NEED socks, and we have to buy them. If I only buy socks throughout my lifetime when they are 50% off, I think it's likely that I'll save the same $1,000, incrementally. On the other hand, an Audi A4 is a luxury that I don't necessarily need. The ability to save $1,000 now on something that puts me in debt for years doesn't balance out for me. I'll agree if you say that's a value judgement, rather than a mathematical one. However, so are most things we do for our health. The tiny absolute increments that we get from scores of little things we do - exercise, eat green, leafy vegetables, wear a seatbelt, get good sleep all likely add up to some small improvement in longevity and, if we're lucky, feeling better while we're doing it. Avoidance of the cigarettes or drugs that I actually don't need (possibly analagous to not buying the Audi, for those of us who abhor the debt) adds, as well. This has no bearing on the argument about which drug to use in any given disease, but is just something to think about. <br /><br />Similarly, while another argument of yours, regarding the normalization fallacy in ICU, holds some water, it does occur to me that the tiny increments we have made across a lot of fronts in the ICU (and the pre-ICU) - possibly including normalizing a potassium level - have resulted in an overall substantially higher survival rate in our ICUs. And that improved survival allows us to quit focusing solely on ICU survival and turn a lot of attention to what it means to survive the ICU, in terms of long term well being and to look for the incremental behaviors that can improve the long term, as well.<br /><br />So, I guess I'm saying that these small, incremental absolute risk reductions should not be dismissed out of hand. If they are expensive, maybe yes, but if they are essentially free, as in head of bed at 30 degrees, then the tiny absolute improvement is likely worth the investment. Additional thoughts welcome.SQShttps://www.blogger.com/profile/06180597771979293689noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-33026597594724782242017-02-01T17:15:03.804-05:002017-02-01T17:15:03.804-05:00And this guy beat us both to it: Rose G: Strategy...And this guy beat us both to it: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1506445/" rel="nofollow">Rose G: Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed) 1981, 282(6279):1847-1851.</a>Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-48583113081077123882017-01-27T13:39:05.231-05:002017-01-27T13:39:05.231-05:00HG Welch beat me to it <a href="http://www.huffingtonpost.com/h-gilbert-welch/health-risk_b_1613912.html" rel="nofollow">HG Welch beat me to it</a><br /><br />Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1474751880645498536.post-85659874292853853772014-04-04T11:26:40.120-04:002014-04-04T11:26:40.120-04:00Many reports in the media about the benefits of tr...Many reports in the media about the benefits of treatments present risk results as relative risk reductions rather than absolute risk reductions. This often makes the treatments seem better than they actually are.Tiffany Pedersenhttp://www.rndeer.com/category/mw/ohio/noreply@blogger.com