Probability at the Bedside: The Knowing of Chances or the Chances of Knowing?

Editorials6 April 1999Probability at the Bedside: The Knowing of Chances or the Chances of Knowing?Steven N. Goodman, MD, PhDSteven N. Goodman, MD, PhDJohns Hopkins University; Baltimore, MD 21205 (Goodman)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-7-199904060-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Steiner (1) discusses the impact on the patient of presenting risk reduction estimates in two ways: as a statement of the patient's relative risk reduction and as the number needed to treat. Steiner calls the relative risk reduction the "language of individuals" and the number needed to treat the "language of populations." This distinction is part of an ongoing discussion in the literature of problems with bringing evidence-based medicine to the bedside (2-6). What is less appreciated is that it is also part of a centuries-old, unresolved philosophical debate about the meaning of an individual patient's risk. ...References1. Steiner JF. Talking about treatment: the language of populations and the language of individuals. Ann Intern Med. 1999;130:618-22. LinkGoogle Scholar2. Green L. Using evidence-based medicine in clinical practice. Prim Care. 1998;25:391-400. CrossrefMedlineGoogle Scholar3. Jacobson LD, Edwards AG, Granier SK, Butler CC. Evidence-based medicine and general practice. Br J Gen Pract. 1997;47:449-52. MedlineGoogle Scholar4. Naylor CD. Grey zones of clinical practice: some limits to evidence-based medicine. Lancet. 1995;345:840-2. CrossrefMedlineGoogle Scholar5. Haynes RB, Sackett DL, Guyatt GH, Cook DJ, Gray JA. Transferring evidence from research into practice: 4. Overcoming barriers to application [Editorial]. ACP J Club. 1997;126:A14-5. AbstractGoogle Scholar6. 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Tonelli MR. The philosophical limits of evidence-based medicine. Acad Med. 1998;73:1234-40. CrossrefMedlineGoogle Scholar15. Summers RL. Evidence-based medicine vs scientific reasoning [Letter]. Acad Emerg Med. 1996;3:183-4. CrossrefMedlineGoogle Scholar16. Polychronis A, Miles A, Bentley P. The protagonists of 'evidence-based medicine': arrogant, seductive and controversial. J Eval Clin Pract. 1996;2:9-12. CrossrefMedlineGoogle Scholar17. Horwitz RI. The dark side of evidence-based medicine. Cleve Clin J Med. 1996;63:320-3. CrossrefMedlineGoogle Scholar18. Davidoff F. The future of scientific medicine [Editorial]. CMAJ. 1998;159:243-4. MedlineGoogle Scholar19. Miettinen OS. Evidence in medicine: invited commentary [Editorial]. CMAJ. 1998;158:215-21. MedlineGoogle Scholar20. Tanenbaum SJ. What physicians know. N Engl J Med. 1993;329:1268-71. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins University; Baltimore, MD 21205 (Goodman)Corresponding Author: Steven N. Goodman, MD, PhD, Johns Hopkins University, 550 North Broadway, Suite 409, Baltimore, MD 21205. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTalking about Treatment: The Language of Populations and the Language of Individuals John F. Steiner Talking about Treatment John C. Peirce Toward Evidence-Based Statistics Steven Goodman Metrics Cited ByWhen will individuals meet their personalized probabilities? A philosophical note on risk predictionEpidemiological Evidence: Use at Your 'Own Risk'?The Predictive Approaches to Treatment effect Heterogeneity (PATH) StatementDavid M. Kent, MD, MS, Jessica K. Paulus, ScD, David van Klaveren, PhD, Ralph D'Agostino, PhD, Steve Goodman, MD, MHS, PhD, Rodney Hayward, MD, John P.A. 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Peirce, MD, MA, MSEvidence-based medicine and hypertension 6 April 1999Volume 130, Issue 7Page: 604-606KeywordsAbsolute risk reductionAutopsyEvidence based medicineForecastingMortalityPopulation statisticsReasoningRelative riskStatistical methodsSurgeons Issue Published: 6 April 1999 CopyrightCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...