Hi Jon,
Shades of the "unknown unknowns" (attributed to Rumsfled, but also know
as the Johari window).
I suspect there are a lot of levels of uncertainty, including at least:
1. Structural uncertainty: where I am not even sure what model/trials to
apply.
2. External validity/Appplicability: where I am not sure whether and how
*this* trial (or review) applies
3. Individual uncertainty: of whether the treatment is needed or effective.
E.g, with an NNT of 25, then 24 of the folk either did not need any
treatment, or this treatment did not "work".
4. Second order uncertainty: uncertainty about the (known) uncertainty -
the CI issue that others have discussed.
In general practice, I come across all of these. And on a bad day, (1)
seems to predominate ;-)
Cheers
Paul Glasziou
Jon Brassey wrote:
> Hello All,
>
> I may be missing the point, but do others get frustrated with the term
> uncertainty in medicine? I've just received another pile of
> promotional material from a publisher who's highlighting uncertainty
> in medicine and insinuating their evidence is the answer. Surely,
> 'all' evidence does is quantify the uncertainty? For instance a drug
> may have a NNT of 25 - where's the certainty in that?
>
> Here's hoping for some serious and lighthearted responses.
>
> Best wishes
>
> jon
>
> Jon Brassey
> TRIP Database
> www.tripdatabase.com <http://www.tripdatabase.com/>
>
>
>
>
--
Paul Glasziou
Director, Centre for Evidence-Based Medicine,
Department of Primary Health Care,
University of Oxford www.cebm.net
ph - +44-1865-289298 fax +44-1865-289287
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