You wrote: <Unfortunately I cannot agree with your claim that you
“have a respectful attitude towards statistics including statistics in
biomedicine”.>
Your claim about my claim seems to me strange. You can agree or cannot agree
but my attitude is mine. If I have an attitude to a thing, then I have it.
And if I say that my attitude is respectful, it means that I feel and deem
and assess it exactly so. Respectfulness, as far as I know English words, is
a sense. Excuse me, do you know my senses better than I do? Your inability
to agree with my claim is meaning for me only one thing -- you do not
believe that I told the truth about my sense. Interestingly...
I am forced to repeat: my attitude to statistics in biomedicine is
respectful. Even very respectful. The main reason of this is probably my
researcher's background. I had many statistical calculations when dealt with
the results of my investigations. And I saw, of course, that statistics is
an useful tool, and in order to make a generalized conclusion as to a group
of objects we cannot dispense with statistics' assistance. And that
statistics often helps us to see such things that are hidden if each object
is considered separately.
However I think that YOUR misunderstanding the situation is that you
attempt, as far as I can coclude from your texts, to look at any separate
phenomenon as a particular case of an appropriate distribution curve. I
think it is a mistake. Any curve obligatorily has the restrictions due to,
at least, the initial mathematical assumptions and the limited quantity of
observations taken into consideration. In principle, you can make any your
statistical conclusion only in regard to those particular points which do
form this curve! Any additional (new) points need, first of all, to be
proved as those pertinent to this curve. Are you sure that any new object is
condemned to fall within the curve (no matter -- at tails or at the middle)?
If yes, you risk to make the fatal for this object mistake. Of course, a
likelihood of such event may be negligible but it always exists!
Your mistake is also a philosophical one. Indeed, dialectics does teach us
that there are unity and struggle of contraries. One thing is simultaneously
general and particular, big and small, bad and good. As to the subject of
our discussion, each our separate patient or his/her separate index is
simultaneously belonging to the whole population and strictly individual! I
think you will agree that EACH given organism is definitely unique and its
combination of components is non-replicated. If so, have you a right to look
at this organism as one of known-to-you points of the curve (even of those
of its tail)? I suppose you have not such a right. You may only ASSUME that
this object MAY belong to the group of those known points. To determine
definitely whether this is true you need to make ALL accessible particular
measurements and calculations, and only AFTER this you have grounds to say
PRESUMABLY about such belonging. As well as grounds to make a clinical
decision (keeping permanently in mind that you are about a failure of this
making!). Consequently, when you are at the beginning of dealing with a
patient and his/her data you are only AROUND the curve but not oligatorily
at it (surely a likelihood of all appropriate events may be more or less; it
is already a quantitative aspect of the problem; I am interested more in a
qualitative analysis of the situation). So you should be very careful with
regard to your conclusions based on your knowledge of appropriate
statistical curve. Otherwise, you risk to make an unpredictable clinical
error.
You write about contradictions in my line of argument. The drama is that the
life is contradictive in all its aspects! In ALL. It seems, our world was
initially made contradictive. If you deem that you have not contradictions
in your past, present or future considerations, a disillusion does wait for
you.
<Your attitude to separation of statistical interpretation in clinical
trials and the clinical decision making process is harmful...>. I really
separate these things (although they have close relations, of course). You
may see above -- why. And I think that uniting these processes is more
harmful because it gives a temptation to classify easily (but a priori) a
clinical case as such that conforms to the results of above-mentioned
trials. This is a huge mistake. In a given case, we can only assume that
such conforming is possible with a certain likelihood.
Statistics really does not take an interest in a separate individual. If you
think otherwise, please provide me with an example of statistics when n=1.
Statistics needs in many (or, at least, several) individuals or individual
indices to make its conclusions. Isn't? Hereof is my statement that
statistics cannot live without groups of digits of the same kind (I meant
groups of results of uniform measurements; sorry if my English is
incorrect).
<John Smith as a ‘sample’ of the wider population must lie
somewhere within a distribution curve...>. Why MUST?? About 15 years ago I
had a patient who MUST rise his body temperature when I treated him with
large applications of warm peloid (mud). At least, the most of people did
exactly so. But he was not wishing to rise it. Absolutely. And I do not know
why up to today (methodical failures are rather excluded since we had
measurements repeated using different investigators and different patients
to compare). Maybe he was without of all known laws of physics? Hardly. Then
why? Maybe because he was, using your words, from the tail of the curve?
Maybe. However I have not a relief from such an 'explanation'. And should I
look at him as a point of that curve (even -- from its tail, or the end of
the tail) I would get his heat shock definitely.
Perhaps your key misunderstanding is best reflected by the following your
words: <this is not a ‘philosophical’ situation but a real life
situation>. Until you have misunderstood that EACH our 'real life situation'
is exclusively a philosophical one, you will make a mistake of too schematic
(mathematical, formalizing; at any event -- simplifying) look at a
phenomenon. Unfortunately (fortunately?) the life is wider and deeper and --
it is also obvious -- less understood than ANY its statistical description.
Even -- generated by the best unit in Europe or in the world.
I think we, clinicians, should indubitably use all available statistical
data and approaches relevant to our separate clinical cases. But we MUST
make our crucial clinical decisions only using all our opinions, senses,
experiences and intuitions.
Stanislav A. Korobov, MD, PhD
Physician-Physiotherapist
'Mountain Air' Study,
'Lermontovskii' Clinical Sanatorium.
PO Box 7, Odessa, 65089, Ukraine
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