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==Some frightening graphs==


Most people believe that


# Unless treated, cancer is necessarily fatal;  and
==Forsooth==
# The earlier cancer is diagnosed and treated, the more likely the cure


Because cancer is a catchall term, #1 is certainly wrong.  Some cancers grow so slowly that death is due to another cause. Indeed, some cancers are so indolent that a person may lead an entire life unaware even of the existence of the cancer.  Therefore, in spite of its plausibility,  #2 is suspect because diagnoses based on a screening test might lead to unnecessary and harmful treatments.
==Quotations==
“We know that people tend to overestimate the frequency of well-publicized, spectacular
The following five graphs [http://jnci.oxfordjournals.org/content/102/9/605.full found in an article by Welch and Black] illustrate this conundrum of modern medicine: it can do a great deal of harm precisely because it is so good at doing things such as finding abnormalities which represent non-threatening deviations from what is deemed normal.
events compared with more commonplace ones; this is a well-understood phenomenon in
the literature of risk assessment and leads to the truism that when statistics plays folklore,
folklore always wins in a rout.”
<div align=right>-- Donald Kennedy (former president of Stanford University), ''Academic Duty'', Harvard University Press, 1997, p.17</div>


<center>[[File:F7.large.jpg‎ |500px ]]</center>
----
 
Notice that for each of the five cancers, its time series of mortality is flat whereas the number of new diagnoses rises prohibitively over time indicating overdiagnosis and therefore, overtreatment with consequent suffering. 
"Using scientific language and measurement doesn’t prevent a researcher from conducting flawed experiments and drawing wrong conclusions — especially when they confirm preconceptions."
As another instance of overdiagnosis, overtreatment and consequent suffering, the following three figures are taken from [http://www.bmj.com/content/348/bmj.g366 an article by Miller, et al], in the British Medical Journal (BMJ 2014;348:g366 doi: 10.1136/bmj.g366), entitled “Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial.” 
 
<div align=right>-- Blaise Agüera y Arcas, Margaret Mitchell and Alexander Todoorov, quoted in: The racist history behind facial recognition, ''New York Times'', 10 July 2019</div>
 
==In progress==
[https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html What if the Placebo Effect Isn’t a Trick?]<br>
by Gary Greenberg, ''New York Times Magazine'', 7 November 2018


<center>[[File:F2_BCmortality.png | 500px]]</center>
[https://www.nytimes.com/2019/07/17/opinion/pretrial-ai.html The Problems With Risk Assessment Tools]<br>
by Chelsea Barabas, Karthik Dinakar and Colin Doyle, ''New York Times'', 17 July 2019


<center>'''Fig 2 All cause mortality, by assignment to mammography or control arms (all participants)'''</center>
==Hurricane Maria deaths==
Laura Kapitula sent the following to the Isolated Statisticians e-mail list:


:[Why counting casualties after a hurricane is so hard]<br>
:by Jo Craven McGinty, Wall Street Journal, 7 September 2018


<center>[[File:F3_BCspecific.png | 500px]]</center>
The article is subtitled: Indirect deaths—such as those caused by gaps in medication—can occur months after a storm, complicating tallies
   
   
<center>'''Fig 3 Breast cancer specific mortality, by assignment to mammography or control arms (all participants)'''</center>
Laura noted that
:[https://www.washingtonpost.com/news/fact-checker/wp/2018/06/02/did-4645-people-die-in-hurricane-maria-nope/?utm_term=.0a5e6e48bf11 Did 4,645 people die in Hurricane Maria? Nope.]<br>
:by Glenn Kessler, ''Washington Post'', 1 June 2018


<center>[[File:F4_BCdiagnosis.png | 500px]]</center>
The source of the 4645 figure is a [https://www.nejm.org/doi/full/10.1056/NEJMsa1803972 NEJM article].  Point estimate, the 95% confidence interval ran from 793 to 8498.


<center>'''Fig 4 Breast cancer specific mortality from cancers diagnosed in screening period, by assignment to mammography or control arms'''</center>
President Trump has asserted that the actual number is
[https://twitter.com/realDonaldTrump/status/1040217897703026689 6 to 18].
The ''Post'' article notes that Puerto Rican official had asked researchers at George Washington University to do an estimate of the death toll.  That work is not complete.
[https://prstudy.publichealth.gwu.edu/ George Washington University study]


This very large--a sample size of approximately 90,000-- 25 year randomized control trial concludes that
:[https://fivethirtyeight.com/features/we-still-dont-know-how-many-people-died-because-of-katrina/?ex_cid=538twitter We sttill don’t know how many people died because of Katrina]<br>
:by Carl Bialik, FiveThirtyEight, 26 August 2015


Annual mammography in women aged 40-59 does not
----
reduce mortality from breast cancer beyond that of physical examination
[https://www.nytimes.com/2018/09/11/climate/hurricane-evacuation-path-forecasts.html These 3 Hurricane Misconceptions Can Be Dangerous. Scientists Want to Clear Them Up.]<br>
or usual care when adjuvant therapy for breast cancer is freely available.
[https://journals.ametsoc.org/doi/abs/10.1175/BAMS-88-5-651 Misinterpretations of the “Cone of Uncertainty” in Florida during the 2004 Hurricane Season]<br>
Overall, 22% (106/484) of screen detected invasive breast cancers were
[https://www.nhc.noaa.gov/aboutcone.shtml Definition of the NHC Track Forecast Cone]
over-diagnosed, representing one over-diagnosed breast cancer for
----
every 424 women who received mammography screening in the trial.
[https://www.popsci.com/moderate-drinking-benefits-risks Remember when a glass of wine a day was good for you? Here's why that changed.]
''Popular Science'', 10 September 2018
----
[https://www.economist.com/united-states/2018/08/30/googling-the-news Googling the news]<br>
''Economist'', 1 September 2018


===Discussion===
[https://www.cnbc.com/2018/09/17/google-tests-changes-to-its-search-algorithm-how-search-works.html We sat in on an internal Google meeting where they talked about changing the search algorithm — here's what we learned]
----
[http://www.wyso.org/post/stats-stories-reading-writing-and-risk-literacy Reading , Writing and Risk Literacy]


1. With regard to the five time series, suppose instead of overdiagnosis and overtreatment, the following (reverse causality) argument is made: despite the rise in each of the cancers, modern medicine has kept the mortality constant. Comment on this assertion.
[http://www.riskliteracy.org/]
-----
[https://twitter.com/i/moments/1025000711539572737?cn=ZmxleGlibGVfcmVjc18y&refsrc=email Today is the deadliest day of the year for car wrecks in the U.S.]


2.  Notice that in the above Figs 2, 3 and 4, a p-value is given for the comparison between the mammography arm and the control arm.  Looking at the curves themselves, comment as to why it makes sense that each of the p-values is well above the mystical .05.
==Some math doodles==
<math>P \left({A_1 \cup A_2}\right) = P\left({A_1}\right) + P\left({A_2}\right) -P \left({A_1 \cap A_2}\right)</math>


3.  With regard to the mammography study, [http://www.bmj.com/content/348/bmj.g1403 there is an accompanying editorial in the BMJ] entitled “Too much mammography.”  This editorial goes on to compare and contrast PSA screening with mammography.  Although PSA screening and mammography seem to be very similar "owing to [the] small effect on mortality and large risk of overdiagnosis ([http://www.screening.nhs.uk/prostatecancer]),"
<math>P(E)  = {n \choose k} p^k (1-p)^{ n-k}</math>


Nevertheless, the UK National Screening Committee does recommend mammography screening for breast cancer but not prostate specific antigen screening for prostate cancer.
<math>\hat{p}(H|H)</math>


<math>\hat{p}(H|HH)</math>


Because the scientific rationale to recommend screening or not does not differ noticeably between breast and prostate cancer, political pressure and beliefs might have a role.
==Accidental insights==


My collective understanding of Power Laws would fit beneath the shallow end of the long tail. Curiosity, however, easily fills the fat end.  I long have been intrigued by the concept and the surprisingly common appearance of power laws in varied natural, social and organizational dynamics.  But, am I just seeing a statistical novelty or is there meaning and utility in Power Law relationships? Here’s a case in point.


We agree with Miller and colleagues that “the rationale for screening by mammography be urgently reassessed by policy makers.” As time goes by we do indeed need more efficient mechanisms to reconsider priorities and recommendations for mammography screening and other medical interventions. This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established.
While carrying a pair of 10 lb. hand weights one, by chance, slipped from my grasp and fell onto a piece of ceramic tile I had left on the carpeted floor. The fractured tile was inconsequential, meant for the trash.
<center>[[File:BrokenTile.jpg | 400px]]</center>
As I stared, slightly annoyed, at the mess, a favorite maxim of the Greek philosopher, Epictetus, came to mind: “On the occasion of every accident that befalls you, turn to yourself and ask what power you have to put it to use.”  Could this array of large and small polygons form a Power Law? With curiosity piqued, I collected all the fragments and measured the area of each piece.
 
<center>
{| class="wikitable"
|-
! Piece !! Sq. Inches !! % of Total
|-
| 1 || 43.25 || 31.9%
|-
| 2 || 35.25 ||26.0%
|-
|  3 || 23.25 || 17.2%
|-
| 4 || 14.10 || 10.4%
|-
| 5 || 7.10 || 5.2%
|-
| 6 || 4.70 || 3.5%
|-
| 7 || 3.60 || 2.7%
|-
| 8 || 3.03 || 2.2%
|-
| 9 || 0.66 || 0.5%
|-
| 10 || 0.61 || 0.5%
|}
</center>
<center>[[File:Montante_plot1.png | 500px]]</center>
The data and plot look like a Power Law distribution. The first plot is an exponential fit of percent total area. The second plot is same data on a log normal format. Clue: Ok, data fits a straight line.  I found myself again in the shallow end of the knowledge curve. Does the data reflect a Power Law or something else, and if it does what does it reflect?  What insights can I gain from this accident? Favorite maxims of Epictetus and Pasteur echoed in my head:
“On the occasion of every accident that befalls you, remember to turn to yourself and inquire what power you have to turn it to use” and “Chance favors only the prepared mind.”
 
<center>[[File:Montante_plot2.png | 500px]]</center>
My “prepared” mind searched for answers, leading me down varied learning paths. Tapping the power of networks, I dropped a note to Chance News editor Bill Peterson. His quick web search surfaced a story from ''Nature News'' on research by Hans Herrmann, et. al. [http://www.nature.com/news/2004/040227/full/news040223-11.html Shattered eggs reveal secrets of explosions].  As described there, researchers have found power-law relationships for the fragments produced by shattering a pane of glass or breaking a solid object, such as a stone. Seems there is a science underpinning how things break and explode; potentially useful in Forensic reconstructions.
Bill also provided a link to [http://cran.r-project.org/web/packages/poweRlaw/vignettes/poweRlaw.pdf a vignette from CRAN] describing a maximum likelihood procedure for fitting a Power Law relationship. I am now learning my way through that.


Comment on the vested interests and why the task is difficult.
Submitted by William Montante


Submitted by Paul Alper
----

Latest revision as of 20:58, 17 July 2019


Forsooth

Quotations

“We know that people tend to overestimate the frequency of well-publicized, spectacular events compared with more commonplace ones; this is a well-understood phenomenon in the literature of risk assessment and leads to the truism that when statistics plays folklore, folklore always wins in a rout.”

-- Donald Kennedy (former president of Stanford University), Academic Duty, Harvard University Press, 1997, p.17

"Using scientific language and measurement doesn’t prevent a researcher from conducting flawed experiments and drawing wrong conclusions — especially when they confirm preconceptions."

-- Blaise Agüera y Arcas, Margaret Mitchell and Alexander Todoorov, quoted in: The racist history behind facial recognition, New York Times, 10 July 2019

In progress

What if the Placebo Effect Isn’t a Trick?
by Gary Greenberg, New York Times Magazine, 7 November 2018

The Problems With Risk Assessment Tools
by Chelsea Barabas, Karthik Dinakar and Colin Doyle, New York Times, 17 July 2019

Hurricane Maria deaths

Laura Kapitula sent the following to the Isolated Statisticians e-mail list:

[Why counting casualties after a hurricane is so hard]
by Jo Craven McGinty, Wall Street Journal, 7 September 2018

The article is subtitled: Indirect deaths—such as those caused by gaps in medication—can occur months after a storm, complicating tallies

Laura noted that

Did 4,645 people die in Hurricane Maria? Nope.
by Glenn Kessler, Washington Post, 1 June 2018

The source of the 4645 figure is a NEJM article. Point estimate, the 95% confidence interval ran from 793 to 8498.

President Trump has asserted that the actual number is 6 to 18. The Post article notes that Puerto Rican official had asked researchers at George Washington University to do an estimate of the death toll. That work is not complete. George Washington University study

We sttill don’t know how many people died because of Katrina
by Carl Bialik, FiveThirtyEight, 26 August 2015

These 3 Hurricane Misconceptions Can Be Dangerous. Scientists Want to Clear Them Up.
Misinterpretations of the “Cone of Uncertainty” in Florida during the 2004 Hurricane Season
Definition of the NHC Track Forecast Cone

Remember when a glass of wine a day was good for you? Here's why that changed. Popular Science, 10 September 2018

Googling the news
Economist, 1 September 2018

We sat in on an internal Google meeting where they talked about changing the search algorithm — here's what we learned

Reading , Writing and Risk Literacy

[1]

Today is the deadliest day of the year for car wrecks in the U.S.

Some math doodles

<math>P \left({A_1 \cup A_2}\right) = P\left({A_1}\right) + P\left({A_2}\right) -P \left({A_1 \cap A_2}\right)</math>

<math>P(E) = {n \choose k} p^k (1-p)^{ n-k}</math>

<math>\hat{p}(H|H)</math>

<math>\hat{p}(H|HH)</math>

Accidental insights

My collective understanding of Power Laws would fit beneath the shallow end of the long tail. Curiosity, however, easily fills the fat end. I long have been intrigued by the concept and the surprisingly common appearance of power laws in varied natural, social and organizational dynamics. But, am I just seeing a statistical novelty or is there meaning and utility in Power Law relationships? Here’s a case in point.

While carrying a pair of 10 lb. hand weights one, by chance, slipped from my grasp and fell onto a piece of ceramic tile I had left on the carpeted floor. The fractured tile was inconsequential, meant for the trash.

BrokenTile.jpg

As I stared, slightly annoyed, at the mess, a favorite maxim of the Greek philosopher, Epictetus, came to mind: “On the occasion of every accident that befalls you, turn to yourself and ask what power you have to put it to use.” Could this array of large and small polygons form a Power Law? With curiosity piqued, I collected all the fragments and measured the area of each piece.

Piece Sq. Inches % of Total
1 43.25 31.9%
2 35.25 26.0%
3 23.25 17.2%
4 14.10 10.4%
5 7.10 5.2%
6 4.70 3.5%
7 3.60 2.7%
8 3.03 2.2%
9 0.66 0.5%
10 0.61 0.5%
Montante plot1.png

The data and plot look like a Power Law distribution. The first plot is an exponential fit of percent total area. The second plot is same data on a log normal format. Clue: Ok, data fits a straight line. I found myself again in the shallow end of the knowledge curve. Does the data reflect a Power Law or something else, and if it does what does it reflect? What insights can I gain from this accident? Favorite maxims of Epictetus and Pasteur echoed in my head: “On the occasion of every accident that befalls you, remember to turn to yourself and inquire what power you have to turn it to use” and “Chance favors only the prepared mind.”

Montante plot2.png

My “prepared” mind searched for answers, leading me down varied learning paths. Tapping the power of networks, I dropped a note to Chance News editor Bill Peterson. His quick web search surfaced a story from Nature News on research by Hans Herrmann, et. al. Shattered eggs reveal secrets of explosions. As described there, researchers have found power-law relationships for the fragments produced by shattering a pane of glass or breaking a solid object, such as a stone. Seems there is a science underpinning how things break and explode; potentially useful in Forensic reconstructions. Bill also provided a link to a vignette from CRAN describing a maximum likelihood procedure for fitting a Power Law relationship. I am now learning my way through that.

Submitted by William Montante

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