Update 9-25-07

Hi,

Not a lot of mail this week, probably due to the holidays.  But we did get a very nice remembrance of Grace Dibble Kincade from Eric Hilton.  That follows below.  There were also a couple of forwards that weren't exactly flattering to President Bush.  But most of you have probably seen them on the Internet, so there's no point insulting Mr. Bush's supporters here.  And there was a picture of the sun, shining over the Verrazano-Narrows Bridge and looking much like the Star of David.  But that seemed less like nature's work than Photo Shop's.  So I'll simply remind you that there's another Alumni Association meeting coming up in early October, Thursday, the 4th to be precise, and tell you that I finally remembered to send my dues in to Dennis Shapiro.
   
    From Eric Hilton:  When I received an e-mail from Larry Kincade, I thought it was from Grace, just saying a quick "hello."  But I was not as shocked as I had been following an earlier e-mail to me telling of Grace's condition, and I knew it was just a matter of time.
        I hadn't really seen Grace since high school, but I always remembered her as a sweet person who never spoke – or spoke very little.  At the thirty-seventh reunion, which Diane Fruzetti made me go to -- I sat at a table, and this very nice woman asked if she could join me.  That was Grace. She told me she was hoping I was going to be there as she had something to show me.
        It was a series of 8x10 black and white photos from Brooklyn Avenue School of me in my Cub Scout uniform.  What a cute little chubby kid I was.  Who ever would have thought I'd grow up to be a cute little chubby adult?  Go figure.  But the fact is, Grace made that reunion very special and memorable for me, and I am truly saddened by her passing.
   
    And you didn't think you'd get away without facing some educational filler, which isn't entirely unrelated to Grace's death:
   
    A recent Chicago Tribune included this article, titled: "Screening Tests Aren't as Precise as We Think."  It was written by Jeremy Manier.
        It's one of the most common questions a patient can ask a doctor:  "How worried should I be?"  The question often arises following a disease-screening test that has yielded an ominous but unconfirmed result.  In some cases, getting the right answer can save a patient from weeks of sleepless nights.  Yet, although gauging the trustworthiness of medical tests is part of a physician's job, recent research suggests that most doctors lack the statistical skills to interpret routine tests for cancer, birth defects, and an array of other conditions.  Researchers say doctors tend to overstate the accuracy of common tests, often because even experts misunderstand the tests' limitations.  The reality is that screening tests such as mammograms for breast cancer and PSA tests for prostate cancer are imprecise tools for determining whether a patient actually has the disease. Yet even when given statistics that show a test's initial results are likely to be wrong, many doctors maintain faith that the tests generally are accurate.
        In one study last year, three-quarters of obstetricians overestimated the accuracy of a test for Down syndrome.  The error is multiplied when physicians relay misinformation to their patients, who may worry unnecessarily over a bad outcome or assume false confidence when the news is good.  "Doctors' innumeracy is a part of the health system that's not recognized as a problem," said Gerd Gigerenzer, a psychologist and director of the Max Planck Institute for Social Research in Berlin.  "Doctors have no practical training in dealing with risks."
        A major source of errors may lie in how we talk about probabilities.  Gigerenzer and other experts believe that using a little creativity in describing the statistical grounding of a test could make its pros and cons more transparent.  Trained doctors and patients alike have a particularly hard time making sense of percentages. Understanding a test's underpinnings requires familiarity with a mind-spinning assortment of percentages, including the likelihood that the test will detect a given condition, the probability that it will yield a false positive result, and how common the condition is in the group being tested.  All of those factors come into play for a doctor trying to tell a patient what a test means.
        "Mammograms offer a stark example of how easy it is to misinterpret a positive result," said Gigerenzer, who taught at the University of Chicago before moving back to Germany.  About 1 percent of 40-year-old women have breast cancer.  The chances of a mammogram detecting the disease are around 90 percent -- not bad.  Roughly 9 percent of women who take the test will get a positive result even though they have no disease -- again, a fairly good ratio as screening tests go.  But those impressive-sounding figures don't directly address a typical patient's most urgent question:  What are the chances that a typical 40-year-old who tests positive on a mammogram actually has cancer?  The answer:  Just 10 percent of those who test positive are later confirmed to have cancer.  Didn't see that coming?  Neither do most doctors.
        "We have a bias toward thinking tests work," said Dr. Steven Woloshin, a professor of medicine at Dartmouth Medical School and a researcher in the outcomes group at White River Junction VA Medical Center in Vermont.  Such shortcomings apply to many screening tests.  But easing the problem can be as simple as portraying a test's underpinnings with what Gigerenzer calls "natural frequencies," rather than probabilities expressed as percentages.  In his book Calculated Risks:  How to Know When Numbers Deceive You, Gigerenzer lays out a blessedly simple way of thinking about the above mammogram example:  "Think of 100 women. One has breast cancer, and she will probably test positive.  Of the 99 who do not have breast cancer, 9 others will also test positive.  Thus, a total of 10 women will test positive.  How many of those who test positive actually have breast cancer?"  Now, Gigerenzer writes, "The fog in your mind should have lifted," and the answer should be clear:  Only about 1 in 10 women with a positive result actually has breast cancer.
        Studies suggest that doctors who can frame tests in similar terms do better at giving their patients the right guidance on what a test result actually means.  A paper last year in the British Medical Journal found that while three-fourths of doctors who used percentages overestimated the accuracy of a Down syndrome test, doctors who were given the problem in terms of frequencies got it right two-thirds of the time.  In some cases, getting the right information beforehand may persuade a patient not to get a screening test at all.  For example, Gigerenzer said his research convinced him that the benefits of mammograms and many other screening tests have been exaggerated.  "The point is not to make a decision for people, but to make sure they have access to information in a form they can understand," Gigerenzer said.