News and Numbers E-Book

Victor Cohn

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 325

Veröffentlichungsjahr: 2011

Beschreibung

Numbers and statistical claims dominate today's news. Politics, budgets, crime analysis, medical issues, and sports reporting all demand numbers. Now in its third edition, News & Numbers focuses on how to evaluate statistical claims in science, health, medicine, and politics. It does so by helping readers answer three key questions about all scientific studies, polls, and other statistical claims: "What can I believe?" "What does it mean?" and "How can I explain it to others?"

Updated throughout, this long overdue third edition brings this classic text up-to-date with the 21st century with a complete updating of examples, case studies, and stories. The text emphasises clear thinking and common sense approaches for understanding, analyzing and explaining statistics, and terms throughout the book are explained in easy-to-understand, nontechnical language. Much new material has been added to ensure the text maintains its pertinent approach to the subject, including:

• A section on computer modelling
• Additional chapters on risks and 'missing numbers'
• Updated sections on health plans and insurance, including updates on President Obama's health system overhaul & new material on health care costs and quality

Leseprobe

Contents

A Note to Our Readers

A Tribute to Victor Cohn, 1919–2000

Foreword

Acknowledgments

Notes on Sources

Part I: Learning the Basics

1 Where We Can Do Better

The Journalistic Challenges

Five Areas for Improvement

2 The Certainty of Uncertainty

The Scientific Method

Focusing on Medicine

3 Testing the Evidence

How to Search for the Truth

Probability and Unexpected Events

The Power of Big Numbers

Bias and Alternate Explanations

Variability

4 What Makes a Good Study?

Experiments Versus Seductive Anecdotes

Clinical Researchers at Work

Alternative Medicine

Epidemiologists at Work

The “H1N1” Strain of Influenza

What’s in a Name?

5 Your Questions and Peer Review

Start the Smorgasbord

Others’ Views and Peer Review

Journalistic Perspective

Getting Down to the Writing …

Special Situations

The Art of Interviewing

Part II: Now Down to Specifics

6 Tests and Drug Trials

Medical Tests for Patients

Drugs and Drug Trials

Animals as Stand-Ins for Us

Writing About New Tests

7 Vital Statistics

The Numbers of Life and Health

Cancer Numbers

Shifts, Drifts, and Blips

8 Health Costs, Quality, and Insurance

Health Insurance Plans

Hospitals

Health Care Costs

9 Our Environment

Let the Questions Fly

Checking the Numbers

Complexity and Assessments

Key Issues: Climate, Nuclear Plants

Six Case Studies: Minds, to Gulf Oil

A Questions Bank

Questions for Evaluating Studies

10 Writing About Risks

Reader-Friendly Writing

Helpful Numbers

The Human Equations

A Risk-Writer’s Checklist

And Looking Ahead

11 Polls

The Principles of Polling

Case Histories

Writing and Other Tips

Snowballs and Focus Groups

12 Statistical Savvy for Many Types of News

Statistical Shenanigans

In Other Types of News

Missing Numbers

GIGO and the Bottom Line

Epilogue The Making of Good Journalists

Glossary

Bibliography

Index

This third edition first published 2012© 2012 Victor Cohn and Lewis Cope

Edition history: 1e 1989; Blackwell Publishing Professional (2e, 2001)

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell.

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Library of Congress Cataloging-in-Publication Data

Cohn, Victor, 1919–2000 News & numbers : a writer’s guide to statistics / Victor Cohn, Lewis Cope.—3rd ed. / with Deborah Cohn Runkle. p. cm. Includes bibliographical references and index.

ISBN 978-0-470-67134-4 (hardcover : alk. paper)—ISBN 978-1-4051-6096-4 (pbk.)1. Public health—Statistics. 2. Environmental health—Statistics. 3. Vital statistics. I. Cope, Lewis, 1934– II. Cohn Runkle, Deborah. III. Title. IV. Title: News and numbers. RA407.C64 2011 614.4′20727–dc23

2011017059

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDFs 9781444344332; epub 9781444344349; Kindle 9781444344356.

A Note to Our Readers

This is a book to help you decide which numbers and studies you probably can trust and which ones you surely should trash.

The rules of statistics are the rules of clear thinking, codified. This book explains the role, logic, and language of statistics, so that we can ask better questions and get better answers.

While the book’s largest audience has been health and other science writers, we believe that it can also be helpful to many other writers and editors, as well as to students of journalism. Health studies are emphasized in many of the chapters because they are so important and they illustrate many principles so well. But this book shows how statistical savvy can help in writing about business, education, environmental policy, sports, opinion polls, crime, and other topics.

News & Numbers is the brainchild of the late Victor Cohn, a former science editor of the Washington Post and sole author of the first edition. I’m glad I could help with later editions, but this is still “Vic’s book.” His inspiring spirit lives on with this edition.

I am particularly pleased that one of his daughters, Deborah Cohn Runkle, a science policy analyst at the American Association for the Advancement of Science, has provided her expertise to help update and expand this latest edition of News & Numbers.

We’ve added a chapter to delve deeper into writing about risks. With President Obama’s health system overhaul plan now law, we’ve added new things to think about in the chapter on health care costs and quality. There’s also a new section on “missing numbers” in the last chapter that we hope will stir your thinking. And we’ve added other new information that we hope you will enjoy along with the old.

Lewis Cope

A Tribute to Victor Cohn, 1919–2000

Victor was a pioneer science writer and a master of his craft. Often referred to as the “Dean of Science Writers,” he became the gold standard for others in his profession.

Beginning his career in the mid-1940s, following service as a naval officer in World War II, he quickly showed an uncanny ability to write about complex medical and other scientific topics in clear, easy-to-understand ways. He provided millions of readers with stories about the landing of the first humans on the moon, the development of the polio vaccine, the then-new field of transplant surgery, the latest trends in health care insurance and medical plans, and many, many other exciting developments over a career that lasted more than 50 years. Throughout, he remained diligent at explaining the cost and ethical issues that came with some of the advances, particularly in the medical sciences.

As part of all this, he showed his fellow journalists the importance of probing numbers to discover what they can reveal about virtually every aspect of our lives. He wrote News & Numbers to share his techniques for doing this in the most revealing and the most responsible way. His quest for excellence in reporting lives on in the Victor Cohn Prize for Excellence in Medical Science Writing, awarded yearly by the Council for the Advancement of Science Writing. With this new edition, Victor’s message lives on.

Lewis Cope, coauthor of this edition

Foreword

I’ve long thought that if journalists could be sued for malpractice, many of us would have been found guilty some time ago. We often err in ways that inevitably harm the public – for example, by distorting reality, or framing issues in deceptively false terms. Among the tools we sometimes wield dangerously as we commit our version of malpractice is the subject of this book: numbers. At one time or another, most of us have written a story that either cited as evidence some number of dubious provenance, or that used numbers or statistics in ways that suggested that the meaning of a medical study or other set of findings was entirely lost upon on us.

Fortunately for many of us, before we did any serious harm, someone handed us a copy of Vic Cohn’s marvelous News & Numbers, now released in a third edition co-authored by Vic and Lewis Cope, with the assistance of Vic’s talented daughter, Deborah Cohn Runkle. I was rescued in this fashion early in my journalistic career, and later had the honor of meeting Cohn and thanking him for his wonderful book. With the advent of this new edition, it is heartening that an entirely new generation of journalists will now have the chance to be saved similarly from their sins.

Much of the content of this book will be familiar to readers of previous editions, even as some of the examples have been updated to reflect recent events, such as the now-discredited vaccines-cause-autism controversy, or the 2010 BP oil spill in the Gulf of Mexico. Perhaps the most important lesson is that almost all stories of a scientific nature deal with an element of uncertainty. And with so much to study amid the rapidly changing sciences of medicine and health care, “truth” often looks more like the images of a constantly shifting kaleidoscope than a message carved on a stone tablet. Thus the book’s excellent advice: “Good reporters try to tell their readers and viewers the degree of uncertainty,” using words such as “may” or “evidence indicates” and seldom words like “proof.”

From the standpoint of the First Amendment, it’s a good thing for society that reporters don’t have to be licensed. But it’s not so good that one can become a reporter – even for an esteemed national publication or news channel – without even a rudimentary grasp of statistics. This book’s crash course on probability, statistical power, bias, and variability is the equivalent of educating a novice driver about the rules of the road. Readers will also be introduced to the wide array of types of medical and scientific studies, and the strengths and weaknesses of each.

Portions of several chapters are devoted to the all-important topic of writing about risk. Important concepts are defined and differentiated, such as relative risk and absolute risk – two different ways of measuring risk that should always be stated together, to give readers the broadest possible understanding of a particular harm. A useful discussion focuses not just on distortions that journalists may make, but common public perceptions and misperceptions that affect the way readers or viewers respond to various risks.

Among the new entries in this edition is a chapter on health costs, quality, and insurance, which wisely cautions careful observation of the effects of the 2010 Affordable Care Act. Because this chapter was written so far ahead of the implementation of most of the law in 2014, its main message is “wait and see” what happens. Perhaps equally important is to encourage journalists to consider and convey to our audiences the totality of the law’s effects, which inevitably will bring tradeoffs – for example, possibly more spending on health care because many more Americans have health insurance. As critical as verifying the “numbers” coming out of health reform will be understanding how the many different sets of numbers will relate to each other, and what values – and I don’t mean numerical ones – Americans will assign to the collective results.

Overall, this new edition upholds Cohn’s perspective that behind bad use of numbers is usually bad thinking, sometimes by the user and sometimes by the person who cooked up the numbers in the first place. And Cohn was a staunch believer in the notion that journalists had a duty to be good thinkers. This edition’s epilogue quotes a list Cohn once made of what constitutes a good reporter; one entry asserts, “A good reporter is privileged to contribute to the great fabric of news that democracy requires.” This edition powerfully evokes Cohn’s spirit, and his belief that, with that privilege, the responsibility also comes to get the facts – and the numbers – right.

Susan DentzerEditor-in-Chief, Health Affairs

Acknowledgments

Victor Cohn’s main mentor and guide in preparation of the first edition of this book was Dr. Frederick Mosteller of the Harvard School of Public Health. The project was supported by the Russell Sage Foundation and by the Council for the Advancement of Science Writing.

Cohn did much of the original work as a visiting fellow at the Harvard School of Public Health, where Dr. Jay Winsten, director of the Center for Health Communications, was another indispensable guide. Drs. John Bailar III, Thomas A. Louis, and Marvin Zelen were valuable helpers, as were Drs Gary D. Friedman and Thomas M. Vogt at the Kaiser organizations; Michael Greenberg at Rutgers University; and Peter Montague of Princeton University. (For those who aided Cohn with the first edition of this book, the references generally are to their universities or other affiliations at the time of that edition’s publication.)

For their assistance with later editions, special thanks go to: Dr. Michael Osterholm of the University of Minnesota, for his great help on epidemiology; Rob Daves, director of the Minnesota Poll at the Minneapolis-St. Paul Star Tribune, for sharing his great expertise on polling; and Dr. Margaret Wang of the University of Missouri-Columbia, for her great enthusiasm about all aspects of patient care.

Very special thanks go to Cohn’s daughter Deborah Cohn Runkle, a senior program associate at the American Association for the Advancement of Science. Without her encouragement and assistance, this edition would not have been possible.

Others who provided valuable counsel for the second edition include Dr. Phyllis Wingo of the American Cancer Society; Dr. Ching Wang at Stanford University; John Ullmann, executive director of the World Press Institute at Macalester College in St. Paul; and the great library staff at the Star Tribune in Minneapolis-St. Paul.

Many other people helped with the first edition of this book. Thanks go to Drs. Stuart A. Bessler, Syntex Corporation; H. Jack Geiger, City University of New York; Nicole Schupf Geiger, Manhattanville College; Arnold Relman, New England Journal of Medicine; Eugene Robin, Stanford University; and Sidney Wolfe, Public Citizen Health Research Group. Thanks also go to Katherine Wallman, Council of Professional Associations on Federal Statistics; Howard L. Lewis, American Heart Association; Philip Meyer, University of North Carolina; Lynn Ries, National Cancer Institute; Mildred Spencer Sanes; and Earl Ubell – and also Harvard’s Drs. Peter Braun, Harvey Fineberg, Howard Frazier, Howard Hiatt, William Hsaio, Herb Sherman, and William Stason.

This book has been aided in the past by the Robert Wood Johnson Foundation, the Ester A. and Joseph Klingenstein Fund, and the American Statistical Association, with additional help from the Commonwealth Fund and Georgetown University.

Despite all this great help, any misstatements remain the authors’ responsibility.

Notes on Sources

Book citations – The full citations for some frequently cited books are given in the bibliography.

Interviews and affiliations – Unless otherwise indicated, quotations from the following are from interviews: Drs. Michael Osterholm, University of Minnesota; John C. Bailar III, Peter Braun, Harvey Fineberg, Thomas A. Louis, Frederick Mosteller, and Marvin Zelen, at Harvard School of Public Health: H. Jack Geiger, City University of New York; and Arnold Relman, New England Journal of Medicine. In most cases, people cited throughout the book are listed with their academic affiliations at the time that they first were quoted in an edition of News & Numbers.

Quotations from seminars – Two other important sources for this manual were Drs. Peter Montague at Princeton University (director, Hazardous Waste Research Program) and Michael Greenberg at Rutgers University (director, Public Policy and Education Hazardous and Toxic Substances Research Center). Quotations are from their talks at symposiums titled “Public Health and the Environment: The Journalist’s Dilemma,” sponsored by the Council for the Advancement of Science Writing (CASW) at Syracuse University, April 1982; St. Louis, March 1983; and Ohio State University, April 1984.

Part I

Learning the Basics

A Guide to Part I of News & Numbers

In the first five chapters, we cover the basics:

1. Where We Can Do Better

Improving how stories with numbers are reported.

2. The Certainty of Uncertainty

Scientists are always changing their minds.

3. Testing the Evidence

Thinking clearly about scientific studies.

4. What Makes a Good Study?

Separating the wheat from the chaff.

5. Your Questions and Peer Review

What to ask the experts.

2

The Certainty of Uncertainty

The only trouble with a sure thing is the uncertainty.

Author unknown

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we now know we don’t know. But there are also unknown unknowns. These are things we do not know we don’t know.

Donald Rumsfeld

Scientists keep changing their minds.

Pediatricians’ advice on how to put a baby down to sleep has changed over time. The tummy position was first to go, and then even the side position was vetoed. Now it’s on-the-back only, based on the latest research about reducing the risk of Sudden Infant Death Syndrome (SIDS).1

Vioxx hit the market in 1999 as a major advance to treat the pain from arthritis and other causes. Later, it was tested to see if it also could help prevent colon polyps (and thus colon cancer). Instead, that study found a major heart risk in people who had taken the drug for a while. Much of the controversy over Vioxx is about whether the heart risk should have been seen and acted on earlier. Vioxx was pulled from the market and research continues to identify any possible risks from other pain-relief drugs.2

Many experts once thought that postmenopausal hormone treatments could help protect women’s hearts. Then a National Institutes of Health study made big headlines by concluding that long-term use of this treatment increased heart, stroke, and breast cancer risks. But debate still simmers over specifics.3

In another seesaw, experts continue to tell us that coffee is good for us or bad for us.4

And poor Pluto! It had long reigned as our solar system’s ninth planet. Then astronomers discovered similar far-out orbiting bodies, and there was talk of granting them planethood status. And some pointed out that Pluto’s orbit was not like that of the eight other planets. So the International Astronomical Union took a vote and decided to demote Pluto to a secondary dwarf category – shrinking our roster of planets to eight.5

To some people, all this changing and questioning gives science a bad name. Actually, it’s science working just as it’s supposed to work.

The first thing that you should understand about science is that it is almost always uncertain. The scientific process allows science to move ahead without waiting for an elusive “proof positive.” Patients can be offered a new treatment at the point at which there’s a good probability that it works. And decisions to prohibit the use of a chemical in household products can be made when there’s a pretty good probability that it’s dangerous.

How can science afford to act on less than certainty? Because science is a continuing story – always retesting ideas. One scientific finding leads scientists to conduct more research, which may support and expand on the original finding. In medicine, this often allows more and more patients to benefit. And in cosmology this can lead to a better understanding of the origins of our universe.

But in other cases, the continuing research results in modified conclusions. Or less often, in entirely new conclusions.

Remember when a radical mastectomy was considered the only good way to treat breast cancer? When doctors thought that stress and a spicy diet were the main causes of ulcers – before research demonstrated that the chief culprit is bacteria? These and many other treatments and beliefs once seemed right, then were dropped after statistically rigorous comparisons with new ideas.

In considering the uncertainty inherent in science, we can say one thing with virtual certainty: Surprise discoveries will alter some of today’s taken-for-granted thinking in medicine and other fields.

Now let’s take a deeper look at some of research that shows how scientists change their minds with new evidence:

The dietary fat study – The federal Women’s Health Initiative conducted the largest study ever undertaken to see whether a low-fat diet could reduce the risk of cancer or heart disease. It involved 49,000 women, ages 50 to 79, who were followed for eight years. In the end, there was no difference in heart or cancer risks between the participants assigned to the low-fat diet and those who weren’t.

But wait! A closer look showed that women on the low-fat diet hadn’t cut back their fat intake as much as hoped. And the diet was designed to lower total fat consumption, rather than targeting specific types of fat. That was considered good advice when the study was planned, but experts now emphasize cutting back on saturated and other specific fats to benefit the heart.

So the big study didn’t totally settle anything – except maybe to confirm how hard it is to get people to cut back on fatty foods. It certainty didn’t provide an endorsement for low-fat diets in general, as many thought it would. But a chorus of experts soon proclaimed continuing faith in the heart-health advice to cut back on specific types of fats. And more research has indicated that certain fats may be good for you – like the fat in certain fish and in dark chocolate! More research will try to sort everything out. Please stay tuned.6

The Scientific Method

Let’s pause and take a step-by-step look at the scientific way:

A scientist seeking to explain or understand something – be it the behavior of an atom or the effect of the oil spilled in the Gulf – usually proposes a hypothesis, then seeks to test it by experiment or observation. If the evidence is strongly supportive, the hypothesis may then become a theory or at some point even a law, such as the law of gravity.

A theory may be so solid that it is generally accepted.

Example: The theory that cigarette smoking causes lung cancer, for which almost any reasonable person would say the case has been proved, for all practical purposes.

The phrase “for all practical purposes” is important, for scientists, being practical people, must often speak at two levels: the strictly scientific level and the level of ordinary reason that we require for daily guidance.

Example of the two levels: In 1985, a team of 16 forensic experts examined the bones that were supposedly those of the Nazi “Angel of Death,” Dr. Josef Mengele. Dr. Lowell Levine, representing the U.S. Department of Justice, then said, “The skeleton is that of Josef Mengele within a reasonable scientific certainty,” and Dr. Marcos Segre of the University of São Paulo, explained, “We deal with the law of probabilities. We are scientists and not magicians.” Pushed by reporters’ questions, several of the pathologists said they had “absolutely no doubt” of their findings.7 Yet the most that any scientist can scientifically say – say with certainty in almost any such case – is: There is a very strong probability that such and such is true.

“When it comes to almost anything we say,” reports Dr. Arnold Relman, former editor of the New England Journal of Medicine, “you, the reporter, must realize – and must help the public understand – that we are almost always dealing with an element of uncertainty. Most scientific information is of a probable nature, and we are only talking about probabilities, not certainty. What we are concluding is the best we can do, our best opinion at the moment, and things may be updated in the future.”

Example: In the beginning, all cholesterol that coursed the bloodstream was considered an artery-clogging heart hazard. Then researchers discovered that there’s not only bad cholesterol, but also some good cholesterol that helps keep the arteries clean. Exercise, among other things, can help pump up the level of HDL (good cholesterol).

Just as Americans were taking this message to heart, the what-to-eat part of the cholesterol message began to change, too.

The chief concern had long focused on eating too much saturated fat, which is the type typically found in meats. Then, research in the 1990s uncovered growing worries about the consumption of “trans fats,” an unusual form of vegetable fat that’s typically found in some snack foods and some types of fried foods.

By 2006, when trans fats were added to food labels, some experts were calling this the worst of all fats for the heart. Recent research has shown that trans fats can both lower the bloodstream’s level of good cholesterol, and raise the level of bad cholesterol.

Of course, research continues on all aspects of heart attack prevention, with hopes of coming up with new and better advice. So please stay tuned.8

Nature is complex, and almost all methods of observation and experiment are imperfect. “There are flaws in all studies,” says Harvard’s Dr. Marvin Zelen.9 There may be weaknesses, often unavoidable ones, in the way a study is designed or conducted. Observers are subject to human bias and error. Measurements fluctuate.

“Fundamentally,” writes Dr. Thomas Vogt, “all scientific investigations require confirmation, and until it is forthcoming all results, no matter how sound they may seem, are preliminary.”10

But when study after study reaches the same conclusion, confidence can grow. Scientists call this replication of the findings. We call it the way that science grows by building on itself.

Even when the test of time provides overwhelming evidence that a treatment really does help, there may be questions about just which patients should get the treatment. These questions are arising more as we enter an age of “personalized medicine,” in which patients with particular genetic profiles or other biological markers (called “biomarkers”) are found to be better candidates for a treatment than others with the same disease. And if an “improved” treatment comes along, is the new treatment really an improvement? Comparitive effectiveness research, another type of medical research, aims to test one therapy against another to try to answer that question.

The bottom line for journalists covering all types of research: Good reporters try to tell their readers and viewers the degree of uncertainty, whether it’s about a medical research finding or the effects of global warming. And wise reporters often use words such as “may” and “evidence indicates,” and seldom use words like “proof.” A newspaper or TV report or blog that contains needed cautions and caveats is a more credible report than one that doesn’t.

Focusing on Medicine

Medicine, in particular, is full of disagreement and controversy. The reasons are many:

There’s the lack of funds to mount enough trials. There’s the swift evolution and obsolescence of some medical techniques.

There’s the fact that, with the best of intentions, medical data – histories, physical exams, interpretations of tests, descriptions of symptoms and diseases – are too often inexact and vary from physician to physician.

There are ethical obstacles to trying a new procedure when an old one is doing some good, or to experimenting on children, pregnant women, or the mentally ill.

There may not be enough patients at any one center to mount a meaningful trial, particularly for a rare disease. And if there’s a multicenter trial, there are added complexities and expenses.

And some studies rule out patients with “co-morbidities” – that is, diseases the patients have in addition to the one being studied – which might make for a purer result, but are usually not a reflection of the real world, where people often have more than one medical condition.

Studies have found that many articles in prestigious medical journals have shaky statistics, and a lack of any explanation of such important matters as patients’ complications and the number of patients lost to follow-up. The editors of leading medical journals have gotten together and established standards for reporting clinical trials, so they will be of greater use to clinicians and other scientists. And most journals now have statisticians on their review boards. Research papers presented at medical meetings, many of them widely reported by the media, raise more questions. Some are mere progress reports on incomplete studies. Some state tentative results that later collapse. Some are given to draw comment or criticism, or to get others interested in a provocative but still uncertain finding.