HELPING DOCTORS AND PATIENTS MAKE SENSE OF

HEALTH STATISTICS
Study by Gerd Gigerenzer, Wolfgang Gaissmaier, Elke Kurz-Mileke,
Lisa M. Schwartz, and Steve Woloshin

INTRODUCTION
In a 2007 campaign advertisement, former New York City Mayor
Rudy Guiliani said, “I had prostate cancer 5,6 years ago. My
chances of surviving prostate cancer-and thank God, I was cured
of it-in the United States? Eighty-two percent. My chances of
surviving prostate cancer in England? Only forty-four percent
under socialized medicine” (Dobbs,2007). For Guiliani, these
health statistics meant that he was lucky to be living in New
York and not in England, since his chances of surviving prostate
cancer appeared to be twice as high. This was big news. As this
matter is further discussed, it was also deemed as a big mistake.
High-profile politicians are not the only ones who lacks
understanding health statistics or misuse them.
A team of psychologists and physicians described societal
problems and called the statistical illiteracy. In World Brain
(1938-1994), H.G. Wells predicted that for an uneducated
citizenship in a modern democracy, statistical thinking would be
as indispensable as reading and writing. At the beginning of the
21st century, nearly everyone living in an industrial society has
been taught reading and writing but not statistical thinking-ow
to understand information about risks and uncertainties in our
technological world. The qualifier collective signals that lack
understanding is not limited to less educated patients; many
physicians do not understand statistics either. Journalists and
politicians further contribute to the problem. One might wonder
why collective statistical illiteracy a top priority of ethics
committees, medical curriculum, and psychological research is
not. One reason is that its very nature generally ensures that it
goes undetected. Humans are facing a concealed societal problem.
In this study, the researchers define statistical illiteracy
in health care and analyze its prevalence, the damage it does to
health and emotion, its potential causes, and its prevention. The
researchers argued that the cause is not simply inside the minds
of patients and physicians-such as the lack of math gene or the
tendency to make hard-wires cognitive biases. Rather, the
researchers showed that statistical literacy is largely a
function of the external environment, and it can be fostered by
education and, even more simply, by representing numbers in ways
that are transparent for the human mind.

CONTEXT OF THE STUDY

Many doctors, patients, journalists, and politicians alike
do not understand what health statistics mean or draw wrong
conclusion without noticing. Collective statistical illiteracy
refers to the widespread inability to understand the meaning of
numbers. For instance, many citizens are unaware that higher
survival rates with cancer screening do not imply longer life, or
that the statement that mammography screening reduces the risk of
dying from breast cancer by 25% in fact means that 1 less woman
out of 1,000 will die of the disease. Evidence is provided that
statistical illiteracy (a) is common to patients, journalists,
and physicians; (b) is created by nontransparent framing of
information that is sometimes an unintentional result of lack of
understanding but can also be a result of intentional efforts to
manipulate or persuade people; and (c) can have serious
consequences for health.
The causes of statistical illiteracy should not e attributed
to cognitive biases alone, but to the emotional nature of the
doctor-patient relationship and conflicts of interests in the
healthcare system. The classic doctor-patient relation is based
on (physician’s) paternalism and (patient’s) trust in authority,
which makes statistical literacy seem unnecessary; so, does the
traditional combination of determinism (physicians who seek
causes, not chances) and the illusion of certainty (patients who
seek certainty when there is none). The researchers showed that
information pamphlets, web sites, leaflets distributed to doctors
by the pharmaceutical industry, and even medical journals often
report evidence in nontransparent forms that suggest big benefits
of featured interventions and small harms. Without understanding
the numbers involved, the public is susceptible to political and
commercial manipulation of their anxieties and hopes, which
undermines the goals of informed consent and shared decision
making.
The researchers discussed the importance of teaching
statistical thinking and transparent representations I primary
and secondary education as well as in medical school. Yet this
requires familiarizing children early on the concept of
probability and teaching statistical literacy as the art of
solving real-world problems rather than applying formulas to toy
problems about coins and dice. Major precondition for statistical
literacy is transparent risk communication. The researchers
recommend the use of frequency statements instead of relative
risks, mortality rates instead of survival rates, and natural
frequencies instead of conditional probabilities. Psychological
research on transparent visual and numerical forms of
communication, as well as training of physicians in their use, is
called for.
Statistical literacy is a necessary precondition for
educated citizenship in a technological democracy. Understanding
risks and asking critical questions can also shape the emotional
climate in a society so that hopes and anxieties are no longer as
easily manipulated by external factors and citizens can develop a
better-informed and more relaxed attitude towards their health.