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vryadliХотя не намного короче.... Но сильнее только... вот, ей-богу, знал, но забыл! Вспоню - впишу, а на сегодня сильнейшее из того, что помню.
Доклад ваще-то прочитан в Фермилабе, есть там такой регулярный семинар... и вот там такая
Thomas B. Newman, MD, MPH
University of California, San Francisco
...As aпростой провинциальный совок professor in a department of epidemiology and biostatistics , I believe that in order to optimize что угодно health outcomes, our approach к почти любой проблеме to public health , decision making generally should be probabilistic and statistical -- using available data to estimate numbers of people expected to benefit various amounts from different courses of action, and choosing the course of action with the highest expected net benefit. On the other hand, as a pediatrician caring for patients типичный сетеовой тролль and trying понять, что толкуют разные умные люди to write "evidence-based" guidelines for common pediatric problems < , I have been confronted with a powerful alternative force: stories. In this talk I will relate some examples of this tension between "evidence-based medicine" and individual patient stories in two areas котрые в рускоячном секторе ЖЖ почти лишены пуперпартийной окраски I have worked on: neonatal jaundice and infant airplane safety . I will close with some general observations and suggestions for harnessing the power of stories over statistics.
http://vmsstreamer1.fnal.gov/VMS_Site_03/Lectures/Colloquium/presentations/050907Newman.ppt
------------
Northern California Kaiser Permanente
No cases in 111,000 births, 1995-8
No cases found in 1991-4 (N~119,000)
Brown and Johnson registry: 90 cases in 15 years in the US
BUT: Evidence of increase in babies with very high bilirubin levels 1999-2003.
---------
“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.”
Margaret Mead (1901 - 1978) US anthropologist
-------------------------
Parents of Infants and Children with Kernicterus (PICK)
-------------
No dispute about former over-treatment or current treatment thresholds
No good data on current incidence of kernicterus, but it is rare
Definition of the problem and proposed solution strongly influenced by 1 story (assisted by industry funding)
Weak data, powerful stories
Universal bilirubin screening is coming
=====================================
July 19, 1989: UAL #232 crash at Sioux City, Iowa. Unrestrained infant dies.
1990: US NTSB recommends universal restraint
July 12, 1994: Another “lap child” dies in crash, NTSB urges FAA to require infant restraint
------------------------
FAA Study, report to Congress, 1995
Methods
Detailed analyses of survivability of previous crashes
Models of price-sensitivity of travel decisions
Results:
Infant restraint would prevent maximum of 5 infant deaths over 10 years
Net increase of 82 deaths over 10 years due to diversion to less safe modes of travel
Rejected as “flawed” by NTSB and Congress
--------------------
Risks: less than FAA when likely characteristics of drivers and driving considered (Net increase in deaths over 10 years 0-30 vs 82 )
Benefits: similar to FAA (6 deaths in 10 years)
Costs: still high
*Newman TB, Johnston B, Grossman D. Arch Pediatr Adol Med 2003;157:969-74
-------------------------------
Congressman Geren: “... five million enplanements. Say it only costs $20. That's $100 million...If we gave you $100 million and you were entrusted with saving lives, where would you apply it, top priority?”
Barry Sweedler, Director, Office of Safety Recommendations, NTSB: “There is a long list of safety issues that need addressing, and I think it's probably best for us to try to lay out what the issues are and try not to prioritize which safety issue is more important than other safety issues... this seems to be one of those areas where it just seems to make common sense to go ahead and take that extra step”
-------------------------------------
Coming into Washington we ran into some turbulence around some thunderstorms and there were some other lap children that the mothers were having trouble restraining. Many of them were crying and screaming. The little kid in the safety seat slept through the whole thing.
So I think there is more than enough evidence that substantiates what we're trying to do.
The question, I think, Mr. Chairman, comes down to how many more children must die, how many more have to be hurt before we reach the threshold of FAA's ghoulish cost/benefit ratio? --Congressman Jim Lightfoot, Iowa
------------------------------------
“The argument in support of the FAA’s resistance to the NTSB...is unreasonable on its face and ridiculous in its justification. It protects theoretical children driving in cars at the expense of real flesh-and blood infants whose safety is unquestionably compromised when flown as a lap-baby”
-------------------------------
"During takeoff, landing and turbulence, adults are required to be buckled up, baggage and coffee pots are stowed, computers are turned off and put away, yet infants and toddlers need not be restrained," [NTSB Acting Chair] Rosenker said in a statement.
----------------
Доклад ваще-то прочитан в Фермилабе, есть там такой регулярный семинар... и вот там такая
Thomas B. Newman, MD, MPH
University of California, San Francisco
...As a
http://vmsstreamer1.fnal.gov/VMS_Site_03/Lectures/Colloquium/presentations/050907Newman.ppt
------------
Northern California Kaiser Permanente
No cases in 111,000 births, 1995-8
No cases found in 1991-4 (N~119,000)
Brown and Johnson registry: 90 cases in 15 years in the US
BUT: Evidence of increase in babies with very high bilirubin levels 1999-2003.
---------
“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.”
Margaret Mead (1901 - 1978) US anthropologist
-------------------------
Parents of Infants and Children with Kernicterus (PICK)
-------------
No dispute about former over-treatment or current treatment thresholds
No good data on current incidence of kernicterus, but it is rare
Definition of the problem and proposed solution strongly influenced by 1 story (assisted by industry funding)
Weak data, powerful stories
Universal bilirubin screening is coming
=====================================
July 19, 1989: UAL #232 crash at Sioux City, Iowa. Unrestrained infant dies.
1990: US NTSB recommends universal restraint
July 12, 1994: Another “lap child” dies in crash, NTSB urges FAA to require infant restraint
------------------------
FAA Study, report to Congress, 1995
Methods
Detailed analyses of survivability of previous crashes
Models of price-sensitivity of travel decisions
Results:
Infant restraint would prevent maximum of 5 infant deaths over 10 years
Net increase of 82 deaths over 10 years due to diversion to less safe modes of travel
Rejected as “flawed” by NTSB and Congress
--------------------
Risks: less than FAA when likely characteristics of drivers and driving considered (Net increase in deaths over 10 years 0-30 vs 82 )
Benefits: similar to FAA (6 deaths in 10 years)
Costs: still high
*Newman TB, Johnston B, Grossman D. Arch Pediatr Adol Med 2003;157:969-74
-------------------------------
Congressman Geren: “... five million enplanements. Say it only costs $20. That's $100 million...If we gave you $100 million and you were entrusted with saving lives, where would you apply it, top priority?”
Barry Sweedler, Director, Office of Safety Recommendations, NTSB: “There is a long list of safety issues that need addressing, and I think it's probably best for us to try to lay out what the issues are and try not to prioritize which safety issue is more important than other safety issues... this seems to be one of those areas where it just seems to make common sense to go ahead and take that extra step”
-------------------------------------
Coming into Washington we ran into some turbulence around some thunderstorms and there were some other lap children that the mothers were having trouble restraining. Many of them were crying and screaming. The little kid in the safety seat slept through the whole thing.
So I think there is more than enough evidence that substantiates what we're trying to do.
The question, I think, Mr. Chairman, comes down to how many more children must die, how many more have to be hurt before we reach the threshold of FAA's ghoulish cost/benefit ratio? --Congressman Jim Lightfoot, Iowa
------------------------------------
“The argument in support of the FAA’s resistance to the NTSB...is unreasonable on its face and ridiculous in its justification. It protects theoretical children driving in cars at the expense of real flesh-and blood infants whose safety is unquestionably compromised when flown as a lap-baby”
-------------------------------
"During takeoff, landing and turbulence, adults are required to be buckled up, baggage and coffee pots are stowed, computers are turned off and put away, yet infants and toddlers need not be restrained," [NTSB Acting Chair] Rosenker said in a statement.
----------------
