2017, Number 5
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Rev Med Inst Mex Seguro Soc 2017; 55 (5)
Bayesian tragedy, from clinical iatrogenesis to biotechnology
Lamothe M, Lamothe N, Lamothe D, Lamothe PA
Language: Spanish
References: 28
Page: 641-653
PDF size: 266.53 Kb.
ABSTRACT
Diagnostic algorithms, as well as the biotechnological design,
require the calculation of conditional probability, given the presence
of certain positive data, in the context of prevalence,
sensitivity and specificity; It is necessary to estimate the probability
that the patient has a certain disease. Sometimes, with
a test of scrutiny, it goes from a probability of 1/1000 to 1/20,
constituting a great diagnostic advance, reducing the uncertainty
spectacularly; However, the tragedy is that most doctors believe
that the probability changed from 0.1% (1/1000) to more than
90%, which is outrageously wrong. Iatrogeny arises from the
error in answering the question: “given that the test is positive,
what is the probability that the patient has the disease?” In other
cases, tragedy is to apply a test to an individual belonging to a
subpopulation for which it was not designed. In addition, it is evident
that the fascination for the sensitivity avoids the application
of less sensitive methods in populations that are abandoned; It
is not a matter of making better tests than those that the State
does to the patients it attends, but of making less accurate tests
for the patients that the State does not attend.
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