I hate when statistics challenge my version of the truth

With absolutely no intent to offend, I really don’t like basketball. I am definitely impressed by the physical capabilities of the athletes as they leap through the air and dunk basketball after basketball into a small round hoop. What I don’t like about basketball is that a game can be fundamentally changed within the last second of play. Two teams could battle it out until they are one point apart, and then someone throws an across court ball, gets it in and their team wins.

This reminds me of a phrase from the movie “Rocky 2”. The champion who lost to Rocky in the first movie is plagued by the fact that he technically won but did not “beat” Rocky. For many athletes, it’s not just about having the higher score on the “big board”. It is about demonstrating superior skill and might on the playing field.

I do enjoy football, but to be honest, it is mostly because my son is so into it. A week ago, like millions and millions of other people, I was watching the Super Bowl. In Israel, the game was being played in the middle of the night and as such I only woke up early enough to see the start of the second half. I think everyone will agree that the last couple of minutes, and more so the last tens of seconds, of this game were a real nailbiter. A miracle catch was followed by a play on the 1 yard line of the Patriots. In other words, there was a 1 yard distance separating the Seahawks from claiming their second Super Bowl in a row.

But it was not to be. On the last play by the Seahawks, the coaches and quarterback decided to pass the ball rather than give it over to the most effective “bulldozer” who would have driven it across the touchdown line. I am not exaggerating when I say that everyone was in shock. I suspect that there are aliens millions of light-years away who have hacked into our sports networks and were just as surprised as everyone else.

In the endless line of news reports and TV interviews about this apparently “criminal” play, there did not seem to be one person who could justify it. So the Patriots won. History had made yet another choice. And now, once the emotions have died down just a bit, one can start trying to understand why this apparently totally inappropriate passing play was used.

In the following article, the author, Benjamin Morris, does a very detailed statistically-based analysis of this final major play. In reading this article, I personally discovered a whole new perspective to assessing a situation. Mr. Morris is almost like Batman, sifting through the clues and finally presenting his conclusions to me, the reader. Of course, my response was “holy touchdown, Batman”.

Let me step in and say that this article’s analysis of the Super Bowl game also opened my eyes to the need to analyze every diagnosis and treatment course that doctors prescribe. Even the best doctor can have a misconception of the recent events and can make an error in judgment. But perhaps, we should have a greater tendency towards giving the treating physician the benefit of the doubt. We should give the doctor a chance to explain his or her logic before claiming he or she is a quack.

Before I focus back on medicine, I will speak a bit more about the analysis of the Super Bowl events. One of the simple conclusions of Mr. Morris is that a straight handoff leading to a touchdown would still have left 25 seconds on the clock. It is one of the proofs of Einstein’s theory of the relativism of time that the last two minutes of a football game take as long as everything leading up to those last two minutes. In fact, there are some theorists that believe that a black hole forms at the two-minute mark in a football game distorting time and place and hot dogs.

Mr. Morris shows with table after table of hard data and stats, that the risk of passing, as the Seahawks did, was only about 2% greater than running the ball, as everyone expected them to do. It is of course easy to argue that even a 2% advantage should have pushed the Seahawks to choose a running play. I can tell you that in the medical world, it is not common that there is only a 2% difference in the likelihood of success between two critical treatments. And in these medical cases, there are many factors that play into the patient’s final decision, that are far more significant than 2%.

I have personally faced patients who have turned down opportunities at treatments with far greater chances of success than what was finally chosen. Sometimes, it had to do with fear, or emotional exhaustion, or finances [which is thankfully much less of an issue in a socialized system of medicine]. Contrarily, I have seen people choose a treatment that did not offer any real chance of success. But the patient simply refused to give up.

A doctor clearly has two responsibilities. Firstly, a physician should be able to present with numbers and statistics and the most up-to-date information, the status of the disease from which the patient suffers. This doesn’t just apply to cancer and major trauma. Even the choice of using antibiotics for an ear infection requires an extensive familiarity  with the most recent research.

A doctor’s second responsibility is to help the patient work through the human component of their condition. Let’s say a patient faces two choices: a treatment with a 70% likelihood of success but with a 90% likelihood of causing total kidney failure, versus a second treatment with a 50% likelihood of success and with a 30% chance of causing kidney failure.

We are still far away from being able to quantify the human elements  that would lead to this decision. That actually is not a good thing. If we were smarter and if, as such, computers were smarter, we could offer patients a much more complete picture which includes every facet of their lives. Patients might be worried about their ability to return to work. With enough data and the analysis of that data, we could tell the patient that his or her likelihood of returning to work would be 40%, with treatment one and 20% with treatment two.

Perhaps the male patient is concerned about the effect on his potency. And in Urology, this is a major factor in choosing between alternative therapies. A man will take a huge risk on a medical plan if it has a high likelihood of preserving his potency.

These human factors are still not part of the equations that data warehouses run. I personally think that we desperately need to be able to include such human factors into the calculations that determine which treatment is best. This will help patients make personalized choices that they will be emotionally and psychologically comfortable with over the years to come. But until computers can do this, we need humans to help patients work out that part of the equation.

There is nothing wrong with emotion factoring into our decisions. We are not robots. We are humans and we can be proud of that fact. But we still should know what it is we are making decisions about. My football parable  is actually a perfect example of how we need to temper emotion with hard data.

Even today, very few people can remember the name of the person who developed the measles vaccine, which saved the lives of countless people around the world. But in the many years to come, people will likely remember every detail of those last 30 seconds in this past Super Bowl. As I said, there’s nothing wrong with being emotional about certain events in our lives. But we have to balance those emotions with critical knowledge, so that we make informed and human decisions, rather than stab out in the dark.

I do remember once seeing a physician dance as if he had just scored a touchdown when he heard that a patient under his care was clean of cancer. I don’t know if that doctor considered the treatment that had been given to be more equivalent to a passing or a running play. At that moment, I think that the doctor only cared about the fact that the patient had won the game.

Thanks for listening

My website is at http://mtc.expert