# Tarnished Gold Chapter 4: Beating The Odds

Finally, a chapter I somewhat agree with.

This chapter discussed the difficulties in understanding probability. The examples they use aren’t good analogies for clinical probabilities but are interesting nonetheless.

From QuoteAddicts.com

I’ll focus on what I agree with for this post. They discuss the misleading nature of reporting relative risks (and relative risk reductions also) in research reports. This is a real problem as clinicians often don’t understand that while the relative risk/benefit of an intervention is fairly constant across patient subgroups the absolute benefits aren’t. In general, if something is beneficial the sicker you are the more benefit you gain. For example, let’s say a treatment has a relative risk reduction for death in the next year of 75% (RR of 0.25) and we have 2 patients we are seeing. One has a risk (or probability) of death of 50% without the intervention and the other has a risk of death of 10%.  If patient one is given the treatment her risk is reduced from 50% to 12.5% (to see how I did this watch this video). If patient two is given the treatment his risk is reduced from 10% to 2.5%. So the absolute benefit is greater for patient one (37.5%) than for patient two (7.5%) even though the relative benefit is the same (75%). This is often a difficult concept for physicians to understand but once mastered is a useful way to discuss the benefits and harms of a proposed intervention with patients. Furthermore, it’s patient specific.  To get the probability of an outcome for an individual patient you could use a validated clinical prediction rule, the placebo rate from a trial, the results from studies of disease frequency (though these are rare) or, as a last ditch effort, guesstimation.