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Edward H. Livingston, MD, and Roger J. Lewis, MD, PhD, discuss the new JAMA Guide to Statistics and Methods book.
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Edward H. Livingston, MD, and Roger J. Lewis, MD, PhD, discuss the new JAMA Guide to Statistics and Methods book.
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[ Music ] >> Hello, and welcome to JAMAevidence. There's a new book out in the portfolio of JAMAevidence. This book is entitled The JAMA Guide to Statistics and Methods and is based on a series of articles that were published in the last several years in JAMA. These articles in the book were edited by Roger Lewis and me, Ed Livingston.
Today's episode is a little bit of a conversation Roger and I had to discuss why we put this book together and what we intend for it to accomplish. [ Music ] So, I'm Ed Livingston, Deputy Editor for Clinical Reviews and Education for JAMA. >> Hi. I'm Roger Lewis. I'm the Chair of Emergency Medicine at Harbor-UCLA Medical Center in Los Angeles. >> You are one of our lead statisticians here at JAMA and we rely on you for helping us understand complicated clinical trials.
And some years ago, you and I started on a collaborative project to create a new article series in JAMA about statistics and statistics presented in a way that clinicians can understand them. So, as you and I both know, statistics is taught in medical school tends to be rather technical and mostly beyond the understanding of the phenotype of people who go to medical school. There's a lot of math and a lot of equations and they just don't seem to ever get it. So, we embarked on this project to try to present complicated statistical and methodological procedures that are used and reporting in the Journal and present it in ways that clinicians who don't understand math and don't understand a lot about statistics can understand.
So, that was the basic thing that we were trying to accomplish. So, from your perspective as a clinician, educator who has tremendous command of statistics and methodology, how do you see this series as factoring in to clinicians' understanding of clinical research that's reported in journals like JAMA? >> Well, I think the challenge facing many busy academic or just methodologically-interested clinicians is that they read reports of clinical trials or other clinical literature with the intent of understanding the main message of the paper and whether or not the underlying science is sufficiently rigorous so that they should apply or can apply the results of those studies to their individual practice and decision-making.
And I think to understand that, one has to understand the assumptions and the application and the limitations of the overall research methodology and the statistical methods used to derive conclusions from the data that are acquired. Too much of statistical teaching has historically been focused, as you mentioned, on mathematical characteristics and proofs and statistical tests that really don't help clinicians answer the question, "Should this information that I'm reading be deemed reliable and actionable in the sense that it can affect my clinical practice and decision-making?" So, I think the goal of the series we worked on together is to take small bite-size pieces of methodologic concepts and procedures that are being used in modern research publications like those that appear in JAMA and explain them in a way that the interested clinician can use the information to decide to what extent that clinical research report should influence their day-to-day practice.
>> Much more so than me, you live in both the worlds of clinical medicine and research methodology and statistics and you have a great command of both fields. And one of the things that you and I have struggled with in developing these articles and ultimately this book is trying to get statisticians to write about some of these methodologies and one, not use equations, and two, to present the information in ways that clinicians can understand, which oftentimes means sacrificing some of the statistical precision -- a lot of the assumptions and other things that go into the use of the statistics, which they're always unhappy about when we cut.
Now that we've published a whole lot of these articles and have this book coming out, what is your thought about striking that balance between statistical rigor and finding ways to present material in ways that clinicians can understand? >> Well, I think I try to think of it not as a choice between rigor and the accessibility or effectiveness of the article, but I really try to embrace the challenge of presenting complicated thought processes or procedures without the use of jargon.
Like so many fields, medicine included, statistics has its own private language and that private language is extremely helpful for those within the field in efficiently communicating what they're doing, why they're doing it, and the considerations around the statistical analysis. I think the challenge for many of our authors has been to take a step back and learn to communicate the way they would communicate if they had never learned that jargon and had to actually explain in lay terms that same rationale or the approach with the same level of rigor and precision.
So, I try very hard in our discussions with authors and the editing of the pieces to never have us publish something that is technically incorrect and strive at the same time to not publish things in which you have to have a pre-existing knowledge and comfort with the jargon in order to understand the information that's being presented. >> How do you think this book could factor into medical student education for learning about statistics and methodology?
Do you think it should replace the more rigorous textbooks -- I mean, and rigorous in terms of explaining the math behind this -- or do you think what we present in this book is enough for clinicians or clinicians-to-be who are in medical school? >> Well, I think there's a lot of evidence that the traditional approach to teaching this material in medical schools is not very effective. And what I mean by that is that when clinicians-in-training get to their late residency or fellowship or proceed into independent practice, they are no longer using whatever material they learn from a traditional statistics course to become or to be better consumers of the medical literature.
So, I think the first part of the answer to your question is that we have to admit that what we've been doing for decades really hasn't been that effective. So, the book is based, as you know, on a series of articles published in JAMA, with each article being anchored in a particular publication within JAMA or the JAMA Network of journals. And so, it necessarily focuses on those techniques that are being used today to analyze and present information from the emerging medical literature.
So, based on that, I think the coverage of topics really closely mirrors what the practicing clinician who's the consumer of medical literature needs to know. I also believe that by anchoring each of the articles, and therefore each of the chapters in the book, in a recently-published article, we ensure that the examples are grounded in clinically-relevant and important cases or case studies, if you will. And I think that concreteness helps solidify the material for the reader.
I think most of us who took those traditional statistics courses early in our career had trouble seeing the relevance and that lack of obvious clinical relevance of what we were learning made the material more difficult to both understand at the time and to apply over the long haul. >> Have you gotten any feedback from clinicians or statisticians about these chapters that are in this book, and, if so, what are they telling you? >> So, I've gotten quite a bit of very positive response to the articles, mostly focused on their clarity and accessibility to the non-specialist in terms of statistical methodology, and, frankly, the fact that they are relatively brief.
So, that allows the busy clinician or the busy academician to read something briefly and feel they have a handle on something that they did not fully understand prior to reading the article. The response from statisticians has been generally quite positive, and I think many statistician are frankly gratified to see a journal of the stature of JAMA devote page space to pure methodologic expositions because statisticians also want the merits of the approaches that they're bringing to these projects to be appreciated.
There are the inevitable examples in which statisticians are concerned about a lack of completeness in the article, which is, of course, a necessity based on their brief format, or sometimes we receive criticism over technical details. I see that as a success because it means the statisticians are reading the articles and care about the way JAMA is presenting the bread and butter of their professional activities.
>> Where do you see this going beyond what we've already done? We've covered a number of topics, sort of some of the most important statistical and methodological things that come up in the Journal all the time. But do you see this article series changing or evolving into something more or something different? Or do you think there are needs we have still not met that we need to address in the Journal? >> So, I think we're in the wonderful position of, at this point, having addressed a wide variety of fundamental topics in the design and interpretation of clinical trials.
I think there are quite a few methodologic areas in which there's active development of new approaches and that those new approaches are going to be more rapidly introduced into the mainstream clinical research literature sooner than has historically been the fact. As you know, there are approaches to the randomization of patients in clinical trials and the analysis of clinical trial data that date back many, many decades.
But new approaches include things like causal analysis from observational data, propensity score matching or other approaches to evaluating non-randomized clinical trial data to yield the best possible inference. Other approaches to the use of large, observational data sets -- so-called "big data" -- are also areas in which there is lots of active development. And we're going to see that development reflected in the submissions and publications in JAMA and it's important that the challenges from a methodological and interpretation point of view also be presented, so, again, our readership can both appreciate the science and also understand the literature and be an intelligent consumer of that information.
So, I think there's quite a bit of methodologic development that's undergoing, and we will have ample examples of things that we need to continue to present in those areas. And then, finally, having made a pass through a number of standard topics in the analysis and interpretation of randomized clinical trials, I think we have the opportunity to go back and address some finer points that are nonetheless important for the clinical specialist that will allow us to build on the foundation of the earlier articles in the series.
>> Is there anything else you think we should talk about that we haven't already discussed? >> I think I'm looking very forward to the response to the book and I think that it's going to be a great reference for clinicians who are really struggling with striking the balance between keeping up-to-date in their clinical area of practice and in the scientific underpinning of their specialty. >> This has been a conversation between Roger Lewis and myself, Ed Livingston, about our new book, The JAMA Guide to Statistics and Methods.
We hope you'll enjoy reading this book and look forward to any feedback you might have about it. The best way to provide that feedback is to reach me on Twitter, using my Twitter handle, @ehlJAMA. If you're interested in getting the book, you can find it at JAMAevidence.mhmedical.com. Thanks for listening. This is Ed Livingston. We'll catch you next time on the next episode of the JAMAevidence podcast. [ Music ]
Segment:0 .
[ Music ] >> Hello, and welcome to JAMAevidence. There's a new book out in the portfolio of JAMAevidence. This book is entitled The JAMA Guide to Statistics and Methods and is based on a series of articles that were published in the last several years in JAMA. These articles in the book were edited by Roger Lewis and me, Ed Livingston.
Today's episode is a little bit of a conversation Roger and I had to discuss why we put this book together and what we intend for it to accomplish. [ Music ] So, I'm Ed Livingston, Deputy Editor for Clinical Reviews and Education for JAMA. >> Hi. I'm Roger Lewis. I'm the Chair of Emergency Medicine at Harbor-UCLA Medical Center in Los Angeles. >> You are one of our lead statisticians here at JAMA and we rely on you for helping us understand complicated clinical trials.
And some years ago, you and I started on a collaborative project to create a new article series in JAMA about statistics and statistics presented in a way that clinicians can understand them. So, as you and I both know, statistics is taught in medical school tends to be rather technical and mostly beyond the understanding of the phenotype of people who go to medical school. There's a lot of math and a lot of equations and they just don't seem to ever get it. So, we embarked on this project to try to present complicated statistical and methodological procedures that are used and reporting in the Journal and present it in ways that clinicians who don't understand math and don't understand a lot about statistics can understand.
So, that was the basic thing that we were trying to accomplish. So, from your perspective as a clinician, educator who has tremendous command of statistics and methodology, how do you see this series as factoring in to clinicians' understanding of clinical research that's reported in journals like JAMA? >> Well, I think the challenge facing many busy academic or just methodologically-interested clinicians is that they read reports of clinical trials or other clinical literature with the intent of understanding the main message of the paper and whether or not the underlying science is sufficiently rigorous so that they should apply or can apply the results of those studies to their individual practice and decision-making.
And I think to understand that, one has to understand the assumptions and the application and the limitations of the overall research methodology and the statistical methods used to derive conclusions from the data that are acquired. Too much of statistical teaching has historically been focused, as you mentioned, on mathematical characteristics and proofs and statistical tests that really don't help clinicians answer the question, "Should this information that I'm reading be deemed reliable and actionable in the sense that it can affect my clinical practice and decision-making?" So, I think the goal of the series we worked on together is to take small bite-size pieces of methodologic concepts and procedures that are being used in modern research publications like those that appear in JAMA and explain them in a way that the interested clinician can use the information to decide to what extent that clinical research report should influence their day-to-day practice.
>> Much more so than me, you live in both the worlds of clinical medicine and research methodology and statistics and you have a great command of both fields. And one of the things that you and I have struggled with in developing these articles and ultimately this book is trying to get statisticians to write about some of these methodologies and one, not use equations, and two, to present the information in ways that clinicians can understand, which oftentimes means sacrificing some of the statistical precision -- a lot of the assumptions and other things that go into the use of the statistics, which they're always unhappy about when we cut.
Now that we've published a whole lot of these articles and have this book coming out, what is your thought about striking that balance between statistical rigor and finding ways to present material in ways that clinicians can understand? >> Well, I think I try to think of it not as a choice between rigor and the accessibility or effectiveness of the article, but I really try to embrace the challenge of presenting complicated thought processes or procedures without the use of jargon.
Like so many fields, medicine included, statistics has its own private language and that private language is extremely helpful for those within the field in efficiently communicating what they're doing, why they're doing it, and the considerations around the statistical analysis. I think the challenge for many of our authors has been to take a step back and learn to communicate the way they would communicate if they had never learned that jargon and had to actually explain in lay terms that same rationale or the approach with the same level of rigor and precision.
So, I try very hard in our discussions with authors and the editing of the pieces to never have us publish something that is technically incorrect and strive at the same time to not publish things in which you have to have a pre-existing knowledge and comfort with the jargon in order to understand the information that's being presented. >> How do you think this book could factor into medical student education for learning about statistics and methodology?
Do you think it should replace the more rigorous textbooks -- I mean, and rigorous in terms of explaining the math behind this -- or do you think what we present in this book is enough for clinicians or clinicians-to-be who are in medical school? >> Well, I think there's a lot of evidence that the traditional approach to teaching this material in medical schools is not very effective. And what I mean by that is that when clinicians-in-training get to their late residency or fellowship or proceed into independent practice, they are no longer using whatever material they learn from a traditional statistics course to become or to be better consumers of the medical literature.
So, I think the first part of the answer to your question is that we have to admit that what we've been doing for decades really hasn't been that effective. So, the book is based, as you know, on a series of articles published in JAMA, with each article being anchored in a particular publication within JAMA or the JAMA Network of journals. And so, it necessarily focuses on those techniques that are being used today to analyze and present information from the emerging medical literature.
So, based on that, I think the coverage of topics really closely mirrors what the practicing clinician who's the consumer of medical literature needs to know. I also believe that by anchoring each of the articles, and therefore each of the chapters in the book, in a recently-published article, we ensure that the examples are grounded in clinically-relevant and important cases or case studies, if you will. And I think that concreteness helps solidify the material for the reader.
I think most of us who took those traditional statistics courses early in our career had trouble seeing the relevance and that lack of obvious clinical relevance of what we were learning made the material more difficult to both understand at the time and to apply over the long haul. >> Have you gotten any feedback from clinicians or statisticians about these chapters that are in this book, and, if so, what are they telling you? >> So, I've gotten quite a bit of very positive response to the articles, mostly focused on their clarity and accessibility to the non-specialist in terms of statistical methodology, and, frankly, the fact that they are relatively brief.
So, that allows the busy clinician or the busy academician to read something briefly and feel they have a handle on something that they did not fully understand prior to reading the article. The response from statisticians has been generally quite positive, and I think many statistician are frankly gratified to see a journal of the stature of JAMA devote page space to pure methodologic expositions because statisticians also want the merits of the approaches that they're bringing to these projects to be appreciated.
There are the inevitable examples in which statisticians are concerned about a lack of completeness in the article, which is, of course, a necessity based on their brief format, or sometimes we receive criticism over technical details. I see that as a success because it means the statisticians are reading the articles and care about the way JAMA is presenting the bread and butter of their professional activities.
>> Where do you see this going beyond what we've already done? We've covered a number of topics, sort of some of the most important statistical and methodological things that come up in the Journal all the time. But do you see this article series changing or evolving into something more or something different? Or do you think there are needs we have still not met that we need to address in the Journal? >> So, I think we're in the wonderful position of, at this point, having addressed a wide variety of fundamental topics in the design and interpretation of clinical trials.
I think there are quite a few methodologic areas in which there's active development of new approaches and that those new approaches are going to be more rapidly introduced into the mainstream clinical research literature sooner than has historically been the fact. As you know, there are approaches to the randomization of patients in clinical trials and the analysis of clinical trial data that date back many, many decades.
But new approaches include things like causal analysis from observational data, propensity score matching or other approaches to evaluating non-randomized clinical trial data to yield the best possible inference. Other approaches to the use of large, observational data sets -- so-called "big data" -- are also areas in which there is lots of active development. And we're going to see that development reflected in the submissions and publications in JAMA and it's important that the challenges from a methodological and interpretation point of view also be presented, so, again, our readership can both appreciate the science and also understand the literature and be an intelligent consumer of that information.
So, I think there's quite a bit of methodologic development that's undergoing, and we will have ample examples of things that we need to continue to present in those areas. And then, finally, having made a pass through a number of standard topics in the analysis and interpretation of randomized clinical trials, I think we have the opportunity to go back and address some finer points that are nonetheless important for the clinical specialist that will allow us to build on the foundation of the earlier articles in the series.
>> Is there anything else you think we should talk about that we haven't already discussed? >> I think I'm looking very forward to the response to the book and I think that it's going to be a great reference for clinicians who are really struggling with striking the balance between keeping up-to-date in their clinical area of practice and in the scientific underpinning of their specialty. >> This has been a conversation between Roger Lewis and myself, Ed Livingston, about our new book, The JAMA Guide to Statistics and Methods.
We hope you'll enjoy reading this book and look forward to any feedback you might have about it. The best way to provide that feedback is to reach me on Twitter, using my Twitter handle, @ehlJAMA. If you're interested in getting the book, you can find it at JAMAevidence.mhmedical.com. Thanks for listening. This is Ed Livingston. We'll catch you next time on the next episode of the JAMAevidence podcast. [ Music ]
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