Editor's Note
Making Sense of Numbers
I went through grade school during the pencil-and-paper era of teaching math. Straddling the transition from old math to “new math,” I not only learned how to do long division, carefully showing my work, but I also slogged through the brute force calculation of square roots, a questionably useful skill that became obsolete when math entered the push-button era. Pages of problem sets were intended to cultivate an understanding of how numbers worked. But somehow, even after doing reams of worksheets, the concepts were still elusive, and I certainly didn’t come away understanding how to divine the significance of numbers.
Math was a constant companion on my journey through medical training. Although the college-level calculus required by most medical schools was supposed to prepare us for basic science in the G1 and G2 years, I thought I’d push a little further during my freshman year in college. Armed with some advanced placement, I signed up for mathematical analysis and spent three terrifying days baffled by vectors and other unfathomable topics before I transferred out. I still have nightmares about that class.
When I finally hit biochemistry and physiology in medical school, there were formulas and equations, but few seemed to require much of the math I learned. My hard-won calculus skills soon atrophied. Today, integrals and derivatives are foggy memories that don’t get refreshed during my daily practice. Indeed, the math skills required in clinical medicine rarely eclipse high school algebra. Most days, what is needed for practicing medicine is numeracy, understanding the whys and wherefores of the numbers we use every day and being able to communicate them to patients. When a petrified patient comes in clutching the morning newspaper with its report of their medication doubling their risk of heart attack, we need to be able to explain to this person what that really means.
Numbers have always anchored the science of medicine; but many physicians have suffered from their own variety of math anxiety when confronting the squiggly sigmas of biostatistics, shunning the broccoli of the methods section in journal papers for the meat and dessert of the discussion and conclusion. Hoping to make clinicians more comfortable with the numbers behind the science, the evidence-based medicine (EBM) movement is attempting to bring biostatistics into the exam room. Yet EBM has spawned hundreds of meta-analysis studies that attempt to summarize literature using statistical methods that I find particularly opaque. Before it’s ready for prime time, EBM will have to make its biostatistics more approachable and comprehensible.
At the end of my final year of medical school, I wrote a paper on acute renal failure. For the results section, I calculated P values. I had a vague sense about what the significance of this measure of significance was; but in truth my initial venture into biostatistics was a lot like grade-school math, cranking out calculations and putting down answers.
Medical science will always need numbers to get its answers and doctors will always need math skills, but the art of medicine needs a comfortable marriage of numbers and meaning.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org