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Aboriginal health: a decade-old election promise
Editorial
Science Photo Library
Doctors and medical statistics
For the Windish paper see JAMA 2007; 298: 1010–22 DOI:10.1001/jama.298.9.1010
A systematic error in design, conduct, or analysis is confounding, bias, interaction, or stratification? That was one question in a recent test of residents in the USA by Donna Windish and colleagues. Critical appraisal of statistics is needed for the accurate interpretation of research that underpins evidence-based medicine. But Windish showed that some residents cannot interpret many results from clinical research. 277 residents did a multiple-choice statistical test. Residents correctly answered a mean 41% of questions. Fellows and those within the general medical faculty answered a mean 71% correctly, a statistically significant difference from the residents. Previous training in biostatistics and advanced degrees led to better performance, but scores declined with progression through training. The poor results could be due to the increasing complexity of statistical methodology or insufficient statistical training. Can understanding be improved to avoid incorrect interpretation and erroneous application of clinical
research? Medical statistics are often taught in preclinical years as abstract concepts removed from clinical relevance. Their importance in enabling clinicians to justify clinical decisions, to communicate risk to patients, and to evaluate research may thus not be fully realised. More emphasis should be placed on the quality of teaching of statistics, to generate interest by applying statistics to relevant clinical topics. Additionally, previously learned statistical concepts should be regularly reinforced throughout career progression, with clinically integrated and interactive teaching. A heretical thought: are expectations for the average clinician too high? For the practising doctor who is not a researcher, is the ability to interpret statistics as important as the ability to critically appraise bestpractice guidelines, derived by experts with the necessary statistical knowledge? Statistics could instead be left to those who have the appetite, skills, and the need to use them. The answer to the question above, by the way, is bias. ■ The Lancet
Aboriginal health: a decade-old election promise
Corbis
The printed journal includes an image merely for illustration
For the AMA report see http://www.ama.com.au/web. nsf/doc/WEEN-76RAVH/ $file/060907_-_AMA_Key_ Health_Issues_-_Document.pdf For a summary of the Northern Territory National Emergency Response Bill 2007 see http://parlinfoweb.aph.gov.au/ piweb//Repository/Legis/ems/ Linked/07080702.pdf For the Little Children Are Sacred report see http://www.nt.gov. au/dcm/inquirysaac/pdf/ bipacsa_final_report.pdf
910
Last week, the Australian Medical Association (AMA) released Key Health Issues for the 2007 Federal Election—a document that highlights areas of the health system which are currently failing some or all of the population. At the top of the AMA’s list of 18 issues is Indigenous health. When John Howard’s Government came to power over 11 years ago they promised to improve the health and social wellbeing of Aboriginal people. To date there is no evidence that this pledge has been met. Indigenous Australians have a greater burden of ill health than the rest of the Australian population, experience lower levels of access to health services, are more likely to experience disability and reduced quality of life due to ill health, and die at younger ages. This dire situation now looks set to worsen. On Aug 17, the Australian Senate passed the Northern Territory National Emergency Response Bill 2007. This Bill, which was rushed through parliament, is Howard’s reply to Little Children Are Sacred: Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse. The legislation allows the
government to take control of 73 Aboriginal communities in the Northern Territory, boost police and army presence, enforce bans on alcohol and pornography, abolish the permit system—which restricts access to Aboriginal land by non-Indigenous people—and limit welfare payments. But few of the aggressive measures in the Bill address child abuse; most are only likely to exacerbate the problem. The proposed interventions also do not tally with the report recommendations and contradict the approach called for by the authors, who emphasised the “critical importance” of consulting with Aboriginal people when designing initiatives for Aboriginal communities. Indigenous health is a national emergency that requires investment in health services and the social determinants of health—education, housing, economic development—which underlie the appalling inequalities that Aboriginal people face. The Howard administration’s latest approach to Indigenous health will not fulfil its decade-old election promise. John Howard’s legitimacy to govern seems fatally compromised based on this critical health failure. ■ The Lancet www.thelancet.com Vol 370 September 15, 2007
Science Photo Library
Doctors and medical statistics
For the Windish paper see JAMA 2007; 298: 1010–22 DOI:10.1001/jama.298.9.1010
A systematic error in design, conduct, or analysis is confounding, bias, interaction, or stratification? That was one question in a recent test of residents in the USA by Donna Windish and colleagues. Critical appraisal of statistics is needed for the accurate interpretation of research that underpins evidence-based medicine. But Windish showed that some residents cannot interpret many results from clinical research. 277 residents did a multiple-choice statistical test. Residents correctly answered a mean 41% of questions. Fellows and those within the general medical faculty answered a mean 71% correctly, a statistically significant difference from the residents. Previous training in biostatistics and advanced degrees led to better performance, but scores declined with progression through training. The poor results could be due to the increasing complexity of statistical methodology or insufficient statistical training. Can understanding be improved to avoid incorrect interpretation and erroneous application of clinical
research? Medical statistics are often taught in preclinical years as abstract concepts removed from clinical relevance. Their importance in enabling clinicians to justify clinical decisions, to communicate risk to patients, and to evaluate research may thus not be fully realised. More emphasis should be placed on the quality of teaching of statistics, to generate interest by applying statistics to relevant clinical topics. Additionally, previously learned statistical concepts should be regularly reinforced throughout career progression, with clinically integrated and interactive teaching. A heretical thought: are expectations for the average clinician too high? For the practising doctor who is not a researcher, is the ability to interpret statistics as important as the ability to critically appraise bestpractice guidelines, derived by experts with the necessary statistical knowledge? Statistics could instead be left to those who have the appetite, skills, and the need to use them. The answer to the question above, by the way, is bias. ■ The Lancet
Aboriginal health: a decade-old election promise
Corbis
The printed journal includes an image merely for illustration
For the AMA report see http://www.ama.com.au/web. nsf/doc/WEEN-76RAVH/ $file/060907_-_AMA_Key_ Health_Issues_-_Document.pdf For a summary of the Northern Territory National Emergency Response Bill 2007 see http://parlinfoweb.aph.gov.au/ piweb//Repository/Legis/ems/ Linked/07080702.pdf For the Little Children Are Sacred report see http://www.nt.gov. au/dcm/inquirysaac/pdf/ bipacsa_final_report.pdf
910
Last week, the Australian Medical Association (AMA) released Key Health Issues for the 2007 Federal Election—a document that highlights areas of the health system which are currently failing some or all of the population. At the top of the AMA’s list of 18 issues is Indigenous health. When John Howard’s Government came to power over 11 years ago they promised to improve the health and social wellbeing of Aboriginal people. To date there is no evidence that this pledge has been met. Indigenous Australians have a greater burden of ill health than the rest of the Australian population, experience lower levels of access to health services, are more likely to experience disability and reduced quality of life due to ill health, and die at younger ages. This dire situation now looks set to worsen. On Aug 17, the Australian Senate passed the Northern Territory National Emergency Response Bill 2007. This Bill, which was rushed through parliament, is Howard’s reply to Little Children Are Sacred: Report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse. The legislation allows the
government to take control of 73 Aboriginal communities in the Northern Territory, boost police and army presence, enforce bans on alcohol and pornography, abolish the permit system—which restricts access to Aboriginal land by non-Indigenous people—and limit welfare payments. But few of the aggressive measures in the Bill address child abuse; most are only likely to exacerbate the problem. The proposed interventions also do not tally with the report recommendations and contradict the approach called for by the authors, who emphasised the “critical importance” of consulting with Aboriginal people when designing initiatives for Aboriginal communities. Indigenous health is a national emergency that requires investment in health services and the social determinants of health—education, housing, economic development—which underlie the appalling inequalities that Aboriginal people face. The Howard administration’s latest approach to Indigenous health will not fulfil its decade-old election promise. John Howard’s legitimacy to govern seems fatally compromised based on this critical health failure. ■ The Lancet www.thelancet.com Vol 370 September 15, 2007