So, on hearing Matthew Thompson open up a mini-session with natural frequencies my mind turned to the healing power of crystals, and I become acutely concerned that the open-minds approach of the Teaching EBM Conference had gone too far.
But this was quashed quickly by his description: ‘Natural frequencies’ means ‘real numbers’ … like 30 of 100 patients, not 30% or 0.3 … and this is easier for most people to deal with.
He went on to show that a single box can crack the nut of turning diagnostic test information from meaningless prattle into something highly understandable:
Using this approach means you can loose the faff of nomgrams, converting into odds or pocket calculating and work out, really quickly, what a test result means.
It works like this: take a problem where 30% of the walk-ins will have it. The test you run has 50% sensitivity and 90% specificity. Of 100 people, 30 have the condition. 50% sensitivity means half of the diseased have a +ve test (= 15). 90% specificity means 9/10th of the undiseased will have a -ve test … so one-tenth (=7) will be test +ve.
The result – 70% of the positive tests (15/22) really do have the condition.
Re-run it with a test prevalence of 60% :
60 >>>>> 30
\not disease .
40 >>>>> 4
Now 30/34 ~ 90% of +ve test results are in folk who really have the disease.
Try it yourself with a prevalence of only 10% and see what the positive test really means …