AI 中文总结
批判临床决策统计研究中造成系统性功能失调的方法学惯例，指出其包括用假设检验比治疗、评估预后预测方法与患者护理脱节等，认为由教学、对生物统计学家依赖及机构做法三因素导致，需系统性变革打破僵局。
AI 中文摘要
我批判了一系列根深蒂固的方法学惯例，这些惯例在临床决策的统计研究中共同造成了系统性功能失调。其中包括：（1）普遍使用假设检验来比较治疗方法；（2）用于评估患者预后预测准确性的方法与患者护理脱节；（3）荟萃分析在整合研究结果方面的不良做法；（4）大量研究的确定性令人难以置信。这种功能失调似乎由三个因素导致：（i）医学生和住院医生接受的统计学方法基础教学；（ii）临床研究人员对咨询生物统计学家的依赖，他们在评估资助申请和论文投稿时充当统计把关人；（iii）研究资助机构、医学期刊和监管医疗的政府机构的制度性做法。我推测需要系统性变革来打破现有僵局，使统计研究达到更好的平衡。
英文摘要
I critique a set of entrenched methodological conventions that collectively create systemic dysfunction in statistical research for clinical decisions. These include: (1) the prevalent use of hypothesis tests to compare treatments, (2) remoteness from patient care of the methods used to evaluate the accuracy of predictions of patient outcomes, (3) poor practice of meta-analysis to combine findings across studies, and (4) widespread research with incredible certitude. It appears that the dysfunction is held in place by three factors: (i) rudimentary instruction in statistical methodology received by medical students and residents, (ii) reliance of clinical researchers on consulting biostatisticians, wo act as statistical gatekeepers in evaluation of grant proposals and paper submissions, and (iii) institutional practices of research funding agencies, medical journals, and governmental bodies that regulate medical treatment. I conjecture that systemic changes are necessary to break the existing impasse, moving statistical research to a better equilibrium.
