Burton P R
Western Australian Research Institute for Child Health, Princess Margaret Hospital for Children, Subiaco.
Stat Med. 1994 Sep 15;13(17):1699-713. doi: 10.1002/sim.4780131702.
Most clinicians and many medical statisticians interpret standard frequentist confidence intervals by invoking the Bayesian concept of subjective probability. Fortunately, the assumptions that render this interpretation acceptable are often quite reasonable in the setting of the practical day-to-day analysis of medical data. This article takes the subjective interpretation of confidence intervals to its logical conclusion and argues that the inferential understanding of clinicians and public health physicians could potentially be improved if, where it was appropriate, standard inferential statements--point estimates, 95 per cent confidence intervals and P-values--were supplemented by estimates of the subjective posterior probability, assuming a uniform prior density, that the true value of a parameter to be estimated exceeds one or a series of thresholds that are clinically critical or easily interpretable. Many decision makers in the health care arena draw totally inappropriate inferences from analyses where the point estimate indicates a clinically valuable effect but the null hypothesis cannot formally be rejected, and, although the proposed approach could be of potential value in a range of settings, it is argued that it could be of particular use in the rational interpretation of underpowered studies that must inform critical clinical or public health decisions.
大多数临床医生和许多医学统计学家通过援引主观概率的贝叶斯概念来解释标准的频率主义置信区间。幸运的是，在日常医学数据分析的背景下，使这种解释可接受的假设通常是相当合理的。本文将置信区间的主观解释推至其逻辑结论，并认为，如果在适当的情况下，标准的推断性陈述——点估计、95%置信区间和P值——由主观后验概率的估计值加以补充，假设先验密度均匀，即待估计参数的真实值超过一个或一系列具有临床重要性或易于解释的阈值，那么临床医生和公共卫生医生的推断性理解可能会得到潜在的改善。医疗保健领域的许多决策者从分析中得出了完全不恰当的推断，在这些分析中，点估计表明存在具有临床价值的效应，但零假设不能被正式拒绝，并且，尽管所提出的方法在一系列情况下可能具有潜在价值，但有人认为它在对那些必须为关键临床或公共卫生决策提供依据的效能不足的研究进行合理诠释时可能会特别有用。
