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Health
AND
Numbers
Health
AND
Numbers
A Problems-Based Introduction
to Biostatistics, Third Edition
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ISBN 978-0470-18589-6
10 9 8 7 6 5 4 3 2 1
To my wife, Minh-Ha,
& my daughters, Mina and Jenna
with deepest love and appreciation
Contents
Preface xi
Introduction from the First Edition xv
1.1 Proportions 1
1.1.1 Comparative Studies 2
1.1.2 Screening Tests 5
1.1.3 Displaying Proportions 7
1.2 Rates 12
1.2.1 Changes 12
1.2.2 Measures of Morbidity and Mortality 13
1.2.3 Standardization of Rates 15
1.3 Ratios 18
1.3.1 Relative Risk 18
1.3.2 Odds and Odds Ratio 19
1.3.3 The Mantel–Haenszel Method 21
vii
viii HEALTH AND NUMBERS
3.1 Probability 98
3.1.1 The Certainty of Uncertainty 99
3.1.2 Probability 99
3.1.3 Rules of Probabilities 101
3.1.4 Statistical Relationship 103
3.1.5 Using Screening Tests 104
3.1.6 Measuring Agreement 106
3.2 The Normal Distribution 110
3.2.1 Shape of the Normal Curve 110
3.2.2 Areas Under the Standard Normal Curve 112
3.2.3 The Normal as a Probability Model 118
3.3 Probability Models 120
3.3.1 Variables and Distributions 121
3.3.2 Probability Models For Discrete Data 121
3.3.3 Probability Models For Continuous Data 125
Contents ix
Bibliography 271
Appendices 275
Index 303
Preface
xi
xii HEALTH AND NUMBERS
out a few advanced topics and adding many more hints and examples on the use of Excel in
every chapter.
The ‘‘way of thinking’’ called statistics has become important to all professionals who
not only are scientific or business-like but also caring people who want to help and make
the world a better place. But what is it? What is biostatistics and what can it do? There are
popular definitions and perceptions of statistics. For this book and its readers, we dont
emphasize the definition of ‘‘statistics as things’’, but instead offer an active concept of
‘‘doing statistics’’. The doing of statistics is a way of thinking about numbers, with
emphasis on relating their interpretation and meaning to the manner in which they are
collected. Our working definition of statistics, as an activity, is that it is a way of thinking
about data, its collection, its analysis, and its presentation. Formulas are needed but not as
the only things you need to know.
To illustrate statistics as a way of thinking, lets start with a familiar scenario of our
criminal court procedures. A crime has been discovered and a suspect has been identified.
After a police investigation to collect evidence against the suspect, a prosecutor presents
summarized evidence to a jury. The jurors learn about the rules and debate the rule about
convicting beyond a reasonable doubt and the rule about unanimous decision. After the
debate, the jurors vote and a verdict is reached: guilty or not guilty. Why do we need this
time-consuming, cost-consuming process called trial by jury? Well, the truth is often
unknown, at least uncertain. It is uncertain because of variability (every case is different)
and because of incomplete information (missing key evidence?). Trial by jury is the way
our society deals with uncertainties; its goal is to minimize mistakes.
How does society deal with uncertainties? We go through a process called trial by jury,
consisting of these steps: (1) we form assumption or hypothesis (that every person is
innocent until proven guilty), (2) we gather data (evidence supporting the charge), and
(3) we decide whether the hypothesis should be rejected (guilty) or should not be rejected
(not guilty). Basically, a successful trial should consist of these elements: (1) a probable
cause (with a crime and a suspect), (2) a thorough investigation by police, (3) an efficient
presentation by the prosecutor, and (4) a fair and impartial jury.
In the above-described context of a trial by jury, let us consider a few specific examples:
(1) the crime is lung cancer and the suspect is cigarette smoking, or (2) the crime is
leukemia and the suspect is pesticides, or (3) the crime is breast cancer and the suspect is a
defective gene. The process is now called research, and the tool to carry out that research is
biostatistics. In a simple way, biostatistics serves as the biomedical version of the trial by
jury process. It is the science of dealing with uncertainties using incomplete information.
Yes, even science is uncertain; scientists arrive at different conclusions in many different
areas at different times; many studies are inconclusive. The reasons for uncertainties
remain the same. Nature is complex and full of unexplained biological variability. But,
most important of all, we always have to deal with incomplete information. It is often not
practical to study the entire population; we have to rely on information gained from
samples.
How does science deal with uncertainties? We learn from how society deals with
uncertainties; we go through a process called biostatistics, consisting of these steps: (1) we
form assumption or hypothesis (from the research question), (2) we gather data (from
clinical trials, surveys, medical records abstractions), and (3) we make decision(s) (by
doing statistical analysis/inference, a guilty verdict is referred to as statistical
Preface xiii
significance). Basically, a successful research should consist of these elements: (1) a good
research question (with well-defined objectives and endpoints), (2) a thorough
investigation (by experiments or surveys), (3) an efficient presentation of data (organizing
data, summarizing, and presenting data; an area called descriptive statistics), and
(4) proper statistical inference. This book is a problems-based introduction to the last three
elements; together they form a field called biostatistics. The coverage is rather brief on
data collection, but very extensive on descriptive statistics (Chapters 1 and 2), and on
methods of statistical inference (Chapters 4, 5, 6, 7 and 8). Chapter 3, on probability and
probability models, serves as the link between descriptive and inferential parts.
The author would like to express his sincere appreciation to colleagues for feedback, to
teaching assistants who helped with examples and exercises, and to students for feedbacks.
Finally, my family bore patiently the pressures caused by my long-term commitment to
write books; to my wife and daughters, I am always most grateful.
CHAP T. LE
Edina, Minnesota
Other documents randomly have
different content
Fig. 1. Lophos Loutrou
from Daskalio station.
Fig. 3. Kamaresa.
Fig. 4. Kitsovouno from
Kamaresa.
Plutarch says that before this time the Athenians were in the habit
of distributing the Laurium revenues among themselves, and that
Themistocles had the courage to persuade them to give the habit
up[239]. This agrees with Xenophon where he declares that “no one
even attempts to say from what period people have tried to work
them[240].” The mines of Lydia, Cyprus, and Spain all appear to have
been developed in the seventh century B.C.[241]. The Siphnian mines
were at full work about 525 B.C.[242]. Mining operations are depicted
on several Corinthian clay tablets, that cannot be later than the early
part of the sixth century[243]. One of them is here reproduced (fig. 5).
Herodotus says nothing about the date of discovery of the Attic
mines in his account of the proceedings of 484 B.C.[244]. It would not
be like him to keep silence about an epoch-making discovery, or even
a phenomenal “rush,” if any had occurred just at this time. Elsewhere
he tells us that the Siphnians were already distributing among
themselves the money from their mines about the year 525 B.C.[245].
Modern writers have been inclined to talk of the great “rush” of
484[246]. But against the silence of Herodotus they can set only the
reference in the Constitution of Athens to the “discovery” at
Maronea, which has been discussed already. What made the great
impression at this time was probably not so much the output as the
employment of the output on the building of a fleet. That surely is
the point of the contemporary allusion in the Persae of Aeschylus.
The chorus of Persian elders tells the Persian queen about the
Athenians’
Fount of silver, treasure of the land[247]
just after mentioning the prowess of the Athenian troops, and just
before explaining the weapons that they use.
The idea proposed in 484 by Themistocles was not original. Seven
years earlier the Thasians had used the revenues from their mines to
build a fleet against the Persians[248]. It was doubtless the success of
the Athenian fleet in a supreme crisis that caused the Athenians to
remember with such pride this triumph of the voluntary system.
There can therefore be no question that the mines were worked in
the sixth century[249]. But if we are to understand the position of the
leader of the mining interests at that period, we must learn
something about the conditions and position of the miners.
The leaders of the Plain and Coast had a and the miners
powerful body of citizens behind their free men, good
backs. The mines on the other hand, at least material for a
political faction.
from the time of Xenophon, were worked
almost exclusively by slaves[250].
In the fourth century very occasionally poor citizens worked their
own allotments[251]. Skilled work like smelting seems always to have
been done by free men. The tombstone of “Atotes the miner,” carved
in letters of the second half of the fourth century, declares that he
was a Paphlagonian “of the root of Pylaimenes, who fell slain by the
hand of Achilles,” and boasts of his unrivalled skill[252]. But there is
no recorded instance of a citizen working in a mine for wages[253].
This however does not prove that they did not do so in the days of
Peisistratus, when, as pointed out in the introductory chapter, the
conditions of labour must have been very different from what they
became in the fifth and fourth centuries, and industrial slavery had
scarcely yet begun. A fragment of Solon suggests that it was quite
usual in his days for citizens to work with their own hands, though
whether for pay or on their own account is not stated and no
particular occupations are specified[254].
About ten years after Solon’s legislation the Athenians are found
resolving “on account of their factions to elect ten archons, five from
the nobility (Eupatridai), three from the farmers (agroikoi), two from
the craftsmen (demiourgoi)[255].” The equation of these three groups
of archons with the three factions of the Plain, Coast, and Hill is
more than doubtful[256]. The farmers par excellence are naturally
located in the plain: also it is doubtful whether Peisistratus had
already “raised the third faction” twenty years before he became
tyrant, and over fifty before his death. The two different sets of
names point in themselves to two different groupings of the
population. Solon’s quadruple division into pentekosiomedimnoi,
hippeis, zeugitai, and thetes proves a certain fluidity and tendency to
cross grouping. But in any case the two craftsman magistrates prove
that craftsmen or artizans were already an important element in the
free population.
In this matter of free labour in an industry such as mining, fifth
century Phrygia is perhaps a better guide than the Attica of Nikias or
Demosthenes as to the state of things in Attica during the sixth
century. In Phrygia a generation after the Samian tyrant Polycrates,
who died about 522 B.C., Pythes was working mines with citizen
labour[257]. Even in Athens in the early days of Pericles the earlier
conditions seem still to have prevailed. “Each trade τέχνη had its
body of (free) labourers organized (τὸν θητικὸν ὄχλον
συντεταγμένον)” to carry out the great public works that were
financed from the Delian treasury. A long list of the trades thus
organized ends with miners[258].
Considering the evidence already adduced for equating the sixth
century miners at Laurium with the presumably free Diakrioi, may
we not use the notices already quoted about the latter as being of
impure race and a mob of hirelings[259], and infer that in the sixth
century the mines of Laurium were worked by free men, partly of
foreign extraction and mainly working for hire?
This is of course conjecture. But it produces for the first time a
picture of the Diakrioi that harmonizes with the notices in question.
Alien shepherds and alien small farmers are most unlikely in
autochthonous Attica.
Outlander miners on the other hand have always been familiar,
wherever there have been mines to work. When mining operations
were resumed at Laurium some thirty years ago, the immediate
result was a very mixed population, the local supply of labour being
supplemented from France, Italy, and Turkey. One of the ancient
gold mines near Philippi bore the significant name of the asylum[260].
In the Laurium district itself in ancient times the people of at least
one deme, Potamioi, were famous for their readiness to admit
foreigners to citizenship[261]. Potamioi is placed by Loeper right in the
centre of the mining district, well away from the sea[262], and very
near the probable site of Maronea[263]. A member of the deme
Semachidai is found sharing a tombstone with two strangers from
Sinope[264]. We have just had occasion to notice a Paphlagonian
miner, though of a later date, and we shall see in a moment that in
the sixth century the mines of Laurium were worked in close
connexion with those of Thrace. There are no records of specific
Thracians employed in the Attic mines during the sixth century. We
only know that just after the Persians conquered Thrace, at the close
of the reign of Hippias, there was a large Greek element in the
mining population near the Strymon[265]. But in the fifth century we
have a famous case of a Thracian mine-owner settling in Athens in
the person of Thucydides, whose father was a Thracian, and whose
Thracian mines probably lost him his command in the Athenian
navy, and turned a second-rate admiral into the greatest of
historians[266]. Nikias hired out a thousand hands whom he owned in
the mines to Sosias the Thracian[267].
This ends our examination of the various steps by which
Peisistratus made himself tyrant, effected his second restoration, and
finally rooted his power. In all three cases the evidence points to the
conclusion that the secret of the tyrant’s power was his control of
mines either in Attica or Thrace. To complete the enquiry it is
necessary now to examine the accounts of his first restoration. As
observed already, this event is recorded only in anecdotal form. As
independent evidence it would hardly be worth considering. All that
is here claimed for it is that it can be so interpreted as to corroborate
the conclusions already reached.
According to the story Peisistratus The strange story
persuaded the Athenians to take him back of Peisistratus’
by dressing up a stately woman named Phye first restoration
to personate Athena and order his recall[268]. It is generally agreed
that this story will not do as it stands. Various attempts have been
made to explain it away[269], but all of them are equally unconvincing.
Perhaps the reason is that all alike are based on some single
unessential detail of the story. None of them interprets it in the light
of the better known parts of the tyrant’s career, and more
particularly of the matter of fact accounts of his second restoration.
Beloch indeed, like the Russian Hirschensohn, believes that there
was only one restoration, with which the Phye story and the account
of Peisistratus’ return from the Thracian mining district are both to
be connected[270]. He notes that the cause of banishment is the same
in both cases; that the chronology is suspiciously symmetrical; that
Polyaenus combines incidents from the two restorations; and that
Eusebius[271] and Jerome[272] both make Peisistratus begin his second
reign about the time that Herodotus begins his third, while neither of
them mentions a third reign at all. Note too that corresponding to
Phye in the first restoration we have in the second a “sacred
procession” from the temple of Athena Pallenis conducted by an
Acarnanian soothsayer[273].
These points are not convincing. Similar improbabilities, and
repetitions and chronological symmetries can often be discovered in
narratives of the most unquestionable authenticity[274]. The fact that
Polyaenus combines the two accounts proves nothing, unless we
assume him to be incapable of confusing two similar events. Further,
Beloch is forced to make the marriage of Peisistratus with Megacles’
daughter precede his first exile, since he sees that the childlessness of
the marriage led to the breach with the Coast[275]. In this he goes dead
against the tradition on a point where there is no reason to suspect it.
What Beloch’s arguments do emphasize is the fact that the
situations during Peisistratus’ two periods of exile were in some ways
very similar. The sameness of the two situations may in fact be the
reason why so little has been remembered about the earlier. It raises
the question whether the tyrant mined and coined during his first
exile. There is no certainty that he did either, but the probability is
that he did both. As regards Thrace we know that Miltiades, probably
with Peisistratus’ permission and approval[276], had settled in the
Gallipoli peninsula soon after the tyranny was first established at
Athens[277]. Thrace is the one region that we can be sure that the
tyrant must have considered as a possible place of exile. As regards
the coinage it has been suggested on the is connected by
[278]
high authority of Babelon , that the Babelon with the
famous series with the owl on one side, and Athena-head
coins of Athens
the head of Athena on the other (fig. 6),
which remained for centuries the coin types of the city, was actually
started to commemorate the help that the tyrant claimed to have
received from his patron goddess at the time of his first restoration.
The evidence is not conclusive. The arguments for and against this
date are based on a few literary references that are too vague to be of
much use, on points of style and technique from which it is
notoriously dangerous to draw conclusions, on a comparison of the
coin and pottery statistics from Naukratis which it is no less
dangerous to use as evidence, on a hoard found in 1886 among the
pre-Persian remains on the Athenian Acropolis which, as far as the
circumstances of the find are concerned, may have been lost or
deposited there long before the catastrophe, and only establish a
terminus ante quem that nobody would think of disputing, and on
certain alliance coins (Athens-Lampsacus, Athens-Sparta?, Athens
and the Thracian Chersonese)[279]. These last look more promising at
first sight, but only the Athens-Lampsacus coins can be dated with
any certainty, and they, unfortunately, are very small, and may have
been struck under difficulties, so that it is not easy to be sure of their
chronological position in the Athenian series.
We are driven back therefore on to the impressions of experts,
most of whom agree with Babelon that the owl-Athena series cannot
begin either much before or much after 550 B.C.[280]. That is to say
that this double type was certainly in vogue when the tyrant secured
his second restoration by means of his Thracian silver[281], and
“rooted his tyranny” in revenues derived “partly from the river
Strymon, partly from home.”
Pieces with the double type were nicknamed
sometimes colloquially called girls (κόραι), (probably just
sometimes virgins (παρθένοι), sometimes about this time)
girl, virgin,
by the virgin goddess’ own name of Pallas Pallas.
(Παλλάδες)[282]. Sometimes they got their
nickname from the reverse type, and were called owls[283]. “Virgin” is
used by Euripides, “girl” by Hyperides, “Pallas” by Eubulus, “owl” by
Aristophanes. “Owl” is said by the Aristophanes Scholiast to have
been applied to the tetradrachms; the “girl” of Hyperides is some
smaller coin[284]. In the fifth and fourth centuries therefore the bird
name, and the virgin goddess names seem to have been used side by
side, like our sovereign and crown, to indicate two different
denominations. When the names were first used is nowhere stated.
The most likely time for a type to give rise to a nickname is when the
type itself is still a novelty. If this holds good for the coins of Athens,
the nicknames Pallas, virgin, and girl go back to the time of
Peisistratus. The owl had already appeared on earlier issues,
stamped on the reverse with a simple incuse[285], and would therefore
at this time attract less attention than the Athena head.
Is it possible that we have here the clue to the Phye story? The
details about her being dressed up in full armour and placed in a
chariot are not the essence of the story: they all appear in Herodotus
in quite a different setting, as part of the ritual of the worship of
Athena in North Africa by Lake Tritonis[286]. It can hardly be doubted
that one of these passages is plagiarized from the other, and it is
scarcely less certain that Phye is indebted to the ritual of Lake
Tritonis and not vice versa.
The kernel of the Phye story lies in the Was the Athena
tradition that Peisistratus was restored by a who restored
woman, “as Herodotus says, from the deme Peisistratus the
lady of the coins?
of the Paianians, but as some say, a
Thracian flower girl from the deme of Kollytos[287].” In fact Phye, the
human goddess four cubits high, said by some to come from Attica,
and by others from Thrace, who brought Peisistratus back to Athens
for the first time, bears a suspicious likeness to the coins called
sometimes girls and sometimes goddesses, derived some from Attica,
and some from Thrace, with which Peisistratus secured his second
return, and finally established his power.
Assume for the moment that they were indeed identical, and it is
easy to see how the Phye story may have arisen. Peisistratus certainly
claimed to rule by the grace of Athena. Everyone is agreed in
inferring from the Phye story that he attributed his restoration to the
intervention of the goddess. After the citizens had fulfilled Solon’s
prophecy, and “consented to ruin their great city, induced by
money[288],” what more natural than that one of the tyrant’s
opponents should sarcastically agree that it was indeed Athena who
had restored Peisistratus: on which another might comment that it
was not the virgin goddess of Athens who had restored the tyrant,
but an alien being of quite a different order, a Thracian flower girl.
The name of flower girl (στεφανόπωλις) is cp. (i) details in
never applied to Athenian drachmae. If we the story that
accepted Head’s early dating for the Athena suggest a
derivation from
type, and assumed a Peisistratan date for the coins,
certain Athenian coins[289] where the
goddess has had her hair done by a κεροπλάστης[290] in corkscrew
curls (fig. 7a) that suggest an early date[291], and wears the garland
(στέφανος) of olive leaves (fig. 7a, b) that appears regularly on coins
of the fifth century, we might find in flower girl (lit. garland seller,
στεφανόπωλις) an allusion to this detail. The garland seller may
often have advertised her garlands by wearing one herself[292].
Fig. 7. Athenian coins: the wreath on the head of
Athena.
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