the democratic fallacy in matters of clinical opinion implications for analysing cause-of-death data民主党的谬论在临床方面的意见影响分析死因数据.pdfVIP

Byass Emerging Themes in Epidemiology 2011, 8:1 EMERGING THEMES /content/8/1/1 IN EPIDEMIOLOGY ANALYTIC PERSPECTIVE Open Access The democratic fallacy in matters of clinical opinion: implications for analysing cause- of-death data Peter Byass Abstract Arriving at a consensus between multiple clinical opinions concerning a particular case is a complex issue - and may give rise to manifestations of the democratic fallacy, whereby a majority opinion is misconstrued to represent some kind of “truth” and minority opinions are somehow “wrong”. Procedures for handling multiple clinical opinions in epidemiological research are not well established, and care is needed to avoid logical errors. How to handle physicians’ opinions on cause of death is one important domain of concern in this respect. Whether multiple opinions are a legal requirement, for example ahead of cremating a body, or used for supposedly greater rigour, for example in verbal autopsy interpretation, it is important to have a clear understanding of what unanimity or disagreement in findings might imply, and of how to aggregate case data accordingly. In many settings where multiple physicians have interpreted verbal autopsy material, an over-riding goal of arriving at a single cause of death per case has been applied. In many instances this desire to constrain findings to a single cause per case has led to methodologically awkward devices such as “TB/AIDS” as a single cause. This has also usually meant that no sense of disagreements or uncertainties at the case level is taken forward into aggregated data analyses, and in many cases an “indeterminate” cause may be recorded which actually reflects a lack of agreement rat