On the fallacy of labs

Jackson, Brian brian.jackson at ARUPLAB.COM
Thu May 9 21:04:22 UTC 2019


In principle this is an appealing concept, but the devil would be in the details.  Mathematically it would ideally take the form of likelihood ratios for specific diseases, associated with specific lab results.  For most test/disease combinations these numbers aren’t easy to find in the literature.  You can calculate LRs using sensitivity and specificity numbers, but when you consider how sensitivities and specificities for lab tests can vary quite a bit across studies, you can imagine how the LRs would vary as well.  I think it would also require a lot of education on how to interpret and apply the LRs; something that has historically been taught in EBM classes but largely as a theoretic exercise.

In a more qualitative sense, I got a phone call from my sister-in-law this morning, who recently passed her boards and started in primary care practice as an NP.  She had a patient from the Northeast with a documented tick bite and (vague) symptoms, combined with negative Lyme immunoblots.  So we discussed the limitations of serology for this particular disease, and how this is a case where therapy should be based more on clinical assessment.

--Brian Jackson

From: Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Thursday, May 9, 2019 2:12 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] On the fallacy of labs

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Would accuracy rankings on all tests reported help by promoting research to improve the test, and also lead to fewer errors in diagnosis?

Rob Bell, M.D.

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On May 9, 2019, at 9:48 AM, Edward Hoffer <ehoffer at gmail.com<mailto:ehoffer at gmail.com>> wrote:
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Edward P Hoffer MD
Associate Professor of Medicine, part-time, Harvard
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