Abstract
In the past, hypothesis testing in medicine has employed the paradigm of the repeatable experiment. In statistical hypothesis testing, an unbiased sample is drawn from a larger source population, and a calculated statistic is compared to a preassigned critical region, on the assumption that the comparison could be repeated an indefinite number of times. However, repeated experiments often cannot be performed on human beings, due to ethical or economic constraints. We describe a new paradigm for hypothesis testing which uses only rearrangements of data present within the observed data set. The token swap test, based on this new paradigm, is applied to three data sets from cardiovascular pathology, and computational experiments suggest that the token swap test satisfies the Neyman Pearson condition.
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Angell, M.: 1984, ‘Patients' preferences in randomized clinical trials’, New England Journal of Medicine 310, 1385–1387.
Arcidi, J. M., Jr., Moore, G. W., and Hutchins, G. M.: 1981, ‘Hepatic morphology in cardiac dysfunction: A clinicopathologic study of 1000 autopsied patients’, American Journal of Pathology 104, 159–166.
Barnett, G. O.: 1984, ‘The application of computer-based medical-record systems in ambulatory practice’, New England Journal of Medicine 310, 1643–1650.
Berkson, J.: 1946, ‘Limitations of the application of fourfold table analysis to hospital data’, Biometrics Bulletin 2, 47–53.
de la Monte, S. M., Hutchins, G. M., and Moore, G. W.: 1985, ‘Peripheral neuroblastic tumors and congenital heart disease: Role of hypoxic states in tumor induction’, American Journal of Pediatric Hematology and Oncology 17, 109–116.
de la Monte, S. M., Hutchins, G. M., and Moore, G. W.: 1984, ‘Compensatory neoplasia: Chronic erythrocytosis and neuroblastic tumors’, Theoretical Medicine 5, 279–292.
Diaconis, P. and Efron, B.: 1983. ‘Computer-intensive methods in statistics. They replace standard assumptions about data with massive calculations. One method, the “bootstrap,” has revised many previous estimates of the reliability of scientific inferences’, Scientific American 248, 116–131.
Efron, B.: 1979, ‘Computers and the theory of statistics: Thinking the unthinkable.’ Society for Industrial and Applied Mathematics Review 21, 460–480.
Ellenberg, S. S.: 1984, ‘Randomization designs in comparative clinical trials’, New England Journal of Medicine 310, 1404–1408.
Feinstein, A. R. and Horwitz, R. I.: 1982, ‘Double standards, scientific methods, and epidemiologic research’, New England Journal of Medicine 307, 1611–1617.
Fisher, R. A.: 1958, ‘Tests of goodness of fit, independence and homogeneity; with table of x 2’, Chapter 10. In, Statistical Methods for Research Workers, 13th ed. Hafner Publishing Company, Inc., New York, pp. 78–113.
Haupt, H. M., Hutchins, G. M., and Moore, G. W.: 1981, ‘Ara-C Lung: Noncardiogenic pulmonary edema complicating cytosine arabinoside therapy of leukemia’, American Journal of Medicine 70, 256–261.
Hoel, P. G.: 1971, Introduction to Mathematical Statistics, 4th ed. John Wiley & Sons, Inc., New York, pp. 97–112, 190–220.
Kircher, T., Carter, J. R., and Sinton, E.: 1985, ‘The National Autopsy Data Bank’, Pathologist 39, 22–26.
Kircher, T., Nelson, J. and Burdo, H.: 1985, ‘The autopsy as a measure of accuracy of the death certificate’, New England Journal of Medicine 313, 1263–1269.
Mantel, N. and Haenszel, W.: 1959, ‘Statistical aspects of the analysis of data from retrospective studies of disease’, Journal of the National Cancer Institute 22, 719–748.
Mood, A. M. and Graybill, F. A.: 1963, ‘Sampling distributions’, Chapter 10. In, Introduction to the Theory of Statistics, 2nd ed. McGraw-Hill Book Co., Inc., New York, pp. 220–247.
Moore, G. W., Haupt, H. M., and Hutchins, G. M.: 1982, ‘A hypothesis test for causal explanations in human pathology: Evaluation of pulmonary edema in 181 autopsied patients with leukemia’, Mathematical Bioscience 62, 253–279.
Moore, G. M., Hutchins, G. M., and Miller, R. E.: 1984, ‘Strategies for searching medical natural language text: Distribution of words in the anatomical diagnoses of 7000 autopsied patients’, American Journal of Pathology 115, 36–41.
Moore, G. W., Hutchins, G. M., and Miller, R. E.: 1986, ‘Token swap test of significance for serial medical databases’, American Journal of Medicine 80, 182–191.
Roberts, W. C.: 1978, ‘The Autopsy. Its decline and a suggestion for its revival’, New England Journal of Medicine 299, 332–338.
Shapiro, A. R.: 1982, ‘Exploratory analysis of the medical record’, Proceedings of the Sixth Annual Symposium on Computer Applications in Medical Care, 781–786.
Simborg, D. W., Chadwick, M., and Whiting-O'Keefe, Q. E.: 1983, ‘Local area networks and the hospital’, Computers in Biomedical Research 16, 247–259.
Taylor, K. M., Margolese, R. G., and Soskolne, C. L.: 1984, ‘Physicians' reasons for not entering eligible patients in a randomized clinical trial of surgery for breast cancer’, New England Journal of Medicine 310, 1363–1367.
White, C.: 1953, ‘Sampling in medical research’, British Medical Journal 2, 1284–1288.
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From the Departments of Pathology and Laboratory Medicine of The Johns Hopkins Medical Institutions, Baltimore, Maryland. Address correspondence and reprint requests to Dr. G. William Moore, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21205.
Supported by NIH Grant LM-03651 from the National Library of Medicine.
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Moore, G.W., Hutchins, G.M. & Miller, R.E. A new paradigm for hypothesis testing in medicine, with examination of the Neyman Pearson condition. Theor Med Bioeth 7, 269–282 (1986). https://doi.org/10.1007/BF00539848
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DOI: https://doi.org/10.1007/BF00539848