Tuesday, October 30, 2012

The Inferiority of Expert Judgment

What follows applies to a vast range of topics, but is of particular interest (to me) in how it relates to the practice of medicine.

I quote from the book by Daniel Kahneman, Thinking, Fast and Slow.

In the slim volume that he later called "my disturbing little book," [Paul] Meehl reviewed the results of 20 studies that had analyzed whether clinical predictions based on the subjective impressions of trained professionals were more accurate than statistical predictions made by combining a few scores or ratings according to a rule. In a typical study, trained counselors predicted the grades of freshmen at the end of the school year. The counselors interviewed each student for forty-five minutes. They also had access to high school grades, several aptitude tests, and a four-page personal statement. The statistical algorithm used only a fraction of this information; high school grades and one aptitude test. Nevertheless, the formula was more accurate than 11 of the 14 counselors. Meehl reported generally similar results across a variety of other forecast outcomes, including violations of parole, success in pilot training, and criminal recidivism.

Not surprisingly, Meehl's book provoked shock and disbelief among clinical psychologists, and the controversy it started has engendered a stream of research that is still flowing today, more than fifty years after its publication. The number of studies reporting comparisons of clinical and statistical predictions has increased to roughly two hundred, but the score in the contest between algorithms and humans has not changed. About 60% of the studies have shown significantly better accuracy for the algorithms. The other comparisons scored a draw in accuracy, but a tie is tantamount to a win for the statistical rules, which are normally much less expensive to use than expert judgment. No exception has been convincingly documented.
The range of predicted outcomes has expanded to cover medical variables such as the longevity of cancer patients, the length of hospital stays, the diagnosis of cardiac disease, and the susceptibility of babies to sudden infant death syndrome.... In every case, the accuracy of experts was matched or exceeded by a simple algorithm.
Why are experts inferior to algorithms? One reason, which Meehl suspected, is that experts try to be clever, think outside the box, and consider complex combinations of features in making their predictions. Complexity may work in the odd case, but more often than not it reduces validity. Simple combinations of features are better. Several studies have shown that human decision makers are inferior to a prediction formula even when they are given the score suggested by the formula! They feel that they can overrule the formula because they have additional information about the case, but they are wrong more often than not.  
Another reason for the inferiority of expert judgment is that humans are incorrigibly inconsistent in making summary judgments of complex information. When asked to evaluate the same information twice, they frequently give different answers. The extent of the inconsistency is often a matter of real concern. Experienced radiologists who evaluate chest X-rays as "normal" or "abnormal" contradict themselves 20% of the time when they see the same picture on separate occasions. ... A review of 41 separate studies of the reliability of judgments made by auditors, pathologists, psychologists, organizational managers, and other professionals suggests that this level of inconsistency is typical, even when a case is reevaluated within a few minutes. Unreliable judgments cannot be valid predictors of anything.

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Truth is...there's a reason why it's called practicing medicine.

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