Out With the Outliers!

In statistics (the basis of all good scientific research) we talk about outliers. There are the pieces of information that fall way outside of expectations – imagine that you ordered a slice of pepperoni pizza and the waiter brought you Chinese food, that’s an outlier. It’s when all the data, all the people in a study look the same, have similar outcomes, and then one or two people have VERY bad or good results compared to the rest. Why am I telling you about statistics? Because so often, patients come to me talking about the latest pain treatment they read about online, or something the person in the waiting room mentioned – and so very often I hear how absolutely terrible the experience was and someone nearly died, or how amazing it worked and after one pill or treatment all the pain was gone! What people hear about (or talk about) are the outliers. These are the most extreme (and thus the most interesting) cases. The 98% that have normal, expected results from treatment don’t tell their stories – or if they do, the stories don’t get repeated. This is because no one thinks it’s interesting that you ordered pepperoni pizza and got pepperoni pizza. That story has no big emotional component, no twist, no surprise. For better or worse, I think the Internet makes outliers even more prominent these days. (How else could some of these “celebrities” ever become famous?!) The average Joe or Jane isn’t interesting. The person who has a nerve block and the outcome is just as predicted – some relief, not total, it was a “little better for a while” – that’s just boring. The person who had a terrible reaction to anesthetic and almost went into a coma! The person who went back to work and the gym the next month! Those stories stir up strong emotions – the first because we have a protective reaction and want to avoid such negative outcomes; the second because we all want hope (pain patients crave it like water), and we WANT to believe. The problem is this – there is research to support the idea that we remember stories with strong emotional components better than those stories that are typical and bland. Furthermore, we have a tendency to remember the story later on, but not where we heard it; so, information from doctors and studies get lumped in the same category as anecdotes in the waiting room – we end up confusing the facts and the fairytales. Now, all that I have just said here doesn’t discount the fact that outliers do exist – some people (unfortunately) do die from surgery gone wrong, and some people do (thankfully) find the “miracle cure.” The thing to remember is that they are literally the exception to the rule. They are interesting because they are highly unlikely and improbable. What are the odds?! The take home point should be this – I am not trying to steal your hope, just as I am not trying to convince you to try every treatment regardless of the risk. I am telling you to think with your brain and not your gut or emotions. “Wanting” something to work or being “scared it will go wrong” rarely impact the outcome – most of us don’t have superpowers like that. (The small caveat here is that some studies show that pain improves/worsens based on emotional expectations, but this is also more the exception than the rule.) The numbers don’t lie – play the odds – do your research based on the data, not on the stories. Trust the professionals (or at least the masses) more than the person next to you in line. And be careful – talking about outliers (or believing those stories wholeheartedly) may make a liar out of you…
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