Diving with Diabetes
nikharvey
A friend has asked if it is safe to dive with this condition.
He has a regular supply of insulin and if this is taken before a dive is
there any risk.
Also, What is the chance of getting a diving medical with this problem. I
know that some jockeys have now been stopped.
Any Comments welcome
Mike Gray
I am an insulin dependent diabetic and do about 140 dives/year. There
are many diabetics diving with no problems. A good meal on schedule and
a heavy dose of carbs between dives does the trick. My experience is
that hypoglycemic hits underwater are no more difficult to handle than
on the surface, the biggest danger being loss of concentration.
regards
m
Dillon Pyron
nikharvey wrote:
>
> A friend has asked if it is safe to dive with this condition.
>
> He has a regular supply of insulin and if this is taken before a dive is
> there any risk.
Yes. How well controlled is his glucose level in heavy exercise
conditions? This a question only he and his doctor can determine.
>
> Also, What is the chance of getting a diving medical with this problem. I
> know that some jockeys have now been stopped.
I know of insulin dependent diabetics who dive. Although it is
discouraged. One is also a marthoner, so he knows his limits (I hope).
>
> Any Comments welcome
--
dillon pyron
dillon...@amd.com
PADI OWSI-54909 USPSA TY-26031
Corgis are big dogs in small suits.
Reef Fish (Large Nassau Grouper)
Larry "Harris" Taylor wrote:
>
> The conservative hyperbaric physician will indicate that insulin dependent
> diabetes is an absolute contraindication to diving. The majority of the
> dive medical texts so state ... it is my opinion, based on the materials in
> my library that this is the majority opinion of the hyperbaric medical
> community.
The material in your library appears dated.
IDDM (Insulin Dependent Diabetes Mellitus) is no longer an absolute
contraindication to diving, as evidenced by a series of reports
published
in DAN's Alert Diver. In fact, DAN has been collecting in-water
diving research data on IDDM divers for some time.
In Alert Diver (Jan/Feb 1995), DAN reported the recommendation of the
UHMS (Undersea and Hyperbaric Medicine Society) following a meeting
held in 1994. Item 6 should be of interest to IDDM divers here:
6. There remains a group of individuals with well controlled
diabetes mellitus, treated with insulin or oral hypoglycemic
agents, with good understanding of their disease, who with
suitable training and by following a specially designed
management protocol may be considered for recreational diving.
The language is VERY CONSERVATIVE, and the keywords are "controlled",
"good understanding", and "management protocol".
For more up-to-date details and recommendations, see the 4-page
article "Diabetes & Diving" in Diver Alert (Jan/Feb 1997).
> Recently, there has been a trend for some physicians to examine diabetics,
> asthmatics & epileptics (traditionally excluded from training) and make a
> case by case determination.
Yes, that is the current recommendation by UHMS and DAN. PHYSICIANS
are
the ones who can make case-by-case determination and recommendation on
particular patients based on their history. NOT blanket
recommendations.
> The risks associated with diabetes and diving appear non-trivial ...I
> remember a young male who realized that putting insulin dependent on his
> history form would disqualify him from diving ... so he lied ,,, and died
> in the pool training portion of his class.
Ironic isn't it? I would say the "uninformed blanket contraindication"
contributed as much to KILLING this diver as he did himself. Under
CURRENT
guidelines, he certainly might have lived had he (a) consulted with
physicians to have come to the determination that he should NOT have
dived; or (b) determined that he COULD dive under special management
protocol.
In either case, there is no need for any diver to lie about the IDDM
status!
Informed decision is ALWAYS better than ill-informed regulations.
> A private scuba instructor, I will not train an insulin dependent person,
> but there are always instructors out there who will ... but, by now, it
> should be obvious I am always on the conservative side when health/safety
> issues are discussed.
It is one thing to be on the conservative side, and is another to
deprive
someone the opportunity to dive when it may be AS SAFE or safer for said
IDDM diver-wannabe compared to an "average" diver-wannabe under the
case-
by-case UHMS/DAN scenario.
Of course a risk-averse scuba instructor has the right NOT to train any
IDDM person, but I hope more instructors will make such decisions based
on the advice of the person's PHYSICIANS, together with INFORMATION
about the disease and management protocols.
No, I am not an IDDM person; just an informed diver on many aspects
of dive safety.
-- Bob.
Jason O'Rourke
Mike Gray <omg...@worldnet.att.net> wrote:
>I am an insulin dependent diabetic and do about 140 dives/year. There
>are many diabetics diving with no problems. A good meal on schedule and
>a heavy dose of carbs between dives does the trick. My experience is
>that hypoglycemic hits underwater are no more difficult to handle than
>on the surface, the biggest danger being loss of concentration.
Before your friend goes off to lie on his medical form based on the
above, keep in mind that Mike has stated that the risk of decompression
sickness is 1 in 50000 and is therefore negiable. This suggests to me a
fairly high tolerance for risk - something your friend may not share.
Send him off to a diving doctor to see...do not act based on advice from
us.
--
Jason O'Rourke jas...@netcom.com
'96 BMW r850R www.csua.berkeley.edu/~jor
last dive: September 9th, Monastery (North) Beach, Carmel.
24 mins at 113 ft max, viz as high as 30' (soupy)
Carl Heinzl
Bob,
>Of course a risk-averse scuba instructor has the right NOT to train any
>IDDM person, but I hope more instructors will make such decisions based
>on the advice of the person's PHYSICIANS, together with INFORMATION
>about the disease and management protocols.
Do agencies allow the instructor to have the final say as to who they
teach and who they do NOT teach or must the instructors accept anyone
who has passed the agency's criteria?
-Carl-
Le Belgo
Are you talking only about Type I diabetes? As a family physician
with a fairly large number of diabetic patients, I do have my own opinions,
although I'm not familiar with the literature, if any, on this area. I
would definitely discourage Type I diabetics (those who must take insulin)
from scuba diving. There are a number of reasons for this. Firstly, it is
impossible to predict or anticipate how your body will consume glucose in
the water. This will certainly vary greatly according to activitity level,
depth, and water temperature, let alone other factors such as buoyancy
control and experience. If you go on a hike in the mountains, you will
learn by trial and error how this activity (and altitude) affects your
insulin requirements. If you start feeling low (or high), you can check
your glucose level and take some glucose tablets (or insulin) as needed.
Obviously such trial and error is absolutely impossible when diving
(you can neither check yourself, eat glucose tablets, nor give yourself
insulin). The best you can do is check yourself once you surface--not an
accurate method. Secondly, the cost of being wrong, even once, can be
fatal. A diver is unlikely to survive becoming unconscious or having a
hypoglycemic seizure underwater, even with a Rescue Diver or above-trained
buddy. Neither would I advise "hedging your bets" by starting very high,
say around 400, since this will obviously lead to dizziness and blurry
vision from the hyperglycemia alone, as well as lead to volume loss and
resulting lightheadedness from the glucosuria.
Some Type II diabetics, however, should be able to dive safely.
Obviously, someone whose diabetes is controlled by diet and exercise alone
should be safe. Also, the type II diabetic drug metformin supposedly does
not cause hypoglycemia when taken alone. I have not seen any data on
diabetic divers taking metformin, but it is quite likely that, if no other
diabetes medications were taken, that this might be another category of
diabetics who could safely dive. This would make an interesting study, but
at this point it's a bit speculative.
So my advice would be (1) Type I's--definitely not a good idea, and
(2) Type II's--probably OK if not on any drugs, and quite possibly OK if
taking ONLY metformin.
SeaWitch
I found it interesting that HSA does not discourage people with diabetes
from diving. They just have to take some extra precautions.
Jim.Gr...@cc.gatech.edu
Regarding "Diving with Diabetes", RF...@clemson.edu wrote:
>Carl Heinzl wrote:
>>
>> Do agencies allow the instructor to have the final say as to who they
>> teach and who they do NOT teach or must the instructors accept anyone
>> who has passed the agency's criteria?
>
>interested in the answer to that question too, from instructors of
>various agencies.
Basically, as an instructor, you have the freedom to certify anyone
that you choose to, regardless of any pre-existing conditions. The
only thing is that if a claim against you or the agency arises out of
it, then you are only protected if the student fits the agency's
expected medical profile.
In most cases, diabetes is an absolute contraindication, and many
agencies will not support you if you certify a diabetic diver who has
an episode and then sues as a result of it. At least one agency (YMCA)
has a procedure for certifying diabetic divers, so if your liability
insurance is obtained through that agency, then you are protected.
The bottom line is that it really has nothing to do with whether a
condition can or will cause a problem, and everyhing to do with
liability. If you certify someone who was known (to you) to have a
contraindicating condition at the time of certification, then you
tacitly assume the risk for any actions that person may bring against
you or the agency, that resulted from having that condition.
>That freedom of choice may very well be imbedded in an
>"agency's criteria" so that your "anyone" may not exist for any
>agency whose "criteria" include an instructor's consent. :^)
Some agencies (NAUI is an example) require their instructors to sign
a document stating that they will NOT certify an person with any of
the following conditions (asthma, epilepsy, diabetes, etc, etc).
What makes this interesting is that if the instructor cross-certifies
for two different agencies, then they may be technically bound by the
more restrictive agency agreement.
So if I certify for both YMCA and NAUI, and YMCA says "yes" to
diabetic divers, and NAUI says "no", then I am stuck in an
interesting dilemma. If I have my insurance through YMCA, then I am
probably OK to certify that person, but if I have it through NAUI,
then I am not (independent of what particular agency course I am
teaching at the time).
Of course, most instructors will probably err on the side of caution,
figuring that there are a lot of instructors out there, and that the
student is always free to go to another one. And what many students
do is find another instructor, lie about their condition, and then
get certified anyway. In that case, however, the instructor should be
protected in the event of a lawsuit, since he was not informed of the
condition at the time of certification.
-JimG
--
Jim Greenlee (j...@cc.gatech.edu) Naq gur zbeny bs gur fgbel vf: Rira
Instructor, College of Computing cbfgvatf jvgu ab pbagrag pna rnfvyl
Georgia Tech, Atlanta, GA 30332 nzhfr na vqvbg jvgu n fghcvq fnlvat
Fishbre396
In article <CGH.97Se...@nestle.ai.mit.edu>, c...@nestle.ai.mit.edu
(Carl Heinzl) writes:
>Do agencies allow the instructor to have the final say as to who they
>teach and who they do NOT teach
Yes, SOME agencies do allow instructors to have the final say . . . let's
not forget that nearly ALL agencies require a MEDICAL release (some
require signiture by MD, others just require the potential student's
signiture.) If the student lies about any medical conditions, get hurt
(bends or such) while training, MOST instructors and agencies will not be
held libel.
Le Belgo
>
>I found it interesting that HSA does not discourage people with diabetes
>from diving. They just have to take some extra precautions.
>
>
A good analogy to diving with type I diabetes would be diving without
an air gague or a buddy. Both air and blood glucose are necessary for
life. One can imagine someone who choses to dive without an air gauge, but
checks the pressure only when he gets back. After a while, he can feel
fairly confident about his air usage at any given activity level or depth,
and most of the time he'd probably do OK. Possible, just not a good idea.
A buddy can provide an alternate air source, however. Since there's
no way a buddy can share his blood glucose, however, diving while on
insulin is worse than diving without a buddy. What happens if something
unexpected happens, such as currents changing (as they sometimes will), or
getting separated from the boat? You will need more glucose than you
anticipate, and may end up in deep trouble.
I have had hundreds of diabetic patients, and have yet to meet one
who (1) has never had a hypoglycemic event, or who (2) can always
accurately predict where his blood sugars are going (even under fairly
well-controlled circumstances, let alone in the water, where the unexpected
is often inevitable).
Is it possible to dive multiple times without an air gague or a
buddy and not get injured? Yes, absolutely. Are there diabetics on
insulin out there who have done numerous dives and not gotten into trouble?
I'm sure there are. Would I recommend such activities? No, I would
not....
Scuuba me
Who are you to begin with! I take it you are an MD. I know thousands of
people that drive a car, and have either been in an accident or witnessed
one. They couldn't predict those either, but they still drive cars.
That's pretty risky also, wouldn't you say!
We all pick the risks we are willing to take like eating that big fat
juicy cheesesteak, with a side of fries and 2 or 3 beers. If you are an MD
you know what just 1 of those meals does to the intima of your
bloodvessels. When was the last time you had one?
Mike
Enjoy the bubbles
Scuuba m...@aol.com
Reef Fish (Large Nassau Grouper)
Le Belgo wrote:
> A good analogy to diving with type I diabetes would be diving without
> an air gague or a buddy. Both air and blood glucose are necessary for
> life. One can imagine someone who choses to dive without an air gauge, but
> checks the pressure only when he gets back. After a while, he can feel
> fairly confident about his air usage at any given activity level or depth,
> and most of the time he'd probably do OK. Possible, just not a good idea.
A reasonable analogy to dramatize the POTENTIAL risks. But what's at
issue here is NOT only the risk factors, but also the factors of self-
responsibility; and whether divers with Type I IDDM should be BARRED
from diving IF they know their OWN condition, risks, and are willing
to take the risk for the enjoyment of scuba diving.
It's an undramatic thing to say that we ALL take certain risks when we
go underwater. Divers get embolized at depths less than 20 ft. Other
divers die from DCI or other "accidents". To this I can also say,
> fairly confident about his air usage at any given activity level or depth,
> and most of the time he'd probably do OK. Possible, just not a good idea
And add, "take up golf -- it's MUCH safer." In fact, some readers
have been telling Giovanni to do that for months. :-)
> I have had hundreds of diabetic patients, and have yet to meet one
> who (1) has never had a hypoglycemic event, or who (2) can always
Now THAT is not a good argument, or even good anedotal data. That's
like a physician saying "I've yet to meet one patient who has not been
sick." A self-selected, biased sample.
> Is it possible to dive multiple times without an air gague or a
> buddy and not get injured? Yes, absolutely. Are there diabetics on
> insulin out there who have done numerous dives and not gotten into trouble?
> I'm sure there are. Would I recommend such activities? No, I would
> not....
I would not RECOMMEND it either. But I wouldn't support the idea that
some Big Brother makes it LAW to BAR such activities either.
Heck, to follow your air gauge example, I've posted my Acapulco diving
experience (in 1987) more than once. I saw a "scuba shop" during our
lunch break where Mayan fire-dancing and a beer-drinking goat (the FOUR
legged kind) were the main entertainment. So, I decided to do a short
shore dive there. I was handed a tank with straps and a regulator for
my rental equipment. NO DEPTH GAUGE. NO AIR GAUGE.
Needly to say (well perhaps I NEED to say :-)) that I DECLINED to dive
under those conditions. Would I RECOMMEND such activities? Definitely
not. Would I recommend making it an ABSOLUTE contraindication to
dive with a tank and a reg? ABSOLUTELY not! That's the standard
way of diving for many Mexicans for many years, and quite obviously
the shop even thought SOME Gringos would dive that way.
If up to an INDIVIDUAL to assess the risk and take the action on ANY
event, under ANY circumstance. IMHO, that's the ONLY issue. Not
how risky it is for a Type I IDDM person to dive, but whether such a
person should be barred, absolutely, to dive. DAN doesn't think
so. UHMS doesn't think so. DAN's accident DATA and DAN's ongoing
in-water research on IDDM divers don't seem to suggest risks any
more excessive than "ordinary" divers.
YOU make your own decision based on all available facts and knowledge.
You should let OTHERS make their own decision -- that's my bottom line.
-- Bob.
Le Belgo
Although you didn't quote, I think you were responding to my posting
(even if it wasn't, I'll respond anyways). I did not make the point in my
posting that people shouldn't be allowed to take risks. I'm somewhat of a
libertarian, and I think people should be able to to what they want as long
as it doesn't infringe on the rights or well-being of others. I've seen
cliff divers in Mexico, and their sight leaves me (1) marveling at the
Mexican legal system that it refrains from being paternalistic and doesn't
allow for the frivolous civil law suits our system allows, and (2) feeling
badly that a person's economic situation is so desperate that he'll put his
life at risk for the pesos. My posting was the expression of an opinion
that I think diving with type I diabetes is very dangerous and a bad idea
in general. So is cliff diving.
Everyone has to pick his risks. The risk of death when driving
sober, alert, and in good health is minimal compared to the risk of diving
while on insulin. Just as drinking greatly increases the risks involved
with driving, being on insulin greatly multiplies the inherent risks of
diving. Henri Paul (Di's driver) probably got away with driving drunk
hundreds, if not thousands of times. But when the unexpected happened (and
unexpected things will happen under water), the danger of his behavior
caught up with him. The comparison with the cheesesteak is rather silly.
While a diet high in saturated fat may carry certain long-term health
hazards, the only way one cheesesteak can kill someone is if he chokes on
it.
Le Belgo
>> I have had hundreds of diabetic patients, and have yet to meet one
>> who (1) has never had a hypoglycemic event, or who (2) can always
>
>Now THAT is not a good argument, or even good anedotal data. That's
>like a physician saying "I've yet to meet one patient who has not been
>sick." A self-selected, biased sample.
>
>
>> Is it possible to dive multiple times without an air gague or a
>> buddy and not get injured? Yes, absolutely. Are there diabetics on
>> insulin out there who have done numerous dives and not gotten into trouble?
>> I'm sure there are. Would I recommend such activities? No, I would
>> not....
>
>I would not RECOMMEND it either. But I wouldn't support the idea that
>some Big Brother makes it LAW to BAR such activities either.
Two points to which I'd like to respond.
(1) At no point have I ever said that I think it should be illegal for a
type I diabetic to go scuba diving. I'm giving my opinion as a physician
and scuba diver with a fair deal of experience with diabetics (and diving),
that I feel scuba diving is probably one of the worst sports for
insulin-dependent diabetics to engage in. I fully encourage diabetics to
engage in almost all sports. However, scuba is unique in that [a] it is
impossible to monitor the condition while under water, and [b] it is
impossible to manage a severe complication, or even "nip it in the bud"
before it becomes life-threatening while under water (nor is there time to
surface).
Just as I would advise someone with uncontrolled seizures to not
drive a car, I would advise a type I diabetic to chose almost any sport
except diving. If I had to certify someone, I would not want the
responsibility of certifying them, and if I ran a dive boat, I would not
want the liability involved either. I would sooner see someone dive
without a depth or air gauge (although that's a bad idea, too). I would
not, however, like to see it a crime for a diabetic to dive. Of course,
I'm somewhat of a libertarian, and have actually had a letter published in
JAMA arguing against mandated motorcycle helmet laws...
(2) With regard to the issue of my never having seen an
insulin-dependent diabetic who's never had a hypoglycemic event simply
being a biased sample, this is just incorrect. Glucose metabolism is
affected by so many factors--not just food and activity level, but also
emotions, hormone levels, ambient temperature, and so forth--that it is
impossible to predict accurately. A type I diabetic who's never had a
hypoglycemic event is truly a rarity, not the other way around.
I was reading this month's issue of Alert Diver, put out by DAN, and
was surprised to read a statement that hyperthyroid patients should be
banned from from diving unless their disease is perfectly controlled. If,
in fact, DAN supports insulin-dependent diabetics diving, but not
hyperthyroid patients, then it is truly hypocritical. The diving risks
involved with hyperthyroidism are relatively minor and mangageable. On the
other hand, there is no such thing as a perfectly-controlled diabetic.
Many do a really great job, and my hat goes off to them. Unlike the
hyperthyroid patient who can stay on the same dose of medication every day
with constant thyroid levels, however, it is the nature of diabetes that
glucose levels and insulin doses will change on a day-to-day (and even
hour-to-hour) basis. We would all agree that the diving risk of
hypoglycemia is certainly not minor.
Mike Gray
Le Belgo wrote:
my opinion as a physician and scuba diver with a fair deal of
experience with diabetics (and diving), that I feel scuba diving is
probably one of the worst sports for insulin-dependent diabetics to
> impossible to monitor the condition while under water, and [b] it is
> impossible to manage a severe complication, or even "nip it in the bud"
> before it becomes life-threatening while under water (nor is there time to
> surface).
A few things from the other side:
The thousands of diabetics diving have learned for themselves and from
other diabetics to manage their glucose levels while diving.
Hypoglycemic reactions underwater are very similar to same above water,
and are no more difficult to deal with. Time to surface is a definite
consideration for deco dives, and takes additional planning. On non-deco
dives, time to surface is extremely rarely a problem.
I would not
> want the liability involved either.
This is the real issue, and the fourth reason that physically active
diabetics do not seek or get regular medical attention (1) no doctor
anywhere can do anything to alleviate diabetes (2) diabetes is a
self-managed condition and doctors just waste time and money - in most
places, a diabetic no longer even needs a scrip to get insulin/needles
(3) a doctor can't make any money on diabetes until the patient is on
Medicare, (4) no doctor will give advice that might come back legally,
therefore the only advice is "don't".
This is not limited to diving. Medicals for diabetic race car drivers
are impossible to get except from the doctors affiliated with the
sanctioning bodies. Why? Liability. "If you hurt yourself you might sue
me." Physician, heal thyself!
Glucose metabolism is
> affected by so many factors--not just food and activity level, but also
> emotions, hormone levels, ambient temperature, and so forth--that it is
> impossible to predict accurately.
HORSEPOOEY!! The vast majority of diabetics are predicting and
controlling their glucose levels quite accurately, thank you, in a wide
range of situations, from mountain climbing and auto racing to triathlon
and scuba.
A type I diabetic who's never had a
> hypoglycemic event is truly a rarity, not the other way around.
Quite true. But not with the same frequency as, say, near misses on the
freeway, and a hypoglycemic event is not much of an event, as events go
except in rare instances (probably quite less frequency than a death on
the highway).
>there is no such thing as a perfectly-controlled diabetic.<
There is no such thing as a perfectly-controlled anything. Stop blowing
the risk out of all proportion. You're a doc, you should know:
How many under age 65 diabetics in the US?
What is the frequency of total loss of control (unconsciousness)in that
group?
How does that frequency compare with, say, postal workers offing their
co-workers?
We would all agree that the diving risk of
> hypoglycemia is certainly not minor.
No, not all of us. I, for one, find the diving risk of hypoglycemia to
be about equal to being buggered do death by a horny loggerhead, and I
think I could quickly find a few dozen other diabetics that would agree.
Diving with physicians is dangerous - an MD from Chicago damn near
killed me a few years ago. Diving with diabetes has never even rated a
close call.
regards
m
Scuuba me
>The thousands of diabetics diving have learned for themselves and from
>other diabetics to manage their glucose levels while diving.
>Hypoglycemic reactions underwater are very similar to same above water,
>and are no more difficult to deal with.
Glad to see that there is someone else out there with some common sense.
Pete Plocher
The YMCA Scuba Program does accept insulin dependent diabetics for entry
level dive training. Please check out the Y Scuba Program's home page at
www.seascripts.com/-ymca/
for the YMCA Scuba Program's Diabetic Diver Protocol. This protocol was
developed by the Y Scuba Program's Medical Advisor in consultation with the
physicians familiar with the affects of diabetes on physically active
people and diabetes self management.
Pete Plocher
YMCA Instructor
Mike Gray <omg...@worldnet.att.net> wrote in article
<60438c$q...@bgtnsc03.worldnet.att.net>...
J. Middleton
Lots of emotions get involved when this subject comes up. Some points to
consider: 1) In reality diabetic divers Have a better safety record than
non diabetic divers (Alert Diver jan/feb) 2) In the US, diabetics has the
legal right to dive (ADA passed in 1990 or 91). 3) DAN sells dive
insurance and has a great incentive to control who dives (conflict of
interest).
Also consider that if DAN were to be allowed to push it's "absolute
contradictions" based on DAN's own whim (which is how the original list
was concieved), DAN may decide to prohibit 40+ year olds from diving
because the risk of heart attack is too great.
People have the right to their own opinions, it's just unfortunate that
that some people are not content with an opinion, they have to control
too.
Mike Gray
Le Belgo <leb...@aol.com> wrote in article
My posting was the expression of an opinion
> that I think diving with type I diabetes is very dangerous and a bad idea
> in general. So is cliff diving.
> Everyone has to pick his risks. The risk of death when driving
> sober, alert, and in good health is minimal compared to the risk of
diving
> while on insulin.
Studies by DAN indicate that this IS NOT SO. Extended deco is not a good
idea, but the risk if no deco/limited deco scares me much less than driving
(and I also drove race cars for 27 years).
Just as drinking greatly increases the risks involved
> with driving, being on insulin greatly multiplies the inherent risks of
> diving.
You should also understand, as an MD, that greatly multiplying an extremely
small risk leaves you with an extremely small risk.
regards
m
Reef Fish (Large Nassau Grouper)
Mike Gray wrote:
>
< ... most of the cogent points snipped for brevity here ... >
>
> You should also understand, as an MD, that greatly multiplying an extremely
> small risk leaves you with an extremely small risk.
An important point that's often overlooked in risk-related debates.
Here's my anecdotal account of the fact that MANY (not all, of course)
MDs
are not the best when it comes to risk (or probability, ANY probability)
assessments.
Some years ago, I was involved (in the design stage) in a large-scale
statistical study of "the efficacy of x-rays" in the diagnosis of skull
and other bone fractures in emergency-room settings.
MDs were asked to assess the PROBABILITY of a fracture BEFORE, and AFTER
x-rays were taken (mostly for medicolegal reasons). In field testing
the QUESTIONNAIRE, we were soon struck by the fact that many MDs not
only couldn't THINK in probability terms, but they couldn't think,
PERIOD!
For PROBABILTY responses, ... , one of the COMMON answers was "1.96".
<G>
Needless to say, we had to REVISE the questionnaire to keep MDs from
making such un-thinking blunders in their responses, AND introduce
short training sessions for MDs to know HOW to answer questions of
quantitative assessments of risks and uncertainties.
The above having said, I'll add that I've TAUGHT MDs in elementary
and advanced courses in stat. AFTER they have already received their
MD degrees. SOME of these are extremely competent in risk assessments
and statistics. So, this is just a disclaimer (of sorts) that I am
NOT flaming all MDs. :-) Only some of them, especially those who
came up with a PROBABLITY figures greater than 1.0. ;-)
What's the moral of the story? I dunno for sure. Perhaps something
to the effect that just because one is good in ONE FIELD (such as
doctoring patients) doesn't mean the same person is necessarily any
good in another, not even to the sub-minimal level (as in the case
of MDs not having any idea what probability numbers MEAN).
Stepping off anecdotal soapbox ...
-- Bob.
-- Bob.