Number Doctors: The Emergence of Biostatistics and the Reformation of Modern Medicine

7.项目总结/摘要 统计学从根本上改变了世纪医学的实践和意义。 尽管保险公司和公共卫生改革者一直依赖于精算和统计计算， 20世纪30年代，在医学文献中很少发现正式的统计测试和测量。只是 然而，半个世纪后，统计计算对临床医生和病人都是必不可少的 寻求衡量新药的疗效，选择治疗方案，建立临床 实践指南，推荐筛查测试，或评估日常暴露的致癌性。 统计驱动的创新，如随机临床试验、荟萃分析、n-of-1和自适应 试验以及前瞻性和回顾性研究已成为现代医学的主要工具。 然而，令人惊讶的是，我们对生物统计学的出现和相关的临床领域知之甚少。 流行病学大多数现有的医学史都注意到了医学解释试验的兴起 作为医生改革者的一种策略，他们希望减少偏见和主观性在医学中的作用， 历史学家们还没有认真地参与技术变革， 一个平均值和聚合的领域（主要用于流行病学家），适用于决策 在个人（临床）水平上。这种转变是有争议的，并面临阻力 来自许多方面，但特别是来自外科和其他程序繁重的专业。这笔赠款 将支持出版一本专著《医生人数：生物统计学的出现》， 现代医学的改革，这将重塑我们对统计学和统计学家如何 在现代医学中扮演了变革性的角色。该专题论文将部分集中在一个 1947年，在社会学家哈罗德多恩的领导下，国家癌症研究所聘请了一群生物统计学家， 但这很快就在美国国立卫生研究院和其他联邦机构，包括 食品和药物管理局，环境保护局，卫生，教育和福利。 其他章节将追溯统计措施的传播，从人口遗传学和农业， 大学的生物统计学和临床流行病学课程以及 专业期刊和专业组织。最后一章将追溯现在的起源- 常用工具如元分析和模拟建模。利用档案材料以及 医疗改革者的叙述，由此产生的专著将是第一部扩展的历史， 生物统计学和临床流行病学，并将有助于更大范围的讨论数据的作用， 风险计算，以及“循证”和“精确”医学的含义。

7. Project Summary/Abstract Statistics fundamentally transformed the practice of and meaning of medicine in the twentieth century. Though insurers and public health reformers had relied on actuarial and statistical calculations for years, formal statistical tests and measures were rarely found in the medical literature in the 1930s. Just a half century later, however, statistical calculations had become essential for clinicians and patients seeking to measure the efficacy of new drugs, choose among treatment options, establish clinical practice guidelines, recommend screening tests, or assess the carcinogenicity of everyday exposures. Statistically-driven innovations such as randomized clinical trials, meta-analyses, n-of-1 and adaptive trials, as well as prospective and retrospective studies have become central tools of modern medicine. Yet we know surprisingly little about the emergence of biostatistics and the related field of clinical epidemiology. Most existing histories of medicine have noted the rise of statistically-interpreted trials as a strategy of physician-reformers looking to reduce the role of bias and subjectivity in medicine but historians have yet to seriously engage with the technical transformations that enabled what was once a field of averages and aggregation (and mainly of use to epidemiologists) to be applicable to decision making at an individual (clinical) level. This transformation was controversial, and faced resistance from many quarters, but particularly from surgical and other procedure-heavy specialties. This grant will support production of a monograph, Number Doctors: The Emergence of Biostatistics and the Reformation of Modern Medicine, that will reframe our understanding of how statistics and statisticians came to play a transformative role in modern medicine. The monograph will partially center on a group of biostatisticians hired in 1947 under sociologist Harold Dorn at the National Cancer Institute, but that soon worked across the National Institutes of Health and other federal agencies, including the Food and Drug Administration, Environmental Protection Agency, and Heath, Education, and Welfare. Other chapters will trace the spread of statistical measures from population genetics and agriculture to biostatistics and clinical epidemiology programs at universities as well as the development of specialized journals and professional organizations. The final chapters will trace the origins of now- common tools like metanalysis and simulation modeling. Drawing on archival materials as well as accounts of medical reformers, the resulting monograph will be the first extended history of biostatistics and clinical epidemiology, and will contribute to larger discussions about the role of data, risk calculations, and the meaning of “evidence-based” and “precision” medicine.