Jules Gavarret's Principes Généraux de Statistique Médicale

Abstract

The burgeoning support for evidence-based medicine in the 21st century has made clear why physicians must depend on quantitative data generated by clinical trials for decisions about treatment. The value to them of data reported from trials depends in part on the adequacy of a trial’s design and how carefully the trial carried out an appropriate design. In addition, if the conclusions reached in a trial are to be reliable, they must be justified by appropriate statistical assessment of the data reported. Today’s ubiquity of statistical analysis of data from clinical trials developed mainly during the second-half of the 20th century. But the concept of needing numerical data to justify conclusions about treatments goes back at least three centuries. An early major attempt to assess with quantitative data the validity of a medical treatment came in the first half of the 18th century, when James Jurin and other English physicians gathered data on differences in mortality from smallpox inoculation as a preventive treatment compared with mortality from naturally-acquired smallpox. Jurin’s judgments, however, came simply from inspecting those mortality data and not from critical statistical analysis of the validity of conclusions that might be drawn from them; such statistical methods had not surfaced for applications in medicine. His use of such mortality data can be described as descriptive statistics – crudely put, ‘simply eyeballing the data’. Jurin’s simple statistical assessment of quantitative data was only one of an increasing number of such assessments in 18th century Britain. But these judgments relied, in essence, on comparing mortality or morbidity proportions in groups of treated and untreated persons. Even the concept of considering the value of data for judgments began to be entertained. For example, in 1785 Gilbert Blane noted that: ‘There is . a great difficulty attending all practical inquiries in medicine; for in order to ascertain truth, in a manner that is satisfactory to a mind habituated to chaste investigation, there must be a series of patient and attentive observations upon a great number of cases, and the different trials must be varied, weighed, and compared, in order to form a proper estimate of the real efficacy of different remedies and modes of treatment.’

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