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Nostalgia
Submit responseRe: Dr. Zwillich complains that my criticism of the “nomogram” epidemic was “fundamentally unsubstantiated.” Moreover, he suggests that use of computers “numbs” physicians. I infer that he would prefer to return to the days of slide rules for physics problems and pencil-and-paper arithmetic for completing income tax returns. When slide rules were used, mistakes by a factor of 10 were easy to make, since the placement of the decimal could be unclear. This does not happen with a calculator. While the utility of electronic vs. hand calculations may be a testable hypothesis, some benefits of technology are self-evident(1).
Despite Dr. Zwillich’s apparent nostalgia, I do not miss the “good old days” of hand calculations. Judging from the ubiquitous use of computers and calculators in everyday life, I am not alone.
References
1. Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327:1459-61.
Conflict of Interest:
None declared
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Nomograms may be relics, but where is the evidence?
Submit responseDr. Grimes's review of the history of nomograms was informative. However, his criticism of the "epidemic" of nomogram resurgence was fundamentally unsubstantiated. Grimes states that "...nomograms provided speed in calculation at the cost of precision", without providing any evidence that the lost precision mattered. Where is the evidence, for example, that calculating likelihood ratios to additional decimal places improves clinical decision making? Conversely, where is the evidence that calculating medication doses using a body surface area nomogram adversely impacted patient well-being?An alternative, testable hypothesis is that contemporary reliance on computer-generated numbers numbs physicians to the meaning of their calculations and blinds them to errors that would have been obvious on a nomogram. Personal computing may be more convenient than nomograms, but inconvenience does not equal inappropriateness ("Hence, the resurgence of this relic is inappropriate").
Conflict of Interest:
None declared