Review

Reviewed Work(s): Practical Statistics for Medical Research by Douglas G. Altman

Review by: Jeffrey Gornbein
Source: Clinical Infectious Diseases, Vol. 14, No. 1 (Jan., 1992), p. 370
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/4456294
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370

BOOK REVIEWS
Practical Statistics for Medical Research

material to be absorbed by the novice at once, it is a useful

reference tool for the physician who needs to understand any of

By Douglas G. Altman. New York: Chapman & Hall, 1991.

611 pp., illustrated. $75.

the commonly used statistical methods and who is unable to

consult with a statistician.

Altman has written a comprehensive book covering the full

Jeffrey Gornbein

range of techniques for elementary statistics used in routine (and

Department of Biomathematics/SBCC,

not so routine) medical research. Examples in the book are

taken exclusively from the medical literature and are usually

University of California, Los Angeles

referenced, making them realistic applications for the biomedi-

cal reader. While the publication is too detailed for the beginning student, it is appropriate for the physician who is involved

in medical research but does not have a complete background in Principles and Practice of Clinical Virology
elementary statistics. Because the work covers a wide range of Edited by A. J. Zuckerman, J. E. Banatvala, and J. R. Pattison.
basic techniques, it is also useful as a reference book.

2nd ed. New York: John Wiley & Sons, 1990. 643 pp., illus-

In addition to covering the standard topics found in almost all trated. $180.

texts on statistics (e.g., descriptive statistics for a continuous

variable, interval estimation and hypothesis testing for means,

Clinical virology, as defined in the preface to the first edition

correlation, and regression), Altman includes chapters on study of this textbook, is the study of the etiology, diagnosis, treatdesign, issues involving the use of computers, survival analysis ment, and prevention of viral infections in humans. In the past,

(including the Cox, or Proportional hazards, model), logistic the relevance of establishing a viral diagnosis was suspect, as this
regression, reliability, and inter rater agreement. He also in- process was regarded as time-consuming, too expensive and
cludes a final chapter on statistics in the medical literature. He technically demanding, and retrospective in nature, and the reincludes a discussion of the statistics useful in epidemiology, sults rarely exerted an influence on patient care. However, drasuch as the relative risk and odds ratios in the chapter on the matic changes during the past 10-15 years have altered this
analysis of categorical data. Inclusion of all these topics is an view. Technological developments and improvements in methimprovement over the standard practice of discussing only theodology have had a significant impact on rapid diagnosis of viral
X2 and Z tests.

infections, and, in combination with the advent of effective anti-

Although the topics outlined above are covered in other pub- viral therapy, these developments have directly influenced palications, it is rare to find one text in which they have all been tient care today. In addressing these observations, this book's
assembled for convenience. The book addresses the needs of the main emphasis is on the clinical features, diagnosis, and manage-

consumer of statistical methods and aims to give the reader ament of viral infections.
qualitative understanding, not technical mastery. Complicated
The 42 contributors to the second edition of Principles and
mathematics is omitted for the most part. Altman includes dis- Practice of Clinical Virology are primarily, but not exclusively,
cussion of some technical material but separates it from the from the United Kingdom and are well-recognized, knowledgemain narrative and indicates when the section can be skipped able specialists who are active in the investigation of the virus
without loss of understanding.
each reviews. The book consists of 17 chapters that are divided
Particularly refreshing is the coverage given to the median as into major subdivisions covering the review of viral properties
an inferential statistic. Altman mentions confidence intervals and the epidemiology, pathogenesis, clinical features, diagnosis,
for a median and includes the usual discussion of confidence and management (including antiviral therapy, immunoprophyintervals for a mean in the chapter on inference (Chapter 8). In laxis, and control measures) of infections due to each virus. The
that chapter, he states that it is better to report a median if the emphases within the major subdivisions vary depending on the
distribution of the data is skewed. Altman is careful in explain- point of view of the author and current research developments

ing the difference between regression and correlation and dis- surrounding each virus; for instance, the subdivisions that cover

cusses the misuse of the correlation coefficient. He not only the management of infections due to herpes-group viruses and
presents simple examples of regression and correlation but also those due to the human immunodeficiency virus place greater

reviews some of the more common pitfalls in the application of emphasis on antiviral therapy, whereas use of vaccines is more
the regression method (such as spurious correlations, due to thoroughly discussed in those chapters that deal with viral infeccorrelations with time and mixing samples of different popula- tions readily managed by this measure, e.g., smallpox, rabies,
and rubella.
tions, and partial correlation).

The few deficiencies in the book are minor. For example,

Changes in the second edition include revisions to each

Altman does not sufficiently caution the reader on overuse of Pchapter, some extensive, that reflect recent advances in viral
values, although he does mention that the P value is uninforma- taxonomy and physical and/or biochemical characterization of
tive if it is the only statistic reported.
each virus, improvements in methods of laboratory diagnosis

Throughout the book, the emphasis is on practical applica- (especially in direct detection of viral antigen or nucleic acid
tion, as the title indicates. Although the book covers too much with use of monoclonal antibody, hybridization, or polymerase

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