Eur J Plast Surg (2004) 27:53–54
Statistics and plastic surgeons
Received: 12 September 2003 / Accepted: 20 November 2003 / Published online: 27 March 2004
Every investigator stands in need of expert criticism,
for no pursuit runs between so many pitfalls
and unseen traps as that of statistics - Francis Galton
In the operating room, we must base our actions on pro-
ven facts: facts that no lawyer or jury will doubt. If we
want a loan, we must prove to the banker the basic facts:
how do we pay it back? Are we not living in a fact-
minded civilization? Not in a world of imaginations,
dreams, wishes and whims? Can we simply divide rea-
soning into cognition and emotion?
When a patient consults us, we give advice which
obviously must conform to reality [1, 2]. This is not al-
ways easy, for example, in the presence of a malignancy.
Statistics may help, this is evidence based medicine. We
are admonished, because we cannot reach a scientific
conclusion without statistics for evidence . Without
science, is medicine not often a deception or, what law-
yers call fraud? Evidence based medicine has been de-
fined as the process of constant, systematic inquiries,
judgements, and the use of the most recent scientific in-
sights as a constant base and it is a must for our daily
medical decisions. We know this, so what is new? Prob-
ably the words “systematic” and “constant”.
Detailed evidence based help comes from the US
National Library of Medicine, the Index Medicus, and
from Medline (free of charge). If you want to know evi-
dence based opinion, for example, on “smoking cessa-
tion” you will find 3932 papers on this subject. If this is
too much information, then you can combine “smoking
cessation” with “therapeutic use of nicotine”, and end up
with 172 titles.
Now perhaps you may consider time as being signifi-
cant, and buy a Swiss time piece. Yet, the president of the
oldest watch manufacturing company said, “When we sell
a watch, we are selling 90% emotion. For us watchmak-
ers, it is the customer with his emotions who is more
important than the excellent time piece he buys!”. This:
inner reality? And our statistics: outer reality? Goethe,
200 years ago, said: “We like individuality; hence our
great pleasure in memoirs, confessions, letters, anecdotes,
even of unimportant individuals” .
Statistics, in general, deal with groups, with collec-
tives. The larger the statistically tested/evaluated group,
the higher the significance of the statistical result. “There
can be little doubt indeed, that every science as it pro-
gresses will become more and more quantitative. Nu-
merical precision is the soul of science” . However,
70 years later, in 1958, Dwight Ingle  stated, “Science
cannot be equated to measurement.....for example, the
editorial policies of many scientific journals support the
publication of data and exclude the communication of
ideas”. Einstein’s dictum was, “Imagination is more im-
portant than science!” We all know Disraeli’s saying,
“There are three kinds of lies: lies, damned lies, and
statistics” . What is wrong, especially in medicine,
with statistics? We have been told:
– Wrong methods have been used
– Correct statistical methods have been used in the
– Statistical results have been interpreted in the wrong
– Patients and healthy volunteers are both considered to
be comparable for statistical use
– Too few patients have been used for statistical analysis
We realize that in medicine, in plastic surgery, statis-
tical results concern the average and much less our pa-
tient, sitting in front of us. For his problem, he usually
– A simple solution, not complicated surgery
– How much pain?
– How much personal risk?
– Visible scars?
– How long in the hospital, how long out of work?
– Who pays?
L. Clodius (
Weid 17, 8126 Zumikon, Switzerland, Fax: +41-1-9182117