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Medical decision making often involves measures of uncertainty, including the explicit use of probability. To the degree uncertainty is present, the quality of a medical decision clearly depends on avoiding violation of the laws governing probability. Adherence to the laws of probability is analogous to following the laws of geometry when computing distances or the characteristics of an object, such as its volume. The basic laws of probability are quite simple, but their application can be subtle, and they are easily violated. Intuition about uncertainty is often at odds with those laws, especially when probabilities are small, conditional, or must be combined.

Violations of the laws of probability arise in other ways. For example, not using probability to measure uncertainty can be problematic in some methodologies, such as those based on fuzzy set theory. Even when a decision-making methodology is inherently probabilistic, misinterpretations and violations of the laws can occur. For example, in Bayesian statistical analyses, medical professionals are sometimes asked to provide input in the constrsuction of prior distributions. This is a relatively new context in which there is great potential for violating the laws of probability.

The Laws of Probability

The axiomatic foundation of probability, and the multitude of theorems derived from it, constitutes the formal—and vast—theory of probability. These, more technical, results are not the subject of this entry. The violations considered here concern the basic laws of probability, which are as follows. Suppose T is an event about which there is uncertainty, such as whether a subject will respond to a treatment. Let A be another event, such as whether the subject will experience an adverse event while responding to treatment. Denote by P(·) the probability of an event. Thus, P(A) is the probability of an adverse event. If one knows that event T has occurred, then the conditional probability of A given T is written as P(A|T), where the vertical line means “given.” All probabilities, conditional or otherwise, for any events E and F, must conform to the following laws:

  • 0 ≤ P(E) ≤ 1; this is the convexity law.
  • If E and F are mutually exclusive (the occurrence of one precludes the occurrence of the other), then P(E or F) = P(E) + P(F); this is the addition law.
  • P(E and F) = P(E|F)P(F) = P(F|E)P(E); this is the multiplication law for the conjunction of E and F.

These laws easily extend to more than two events.

Basic Consequences of the Laws

A useful consequence of the convexity law (1) is that the probability of the opposite or complement of an event E, denoted by Ec, is 1 – P(E). In the addition law (2), note that the “or” in the event “E or F” is not exclusive. The statement of the law proceeds from the assumption that E and F cannot occur simultaneously; that is, they are mutually exclusive. This would hardly be reasonable in the illustration given. One cannot typically preclude the occurrence of an adverse event in a treated subject. In such a case, where E and F are not mutually exclusive, one adjusts by subtracting the probability of their conjunction, a result called the addition

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