CHEE 3334

Numerical and Statistical Methods

in Chemical Engineering
Problem:
2-115 (p. 50, Montgomery and Runger, 5th Ed.)
An article in the British Medical Journal [“Comparison of Treatment of Renal Calculi by Operative
Surgery, Percutaneous Nephrolithotomy, and Extracorporeal Shock Wave Lithotripsy” (1986, Vol. 82, pp.
879–892)] provided the following discussion of success rates in kidney stone removals. Open surgery had
a success rate of 78% (273/350) while a newer method, percutaneous nephrolithotomy (PN), had a
success rate of 83% (289/350). This newer method looked better, but the results changed when stone
diameter was considered. For stones with diameters less than two centimeters, 93% (81/87) of cases of
open surgery were successful compared with only 83% (234/270) of cases of PN. For stones greater than
or equal to two centimeters, the success rates were 73% (192/263) and 69% (55/80) for open surgery
and PN, respectively. Open surgery is better for both stone sizes, but less successful in total. In 1951, E.
H. Simpson pointed out this apparent contradiction (known as Simpson’s Paradox) but the hazard still
persists today. Explain how open surgery can be better for both stone sizes but worse in total.

Solution:
Given

Treatment
Open Surgery (OS) Percutaneous Nephrolithotomy (PN)
Stone size
Group 1 Group 2
Small stones (𝐷𝐷 < 2 cm)
93% (81/87) 87% (234/270)
Group 3 Group 4
Large stones (𝐷𝐷 ≥ 2 cm)
73% (192/263) 69% (55/80)
Both sizes of stones 78% (273/350) 83% (289/350)

the problem is asking: “How come 93% > 87% and 73% > 69% but 78% < 83%?

This is a good example of how careful one has to be when estimating probabilities by simply
taking ratios of outcomes over total possible outcomes. 1 For example, when calculating the probability
of getting a 9 when tossing two dice, the standard calculation is
# of outcomes with total equal to 9 # {3,6}, {4,5}, {5,4}, {6,3} 4
𝑃𝑃[𝑋𝑋 = 9] = = = = 0.11
total # of outcomes total # of outcomes 36

1
The idea is also discussed in the context of a random sample.
which tacitly assumes that no tossing outcome is preferred over any other. 2

Similarly, when calculating the probability that Open Surgery (OS) is successful as
273
𝑃𝑃[OS successful] =
350
given 273 successful OS cases out of 350 total cases, there is a tacit assumption that no case is
preferred over any other; each case could result in successful OS just like any other. But this is not true.
Some classes of cases are distinctly different, e.g. they are more difficult than others (e.g. with large
stones), receive different attention, etc. Therefore the calculation
# of successful OS cases 81 + 192 273
𝑃𝑃[OS successful] = = = = 0.78
total # of OS cases 87 + 263 350
is not appropriate, as not all 350 cases are similar.

A better alternative is to use the total probability rule, to distinguish between large and small
stones with corresponding probabilities of success for each treatment:

𝑃𝑃 [OS successful] = 𝑃𝑃[OS successful | Small stone]𝑃𝑃 [Small Stone] +

+ 𝑃𝑃[OS successful | Large stone]𝑃𝑃[Large Stone]
= 0.93𝑥𝑥 + 0.73(1 − 𝑥𝑥)
and

𝑃𝑃[PN successful] = 𝑃𝑃[PN successful | Small stone]𝑃𝑃[Small Stone] +

+ 𝑃𝑃 [PN successful | Large stone]𝑃𝑃[Large Stone]
= 0.87𝑥𝑥 + 0.69(1 − 𝑥𝑥)

𝑃𝑃[OS successful] > 𝑃𝑃[PN successful]
for any value of 𝑥𝑥, the probability of a stone to be small. To be more specific, assuming that 𝑥𝑥 =
87+270
= 0.51 
87+270+263+80
𝑃𝑃[OS successful] = 0.83 > 𝑃𝑃[PN successful] = 0.78

In summary, when the less effective treatment is applied more frequently to less severe cases, it
can appear to be the more effective treatment.Error! Bookmark not defined.

2
One would be tempted to say “each tossing outcome is equally likely”, but we have explained how this
statement is circular, therefore not well posed, because “equally likely” means “equally probable”, and
probabilities have not been calculated yet.