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Bayes Theorem (continued)...

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that, notwithstanding the test result, the cause may be cardiac in origin and he may be at risk for further problems which will need immediate medical attention?" The answer to these questions is found in all of the major textbooks on cardiology, and summarized in various versions of the illustration on page 1, using Bayesian analysis. In the graph, the horizontal axis is the pretest probability of coronary artery disease, which, in this case, was roughly 85 percent. The vertical axis is the posttest probability that coronary artery disease caused the symptoms. The column indicating (+ST) refers to a positive

test suggestive of ischemia; the column indicating (-ST) refers to a negative test result. The chart clearly demonstrates that when the pretest probability is 85 percent and the treadmill test is negative, the posttest likelihood that the symptoms were caused by coronary artery disease is still greater than 50 percent. The physician who understands the limitations of the treadmill stress test and the principles of Bayesian analysis is never justified in reassuring a patient that typical angina is not caused by coronary artery disease. By doing so in this case, the defendant created a false

sense of security in Mr. Johnson. Plaintiffs argued that "forewarned is forearmed" and that instead of being forewarned, Mr. Johnson left the hospital disarmed by the poor advice given by Dr. Truong. Bayesian principles apply to many types of clinical and laboratory tests done in many aspects of medicine. In every case where a diagnosis is missed, justified on the basis of a test result, it is important to find out what the sensitivity and specificity of the test is, and how Bayesian analysis comes into play to determine the posttest likelihood of disease, notwithstanding a negative test result.

Sport Utility Vehicle Rollovers Continue To Claim Lives

By Patrick A. Hamilton

On July 7, 1995, after a two-month trial, a St. Louis jury awarded $30,000,000 actual damages plus $60,000,000 punitive damages to a woman paralyzed in the rollover of the Suzuki Samurai four-wheel-drive vehicle. The jury found Suzuki knew the Samari was unreasonably prone to rolling over.

On October 30, 1995, an Indiana jury awarded $63,000.000 in damages to two women seriously injured in the rollover of a Ford Bronco II. Deliberating for two and one half hours after a three-week trial, the jury found Ford knew that its Bronco II contained design flaws that contributed to the rollover.

These verdicts bring to light what automobile manufacturers have known for decades: Sport utility vehicles rollover from 5 to 11 1/2 times more often than passenger cars. Vehicles such as the Bronco II, Suzuki Samurai, Toyota 4Runner and Isuzu Trooper have a much greater propensity to roll over than other passenger vehicles because of their short wheel bases, narrow track widths and high centers of gravity.

Rollovers account for 20% of all motor vehicle deaths, but they are involved in 80% of deaths in single-vehicle crashes of small utility vehicles. Only head-on collisions involving alcohol rival deaths associated with rollover accidents. In 1990, 9,565 persons were killed in passenger vehicle rollovers. Small utility vehicles have, by a wide margin, the worst rollover fatality record with 5.7 occupant deaths for every 10,000 registered vehicles. These vehicles far outstrip automobiles and pickups in their fatality experience.

Nevertheless, manufacturers continue to produce utility and other vehicles with poor stability characteristics because no vehicle manufactured or sold in the United States is required to meet any type of minimum stability standard.

In 1973, the National Highway Traffic Safety Administration ("NHTSA") issued two Advance Notices of Proposed Rule Making, one on rollover resistance and the other covering steering control while braking and turning. After strong opposition by automobile manufacturers, neither standard was pursued, and no rules were passed. In 1992, nearly two decades later, NHTSA issued another Advance Notice of Proposed Rule Making for rollover resistance. Automobile manufacturers again opposed any such standards and none were developed even though NHTSA's own engineers concluded that "a high degree of correlation exists between the risk of vehicle rollover and the vehicle rollover stability factor."

The vehicle "rollover stability factor," adopted by many as an accurate indicator of whether a vehicle has an unreasonable tendency to roll over, is derived by the mathematical formula T/2H, where T is the vehicle's track width (measured side-to-side between the center of the tires), divided by H (the height of the vehicle's center of

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