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Comment & Response |

Risk Prediction for Individuals—Reply

Allan D. Sniderman, MD1; Ralph B. D’Agostino Sr, PhD2; Michael J. Pencina, PhD3
[+] Author Affiliations
1Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
2Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
3Duke Clinical Research Institute, Duke University, Durham, North Carolina
JAMA. 2015;314(17):1875-1876. doi:10.1001/jama.2015.12221.
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In Reply We agree with Dr Van Calster and colleagues that risk assessment is valuable in the care of individuals. We stated in the conclusion of our Viewpoint that “Predictive algorithms are an essential component of guideline recommendations.” The phrase about probability not being meaningful in the individual context was misunderstood and not intended to imply that calculating individual risks was not useful.

Instead, we wanted to direct the reader to the excellent discussion by Cohen1 of the limitations of the frequentist notion of probability understood as an estimate of the frequency of a particular event in a total sequence of events. Basically, we meant that frequentist probability is not verifiable in an individual context because a person either experiences or does not experience the event. Consequently, we agree that calibration is important in the assessment of predictive model performance.

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November 3, 2015
Ben Van Calster, PhD; Ewout W. Steyerberg, PhD; Frank H. Harrell, PhD
1Department of Development and Regeneration, KU Leuven–University of Leuven, Leuven, Belgium
2Department of Public Health, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA. 2015;314(17):1875. doi:10.1001/jama.2015.12215.
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