Berkson's paradox

Berkson's paradox, also known as Berkson's bias, collider bias, or Berkson's fallacy, is a result in conditional probability and statistics which is often found to be counterintuitive, and hence a veridical paradox. It is a complicating factor arising in statistical tests of proportions. Specifically, it arises when there is an ascertainment bias inherent in a study design. The effect is related to the explaining away phenomenon in Bayesian networks, and conditioning on a collider in graphical models. It is often described in the fields of medical statistics or biostatistics, as in the original description of the problem by Joseph Berkson. The most common example of Berkson's paradox is a false observation of a negative correlation between two desirable traits, i.e., that members of a population which have some desirable trait tend to lack a second. Berkson's paradox occurs when this observation appears true when in reality the two properties are unrelated—or even positively correlated—because members of the population where both are absent are not equally observed. For example, a person may observe from their experience that fast food restaurants in their area which serve good hamburgers tend to serve bad fries and vice versa; but because they would likely not eat anywhere where both were bad, they fail to allow for the large number of restaurants in this category which would weaken or even flip the correlation. Berkson's original illustration involves a retrospective study examining a risk factor for a disease in a statistical sample from a hospital in-patient population. Because samples are taken from a hospital in-patient population, rather than from the general public, this can result in a spurious negative association between the disease and the risk factor. For example, if the risk factor is diabetes and the disease is cholecystitis, a hospital patient without diabetes is more likely to have cholecystitis than a member of the general population, since the patient must have had some non-diabetes (possibly cholecystitis-causing) reason to enter the hospital in the first place.