Dicing with Death

Stephen Senn

Cambridge University Press, Cambridge, 2003.
ISBN 0-521-54023-2

….the twain were casting dice

The game is done! I’ve won! I’ve won!

Quoth she and whistles thrice.

Coleridge, The Rime of the Ancient Mariner.



Statistics is a wonderful discipline. It has it all: mathematics and philosophy, analysis and empiricism, as well as applicability, relevance and the fascination of data. It demands clear thinking, good judgement and flair. Statisticians are engaged in an exhausting but exhilarating struggle with the biggest challenge that philosophy makes to science: how do we translate information into knowledge? Statistics tells us how to evaluate evidence, how to design experiments, how to turn data into decisions, how much credence should be given to whom to what and why, how to reckon chances and when to take them. Statistics deals with the very essence of the universe: chance and contingency are its discourse and statisticians know the vocabulary. If you think that statistics has nothing to say about what you do or how you could do it better, then you are either wrong or in need of a more interesting job.

In this book Stephen Senn explains what statistics is and what isn't, how medical statistics is essential to evaluating the effects of medicines, to understanding the spread of epidemics, and to examining the causes of disease. He shows that when it comes to rational decision-making if you can't count you don't count.




    1. Circling the Square
    2. The Diceman Cometh
    3. Trials of Life
    4. Of Dice and Men
    5. Sex and the Single Patient
    6. A Hale View of Pills
    7. Time's Tables
    8. A Dip in the Pool
    9. The Things that bug us.
    10. The Law is a Ass
    11. The Empire of the Sum


 Order this book from Cambridge

Japanese translation of Dicing with Death (Published by Seidosha)

There is now an Open University course based on the book. See Open University course - Chance, Risk and Health


About the Author

Stephen Senn is originally from Switzerland and grew up in the Alps. He studied Economics and Statistics at Exeter University and obtained his PhD at The University of Dundee.He is currently head of the competence Center for Methodology and Statistics at the Luxembourg Institute of Health. He was Professor of Statistics at Glasgow University (2003-2011), was previously Professor of Pharmaceutical and Health Statistics at University College London and prior to that head of the Bone, Allergy, Asthma group in the Biometrics Department of CIBA-Geigy (now  Novartis) in Basle, Switzerland. Stephen is married and has two children. His main interests apart from statistics are hill-walking, ski-touring and reading. In addition to Dicing with Death, for Cambridge, he has written two books for Wiley, Cross-over Trials in Clinical Research(second edition 2002) and Statistical Issues in Drug Development, 1997.(Second edition 2007)


From the Reviews

Senn's canvas is much wider, and includes many examples of the paradoxical nature of probability, the philosophy of scientific inference, and fascinating insights into the often monstrous egos of the founders of this most misunderstood of academic disciplines. The results reflects the subject itself: thought provoking and rewarding, though intellectually demanding...Whether your taste is for the nitty-gritty of controversies...or the philosophy of knowledge, you will find much of value here. Robert Matthews, New Scientist.

 If anyone can make statistics interesting, it's Senn. Far too few people will read this book. For one thing, it contains equations, each of which, as Stephen Hawking noted, is likely to cut potential sales in half. In addition, the book deals with statistics--almost everyone's nominee for most boring subject. Still, Senn, a medical statistician at University College London, succeeds brilliantly in overcoming these obstacles. He is witty, provocative, and passionately determined to get across to readers that statisticians truly tackle 'the biggest challenge . . . how do we translate information into knowledge . . . turn data into decisions? Robert Adler

Senn is urbane, charming, and often funny. He uses quotes a lot, and is not averse to using them against his own values…So who is this book for? Anyone seeking understanding, teacher or student, professional or public. You might need a dictionary occasionally, but otherwise you can read this in bed or on the beach, and it won't be out of place. Bandolier loved it.

Senn clearly doesn't subscribe to theshort cuts make long delays; school of writing. Ads for French films, jokes, a Welsh legend or two, all make their way into the book, along with some history and biography and plenty of personal anecdote (the problem with being Swiss, the stupidity of journalists). The style can be summed up with the quote: "Quite frankly, if I cannot indulge a Shandy-like passion for hobby-horses then there is no fun in writing a book like this." And Senn certainly seems to have had fun, indulging himself in flights of fancy and metaphor ...if you would like to persuade people that statisticians count, why not take the easy way out and give them this book? Significance.

Senn is often uproariously funny, which is remarkable in a book that covers so much technical, philosophical and historical ground...it is an idiosyncratic romp and an affirmation of the centrality of quantitative reasoning in decision-making and scientific inference. Nick Barrowman, JAMC

...this well-written and often entertaining book. Brian Everitt, Statistical Methods in Medical Research.

The author's humour and wit is evident throughout, making the book informative but fun to read. I hope that my copy

returns, otherwise I will have to purchase another! Steve Jones, SPIN.


...a great read. This is the ideal book for the pharmaceutical statistician who wants to broaden their knowledge of their chosen subject. Andrew Garrett, Pharmaceutical Statistics.


Have you ever been really entertained reading a book on statistics? No? Then, you should try this book by Stephen Senn. Biometrics

Stephen Senn has attempted to do for medical statistics what Stephen Hawking did for physics in A Brief History of Time (Bantam Press, 1988) and Simon Singh did for pure mathematics in Fermat's Last Theorem (Fourth Estate, 1997). I think he has succeeded. Deborah Ashby, British Medical Journal.

In this superbly written book, the author sets out to celebrate the role and contribution of statistics in the life sciences. He accomplishes this by providing clear explanations of the reasoning behind major statistical concepts and techniques, including interpretations of probability, significance testing, Bayesian reasoning, randomized clinical trials, meta-analysis and others. To engage the reader's attention and interest, he effortlessly makes use of paradoxes, controversies, glimpses into personalities, anecdotes and humor, all with a high degree of success. This is a unique and delightful book about the logic and utility of statistical science, especially in medical research. Prakash Laud

In addition to being excellent for students and practitioners of the subject, it should make essential reading for all those in public life who make critical decisions in the areas of medicine, politics, law and the media.  FH Berkshire, ISI Short Book Reviews

If you like an intellectual challenge and are interested in medical statistics, then this is a wonderful book for you. M.G. Myrian Hunink, EMBO reports.

Whoever thought reading a statistics book could never be exciting needs to read this book! …. On the scale of 1–5 where 1 stands for ‘definitely not recommended’ and 5 for ‘definitely recommended’, it rates a solid 5!

Lehana Thabane, Statistics in Medicine.


Stephen Senn has written an amusing and readable book intended to inform quantitatively and scientifically literate readers (not necessarily statisticians and mathematicians) about a number of statistical methods and concepts….The book is also witty and full of tart asides and tangential excursions. Reading the book is like attending the lectures of a curmudgeonly but beloved professor….I enjoyed this book even though I am not a statistician …The real enjoyment of this book though comes with seeing the impact that the mathematical sciences can have when the outcomes are literally life and death.

Steven R. Dunbar Mathematical Association of America: MAA Online


All throughout the book are an enormous array of quotes, humorous stories and anecdotes, but over and above the ‘fun’ side is a wealth of information, not least in the historical development of the ideas that are presented…Reading the book for this review has been a great pleasure – the enthusiasm of the author for his subject is clear and it rubs off onto the reader. Andrew W Roddam, Statistical Methods in Medical Research.


Stephen Senn’s book is an entertaining, thought-provoking collection of stories valuable for those who teach biostatistics. Daniel W. Byrne, Section of the American Statistical Association: Teaching of Statistics in the Health Sciences

This book about "biostatistics" is the most engrossing popular book on probability that I have read in a long time. Paul  J Campbell, Mathematics Magazine

Senn has accomplished the unattainable. He has composed an enjoyable, indeed grippingly funny, book that contains many nuggets of insight both for the statistician and the public in general. He is unabashedly enthusiastic about statistics and its place in the universe: Paul Alper, Chance News

Throughout the book Senn mixes history, practical applications, and some technical detail in thoroughly engaging prose. In fact, perhaps the best thing going for this book is the charming wit and style of its author.              John D. Nagy,

Cambridge Quarterly of Healthcare Ethics


To this end, Senn uses history, biographies, anecdotes, very dry humor, and even mathematical equations and formulas to bring some life to what is generally considered a dull and prosaic topic….There are some really nice gems in the book

Rudy Guerra, The American Statistician


The text flows with an easiness rarely seen in statistical books…. At times when statistics permeate our lives, not just through medical research but also in the general media, this clarity is very welcome. Renée X de Menezes, Journal of Epidemiology and Community Health.


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This page last updated 22 June 2011