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Why does the base-rate fallacy occur in the fictional screening model?

The base-rate fallacy occurs because learners often ignore the low prevalence of the disease (the base rate) and focus only on the high accuracy of the test. This leads to the incorrect assumption that a positive test result is highly likely to be a true positive, when in fact the large number of healthy people generates many more false positives than true positives.

Conditions

  • Prevalence is low (1%1\%).
  • Test accuracy (sensitivity/specificity) is high (95%95\%).
  • The observer focuses on test accuracy rather than population composition.

Reasoning, step by step

  1. Recognize the low prevalence: Only 20 out of 2,000 people are sick.
  2. Recognize the high accuracy: The test is 95%95\% sensitive and specific.
  3. Observe the consequence: 99 false positives arise from 1,980 healthy people.
  4. Compare counts: 99 false positives vs. 19 true positives.
  5. Identify the fallacy: Assuming P(D∣+)P(D\mid +) is high because P(+∣D)P(+\mid D) is high, ignoring the base rate.

Example

The script states: "The toy population has a disease prevalence of 1%1\%. This prior proportion matters before any test result is observed." and "false positives outnumber true positives even though each stated test rate is high."

Common misconceptions

  • Believing that test accuracy alone determines the probability of disease.
  • Ignoring the prior probability (prevalence) of the condition.
  • Thinking that a rare disease can be detected with high certainty by a standard test without adjusting for base rates.

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