In Ham on Rye, Bukowski talks about his acne. A teenager with acne has a terrible fate. This was depression era America. Bukowski was poor. He went to a hospital, I imagine one for poor people. The doctors suggested the electric needle. A hot needle was used to drill his boils, squeeze them. This was done for weeks. It was useless. He was left scarred.
They experimented on the poor and if that worked they used the treatment on the rich. And if it didn’t work, there would still be more poor left over to experiment upon.
Bukowski is an ugly man. Scarred in his photos. The story could be real. I don’t know. However, humans are powerfully susceptible to anecdotes. Suppose the story was true. Does the fact that the treatment failed mean it wouldn’t work for the chosen few, the rich? Suppose it had succeeded, would it still work for rich people?
I don’t know. Maybe he didn’t have acne. Maybe he got sick from the cans of free hash they got. Maybe he lived in a polluted neighborhood. Maybe Bukowski, as he said it, was just selected to have Acne. I don’t know. Anatole France was however right.
To die for an idea is to set a rather high price on conjecture.
Sometimes, conjecture is all we have. How do we reduce the number that die then? It is hard. There is an art to it. An art of making numerical conjectures: Statistics According to Freedman, anyway..
Say I have a bag of marbles. They are identical. Blue, round, made in the same sweatshop. I sell them in a shop. An angry customer comes by. She was in a ringer competition in Alaska. Her marble cracked; due to the cold, she says. Her life is ruined. She wants to sue. One way to find out for sure what happened is to run an experiment. I could take a marble, fly to Alaska, see if it cracks. What if I cheat? Choose a good marble. We decide the marble will be chosen randomly. Since I may keep the marble in a marble cozy, someone else who doesn’t know about the experiment will take it to Alaska. What if the marble does crack? Does that mean it was the cold? Some marbles could just crack. Maybe a bad batch from the sweatshop. Maybe some of the marbles collided when the truck carrying them ran over a pothole. So we pick some marbles at random. We flip a coin; separate the marbles into two groups. Now, the probability that a marble cracks due to some other reason should be the same in both groups. We fly one to Alaska; the other we keep here. A randomized controlled experiment.
That was hard. It gets harder, especially when human lives are involved. Twenty years after Bukowski’s tryst with Acne, Polio, the disease that left Roosevelt crippled had a possible vaccine. Lab experiments looked optimistic. Again, another conjecture was needed. One way of testing this conclusively is to innoculate everyone. Compare against a previous year. Historical controls, they are called. The problem was that this could be a good year or a really bad year for Polio. Can we compare children whose parents give vaccination permission against those who did not? Not quite. The poor are more healthy. The rich are typically educated, more willing to be vaccinated. An ideal experiment is one which picks children whose parents allow them to be vaccinated. Those children are split into two groups. One is vaccinated. Other is given a placebo. This was what was finally done. A controversial experiment with tough ethical issues to solve.
What of experiments where the researcher can’t play god? After all, not many are willing to engage in a dangerous activity long term just to make a statistician happy. So we run observational studies. Compare groups that are as identical as possible. Male smokers in the age of 40-50 against male non-smokers in the same age group. It is not easy. It is not perfect.
It also explains why nutrition today is such a clusterfuck. My friends are into paleo. Everyone tells me anecdotes about hunter-gatherer civilizations and how they were healthy. It is not clear how long they lived. Whether their behavioral patterns were identical to the modern day hipster. Another danger is to interpret too much from animal trials. Our society is fascinated by the lives of mice and fruitflies. Probably more than cats. Today’s BBC news article is relevant. They talked about the long lives of male mice that were on diabetes pills. No clinical studies on humans, yet. Just like a pack of cigarettes with a warning hidden somewhere, they said at the very end:
it is unclear what the study might mean for human health.
Yet, the article was in the health section and not in the wildlife section.
I wrote this in the UCSF medical library, Parnassus. The medical nature of this article was probably not causal.