The Wisdom of Whores, Excerpts - The accidental epidemiologist by Elizabeth Pisani
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These are excerpts from The Wisdom of Whores, a non-fiction book about sex, science and the mis-use of taxpayers' money. It will be published by Granta in the UK (May 2008), WW Norton in the US (June 2008).
This story is from this book:
The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS
chapters
chapter 1:
The accidental epidemiologist
chapter 2:
Landscapes of Desire
chapter 3:
The honesty box
chapter 4:
Ants in the sugar bowl (Chapter 8)
The accidental epidemiologist
chapter 1
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updated Mar 20, 2008
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Scene setting: After many years covering rebellions and stock market crashes as a journalist in Asia, I found myself studying demography at the London School of Hygiene and Tropical Medicine. One of the required courses was in epidemiology. I didn't even know what the word meant.
At the end of that first lecture, the professor asked us a question. Why was there a 14 year gap between the first case-control study showing a strong association between smoking and lung cancer, and the first U.S. Surgeon General’s report on the dangers of smoking?
Stony silence from the highly educated doctors and technicians in the room, men and women who were adding a public health qualification to an existing wealth of medical experience. Maybe this was because it was the first lecture of the year and people were shy. I was not a doctor. I did not have an existing wealth of medical experience. I had not had any scientific education in 25 years. But I was not shy. A journalist’s work depends on a willingness to ask questions of people who are better informed and more powerful than you. It depends on regarding nothing as sacred and everything as open to question. I was by far the least qualified of the 300 or so people in that echoing lecture theatre, but I was full of been-there-done-that bravado. I stuck up my hand.
“You’re asking the wrong question,” I said.
Even I was aware that the air in the lecture theatre had suddenly turned heavy. Heavy enough to crush the bravado. I blundered on, more doubtful now.
“Surely, the key question is: How much money did British American Tobacco and Philip Morris give to US Senate campaigns in that 14 year interval?”
Immediately, there was a shower of laughter and the air cleared. A forest of hands shot up, everyone competing to explain in technical terms that I only partly understood: case-control studies are subject to recall bias, case-control is not the most appropriate method for looking at causes of death, what is really needed to confirm the findings is a cohort study that follows both smokers and non-smokers over time, and and and….
All of these answers were correct, of course. But did that mean the Big Tobacco answer was wrong?
Science does not exist in a vacuum. It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religions and political ideologies and all the other complexities of human life.
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At the end of that first lecture, the professor asked us a question. Why was there a 14 year gap between the first case-control study showing a strong association between smoking and lung cancer, and the first U.S. Surgeon General’s report on the dangers of smoking?
Stony silence from the highly educated doctors and technicians in the room, men and women who were adding a public health qualification to an existing wealth of medical experience. Maybe this was because it was the first lecture of the year and people were shy. I was not a doctor. I did not have an existing wealth of medical experience. I had not had any scientific education in 25 years. But I was not shy. A journalist’s work depends on a willingness to ask questions of people who are better informed and more powerful than you. It depends on regarding nothing as sacred and everything as open to question. I was by far the least qualified of the 300 or so people in that echoing lecture theatre, but I was full of been-there-done-that bravado. I stuck up my hand.
“You’re asking the wrong question,” I said.
Even I was aware that the air in the lecture theatre had suddenly turned heavy. Heavy enough to crush the bravado. I blundered on, more doubtful now.
“Surely, the key question is: How much money did British American Tobacco and Philip Morris give to US Senate campaigns in that 14 year interval?”
Immediately, there was a shower of laughter and the air cleared. A forest of hands shot up, everyone competing to explain in technical terms that I only partly understood: case-control studies are subject to recall bias, case-control is not the most appropriate method for looking at causes of death, what is really needed to confirm the findings is a cohort study that follows both smokers and non-smokers over time, and and and….
All of these answers were correct, of course. But did that mean the Big Tobacco answer was wrong?
Science does not exist in a vacuum. It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religions and political ideologies and all the other complexities of human life.
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