Thursday, September 3, 2009

The Crooked Stick

Was it sand or stone? It is difficult to remember the seat of the argument. But I believe it must have been the sand. He was seated on a rock with a crooked stick in his hand drawing on the sand. Even though the answers that followed on the sand were as nebulous as clouds constantly changing from cats to dinosaurs and back to a wisp. The moderate breeze blew the sand and erased his answers. The weaving in and out of reality was a constant waking to an image and sleeping to a nightmare. Time spent with him was the flux of thought riddled with distant memory – all a dream.

He was elderly by the standards of the 21st century man in appearance but youngish in intellectual thought. His face marked with the battle scars and frustration of time. His eyes close set protected under deep brows with overhanging dense white hair. The hair on his head long and thick hung straight to merge with those of his flowing white beard. He was an image of Santa Claus without the stuffed pillows or the rosy cheeks. The brown garment he wore made him look like an 18th century Bedouin. An MIT graduate, having given up the comforts of life and lost to the world of fiscal productivity, he was engulfed in the mental den of numbers. He was one with his soul. He could evaluate, manipulate, extrapolate and calculate any mathematical argument. Some say he might have been the first to solve Fermat’s Theorem on torn pieces of paper that he carried around for a while. But he would deny it vociferously.  All the same, folklore did not begin without a kernel of truth somewhere.

“Numbers,” he would say with the throaty, croaky voice of his, “are the basis of our existence and that of this universe.” His explanation was simple; “You can put a number to explain any thing, the velocity of a car, mass of an airplane, tonnage of a ship.” If you got him going he would divulge more of these simple facts.

“We now calculate the surface area and camber of the proposed aircraft wing to determine the lift it would produce to haul the planned weight of the entire aircraft under development. No longer the Wrights Brothers dilemma of experiment, cross check, crash and retool, now one goes right from the computed data to manufacturing.’’ His crooked stick began writing the formula then erased it halfway through, as if not applicable. “And what of the orbit of the earth around the sun? It was calculated by Johannes Kepler (1571-1630) to within 5% error with mathematics long before all the fancy infrared telescopes. Kepler's third law was used to measure distances between planets and the sun. To make that leap of faith, Kepler jumped on Brahe and Copernicus’ ideas to formulate his mathematical intercession. It is always the same one mathematical mind transcends another as Einstein’s Special Relativity was based on Lorentz’s Transformation, which was derived from Galilean relativity. The march to understanding reality is always based on one giant standing on the shoulders of another!” The stick drew three ellipses all interlinked in a gravitational dance and then hovered as this giant sat quietly and analyzed the products of the past. He loved to pass along his learned objectives for others to use as springboard.

“So math can answer all questions?”

“Depends.” He would say.

“On what?”

“On the question.” The smirk remained hidden under the ample beard and moustache.

“Well let’s talk about medical facts.”

“Facts whether they are medical or otherwise are facts. It is how you fashion the argument with them.” He would pause for a long moment and you knew he was going to throw something deep and heavy in your direction.

“Give me an example.”

“Okay,” he paused, “assume you have two baskets of apples. There are 3 bad apples out of ten in one basket and 4 bad out of 10 in the other. How you express that makes the sale. If you say that the first basket has 15% lesser number of bad apples then the other basket you make it look good. But if you say that it has one less bad apple than the other, the argument is less compelling. The higher number makes it sound like a better basket.” The numbers on the sand appeared and disappeared as his thought completed their ritual imagery. This was not hot nor was it heavy.

“But that is simple.”

“It is but how many times the TV or the newspaper or the magazines will make something better or worse than the reality. Real numbers do not hide the truth but relative numbers, fractions and percentages all are modifiers that play to the tune of the piper.”

“Any examples in medicine?”

“Sure the best one is about the effects of the cholesterol medications. The benefits are expressed in relative risk reduction while the toxicity as you people are prone to say is expressed in absolute numbers. That is like apples and oranges.” He again wrote 38 and a 2 on the sand and then erased them wielding the crooked stick.

“What do those numbers stand for?”

“Relative Risk reduction and Absolute Risk.” The crooked stick made an exclamation mark.

“But those data are provided by the statisticians, the gurus, not by doctors.”

“Yes, but the arbiter of reality in expressing the truth is the author of the scientific expedition. If the results are not charming, the journal will not print. And if the print is not there the promoter of the argument will not reap the rewards. The argument is circular to a degree. You manipulate to publish and publish to manipulate.”

“So if I am writing a paper, I can…”

“Let me stop you there. Before you even start writing the paper you have done the experiment. And even before you have done the experiment you have a premise you want to explore. That is where the problem begins.” His voice had a quiver of disdain in it.

“You are referring to ‘observer bias’ aren’t you?”


“Meaning, I am prejudiced in my experiment therefore I will manipulate the events, to suit the desired end result.”

“Bingo.” The “o” in the bingo whistled into a sonorous echo.

“But that is easily verified.”

“By the real numbers and never by the percentages. And also by the events placed in the experiment. If you delete the events that go against your initial premise citing non-compliance, or lack of eligibility in your criteria then those numbers fall out. For example if you do a study where there are more women in one arm of the study then the other arm, and you know that the outcome of women in a certain disease is better than men, you have prejudiced the outcome in your favor slanting the opinion to benefit the experimental drug.”

“But that is easy to see.”

“That is just an example. Another one would be to have a larger number of fair skinned red heads in one arm and dark Irish in the other and expose them to sun tanning. Obviously the red heads would be more at risk to get sunburn. If now you give the group with the larger number of dark Irish a product that protects against sun burn and the other a placebo, you have brought in prejudice and destroyed the validity of that study.”

“I see.”

“Always look at the real numbers. They tell the tale. See how they are matched. See how the events are stacked and then make your own assumptions and not necessarily rely on those of the author.” He looked from beneath his thick eyebrows, scrutinizing the impact and then wrapped it all with the sweep of, “ all probabilities are a game of chance AND never theorize before data otherwise you twist the facts to suit the theories.” The emphasis on “and” was quite forceful. He was silent while his crooked stick continued to doodle on the sandy slate.

Genius does not come in a pinstriped suit nor in a cotton shirt and baggy pants, it comes in all shapes and sizes. It is in our desire to galvanize that spirit of learning and acquire knowledge from anyone even if he is the spitting image of Santa on a diet.

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