你能智胜愚弄了一代医生的谬论吗?—— 伊丽莎白·考克斯 Elizabeth Cox: Can you outsmart the fallacy that fooled a generation of doctors?

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演员: Elizabeth Cox

Oh the humanity!
Ah... humanity...
啊... 人类...
It’s a trainwreck, but I can’t look away.
这是一次沉船事件, 但是我并不想将我的目光移开。
It’s 1843, and a debate is raging among physicians
现在是 1843 年, 一场关于女性
about one of the most common killers of women: childbed fever.
最常见的杀手之一的争论 在医生们中间激烈展开:产褥热。
Childbed fever strikes within days of giving birth,
产褥热在分娩后 几天内就会发作,
killing more than 70% of those infected— and nobody knows what causes it.
造成 70%的 感染者死亡,并且 没人知道这是什么原因引起的。
Obstetrician Charles Meigs has a theory.
产科医生查尔斯·梅格斯(Charles Meigs) 提出了一个理论。
Having observed abdominal inflammation
in patients who go on to develop the fever,
he claims this inflammation is the cause of childbed fever.
他声称这种腹部炎症 是引起产褥热的原因。
Much of the medical establishment supports his theory.
Oh, come on!
They really leave me no choice but to teach them some skepticism.
这让我别无选择,只能教他们 怎么用怀疑的态度看待问题。
That’s better.
Now, Meigs, your argument is based on a fallacy— the false cause fallacy.
梅格斯,你的论点是建立在 谬论的基础上的,即因果谬误。
Correlation does not imply causation:
相关性的存在 并不意味着因果关系的存在:
When two phenomena regularly occur together,
one does not necessarily cause the other.
并不能说明一种现象的发生 导致了另一种现象的出现。
So you say women who have inflammation also come down with childbed fever,
所以你认为因为腹部发炎的 妇女都患有产褥热,
therefore the inflammation caused the fever.
所以产褥热一定 是由于炎症引起的。
But that’s not necessarily true.
Yes, yes, the inflammation comes first, then the fever,
是的是的,病人首先出现炎症, 然后是开始发热,
so it seems like the inflammation causes the fever.
所以这看起来 好像是炎症引起了产褥热。
But by that logic, since babies usually grow hair before teeth,
hair growth must cause tooth growth.
由于婴儿通常先长牙齿, 后长头发,
And we all know that’s not true, right?
那么头发的生长 必然导致了牙齿的生长。
Actually, don’t answer that.
A couple of different things could be going on here.
First, it’s possible that fever and inflammation are correlated
purely by coincidence.
首先,产褥热和炎症的关联 可能纯属巧合。
Or, there could be a causal relationship that’s the opposite of what you think—
the fever causes the inflammation,
但是这种因果关系与 你的设想恰好相反——
rather than the inflammation causing the fever.
即产褥热导致炎症, 而不是炎症导致产褥热。
Or both could share a common underlying cause you haven’t thought of.
再或者,两者都是由同一个 你还没有想到的潜在诱因引起。
If I may, just what do you think causes inflammation? Nothing?
我冒昧问一句,你认为是什么 导致了炎症的产生呢?想不出来原因吗?
It just is? Really?
Humor me for a moment in discussing one of your colleague’s ideas—
话说你的同事奥利弗·温德尔·霍尔姆斯 (Oliver Wendell Holmes)医生
Dr. Oliver Wendell Holmes.
I know, I know, you don’t like his theory—
我知道,我知道, 你不喜欢他的理论;
you already wrote a scathing letter about it.
你已经为此给他写了一封 尖刻的批评信。
But let’s fill your students in, shall we?
但我们还是满足一下 学生们的好奇心吧,好吗?
Holmes noticed a pattern: when a patient dies of childbed fever,
a doctor performs an autopsy.
当一个病人因产褥热而死去时, 医生会对其进行尸检。
If the doctor then treats a new patient,
如果那个医生在完成尸检后 再去治疗一位新的病人,
that patient often comes down with the fever.
那么那个病人通常 也会染上产褥热。
Based on this correlation
基于检验产褥热患者尸体 和新患病的病人之间的关联,
between autopsies of fever victims and new fever patients,
he proposes a possible cause.
因为并没有证据可以证明 尸检导致产褥热
Since there’s no evidence that the autopsy causes the fever beyond this correlation,
he doesn’t jump to the conclusion that autopsy causes fever.
所以他并没有立即下结论 认定是尸检导致了产褥热。
Instead, he suggests that doctors are infecting their patients
相反,他认为医生是通过 他们的双手和手术器械上的
via an invisible contaminant on their hands and surgical instruments.
一种看不见的污染物 感染病人的。
This idea outrages most doctors, who see themselves as infallible.
Like Meigs here, who refuses to consider the possibility
他们都认为自己 是绝对不可能出错的——
that he’s playing a role in his patients’ plight.
就像梅格斯一样,他拒绝相信 自己的行为有可能促使病人陷入困境。
His flawed argument doesn’t leave any path forward for further investigation—
他带有缺陷的理论并没有为 下一步研究留下任何空间——
but Holmes’ does.
It’s 1847, and physician Ignaz Semmelweis
1847 年,内科医生 伊格纳斯·塞梅尔韦斯(Ignaz Semmelweis)
has reduced the number of childbed fever deaths
将产褥热在一个门诊的死亡率 从 12% 降到了 1%。
in a clinic from 12% to 1% by requiring all medical personnel
to disinfect their hands after autopsies and between patient examinations.
在尸检后,以及对不同病人进行检查之间 对自己的双手进行彻底消毒。
With this initiative, he has proven the contagious nature of childbed fever.
通过这一举措,他证明了 产褥热是具有传染性的。
It’s 1879, and Louis Pasteur has identified
现在是 1879 年, 路易斯·巴斯德(Louis Pasteur)发现了
the contaminant responsible for many cases of childbed fever:
Hemolytic streptococcus bacteria.
Hmm, my fries are cold.
Must be because my ice cream melted.