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If you’ve spent any amount of time online in the US true crime scene you’ve probably seen among other things the same account repeated over and over: teenage girl disappears without a trace; her concerned parents want to report her missing but local police refuses on grounds that she obviously just ran away and will probably contact them later. Potentially she’s just a junkie, a troublemaker delinquent or future prostitute; either way they think it’s not their job to search for her because reasons. They might also tell them to wait one/two/three days before filing a missing person claim because that’s the law or something. (True crime nerds will be happy to point out that no such law exists anywhere in fact.)
Later at some point someone finds her corpse or remains and it’s confirmed that she was brutally raped, tortured and slaughtered by some deranged serial killer or opportunistic toxic rapist dudebro. She is often identified only decades later thanks to DNA examination. (DNA research is a huge topic in the true crime subculture/fandom.) Said nerds, normally lipstick feminists and liberals, usually white suburban women, all agree that it’s a sad commentary on US police being lazy, misogynistic, uncaring assholes, especially in the South, of course.
Fair enough, I tell myself after hearing this; it’d be indeed difficult to show the police in a positive light in such cases. But I also notice what always goes unaddressed is the possibility that laziness and human evil alone do not fully explain the attitude of policemen. I mean – surely there were masses of teenagers who did indeed run away from home, weren’t there? And there was also a big surge in their number during the cultural and social upheaval of the ‘60s and ‘70s, right? We never hear about the great majority of them because their names never made it to true crime videos or documentaries, but the police was surely aware of them.
I once came across a description in a true crime book of social ills that led to a surge in crime in Weimar Germany. Millions of war veterans returned home, convinced that they fought for nothing and were humiliated, many of them with shattered bodies and/or shattered minds. Since these men were often violent and became alcoholics or drug addicts, if they had teenaged children, those often ran. The parallels with the US after the Vietnam War are kind of obvious, especially if we also consider the consequences of the upheavals I referred to above. In the Weimar era there were also many cases of divorced women throwing their children out to the street because daddy could no longer pay child support, and children running away from families that lost everything due to hyperinflation and later the Great Depression; many of them ended up as underaged prostitutes.)
So anyway, I find it a bit odd that the prejudices of law enforcement officers, who have to deal with the scum of society everyday, are dismissed automatically as evidently baseless. And this phenomenon does seem to be Blue Tribe coded.
There's a saying in medicine, "when you hear hoofbeats, think horses, not zebras". The idea is that medical students' imaginations get captured by rare exotic diseases, which they spuriously diagnose their patients with on the flimsiest of evidence. It's far more likely that the patient is suffering from an extremely common illness (even an unusual presentation of a common illness) than that they're suffering from a rare, exotic illness. I'm currently rewatching the medical drama House, whose working title was Chasing Zebras, the idea being that House and his team are the ones who chase down the zebras only after the less talented and specialised medics have confirmed that it isn't a horse. Almost every episode begins with House being presented with an unsolved case whose etiology he dismisses as something banal and uninteresting: it's only after the patient's symptoms worsen that he realises it really is a zebra.
The admonition to think of horses rather than zebras is not just an amusing observation about the availability heuristic, about the funny fact that we fixate on statistically rare events at the expense of common ones. Rather, it is an important lesson for doctors to internalise, not just to improve their skill as diagnosticians, but for the sake of their patients' welfare and for the efficiency of the medical system as a whole. Ordering tests for a statistically rare illness your patient almost certainly doesn't have wastes their time and unnecessarily immiserates them: rather than doing so, you should have started treatment for the common illness they probably do have. Ordering unnecessary tests is wasteful, a major contributor to Baumol's cost disease, and means that other doctors will get the results of tests they ordered much later (which in turn delays treatment for their patients). Doctors, sadly, are notoriously bad at statistics, which is a shame when statistics are such a huge part of their job.
A huge proportion of complaints about the deficiencies of a given country's medical system ultimately boil down to people failing to understand the "think horses, not zebras" insight. You'll have an obese person who'll claim that a whole series of doctors erroneously assumed their health problems were caused by their obesity and their advice boiled down to "lose weight", only to discover that they actually had a tumour. We're meant to interpret this as evidence of entrenched fatphobia among medics or whatever, but whenever I hear one of these stories, I can only help but think that this is the medical system working exactly as intended. When an obese person complains of health problems consistent with those caused by obesity, nine times out of ten they are caused by obesity, and would be resolved with lifestyle changes. Running a cancer test on every obese patient who complains about trouble sleeping and shortness of breath would bankrupt the health service overnight. I feel the same when photogenic young women appear on television to complain that their doctors missed the symptoms of their breast cancer and they're trying to "raise awareness" thereof. Despite what ad and awareness campaigns would have us believe, breast cancer is a disease that overwhelmingly affects older women. Preemptively screening every woman in her twenties for breast cancer is not a remotely sensible use of scarce medical resources. But everyone loves a sob story, especially when the victim is young and attractive. Older women might as well not exist for how much attention people pay to them.
Likewise here. When a teenaged girl goes missing, and the police tell the family not to worry because she's only run away from home and she'll surely show up in a day or two – well, I don't have hard stats on this, but it wouldn't surprise me if they were correct nine times out of ten. Having the police drop everything and initiate a full-scale manhunt every time a teenage girl yells "I never asked to be born!" is not a remotely sensible allocation of scarce police resources. (Indeed, if it became common knowledge that this is how police departments react whenever a teenage girl goes missing, it would be something that organised criminals could exploit: pay a junkie a hundred quid to report her non-existent daughter missing, then rob a bank while they're preoccupied looking for her.)
On the margin, this approach inevitably means that doctors will occasionally miss a disease independent from an obese person's BMI, a young woman's breast cancer, or a teenager who actually has been abducted. This is regrettable, and yet I defy you to think of an alternative which is better on net. When you hear missing teenager, think runaway, not serial killer.
I know last month I devoted a whole post to criticising people who think the government should dictate who journalists are allowed to report on, how, and in what timeframe, pointing out the perverse incentives and side effects this would inevitably create. And yet I maintain the world would be a much better place if no one was allowed to report the news unless they could provide accurate definitions of "mean", "median" and "mode".
Your docs suck at stats link is broken.
Thanks, fixed.
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