1 Boring Old Man

The classic Psychologist laboratory animal study involves genetically identical rats living in cages divided into two groups – one control group and one with some experimental intervention. Blinded observations of some pre-defined outcome parameter are recorded and the groups compared statistically at the end of the study. By making everything about the groups exactly the same, you can reasonably conclude that any differences in the outcome parameters are caused by the intervention. In another variation, one might have a single group with a control period of observations, then a second period making the intervention – comparing the control period to the experimental period. Whatever the case, the point is to aim for uniform groups with the only difference being the intervention – control vs experimental.

And then there are the Ethologists who do just the opposite. They often try not to interfere or make their presence known at all. So they sit in trees in the jungle and watch the animals in their natural habitat [or even become a part of it eg Dian Fossey]. Their books tend to be about one individual or a small group – more like a case study or a family study. And the tables, graphs, and statistics aren’t so prominent as they are in the works of the laboratory based scientists. They’re replaced by narrative descriptions.

1. Hypothesis Testing Research versus Material-Exploration

Scientific research and reasoning continually pass through the phases of the well-known empirical-scientific cycle of thought: observation – induction – deduction – testing [observe – guess – predict – check]. The use of statistical tests is of course first and foremost suited for “testing”, i.e., the fourth phase. In this phase one assesses whether certain consequences [predictions], derived from one or more precisely postulated hypotheses, come to pass. It is essential that these hypotheses have been precisely formulated and that the details of the testing procedure [which should be as objective as possible] have been registered in advance. This style of research, characteristic for the [third and] fourth phase of the cycle, we call hypothesis testing research.

This should be distinguished from a different type of research, which is common especially in [Dutch] psychology and which sometimes also uses statistical tests, namely material-exploration. Although assumptions and hypotheses, or at least expectations about the associations that may be present in the data, play a role here as well, the material has not been obtained specifically and has not been processed specifically as concerns the testing of one or more hypotheses that have been precisely postulated in advance. Instead, the attitude of the researcher is: “This is interesting material; let us see what we can find.” With this attitude one tries to trace associations [e.g., validities]; possible differences between subgroups, and the like. The general intention, i.e. the research topic, was probably determined beforehand, but applicable processing steps are in many respects subject to ad-hoc decisions. Perhaps qualitative data are judged, categorized, coded, and perhaps scaled; differences between classes are decided upon “as suitable as possible”; perhaps different scoring methods are tried along-side each other; and also the selection of the associations that are researched and tested for significance happens partly ad-hoc, depending on whether “something appears to be there”, connected to the interpretation or extension of data that have already been processed.

When we pit the two types so sharply against each other it is not difficult to see that the second type has a character completely different from the first: it does not so much serve the testing of hypotheses as it serves hypothesis-generation, perhaps theory-generation — or perhaps only the interpretation of the available material itself.

An Anecdote: A young pregnant woman presented to the ER of our UK military hospital one evening with a severe URI and sore throat. She was given symptomatic medications and started on penicillin. The next day [a Sunday], she returned with a skin rash thought to be a reaction to the penicillin, and it was stopped. By Monday when she returned, the rash covered her body and she was admitted with a diagnosis of Stevens-Johnson Syndrome.  We had two Internists, an Ophthalmologist, a Dermatologist, and we were 25 miles away from Addenbrooks Hospital in Cambridge who supplied a steady stream of expert consultants throughout her hospital stay. When we were finally able to send her back to the US months later, she’d survived what amounted to massive burns; she was blind; she’d lost her child; she survived kidney failure and was off of peritoneal dialysis. I heard from her about a year later excited to say that she was beginning to regain some of her sight. The young general medicine officer who’d initially given her the penicillin [at her request] saw her every day over those months, and after his military service, he became an Ophthalmologist – an interest he developed while following her eye-care with the British consultants. After the fact, one never knows if this kind of maelstrom was from the original viral infection or the penicillin  – both listed as possible causes in such cases. And I, for one, have never seen another such case. With an incidence of single digits per million people per year, many physicians have never seen this illness. I expect that those of us involved in this case see her every time we consider antibiotics for a sore throat or see a penicillin reaction.

In the overwhelming majority of cases, penicillin doesn’t have any effect on the course of a sore throat, whether caused by the Streptococci organisms or not. If, however, it is a Strept Throat, there was a time when the result might well be Scarlet Fever, Rheumatic Fever, Acute Glomerulonephritis – conditions that had long term and often ominous consequences. That penicillin shot has virtually eliminated those once common illnesses – a medical miracle. But the reason to get a culture to be sure it’s a Strept Throat first instead of treating all Sore Throats as Strept Throats is another kind of prevention – to minimize the possibility of cases like the one described above [among other things].