A 19^th century cartoon used as the image for the book cover of Risk, Chance, and Causation by Yale University’s Michael Bracken piqued our curiosity more than usual when we learn about new books. It shows the picture of a man, presumably Benjamin Perkins,  the American who discovered a new treatment, applying electrophysical force with metal rods to a male patient’s face. The cartoon ridicules the claim graphically but also with these words:

The Epidemiology Monitor questioned Mike Bracken about his new book, and here is what he had to say. Readers interested in reviewing the book for The Epidemiology Monitor should contact us at epimon@aol.com We will select a qualified reviewer who will get a free copy of the book in exchange for the review.

Epi Monitor:  The book has a humorous image on the cover for an epidemiology book. What is that image and why was it selected?

Bracken: James Gilray is a famous satirical cartoonist working at the turn of the 18^th century and in this

image he comments on an episode that relates to two themes in the book. A Yale (sorry to say) doctor Benjamin Perkins went to London to promote his metallic tractors that appeared to cure everything from gout to syphilis by using “electro-physical forces”.

This is not unlike many of the numerous quack “treatments and cures” to which the public today falls victim. Our villain, Ben, is exposed by a Dr. John Haygarth who paints wooden tractors to look like metal and achieves the same successful cures. Thus, providing the first known example of masking in a clinical trial, demonstrating the placebo effect, and alluding to another theme in the book - how sources of bias are recognized and avoided.

Epi Monitor:  How did the idea for the book come about?

Bracken: I hoped to write a book that explored for the public the work of epidemiologists. The public faces a tsunami of misinformation about the value of therapies and the risks of environmental and life-style exposures. At the same time, they are ill prepared to properly evaluate this information.

Because epidemiology is not taught in schools (I think it should be but that’s a topic for another day) the public is never formally educated in how to evaluate claims of therapeutic effectiveness and safety.

Risk Chance and Causation is an effort to make some of these concepts available to the general public and to hopefully help them navigate through this wave of hyperbole that constantly washes over them.

Epi Monitor:  How would you describe the book in just a few sentences?

Bracken: We all take risks every day without giving much thought to the pros and cons, or weighing alternatives. We are exposed to events that may occur by chance although we attribute some cause to them. And we are exposed to other events that are not random although we think they are because we do not know a cause.

Indeed how we conceive of causation is poorly understood. Nowhere are these complexities more salient than in the context of health and disease and these are the issues the book is intended to explore

Epi Monitor:  What were your main aim(s) in writing the book?

Bracken: We epidemiologists talk about risk and chance and causation continuously in our daily work, often without spending too much time analyzin