I’ve always loved satire. The official definition is “…the use of humor, irony, exaggeration, or ridicule to expose and criticize people's stupidity or vices, particularly in the context of contemporary politics and other topical issues.” I like to think of it as weaponized humor. Despite being a target-rich environment, medical writing has far less than its rightful share of good satire. When good medical satire comes around, I enjoy it.

Back in 2003, the BMJ published a wonderful satire on the insistence that all medicine be evidence-based, where the authors note that we have no good studies to support the benefit of parachutes and suggest that everyone would benefit if ”…the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."

I rarely enjoy sequels as much as the original, but the BMJ came through this year by publishing a randomized controlled trial that found no evidence that parachutes were more effective at preventing injuries when jumping from an airplane than ordinary backpacks. (See below* for the ironic twist.)

I was not the only reader to note and enjoy this pairing. Dr. Saurabh Jha, who often writes his own satires on medical topics, published an excellent review of the two studies, in which he peels back multiple layers of weaponized humor. (I urge you to read the two studies before reading his review.)

I won’t try to improve upon Jha’s closing comments:

"The penumbra of uncertainty is an eternal flame. Though the conventional wisdom is that a large enough sample size can douse uncertainty, even large n’s create problems. The renowned psychologist and uber researcher Paul Meehl conjectured that as the sample size approaches infinity there’s 50 % chance that we’ll reject the null hypothesis when we shouldn’t. With large sample sizes everything becomes statistically significant. Small n increases uncertainty and large n increases irrelevance. What a poetic trade-off! If psychology research has reproducibility problems, epidemiology is one giant shruggie.

When our endeavors become too big for their boots satire rears its absurd head. Satire is our check and balance. We’re trying to get too much out of the quantitative sciences. Satire marks the territory empiricism should stay clear of. If empiricism befriended satire it could be even greater, because satire keeps us humble.

The absurd coexists with the serious and like pigs and farmers resembling each other in the closing scene of Animal Farm, it’s no longer possible to tell apart the deservedly serious from the blithering nonsense. And that’s why we need satire more than ever."

(*Ironic twist: the planes involved were small planes at rest and parked on the ground.)

Links to more on this topic: