The Double-Blind Thought Experiment

Skeptics in the Pub: Cholera by Mark Crislip

Book cover

One day I'll have to write an in-depth analysis of that neglected step-child of the speculative subgenres, the motivational business fable. If you've ever heard of Who Moved My Cheese?, you know what I'm talking about. Among the few enjoyable moments I had in business school were when teachers assigned us those bizarre manuals of corporate culture disguised in the garb of fiction. The underlying reason for this form of literature is that top management is allegedly too busy to read an entire tome on organizational theory, so any new developments in the field have to be communicated in bite-sized format.

That's how I felt while reading the novel Skeptics in the Pub: Cholera. More than a novel proper, this is a vehicle of public education. Published during the coronavirus pandemic, and written by a real-life doctor who has done very important work in fighting pseudoscience for years, this book imagines an alternate timeline where the US never became independent and its system of free enterprise and free academia never developed. In the 21st century of this version of the British Empire, all doctors must belong to one of a handful of Crown-approved Medical Societies that have a legal monopoly on diagnosis and therapy. (An exception are surgeons, who have their own Guild and come from a separate tradition without fancy philosophy.) The problem is that these Medical Societies are founded on tradition and prestige, so they never bother revising their settled doctrines. Thus you see doctors prescribing obvious rubbish such as bloodletting, moxibustion, or homeopathy. And no one outside of those very distinguished clubs is legally allowed to learn or practice medicine. This is, of course, one of the most horrifying dystopias I've ever read.

The plot concerns an epidemic of cholera in Portland, Oregon, in a fictional 2017. This is only the latest in a series of periodic returns of the disease. But this time, someone has smuggled forbidden papers from France that speak of an “empirical method.” Any sympathy for French ideas is seen as traitorous in the British colonies, but the documents say that this method has already succeeded in proving Mesmerism wrong, so our protagonist, a mid-level public health bureaucrat, hopes that it can help him find the true cause of cholera and therefore its cure.

This mystery proceeds in the manner of a detective novel, which makes this book a very curious read, since we in this timeline and decade already know the answer. The protagonist starts collecting clues, making deductions, running some tests, and it's to the author's credit that he has managed to make these steps feel exciting even though the solution is not a mystery to the reader. We basically watch him invent the entire science of epidemiology in real time, with index cards and a mechanical computer. Of course, the political intention of writing this book is not to popularize the state of the art in therapies for cholera; it's to illustrate the catastrophic social consequences of letting pseudoscience take over the medical profession. At a key point in the plot, when the bureaucrat has finally figured out that the origin of the infection is a defective water pump in a city park, the heads of the Medical Societies stage a public event where they drink water from that pump to prove that their respective methods are effective. I don't need to tell you how successfully the theory of the four humors and its all-purpose treatment of bloodletting fares against a case of severe dehydration, or what awaits those patients who try to protect themselves against cholera by taking homeopathic drops made with water from the same pump.

In an obvious wink to the reader, the protagonist has a scene where he compares his situation to that of detective novels, and wonders, “Why would a novel be any kind of guide to reality?” This soapbox approach to literature reoccurs throughout the text; later on, we find remarks like “It is amazing how much information in the world appears to be hidden in boxes, gathering dust in basements, waiting to be discovered,” and “We need something more akin to engineering to take over Medical Philosophy.”

The author (who, let's remember, is a doctor) was obviously more interested in expressing a position than in telling a story. It's for that reason that I haven't dedicated any space here to speak of the literary qualities of the text; it's just correct prose without stylistic aspirations. More than a work of art for art's sake, this is a fable with the tone of an exasperated cry for good sense.

—Arturo

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