Selection Bias: Statistical Integrity in Christian Community

One day a num ­ber of con ­cerned moth ­ers met with the min ­is ­ter to express their frus ­tra ­tion and anger over the unseemly con ­duct of a par ­tic ­u ­lar boy in Sun ­day School. They did not want their chil ­dren exposed to this child and feared what he rep ­re ­sented. For it seemed that this boy was mod ­el ­ing “bad behav ­ior” – ver ­bal out ­bursts that some ­times involved pro ­fan ­ity, a lack of sen ­si ­tiv ­ity to other children’s per ­sonal space (occa ­sion ­ally bit ­ing them when irri ­tated or pro ­voked) and an unpre ­dictably vio ­lent imag ­i ­na ­tion when play ­ing with toys. No Sun ­day school is equipped to han ­dle prob ­lems of this mag ­ni ­tude. So upon express ­ing their indig ­na ­tion, the moth ­ers requested that the min ­is ­ter call the child’s par ­ents and ask that he not return to Sun ­day school. Obvi ­ously, there were fam ­ily issues that needed seri ­ous and imme ­di ­ate attention.

The “prob ­lem child” was ours. My wife received the call early one morn ­ing. The min ­is ­ter was deeply apolo ­getic and pas ­toral in his approach. But the dam ­age had been done. What were we to do? Where could we go? Over the years, we had been through behav ­ioral pro ­grams, fam ­ily coun ­sel ­ing, and psy ­chi ­atric care. At this point, we were just begin ­ning to come to terms with our son’s recent diag ­no ­sis: Tourette’s syn ­drome. Later, he would also be diag ­nosed with Asperger’s syn ­drome, bipo ­lar dis ­or ­der, and obsessive-compulsive dis ­or ­der. But at this point he was about seven years old, and we knew only of the Tourette’s. We stopped attend ­ing this church. In fact, we stopped attend ­ing church alto ­gether. —Thomas E. Reynolds, Vul ­ner ­a ­ble Com ­mu ­nity: A The ­ol ­ogy of Dis ­abil ­ity and Hospitality (Brazos Press, 2008)

Engineering does not often apply directly to faith, but one method that has transformed the way I view community is a commitment to statistical honesty. In reading papers and critiques of clinical trials, one thing that comes up repeatedly is the question, “Is the community they engaged in this trial one that is diverse? Does it represent society in general? Can it translate into meaningful implications for the people I treat? Or were these participants selected in a biased way to favor a certain outcome? Is there a skew that limits how we may interpret and understand the world?”

One day it struck me to think about my own community with a similar critique. If I took a random sample of my friends from work, my neighborhood, and my church, would it look like it was truly random? Would there be an overrepresentation of certain types of people or a paucity in others? Would that statistical bias be a reflection of intentionality or a revelation in exclusivity?

I did a brief mental estimation and was not happy with the results. It is my natural human tendency to surround myself with others who think like me, talk like me, and act like me. What I have been grateful for in the work of medicine is being forced into contact with those who are very different from me, those whom, I am ashamed to say, I would not ordinarily choose as neighbors, associates, or friends. Through this means of grace, in the past year alone I have encountered former drug dealers and drug addicts, millionaires and mansion owners, wheelchair riders and deaf academics, judges and janitors, Holocaust survivors and pedophiles, saints and sinners. Though my coworkers (and myself) have often varied in expressions of compassion, we were obligated by both law and ethic to work with them in seeking their greatest benefit.

And so I found myself wondering, “Who is my neighbor? And have I shaped the courses of my encounters, friendships, and associations to suit their needs or my own?” I found that I did not like the answer: that my friends were mainly from certain ethnic groups, certain socioeconomic demographics, certain intellectual capacities and predispositions, certain persuasions of personality and even certain sects of faith. I had groomed and self-selected myself into becoming a statistical outlier in ways incompatible with the gospel, and it grieved me to think of those I had hurt in my exclusivity.

In this season of Lent, it is both sobering and encouraging to consider Christ’s disabled state, the divinity of he whose statistical cross-section of acquaintances included fishermen and Pharisees, tax collectors and political zealots, Samaritans and the blind, lepers and the governor’s wife, Centurions and servants:

Who, being in very nature God,
did not con ­sider equal ­ity with God some ­thing to be grasped,
but made him ­self nothing,
tak ­ing the very nature of a servant,
being made in human likeness.
And being found in appear ­ance as a man,
he hum ­bled himself
and became obe ­di ­ent to death—
even death on a cross!
–Philip ­pi ­ans 2:6–8

David

David graduated from Princeton University with a degree in Electrical Engineering and received his medical degree from Rutgers – Robert Wood Johnson Medical School with a Masters in Public Health concentrated in health systems and policy. He completed a dual residency in Internal Medicine and Pediatrics at Christiana Care Health System in Delaware. He continues to work in Delaware as a dual Med-Peds hospitalist. Faith-wise, he is decid­edly Christian, and regarding everything else he will gladly talk your ear off about health policy, the inner city, gadgets, and why Disney’s Frozen is actually a terrible movie.