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Prostitution, the Law of Averages and Nutrition

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The reaction in the press to Showtime's The Secret Diary of A Call Girl is even more interesting than the program itself.

In case you missed it, what seems to have engendered the most apoplexy in the blogosphere are the following lines, spoken by the protagonist, Belle: "I wasn't abused by a relative, I've got no children to support, and I've never been addicted to anything, except maybe the fourth season of The West Wing, Why do I do it? I love sex and I love money".

This, as you can imagine, doesn't jibe well with the meme that all sex workers are abused, addicted, miserable and hate sex (and their clients).

Clearly, since the above meme is not up for re-examination, Belle must be in denial.

Which reminds me of the Charlie Brown cartoon where Lucy picks something up from the ground and says, "Look at this beautiful Brazilian butterfly. It's amazing -- how did it get here all the way from Brazil?" When Charlie tells her that what she picked up was in fact a potato chip, she doesn't miss a beat. "I wonder how this potato chip got here all the way from Brazil," she says.

So here's the thing. The category "prostitute" includes sex slaves from Thailand, hopelessly addicted crack addicts at Hunt's Point in the Bronx doing 20 dollar blow jobs in cars, man-hating lesbians who were abused by their stepfathers and African teenagers sold to tribal lords by their poverty stricken parents. Plenty of them. But -- with all due respect to the wonderful Nicholas Kristof and others who have rightly called for more international attention to this, it also includes women like Belle with no particular issues or hang-ups to speak of -- empowered, sexy and, yup, pretty happy women, who've never been in trouble with the law, who actually enjoy sex, and who have made a killing in the escort and porn businesses and wouldn't have it any other way. And no, they're not all damaged. Sorry.

The sub-groups are as vastly different from one another as Compton is from Beverly Hills and when you're talking about "Los Angeles" you could be referring to either one.

Same thing happens all the time in nutrition and health research.

Subgroups get lost in the averages and the result is we miss some very important distinctions.

"Vegetarians" vs. "Meat-Eaters": who is healthier? Well, are we talking "Twinky Vegetarians" who eat nothing but pop-tarts and pasta? Are we talking meat eaters who eat grass-fed New Zealand lamb twice a week along heaps of kale, blueberries and Swiss chard? To talk about either "meat-eaters" or "vegetarians" as if they're one homogenous group causes us to miss incredibly important underlying data. "Meat eaters have higher rates of prostate cancer" may indeed be true for meat eaters who eat nothing but ballpark franks and deli meats and never met a vegetable they didn't hate. For the lamb-eating Whole Foods crowd... maybe not so much.

We saw this phenomenon recently when data from the Women's Health Initiative about hormone replacement scared countless women off their hormones. Later analysis found that the only women who were at real risk were those who started hormone replacement a decade or more after menopause. There was virtually no problem for the sub-group of women who used hormones for a few years at the start of menopause, but those results got buried in the overall statistics and completely overlooked in the alarmist sound bytes ("Hormone replacement dangerous!")

(And I'm not even touching the fact that "hormone replacement" referred only to pharmaceutical drugs, not bio-identicals.)

Like distinct colors blended into a melting pot of statistical paint, the distinct (and important) characteristics of sub-groups get eaten up by the averages and vitally important health information is lost to all but those who bother to read the fine print.

I'm pretty sure -- though I can't prove it -- that this is what's going on in the whole autism-vaccination debate. There is probably a sub-group of kids whose liver enzymes (they're called Cytochrome P-450 enzymes) simply aren't up to the task of getting rid of mercury. But he studies -- which average this group in with everyone else -- don't show an overall correlation between the vaccination and autism, so apologists for the status quo label the concerned parents crazy and go on about their business. If you average in enough people in a study, you can easily miss what's going on in important sub-groups.

Looked at as a whole, there are probably more prostitutes who are leading miserable lives than there are folks like Showtime's Belle.

But that doesn't mean that Belle's lying. She's not.

She and her cohorts just get lost in the averages.

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