Episode Transcript
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Speaker 1 (00:15):
Pushkin. On the twenty first of August nineteen seventy four,
Elaine Oswald made a visit to the doctor's office in
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a small town not far from Manchester in the north
of England. Oswald had a slight pain in her side,
but she was hoping to go into work later that day.
Oswald had never met this particular doctor before, and he
was only a few years older than she was. She
was only twenty five. He had spectacles and the kind
of big brown beard that was fashionable at the time.
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The doctor couldn't have been friendlier or more accommodating. He
sat beside her, not over on the other side of
a big desk, and he told her she might have
kidney stones. He prescribed some strong painkillers, then suggested she
go home and rest. Leave your door unlocked. He said,
I'll come round after my morning clinic has finished and
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do a blood test. Later that day he stopped by.
His wife and son were in the car outside. He said,
just a quick jab with a needle to draw the
blood and he'd be on his way. The needle slid
into her arm. The next thing Elaine Oswald remembers was
waking up on the floor with a doctor and two
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paramedics trying to revive her. She was rushed to hospital,
where the staff, she recalled, treated her like the scum
of the earth. They assumed she'd overdosed on those painkillers.
The young doctor was much kinder. She must have had
an allergic reaction, he said, Thank goodness he'd been there
to administer the kiss of life. He promised to write
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up the case for a medical journal. She was grateful,
of course, who wouldn't be. When she was discharged from hospital,
the kind doctor even invited her and her husband for dinner.
It was a pleasant evening. He gave her a medic
alert bracelet so that no future clinician would accidentally prescribe
similar drugs. She'd go on to have two children, toughing
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it out through the agonies of labor without pain relief.
Elaine Oswald eventually moved to America, became a professor of English,
and for the next twenty five years assumed that the
kind doctor, a man called Harold Shipman, had saved her life.
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She couldn't have been more wrong. I'm Tim Harford, and
you're listening to cautionary tales. It took twenty five years
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for the world to realize that Harold Chipman was not
the kindly doctor who believed in his patients while others
treated them badly. Not the bold life saver who'd leap
to administer the kiss of life, Not the caring man
who'd go the extra mile to visit his patience at
home rather than drag them into the clinic. No, Harold
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Shipman was a murderer, and not just any murderer. In
sheer numerical terms, he was the worst serial killer in history.
There are plenty of notorious killers, the charming Ted Bundy,
John Wayne Gaycy, the Killer Clown, the son of Sam
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David Berkowitz. But while Bundy, Gaycey, and Berkowitz between them
killed more than seventy people, Shipman alone killed more than
two hundred. Often his victims would be people living by themselves,
elderly but in perfectly fine health. Shipman would come round,
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inject them with an overdose of morphine, just as he
had injected young Elaine Oswald, and then sign a death
certificate saying that they had died of old age. When
I began researching this cautionary tale, I knew that Shipman
was a terrible man. I didn't understand quite how terrible
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I vaguely had in mind a doctor who started down
this path by easing the deaths of patients who were
in pain and terminally ill, and then got carried away.
But the truth is so much more horrible than Shipman
would kill healthy people, then to explain their deaths, he'd
say they'd been drug addicts. He'd retrospectively tamper with their
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medical records and leave the bereaved families bewildered. More than once,
he killed someone in his clinic, then would claim they'd
died of heart failure. He may have killed a severely
disabled four year old girl. When one middle aged man,
Jim King, was misdiagnosed with cancer, Shipman intercepted the letter
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from the hospital with a good news that he was
cancer free after all. Shipman supplied Jim with morphine, got
him hooked, and watched as Jim lost his job and
pawned his possessions. Meanwhile, Shipman skimmed off some of that
morphine and used it to murder Jim King's own father.
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Why did he do it? Plenty of people have speculated,
but nobody knows. One doctor, an expert witness at Shipman's
trial mused that while some doctors would relax from the
stresses of the profession by playing a round of golf,
Shipman seemed to relax by murdering his patience. Shipman, who
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killed himself in prison, never offered an admission of guilt,
let alone an explanation. But this cautionary tale isn't going
to pick apart Harold Shipman's psychology. No, this tale, like
all our tales, is about the lessons we can learn here.
The lesson is that Harold Shipman could have been caught
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much earlier. Maybe not as early as nineteen seventy four
when he injected the young Elaine Oswald with morphine, perhaps
intending to kill her, and perhaps with some other wickedness
in mind, but he could have been caught early enough
to have saved more than a hundred lives. In the
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early hours of July the twenty ninth, nineteen seventy six,
in the Bronx, New York, Jody Valenti and her friend
Donna Lauria sat in their oldsmobile chatting. They were just
outside Donna's home, Donna's parents were inside. Both of them
were in medical training, Jody to be a nurse, Donna
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to be a medic, but Donna would never get the
chance to finish her studies. Jody Valenti was a young
woman like Elaine Oswald, but her brush with death at
the hands of a serial killer was a complete contrast
with Elane's. As Jody and Donna were talking, a man
walked up, pulled out a pistol, and shot them both.
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Donna Laurier died instantly. Jody Valenti took a bullet in
her leg and she survived. She was, of course traumatized,
and she obviously understood quite how close she had come
to death. Unlike Elaine Oswald, she didn't spend the next
twenty five years believing that her attacker was a hero
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who had saved her life. The NYPD had a clearly
defined problem. Someone calling himself the Son of Sam was
wandering around New York City shooting young people, leaving some dead,
some disabled, and the whole community in a panic. He
had to be found, and eventually, in August the following year,
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he was found. In the case of Harold Chipman, the
Greater Manchester Police faced a radically different problem. The problem,
in fact, was to realize that there was a problem,
because The police had no idea that people were being murdered.
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People were dying, yes, but according to their doctor, they
were dying of natural causes. The deaths were a surprise
to friends and family. Most of the time, the victims
weren't seriously ill, just old and alone. In the morning,
there would be pottering around, catching the bus or dropping
in on a neighbor, in good shape and fine spirits.
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And in the afternoon, dear kind doctor Shipman would come
by on a routine visit, and according to doctor Shipman,
well he'd find them dead, dead of old age. He
would often write on the death certificate, even though doctors
would normally be more specific. And while their friends and
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relatives were shocked, they weren't shocked enough to call the police.
As far as the police were concerned, then there was
nothing to investigate. Sarah Marsland died on the seventh of
August nineteen seventy eight at her home in Hyde, a
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small town near Manchester. Harold Shipman was a doctor. He
had moved to hide in nineteen seventy seven. By coincidence,
that was about the time my own family moved to
the area. I was four years old. I'm so glad
I never came any closer to his orbit. We can't
be absolutely sure that Sarah was one of Shipman's victims,
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because nobody even suspected that a crime had been committed
until more than two decades after she had died. But
the circumstantial evidence is this. Although Sarah Marsland seems to
have had no particular health complaint, Harold Shipman came to
see her uninvited and unannounced. While he was there she died.
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It wasn't unusual for Shipman to visit patients for no
particular reason. He did it all the time, and they
loved him for it. A good old fashioned, hard working doctor,
they said, someone with all the time in the world
for his patience. But even so, it is a striking
coincidence that some one would drop dead just when a
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doctor happened to be popping in for a friendly visit.
One physician later testified that this was the sort of
coincidence there might be at once in a lifetime experience
for a family doctor, but for Harold Shipman, it seemed
to happen every few weeks. Nevertheless, nobody raised the alarm
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about Sarah Marsland at the time, and why would they
raise the alarm. She was in her eighties and her
own doctor had declared that she had died of coronary thrombosis.
The situation didn't seem out of the ordinary. A few
years before Sarah Marsland's death, two psychologists, Daniel Carneman and
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Amos Verski, began investigating patterns in the way we make judgments.
One pattern that they discovered helps to explain why nobody
suspected doctor Shipman for a very long time. That pattern
is known as the representativeness heuristic, a habit of mind
that leads us to sort a situation into strange or unremarkable,
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depending not on the true likelihood, but whether it matches
our existing mental groupings. For an example of the representativeness heuristic,
consider the following description of a person. He's called Jeff.
Jeff is forty and very good looking. He works out,
practices yoga, and is a vegetarian. When he was a teenager,
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Jeff was a movie buff, and he also took the
lead role in the school play. He's always been extroverted.
He's already gone through two divorces, and his current girlfriend
is fifteen years younger than him. Which of the following
do you think is more probable A. Jeff is now
a Hollywood movie star or B Jeff is now an accountant. Intuitively,
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Jeff sounds like a movie star, but that's not right.
There are just a few dozen genuine movie stars in Hollywood,
while there are well over a million accountants in the
United States. Many thousands of them will, like Jeff, be
good looking, twice divorced vegetarians with a background in amateur dramatics.
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The representativeness heuristic is a quick and easy way for
our subconscious mind to make decisions. We use it all
the time without knowing, and it often works, but it
can lead us astray. It led the community of Hide
astray too. In a subtly different way. Harold Chipman didn't
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repeat his early mistake of drugging a twenty five year
old Elane Oswald. He began to target much older people,
people like the widow Sarah Marsland. Although Sarah was in
decent health, she fits the mental template of someone who
would die from natural causes. My point is not that
when an elderly person dies we should assume it was murder,
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not even when the elderly person dies, just as her
doctor happens to call past unannounced. No. My point is
that when something fits neatly into our mental story, we
don't ask questions. We don't start to weigh up the
probabilities of murder versus natural causes. If we did, we'd
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simply ask for an autopsy, wouldn't we But we don't,
and we don't because what we see fits naturally into
the story we expect. So the fundamental problem was not
only did people not realize that Shipman was a murderer,
they didn't even realize that there were any murders taking place.
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The representativeness heuristic reassured them, nothing strange is happening. Move on,
there's nothing to see. Cautionary tales will be right back.
Shipmen murdered people with lethal doses of morphine, which left
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no obvious trace unless there was an autopsy. But why
would there be one? The representativeness heuristic tells us nothing
stranger has happened. Shipman would sign the death certificate himself
to certify death from old age or heart failure. No
need to call the ambulance, he'd say, too late, no
need to call the police. He could deal with the
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necessary paperwork himself again and again, Harold Shipman murdered people
in their own homes, and again and again. The friends
and the family of the victims did not realize that
a crime had been committed. Indeed, many people were grateful
to Shipmen, glad that in their final hours the patients
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had had the close attention of the doctor they adored.
Not everyone felt that way. In nineteen ninety four, for example,
Alice Kitchen died suddenly at the age of seventy A
few hours after seeing her son and appearing to be
in good health. Doctor Shipman told her family that he
had called in to visit her, that she had clearly
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suffered a stroke, but that she had refused to go
to hospital as he had suggested. It was a cruel
lie and an arrogant one. Alice Kitchen's family decided against
making a formal complaint, but they were angry. They thought
Shipman was guilty of negligence. In their book about Shipman's crimes,
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Prescription for Murder, the journalists Brian Whittle and Jean Richie
muse on the nature of the murders and the people
who died. Their ages meant that the death would not
make any statistician raise an eyebrow seventy seventy four, sixty
nine eighty three, all within the range that death comes.
The deaths would not make any statistician raise an eyebrow.
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It seems an uncontroversch or phrase. After all, elderly people
die all the time, don't they. But it's quite wrong.
The representativeness heuristic is soothing us into keeping our eyebrows unraised.
But statisticians don't use the representativeness heuristic. They use the data,
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and any statistician given a look at the statistics behind
Harold Shipman's clinical practice would have raised more than an eyebrow.
They would have raised the alarm. Professor Sir David Spiegelhalter
is one of the UK's foremost statisticians. He's a brilliant
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communicator of statistical ideas and the author of a great book,
The Art of Statistics. David was asked to provide advice
to the commissions set up after Shipman was jailed, invited
to answer the obvious question could Shipman have been stopped sooner?
And to David spiegel Alter and the other statisticians considering
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the problem, that answer was, of course he could have
been stopped. All you had to do was look at
the numbers in the right way. Interrogating statistics to set
our alarm. Bells ringing was an idea developed by the
Allies during the Second World War. At Columbia University, New York,
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the great Hungarian mathematician Abraham Vald was working on military
mathematics and he developed what he called sequential testing. Meanwhile,
the young mathematician named George Barnard was working in London
for the fabulously named Ministry of Supply. Because of the
wartime secrecy, Vald and Barnard weren't aware of each other's work,
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but they were working on the same basic problem, which
is this. Let's say you have a process which produces
a random output. Say rolling a die, you are a one,
then a four, and another one, A two, one, five, three, one, six,
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on you go. You can keep rolling as many times
as you like. So at what point do you say, Hey,
there's something strange about this dye. I'm rolling too many wands.
You can use the same idea to check products coming
off the production line. You don't want to stop the
conveyor belt just because of a single faulty product, but
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neither do you want to keep the production line rolling
forever if there is a steady stream of problems. Rold
and Barnard would have been particularly focused on the manufacture
of ammunition and other armaments, but the maths can be
applied more widely. Sample some cookies to check whether they
have enough chocolate chips in them, or check the strength
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of condoms by inflating them to see if they stand
up to the strain. Any product will have a failure rate.
But at what point do you say, hang on a minute,
something's wrong. David Spiegelholter and his colleagues told the Shipman
Inquiry that looking for suspicious patterns in medical records was
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fundamentally similar to looking for suspicious patterns in dice rolls,
or cookies or condoms. You might want to make some
adjustments for the mix of cases. A doctor serving a
retirement community is going to have a very different case
mix from a doctor working on a military base, but
the principle is the same. Track deaths over time among
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each doctor's patients, just as you might track faulty cookies
or faulty condoms. Spiegelholter and his colleagues concluded that the
kind of analysis developed by Vold and by Barnard could
have flagged Harold Shipman for close attention as early as
nineteen eighty four, fourteen years before he was eventually arrested.
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More than a hundred murders could have been prevented, and
that's just statistical method. Other ways to slice the data
also raise questions. For example, there were a couple of
years in which Shipman went quiet, perhaps fearing that other
doctors in the clinic would notice what was happening. When
he left to set up shop as a lone practitioner
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for the murders began again with hindsight. All this is
clear in the data. Even clearer is the fact that
so many of Shipman's patients died in the early afternoon,
a convenient time for Shipman's home visits. The pattern, says
Professor Spiegelhalter, requires no subtle statistical analysis. It is what
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statisticians call interocular. Draw a graph and it hits you
between the eyes. Not all statistical anomalies result from foul play,
of course, David Spiegelhalter told me about one doctor who
had a truly extraordinary number of deaths on his watch,
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even more than Harold Shipman. But there was an innocent explanation.
While Shipman's patients had often died suddenly, this doctor had
been treating terminally ill patients. He had gone to great
lengths to ensure they were able to die at home
rather than spending their final hours or days in hospital.
As a result, the doctor ended up signing a large
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number of death certificates. But statistical analysis isn't designed to
prove guilt. It's designed to focus attention. Close inspection of
this doctor's work revealed a person who upheld the highest
standards of the medical profession. Close inspection of Harold Shipman's
practice would have revealed the appalling truth. A forensic analysis
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of his medical record keeping, for example, would have shown
him back dating entries to invent medical problems after the fact,
and a single autopsy of one of the patients would
have revealed the lethal doses of morphine. All it would
have taken was someone to pay attention, and a simple
analysis of the numbers would have shown them which doctor
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to pay attention to. But given just how simple this
statistical exercise would have been, given how many lives it
would have saved, and given the fact that we didn't
actually do it, I have a question, what else are
we missing? Cautionary tales will return in a minute. The
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health authorities in the UK believe they now have statistical
alarm bells that would ring if another Harold Shipman comes along.
But what other stories are hiding in plain sight? In
twenty fourteen, and Case and Angus Deaton were spending the
summer together in a cabin in Montana. Case and Deaton
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are married. Both are respected economists, and they had both
become deeply interested in the growing problem of suicide among
middle aged white Americans. To put that problem into context,
they decided to compare suicide to the more traditional forms
of death, such as heart disease and cancer. We went
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to the Centers for Disease Control, downloaded the numbers, and
made the calculations. They write in their new book, Deaths
of Despair and the Future of Capitalism. To our astonishment,
it was not only suicide that was rising among middle
aged whites. It was all deaths. Not by much. But
death rates are supposed to fall year on year, so
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even a pause was news, let alone an increase. We
thought we must have hit a wrong key. Constantly falling
death rates were one of the best and best established
features of the twentieth century. The finding was right there
in the data, but nobody, it seems, had thought to look.
We thought we must be wrong, because someone would know
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about it. But they weren't wrong. They were just ignored.
The New England Journal of Medicine didn't want to publish
the results. The Journal of the American Medical Association rejected
us so quickly we thought it was an auto reply
because we'd used the wrong email address. Case and Dton
broadened and deepened their scrutiny of the numbers. Suicide was up,
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so was chronic liver disease a sign of alcoholism. Even
more dramatically, deaths from poisoning were up. Poisoning sounds melodramatic,
like the cause of death in an Agatha Christie story,
but it usually means a fatal overdose of alcohol or drugs,
often opioids such as morphine or fentanyl. Once a rare problem,
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drug overdoses have overtaken lung cancer as a cause of
death for forty five to fifty four year old white America.
And it all happened so quickly from barely being an
issue in the late nineteen nineties to making a major
dent in the mortality data just fifteen years later. It
is an ironic reversal of Harold Shipman's murderous career. Shipmen
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killed vulnerable people with opioid overdoses. In the US, doctors
have simply been supplying ever more powerful opioids to vulnerable people. Misery,
pain or sheer accident have done the rest. Put these
three courses of death together, suicide, accidental overdoses, and livid disease,
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and you have a category that Case and Dton named
deaths of despair. The toll dwarfs anything that one murderer
could achieve. Case and Dton found there were one hundred
and fifty eight thousand deaths of despair in twenty seventeen.
That is a similar scale to the first wave of
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COVID nineteen deaths in the US. It was a catastrophe,
and it was a catastrophe that should have been plainly
visible in the statistics. Yet somehow nobody had taken the
effort to look. On the twenty fourth of June nineteen
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ninety eight, Kathleen Grundy, the former Mayoress of Hyde, died
suddenly at the age of eighty one. It was a surprise.
She had been fit and socially active. On the same day,
a will arrived at a firm of local attorneys with
a covering letter. The will purported to be that of
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Kathleen Grundy. It declared her intention to leave her house
to her dear family, doctor Harold Shipman, but the attorney
had never had any dealings with Kathleen Grundy and the
signatures looked odd. A few days later, a mysterious letter
from someone called Smith told the attorney that missus Grundy
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had died. Puzzled, the attorney contacted Kathleen Grundy's daughter, who
was an attorney herself and well versed in the ins
and outs of making a will. Already stunned by her
mother's death, she was even more astonished to find herself
and her children abruptly disinherited. There had been no family argument,
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no sign that had changed in the will was imminent,
and the new will was odd. Why send it to
an unknown firm of attorneys, Why was it riddled with
typos when her mother was a trained typist, and why
did it show no knowledge of the fact that Kathleen
Grundy owned a second house in Hyde and a holiday
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cottage too. Kathleen Grundy's daughter called the police. It didn't
take long for the police to discover that the will
was a forgery, that the cover letter had been typed
on Harold Shipman's typewriter, and that missus Grundy's medical records
had been altered after her death. If Shipman hadn't made
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such crass misjudgments, who knows, he might never have been caught.
As it was. Harold Shipman was arrested. Faced with the
need to conduct autopsy examinations, the police began the terrible
task of digging up the bodies all over the town
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of Hyde. The slow process of uncovering Shipman's awful crimes
had begun. In the aftermath, some local people blamed themselves
for not having spoken up sooner. John Shaw, the gentle
taxi driver who spent his days driving elderly ladies around,
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knew them well enough to attend funerals when they passed away,
but were simply too many funerals. Shaw told the journalists
Brian Whittle and Jean Ritchie. I noticed that all those
who were dying went to the same doctor, doctor Shipman. Eventually,
john Shaw went to the police to discover that they
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were already investigating the death of Kathleen Grundy. Could he
have spoken up earlier, perhaps a year or two, But
the police admitted that he might well have been ignored
if he had. After all, he was just a taxi driver,
and Harold Shipman was a respected doctor. Other people had
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also been growing concerned. There was Debbie Massey, a funeral
director who was responsible for burying or cremating many of
Shipman's victims. There was Linda Reynolds, another local doctor. Massey
and Reynolds raised the alarm in March of nineteen ninety eight.
Perhaps they could have spoken up in February or January.
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Perhaps the police could have been more vigorous in responding.
But it's important to recognize we're talking about a matter
of weeks or months at best. If instead we had
collected the simplest of data sets, if we had run
the most basic analysis of that data, we would never
have needed to depend on people risking the scorn of
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the police and the enmity of Harold Shipman to stop him.
The statisticians, with their production line mathematics designed to inspect
condoms and chocolate chip cookies, might have stopped his murder
Spree more than a decade earlier. Essential sources on Shipman's
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crimes are The Shipman Inquiry and Brian Whittle and Jeane
Rich's book Prescription for Murder, David Spiegelhalter's excellent book The
Art of Statistics covers the Shipman case, and my own
book The Data Detective makes a plea for taking the
numbers seriously. Other sources are at Tim Harford dot com.
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Cautionary Tales is written by me Tim Harford with Andrew Wright.
It's produced by Ryan Dilley and Marilyn Rust. The sound
design and original music is the work of Pascal Wise.
Julia Barton edited the scripts. Starring in this series of
Cautionary Tales Helena Bonham Carter and Jeffrey Wright, alongside Nazzar Alderazzi,
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Ed Gohan, Melanie Gutteridge, Rachel Hanshaw, copenaholbrook Smith, Greg Lockett,
Messiamunroe and rufless Right. This show wouldn't have been possible
without the work of Mia La Belle, Jacob Weisberg, Heather Fane,
John Schnarz, Carli mcgiori, Eric Sandler, Emily Rostick, Maggie Taylor,
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An Yellow Lakhan and Maya Kanig. Cautionary Tales is a
production of Pushkin Industries. If you like the show, please
remember to rate, share and review.