The AVI sent along a link (from 2013) this week about movies that audiences love and critics hated as judged by their Rotten Tomatoes scores.

For those of you not familiar with Rotten Tomatoes, it’s a site that aggregates movie reviews so you can see overall what percentage of critics liked a movie. After a few years of that, they also allowed users to leave reviews so you can see what percentage of audience members liked a movie. This article pulled out every movie with a critic score and an audience score in their database and figured out which ones were most discordant. The top movies audiences loved/critics hated are here:

The most loved by critics/hated by audiences ones are here:

The article doesn’t offer a lot of commentary on these numbers, but I was struck by how much selection bias goes in to these numbers. While movie critics are often (probably fairly) accused of favoring “art pieces” or “movies with a message” over blockbuster entertainment, I think there’s some skewing of audience reviews as well. Critic and audience scores are interesting because critics are basically assigned to everything, and are supposed to write their reviews with the general public in mind. Audience members select movies they are already interested in seeing, and then review them based solely on personal feelings.

For example, my most perfect movie going experience ever was seeing “Dude, Where’s my Car?” in the theater. I was in college when it came out, and had just finished some grueling final exams. My brain was toast. A friend suggested we go, and the theater was full of other college students who had also just finished their exams. It was a dumb movie, a complete stoner comedy from the early 2000s. We all laughed uproariously. I have very fond memories of this, and the movie in general. It was a great movie for a certain moment in my life, but I would probably never recommend it to anyone. It has a 17% critic score on Rotten Tomatoes, and a 47% audience score. This seems very right to me. No one walks in to a movie with that title thinking they are about to see something highbrow, and critics were almost certainly not the target audience. Had more of the population been forced to go to that movie as part of their employment, the audience score would almost certainly dip. If only the critics who wanted to see it went, their score would go up.

This is key with lists like this, especially when we’re looking at movies that came out before the site that existed. Rotten Tomatoes started in 1998, but a quick look at the top 20 users loved/audiences shows that the top 3 most discordant movies all came out prior to that year. So essentially the user scores are all from people who cared enough about the movie to go in and rank it years after the fact.

For the critics loved/users hated movies, the top one came out in 1974. I was confused about the second one (Bad Biology, a sex/horror movie that came out in 2008), but noted that Rotten Tomatoes no long assigns it a critic score. My suspicion is that “100%” might have been one review. From there, numbers 3-7 are all pre 1998 films. In the early days of Rotten Tomatoes you could sort movies by critic score, so I suspect some people decided to watch those movies based on the good critic score and got disappointed. Who knows.

It’s interesting to think about all of this an how websites can improve their counts. Rotten Tomatoes recently had to stop allowing users to rate movies before they came out as they found too many people were using it to try to tank movies they didn’t like. I wonder if sending emails to users asking them to rank (or say “I haven’t seen this”) to 10 random movies on a regular basis might help lower the bias in the audience score. I’m not sure, but as we crowd source more and more of our rankings, bias prevention efforts may have to get a little more targeted. Interesting to think about.

One of my favorite weird genre of news story occurs when the journalist/editor/newsroom all forget how old they are in relation to the people they are writing about. This phenomena is what often gives rise to articles about millenials that don’t actually quote millenials,  or articles about millenial parents of small children that compare them to Boomer parents of teenage children. I also see this in the working world, where there are still seminars about “how to manage millenials”, even though the oldest millenials are nearing 40 (and age discrimination laws!) and new college grads are most likely “Gen Z”.

Anyway, given my love for this genre of story, I got a kick out of a Megan McArdle Tweet this week that pointed out a Mother Jones article that fell a bit in to this trap.

She was pointing to this article that explained how Juul (an ecigarette manufacturer) had been marketing to teens for several years. As proof, they cited this:

Now for many millenials, this makes perfect sense. How could you screen three teen movies like “Can’t Hardly Wait”, “SCREAM” and “Cruel Intentions” and say you were marketing to adults? Well, that depends on your perspective. Can’t Hardly Wait came out in 1998, SCREAM in 1996 and Cruel Intentions in 1999. Current 14-18 year olds were born between 2001 and 2005. Does a party featuring movies made 5 years before you were born sound like it is trying to attract current teens? Or is it more likely that it would draw those who were teens at the time they were released….i.e. those in their early 30s?

As a quick experiment, subtract  5 years from your current birth year, Google “movies from ______”, take out the actual classics/Oscar winners and see how many of those movies you would have gone to an event to see at age 16. I just did it for myself and I’d have gone to see Rocky (though that’s an actual classic) and that’s pretty much it. I enjoyed the Omen, but not until later in college, ditto for Murder by Death and Network. In thinking back to my teen years, I did attend an event where Jaws was screened at a pool party, but I suspect the appeal of Jaws is more widespread/durable than “Can’t Hardly Wait”.

To be clear, I have very little insight in to Juul’s marketing plan or anything about them other than what I’ve seen on the news. What I do know though is that some movies appeal to broad audiences, and some appeal to a very narrow band of people who saw them at the right age. Teen movies in particular do not tend to appeal endlessly to teens, but rather to continue to appeal to the cohort who originally saw them.

There is an odd phenomena with some movies where they do poorly in the box office then pick up steam on DVD or cable broadcasts. The movie Hocus Pocus  (1993)is a good example. It was a flop at the box office, but was rebroadcast on ABC Family and the Disney Channel and then landed on a kids “13 Nights of Halloween” special in the early 2000s. This has caused the very odd phenomena of kids who weren’t born when it was released remembering it as a movie of their childhood more than those in the “right” cohort would have.

So basically I think it can be a bit of a challenge to triangulate what pop culture appeals to what age groups, particularly once you are out of that age group. Not that I’m judging. I struggled enough to figure out what was cool with teens when I actually was one. I have no idea how I’d figure it out now.

There was an interesting article in the Washington Post this week, about a man with a truly bizarre disorder. Among many other terrible symptoms, he essentially never has to go to the bathroom while he’s standing up and going about his day and appears to be dehydrated no matter how much he drinks, but the minute he lays down at night he has to urinate copiously and shows signs of being overhydrated. He has so many bizarre symptoms that he ended up in something called the Undiagnosed Disease Program, a fascinating group run by the NIH that seeks to find diagnoses for people who have baffled other physicians. They conduct all sorts of testing and try to either find people a diagnosis or to add their information to a database in the hopes that eventually they’ll get some information that will help them figure this out. The overall goal is to both help people and add to our collective knowledge about the human body.

Outlier medical cases are truly fascinating to many people, myself included. The WaPo column is actually part of a series called “medical mysteries“. Oliver Sacks made a whole writing career out of writing books about them. These cases make it in to our textbooks in school, and they are the stories that stick in our minds. These aren’t even one in a million cases, they are often one in 10 or 100 million. The guy in the WaPo story might even be 1 in a billion or 10 billion.

I am also fascinated by these stories in part because last year I started in on a medical mystery of my own. It started innocuously enough: random bouts of nausea, random bouts of extreme fatigue, then noticeable increased sensitivity to smells, tastes and pain. I assumed I was pregnant. I wasn’t.

I followed up with my doctor who confirmed that my hormone and other blood levels were fine. She ran tests to see if I was being poisoned, if I had a weird vitamin deficiency or had ODed on something accidentally.  She referred me to a couple of other doctors. The bouts came and went, but they actually started to get very disconcerting. My increased sense of smell meant that my car would frequently smell strongly of gas…something most of us take to mean there’s a problem. I couldn’t wear certain clothes because it felt like the seems or zippers were cutting my skin, but my skin showed no signs of redness. I couldn’t drink my coffee some mornings because I was convinced it was scalding my mouth. When I ate food I was convinced I could still taste the wrapper. Sensory information is supposed to help us make our way through the world, and to have it suddenly shifting around on you is incredibly disorienting.

Over the course of 6 months I saw 7 different doctors, all of whom were baffled. Since I work at a hospital I informally talked to half a dozen other NPs/PAs/MDs, and none of them had any idea either. The nausea and fatigue could come with hundreds of disorders, but nervous system hypersensitivity is a much less common symptom.

In the course of all this, the Assistant Village Idiot made a comment about how I should remember that strange symptoms were more likely to be an uncommon presentation of a common thing than an uncommon thing. The most experienced doctors I saw also mentioned the limitations of diagnosis. We build diagnoses based on the most common presentations of things, but we often don’t know if there are other possible presentations. We give names to clusters of symptoms because we see them together often, but it’s possible the biological underpinnings of the disorder could end up different places we don’t see as often. One doctor mentioned that in 6 months or a year I might add more symptoms that made things much clearer.

After about 6 months I still had no answers, but got some relief when I discovered that a magnesium supplement I’d taken to help me sleep seemed to help my symptoms. My doctor told me I could increase the dose and take it daily, and over the course of 6 weeks it mostly worked. I had relief, even if I still had no answers.

That was in January, and for the last 8 months I’ve seen small flares of symptoms that magnesium seemed to help. Then, about a month ago a new symptom started that made the whole thing much clearer: I got a headache. A one sided, splitting “gotta go lay down in a dark room” headache. A week or two later I got another one, then I got another one. I had always gotten a handful of migraines a year, but with the sudden change in frequency I started to notice something. For two days before I would be extra sensitive to light, pain, and smell. Sound too. Then during the migraine I would be incredibly nauseous, then the day after I would be so fatigued I could barely get out of bed. I looked back at my journals of my mystery symptoms I’d started keeping last year and realized it fit the same pattern. The symptoms that seemed so mysterious were actually part of the very classic migraine prodome/aura/postdrome pattern. It was then that I learned about the existence of acephalgic or “silent” migraines…..migraines that occur with all of the symptoms except the classic headache. My doctor confirmed my suspicions. I had been having chronic migraines with the headache, that now had developed in to chronic migraines with the headache. Once the headache appeared, my case was textbook. I got prescriptions for Imitrex and Fioricet along with a prophylactic medication.

Now per the Wiki page (and everything else I’ve read), acephalgic migraines are uncommon. It’s not particularly normal to get them as badly as I did without regular migraines, though they admit the data may be flawed. Since most people wouldn’t identify those symptoms as migraines, they might have an underreporting problem. Regardless, the AVIs point stood: this was an uncommon presentation of a common thing, not an uncommon disorder.

I like this story both because I am relieved to have a diagnosis and because it is relieving to have a diagnosis and because it is an interesting example of the entire concept of base rate. Migraines are the third most common disease in the world, after tension-type headaches and dental caries (cavities). One out of every 7 people get them. If we assume that my symptoms are highly unusual for migraine sufferers….say 1% of cases….that still means about 15 out of 10,000 people will get them. For comparison, schizophrenia is 1.5 out of 10,000.  Epilepsy is 120 out of 10,000, or about 10% the rate of migraine sufferers. A small percentage of a big number is often still a big number. An uncommon presentation of a common disorder can often be more common than uncommon disorders.

See, everything’s a stats lesson if you look hard enough. While I’m relieved to have a diagnosis, the downside of this is that the more frequent headaches are impacting my ability to sit in front of a screen as often, which may impact blogging. While we figure out what works to reduce the frequency of these, I may end up doing some more archives posting, maybe a top 100 post countdown like the AVI has been doing. We’ll see. While my doctor is great, any good resources are appreciated!