March 17th 2011
In my first blog entry, I made the rather dubious claim that book authors with a political agenda can change the world. I proffered the example of Harriet Beecher Stowe’s Uncle Tom’s Cabin, which I insinuated had a small something to do with the Civil War and the emancipation of slaves.
To appease anyone who feels this was trite, I’ll counterbalance my previous claim with a new and equally simplistic one: Writing does not change the world. It might even make it worse.
The November 2010 issue of The Atlantic Monthly featured profiles and mini-profiles of nineteen “Brave Thinkers;” trailblazers who The Atlantic lauds for “intrepid and original thinking.” But it’s clear these individuals were selected for brave actions, not brave thoughts. Included were Dan Choi, the homosexual Lieutenant who chained himself to the White House fence in protest against Don’t Ask, Don’t Tell; John Hantz, the entrepreneur who’s attempting to convert Detroit into a colossal urban farm; Carol Ball, a Planned Parenthood doctor who risks her life to perform abortions in South Dakota; Rhode Island education commissioner Deborah Gist, who’s trying to improve education by firing bad teachers; and Jack Weinstein, the rogue New York federal judge who sometimes refuses to impose the state’s mandatory minimum sentence laws for child pornography and drug offenders.
Reading through these stories got me to thinking (again) about the differences between politicians, policymakers, bureaucrats, scientists, entrepreneurs….and writers. What, after all, does a writer do? Dan Choi chained himself to a fence and undoubtedly helped his cause. Granted, journalists (some of whom write) spread the news. But without the actions of people like Choi, there would be no news to spread.
Which leads me to Dr. John Ioannidis, the “Brave Thinker” who dominated the section with almost nine full pages devoted to his story. Though John is a doctor, I include him as one of the two writers featured on The Atlantic’s list, because Ioannidis garnered fame and recognition only after publishing his findings in high-profile medical journals.
Dr. Ioannidis is one of the world’s leading experts in the credibility of medical research. Or, I should say, the lack thereof; in meticulously designed meta-studies, Ioannidis and his research teams prove, again and again, that medical research is so pervasively flawed that it’s probably safest to ignore it altogether.
Before dwelling on the irony of Ioannidis’ endeavor, let’s take a look at the results:
“He (Ioannidis) discovered that the range of errors being made was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.”
In PLoS Medicine, Ioannidis published a mathematical model which predicted that research findings are wrong most of the time. By quantifying how many medical findings are later refuted by subsequent medical findings, he predicted that rates of wrongness will roughly correspond to rates of published (italics mine) refutation. (The design of this study made me think of dominos falling in a cascade of circular logic. Ioannidis says that objective “wrongness” is determined by refutation in a subsequent study. Yet this subsequent study, it seems, is also likely to be wrong. Anyway…..) He predicted that findings are insupportable 80% of the time with non-randomized studies (the most common kind), 25% of the time with randomized trials, and 10% of the time with large randomized trials.
Ioannidis later published a paper in the Journal of the American Medical Association that scrutinized 49 of the most highly regarded findings in the history of medical research. These findings led to, amongst other things, the widespread use of hormone-replacement therapy for menopausal women and the use of coronary stents to ward off heart attacks. 41% of these findings were later convincingly refuted; in most cases, the refutations have gone unnoticed, and the suggestions of the first (and therefore most widely-read) study continue to be implemented in day-to-day medical practice.
Ioannidis’s research is not opposed by the medical community. According to the article, most doctors who read it are unsurprised by the findings and happy that Ioannidis is airing their dirty laundry. From the article: “To say that Ioannidis’s work has been embraced would be an understatement. His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work—that would be a paper he published in Nature Genetics on the problems with gene-link studies.”
But back to the question of writing and the world. Here’s what really got me:
“…while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job…‘There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.’”
It seems whistle blowers don’t do any good if they’re not aligned with wealthy interest groups; or worse yet, if their findings are in direct conflict with the deep pockets of these groups. Perhaps Ioannidis’s time would be better invested in the Dan Choi method of protest. He could chain himself to the fence of the AMA and encircle himself in a tower of little wastebaskets filled with the crumpled detritus of pernicious research papers.
The law against effectiveness seemed to be a problem for the other writer featured in The Atlantic’s roundup, Ghana journalist Nicholas (Anas) Schmidle, the master of undercover investigative reporting. Schmidle has posed as a crooked cop, an imam, a janitor, and a psychiatric patient (to name a few) in his efforts to expose corruption. Schmidle’s critics allege that the journalist is more concerned with playing dress-up than stopping corruption. From the article:
“I asked Anas whether he focused more on catching villains or on stopping villainy. Sure, Carter will lose his job as an orderly, but wasn’t the hospital director, or even the country’s health minister, responsible?
‘The decision to take out the top ones is not mine,’ Anas replied.”
So then are we, as writers, helpless? Even if we devote years of our lives to researching and exposing a particular corruption, are we impotent when it comes to smiting it out?
I don’t believe so. While Schmidle can’t prove he’s made any significant dent in the corruption of his country, the psychological impact he’s had on his readers is impossible to measure. Let’s suppose that Ghana improves its mental health hospitals ten years from now. Who’s to say that the inspiration behind these future reforms couldn’t be traced back to seeds of shame that Schmidle planted in the conscience of the bureaucracy? The same can be said for Ioannidis. True, his studies have not led to reform in medical research. But when real reform becomes a priority, future iconoclasts will use Ioannidis’s papers as reliable research to legitimize their reforms.
I wouldn’t be surprised if every “Brave Thinker” was inspired by something they once read. Ron Paul was one of these featured thinkers, and he says his conversion from medical doctor to politician can be traced back to a single book:
“During medical school, he had happened upon a copy of The Road to Serfdom, the ringing defense of laissez-faire capitalism by the Austrian economist and philosopher Friedrich Hayek. Written in 1944 against the backdrop of Nazi Germany and Fascist Italy, it argues that state control of the economy leads inexorably to tyranny. To Paul, this was an epiphany, and it launched him on a quest to read anything he could find about the Austrian school of economics. The work of Hayek’s mentor, Ludwig von Mises, came to command his singular esteem.”
Years later, Paul decided to run for congress, and decades later, Paul still considers himself a “Misesian.” The Atlantic includes a full-page photograph of Ron Paul. He’s sitting on a park bench, and sitting next to him is a well-worn hardcover of Mises’ Human Action: A Treatise on Economics.