Making "All The Rage" was a long and winding path. About 6 years into the process, when I was recovering from a second bout of frustration-induced back pain, I stumbled upon an article in Wired Magazine by Jonah Lehrer called, "Why Science is Failing Us". The article was a profound revleation to me: it helped me articulate things that I had been struggling to find words for- for years. It was a dense yet easy to read narrative that detailed how the radonmized control trial had gone off track in regards to medicine. It was about how systems operate, often not seeing important information that should cause pause, because to see that information might invalidate many aspects of that system. This information was espeically dangerous to those who wield the most power in that system.
The article begins with a discussion of a drug called Torcibor that was designed to replace Lipitor which had been a blockbuster that was about to become a generic drug. Where Lipitor was designed to keep the "bad fat" from clogging artieres, Torcibor was aimed at stopping the body from even producing the bad fat. In trials, it worked and when announced that it was going to phase three, the value of the company skyrocketed. However, one piece of data that the reserachers had missed was that while it stopped the body from producing the bad fat, the test subjects were dropping like flies. No one had looked at that number. Once recognized, the trial was cancelled and the stock lost billions in value.
What really got me, though, was a later paragraph detailing how test after test had determined that herniated discs were not causally correlated with back pain, yet practice hadn't changed. Again, the article was about how systems are often willfully blind to facts that challenge the system. This was something that I knew about herniated discs, but could not get anyone to accept. Friends or acquaintances had been told that something physical was wrong and there was no dissuading them from that fact. Lehrer goes on to cite other studies that explalin how we often are blinded by what we "see". When people saw a herniation on an MRI - doctors included- they went, "Ah-ha! - that's the reason for the pain..." However, they never did any randomized control trials to prove that the herniation was the problem. When they did do randomized control trials, they found that the herniationa did not predict pain. They did study after study, and never found a causal correlation. Practice did change- but for the worse: even more steroid shots at increasing cost were prescribed. The pain epidemic exploded. Practice continued on. The AMA said don't do steroid shots: people died from contaminated shots. Shots increased, MRI's increased. The Lancet just issued a scathing report on back pain and opioid prescription. Practice in general hasn't changed.... but awareness is slowly growing.
Back to those other studies about how we are wired to tell stories about what we "see". Lehrer cites a study about people who are shown a blue dot and a red dot moving across a screen. Almost all participants describe the situation as the red dot following the blue dot. They create a narrative. When the red dot is made larger it is now chasing the blue dot. In other words, we have an innate desire to make sense of the world. What this article did was weave together a series of different experiments- all making different points about the world- and use them in a way that creates a vastly expanded understanding of what the data tell us about how complex systems operate in relation to human behavior. Some of it is hard-wired, and some of it is culurally related. In other words, Lehrer used this data in a way that helped me make sense of the story we were trying to tell about data, stories we tell ourselves, and how our physical and emotional beings interact.
The writing was amazing, so I looked up Jonah Lehrer and found that we had a mutual friend on facebook- my brother. - full post here: rumur.com/jonah-lehrer-on-the-stories-we-tell-ourselves/