How Cultural Consciousness is Created
/Gladwell’s riveting Revenge of the Tipping Point
Wow! I just finished reading Malcolm Gladwell’s Revenge of the Tipping Point, and I hardly know where to start! It’s an amazing, enlightening story, a set of mind-blowing, data-driven facts offered in the style of a mystery thriller. And the examples Gladwell uses are contemporary and familiar to us: the Covid-19 pandemic, the opioid crisis, the gay marriage issue, our American healthcare system, and more. You will want to read this book (I hope). For those who are reluctant or terribly time-constrained, let me try to share something of what this genius has to say.
As I said, Gladwell structures his narrative more like a mystery thriller than a dissertation; I’m afraid I cannot emulate his style. So I will be more pedestrian, just hoping to give you enough of an overview to entice you to read the book and talk to me about it – or at least enjoy something of this amazing perspective.
In this book, Gladwell revisits the concept of the “tipping point,” which I found tantalizing way back when. He reminds us: “The laws of epidemics, I argued, could be used to promote positive change: lower crime rates, teach kids how to read, curb cigarette smoking. Now we’ll look at the underside of those possibilities.” As for epidemics, he says, “we need to acknowledge our own role in creating them.”
Your specific environment, Gladwell asserts, has much more sway over what you believe and how you act than you’d imagine. He calls this “small-area variation,” in evidence all over the U.S. People in one community become “infected by the same contagious idea... patterns of behavior attach themselves to places in ways that can sometimes surprise us.” He explains that, over and over, in all sorts of situations (some of which I will share below – fascinating!), it’s about “a behavior or an attitude, a belief that people pick up when they go there.” And, he says, “the longer you stay... the deeper the hold the spell has on you.”
The Overstory
Here Gladwell reminds us of the “canopy high over the forest floor [that] casts a shadow on everything beneath.” It is specific he says, powerful, tied to a place, and it shapes behavior. The author says that things , therefore, actually do not emerge out of nowhere; they happen for a reason. In the forest, the overstory – the upper layer of foliage – “affects the behavior and development of every species far below.” Social epidemics, he says, are “not wild and out of control. They attach themselves to places.”
The overstory can gradually create a “monoculture,” we are told, “where individual differences have been sanded down and every organism follows the same path of development.” Such cultures are rare, he says, because “the default state for most natural systems is diversity.” A monoculture “emerges only when something happens, deliberate or otherwise, to upset the natural order.” And what is the result? “What you give up in a world of uniformity is resilience... no internal defenses against an outside threat.”
Now, as I said, Gladwell presents this as a mystery, tantalizing us with one piece of a story, then moving to a totally different example. Then he circles back and starts putting the puzzle pieces together, and the reader gasps. Finally he brings each fascinating story to its actual, documented conclusion, and you just can’t argue with the facts. For me, the most exciting aspect of the story is that it’s all built on actual, demonstrable facts that engage and captivate – weirdly but inarguably. Let me give you a few examples of the fascinating stories the author employs to illustrate the overstory, small-area variation, and monoculture.
Bank robberies, for example
Through an absolutely compelling tale, Gladwell illustrates the huge growth of bank robberies in the US during the 1970s and ‘80s, from 847 banks robbed in all of 1965 to 9,388 bank-robbery-related calls to the FBI in 1991. It was an epidemic of bank robberies! But the interesting thing is that these robberies were not happening evenly, all over the country: a quarter of them happened in Los Angeles! Why? Because just a few local “robbers” got very good at their art, the author explains. A two-man team reverted back to the grand tradition of Bonnie and Clyde, coming in “hot, in wigs and masks, waving assault weapons.” They were very successful in their stealing.
Wells-Fargo made the mistake of telling the press exactly how much money this pair had succeeded in stealing, which triggered the interest of “an enterprising twenty-three-year-old” named Casper. Understanding that the greatest risk would be actually going into the bank, he hired young kids and taught them how to “go kamikaze,” paid them a pittance for their work, and turned them loose, only to hire another young team. “Once Casper showed the world how easy it was to take over a bank, other gangs jumped in.” When Casper was finally arrested, the “fever that had seized Los Angeles finally broke,” and the number of bank robberies “dropped 30 percent, then drifted even lower.” What the city had experienced, Gladwell says, was an epidemic, something contagious.
Now, that’s just an appetizer; Gladwell offers much more fascinating material about bank robberies, but let’s look now at another of his stories.
Doctors and patients
The author tells us about a study conducted in Vermont by a man still believing “in the general paradigm that science was advancing and that it was being translated rationally into effective care.” As he studied spending trends in different districts, however, he found “the differences weren’t small. They were enormous.” In some districts, hemorrhoid surgery was five times more prevalent than in others. Depending on where in the state you lived, you were three times more (or less) likely to have your appendix removed after an appendicitis. In two communities only ten miles apart, the difference in rates of childhood tonsillectomy varied from 70% of all children to 20% – just ten miles down the road.
Gladwell tells us that where your doctor trained, or what he/she learned in medical school, or what kind of personality the doctor has are miniscule in the decision-making process compared simply to where your doctor lives! He tells us this “small-area variation does not stem from what patients want their doctors to do. It stems from what their doctors want to do to their patients.” So, he asks rhetorically, “why do doctors behave so differently from place to place?” It’s not just about money, he says. It’s about “medical clusters, where the doctors... took on a common identity.” They were, the author asserts, “infected by the same contagious idea,” a topic that has now “become something of an obsession with medical researchers.”
Another astonishing example of medical “monoculture” is in the use of a cardiac catheter. Gladwell found that, “If you had a heart attack in Boulder, you got ‘cardiac cath’ 75.3% of the time.” In Buffalo, New York, he says, cardiac catheters “were used only 23.6% of the time.” So, the critical question: “What happens if a cardiologist moves from a place like Boulder to a place like Buffalo?” He says, “the Boulder cardiologist turns into a Buffalo cardiologist,” moving “about two-thirds of the way toward the practice pattern within the first year.” Gladwell quotes his source, Molliter, thus: “This isn’t really about learning about what works. It’s more about the influences of your environment.”
It's the place, people!
Moving to a totally different healthcare issue, Gladwell reinforces his position that “patterns of behavior attach themselves to places in ways that can sometimes surprise us.” Amazingly, this truth arises in a comparison of school districts in California. “There are several thousand Waldorf schools around the world... almost without exception, the lowest vaccination rates in any California town that has a Waldorf school are... at the Waldorf school. Vaccine skepticism is small-area variation.” He explains that the first lesson of social epidemics is about the path it takes, which is nothing wild and unruly after all. “Whatever contagious belief unites people... has the discipline to stop at the borders.”
Gladwell explains that to assume anti-vaxxers were simply choosing to send their children to Waldorf school just isn’t true. “There is something about being part of the Waldorf community,” he explains, “that encourages people not to default to the judgment of experts... none of that outside pressure matters. The Waldorf spell, wherever it comes from, is really powerful.” And then he reminds us that “the overstory is outside our awareness.”
Then the author tells a mesmerizing story of a community he nicknames “Poplar Grove,” a town that had “everything you’d want.” He says it felt safe and secure, with good neighbors, charming neighborhoods, a massive park, a petting zoo, jogging trails... The public schools were safe, and they were known in many ways as the best in the state. “If your kids grew up in Poplar Grove, there was little chance they would wander off the path.” They would make “the kinds of choices that lead to a better life.”
The book now veers to the story of a monoculture in the animal world, but, as I said above, I’m not writing a mystery thriller, so I’m going to stay in Poplar Grove for the bad news, and we’ll get back to the zoo animals later. What happened in this idyllic town where all the kids were “active and popular and worked hard at school”? An epidemic started, we are told, when a young woman named Alice did something unthinkable and tragic. Six months later, her classmate and teammate did the same. Four months later a different classmate conducted a similar awful act. Seven years passed, and then two more students took such horrifying actions. A year later, “another large cluster emerged.”
Now, you’ve noticed that I’m not telling you what the students did, because I don’t want to spoil the surprise. I can only tell you that it was absolutely abhorrent to the norms of Poplar Grove and defied the statistics about American teens overall. But Gladwell explains, “Poplar Grove was a monoculture – a long, straight highway with no off-ramp.” This true story is so appalling that I’m leaving it to you to read the book and get the details. Now let’s move to the zoo.
Epidemics love monocultures
Gladwell unwinds a “strangely analogous crisis in the world of zoos.” The cheetah, he explains, seldom had offspring and couldn’t breed. Scientific investigation showed why: very low sperm counts, and badly malformed spermatozoa. And then blood samples showed all the cheetahs had the same genes – it was a “genetically uniform” species! He explains that the world’s cheetah population must have at some point been devastated, and so they had to overcome natural inhibitions and interbreed with siblings and cousins in order for the species to survive. They became a rare monoculture.
And then “the cheetah monoculture fell prey to a coronavirus. It was devastating... Eighty percent of the cats under sixteen months [old] died... they could not get rid of the virus.” The cheetahs – all the same – shared the same susceptibility to feline coronavirus. Now, let me just tell you that the cheetah population was saved by way of a cross-breeding program with a totally different species. The new generation emerged stronger and bigger. I’ll let you read the story to learn about the mingling of those two species, but note that the author concludes: “The best solution to a monoculture epidemic is to break up the monoculture... Epidemics love monocultures, but so do we.”
Now the author launches (but, of course, does not finish) a gripping story of a California community he calls the “Lawrence Tract,” unlike any I’ve ever known. Cognizant of the norms of “white flight,” the first residents of this small suburban tract made rules – and came together to enforce them, year after year. To set the scene: Remember Gladwell’s initial concept of the tipping point to which he introduced us long ago. He had found that, when a white school is racially integrated, the tipping point is 30%: Once 30% of the students in the school are Black, the white students withdraw and the school quickly becomes a “Black school.”
The same is true in communities as they are integrated: The tipping point is reached, and the white residents withdraw. Gladwell says it happened in part of Baltimore, and in Atlanta and parts of St. Louis and New York and Cleveland, Denver and Kansas City. But tipping points can be manipulated, “intentionally orchestrating the course of contagious behavior” (as in the cheetahs above, perhaps). And so he introduces us to the concept of social engineering, at the end of which we’ll return to “Lawrence Tract.”
Social Engineering – for better or worse
First the author reminds us of how difficult it can be to be perceived as “other.” He uses women as an example, demonstrating that it matters not that a group is nominally integrated – it’s the extent to which they are integrated that matters. So, one woman serving on a board of directors is always identified as “the woman.” She is always “other,” and labeled “exceptional,” as if she is there for unique reasons and doesn’t really belong. But, to move from “token” to “member,” the woman needs to be accompanied by at least two other women. Two women on a board are friends; three women on a board are a team, Gladwell’s source told him. And, at that point, they could be seen not as “other” or “woman” but as a member of the board like all the other members.
Gladwell refers to the “Magic Third,” explaining that “Something significant happens when a once-insignificant set of outsiders reached between one-quarter and one-third of the population of whatever group they were joining.” They “cease to be distinct because of their differences where there’s so many in the room that you don’t even think about it.” Consensus emerges at the point of the Magic Third, “lightning fast compared to expectations... because human beings are really, really good at agreeing on how they should think about something.”
Now the author tells us about an interesting experiment in which the Magic Quarter is discovered. Trying to determine at what point a group will “cave” and agree to go in a new direction, a researcher using the format of a game found that, “when the proportion of dissidents hit one quarter – bingo! – something magical happened.” Gladwell also refers to the research of Tara Yosso, who discovered that in “classrooms where the percentage of minority students exceeded 25 percent, they found the test-score gap completely vanished.” The Magic Quarter!
In the open, or in secret?
And now, with all of that in mind, let’s take a look at that fascinating example of “social engineering” using the “magic third” as its rule: the Lawrence Tract. In the late 1940s, a parcel outside of Palo Alto, near a dairy farm, became available for development. A group that called itself the Palo Alto Fair Play Committee divided the tract into 24 residential lots and one park. Then, using the “Law of the Magic Third,” they determined that the community would be developed in equal parts – white, Black and Asian. But, they would also maximize the contact between races: no two families of the same race could live next door to each other.
The committee met monthly, determined to show the world that different races could live in harmony. How would they avoid the white flight of the 1950’s? They believed their rules, if maintained, would make the experiment sustainable, and so it did, for a long time. Gladwell acknowledges this was “segregation itself, but a different type, a beneficial type.” It constituted, the committee said, “mild discrimination so that a vicious discrimination might be prevented.” And Gladwell says. “This is what it looks like to take tipping points seriously.” The total welfare of the entire community came first.
Ultimately the rules of the magic third were put to the test when one property owner wanted to sell – and the buyer chosen by the realtor didn’t fit the correct racial identity for that tract. I’m not going to spoil the story by telling you what they did, but the author calls it “social engineering” and advises, “in the end, the solutions aren’t really that simple... in order to preserve that racial harmony, they had to harm the very people they were trying to help.”
And then Gladwell makes a turn, asserting that “Social engineering takes on a very different face, however, when the engineers go about their business in secret.” He refers to a “hidden kind of manipulation,” and you’ll never guess where it was happening: college admissions! In the early 1900’s it was about controlling the Jewish population by such establishments as Columbia University, Harvard, and NYU. So Harvard established four admissions categories, always able to measure the percentage identified as J1 or J2 (Jewish). By 1925 the two groups combined had almost reached the cusp of the “magic third”; the wrong students were passing the entrance exams. Remember, as long as the “other” falls below 15 percent of the total, they can be thought of as merely “tokens.”
Then it became a question of admitting Black students, and suddenly Harvard added a women’s rugby team to its athletic program, increasing the propensity to admit students on the basis of their athletic ability rather than on the merits of scholarship or testing. Now, it’s Gladwell’s book, so I’m going to stick to his story. He claims that, to be a really good tennis player – or perhaps a female rugby player – you had to “come from a wealthy family and live near a country club.” Women’s rugby, he says, is overwhelmingly white, making that group very attractive to Harvard’s admissions team. This is social engineering in secret. He concludes: “If you don’t think that social engineering has quietly become one of the central activities of the American establishment, you haven’t been paying attention.”
The Law of the Few
Finally, we get to Covid-19. Remember that I told you Gladwell would use the recent pandemic as an example? Here we go. The analysis begins: “Tipping points create an irresistible temptation to intervene in the world. How do we balance the needs of the individual against those of the group?” This, he says, is an even more difficult social engineering challenge. Well-meaning attempts at social engineering run into impossible problems: We have the information, but what will we do with it?
In this section, I was introduced to a branch of science I’d never heard of before: aerosolology. But that perspective confirmed ideas I’d had about the spread of Covid from the early months of the pandemic. Remember when we all started wearing masks? I used to be so irked by people who pulled their masks down to talk. What? Masking is not just in case you sneeze or cough; it’s also about spreading the virus by talking, right? That’s how I saw it. It seemed to me they were more of a threat to the crowd when talking than when just listening; I’d wished they’d left their masks on. And it turns out I was right! Let me share a bit of the Covid example here.
In Boston, in those early months, a Biogen conference was held at the Marriott Long Wharf. People came from all over the country – and apparently took back with them the Covid virus. Every case that arose from that meeting had a distinctive genetic signature – a mutation called C2416T. So, just by tracing the path of C2416T – the Biogen strain – through the population, [a researcher named] Lemieux and his colleagues could get a sense of how much impact that single event had. The first estimate was that 20,000 people in 29 states and countries as far afield as Australia, Sweden, and Slovakia, were infected as a result of that conference. That estimate soon rose to 300,000 infections “all introduced by one person,” according to Lemieux. What was so special about that person?
Before he answers that question, Gladwell takes another side trip, this time to Denver. He tells us about a study that showed that 5% of the vehicles on the road produce 55% of the automobile pollution. And so we are introduced to the “Law of the Few.” You could pull over all vehicles testing over a certain level; a man named Stedman had figured out how to identify them as they drove by. But “what if the people pulled over were disproportionately poor? What if they couldn’t afford to get their cars fixed? Moving from the position that a problem belongs to all of us to the position that a problem is being caused by a few of us is really difficult.”
So, now we apply that new “law of the few” to the Covid spread – specifically to that Biogen conference in Boston. Here is where the aerosolologists came in. They clearly demonstrated that humans send out tiny bubbles into the air when they talk. Those bubbles are generated by particles in the liquid bridges between the vocal chords, and they can stay aloft in a room for as long as an hour! “A face-to-face conversation with an asymptomatic infected individual might be adequate to transmit Covid-19.” AND, they had discovered through testing that humans produce hugely different amounts of those bubbles – some people, who seem pretty much like anyone else, have far more liquid bridges and produce far more particles, and therefore aspirate far more bubbles when they speak. Some of them “are off the charts.” It’s part of their genetic makeup. They are “superemitters,” and they don’t know it.
The author tells of a similar study involving a Covid infection in a school. The first wave that got sick were 28 children, and it was determined that they were all infected by the same person – she infected children across 14 different classrooms. Like the one person at the Biogen conference, this woman was a superemitter. This, Gladwell says, is the “law of the very, very, very few.” But then the author tells us, “the biggest predictors of high production of aerosols were age and body-mass index (BMI).” The temptation to control the course of future epidemics, he says, will be as great as it was for the Fair Play Committee of the Lawrence Tract and the admissions team at Harvard University. Interesting!
Storytellers change the overstory
Now Gladwell offers two examples of the power of the media – television specifically – to create cultural consciousness and actually change the overstory. He explains, “Overstories are far more volatile than they appear... We miss the signs because we’re looking for them in the wrong places.”
First he spends a long time describing how people of America and, indeed, the world, came to start talking about that thing we now call “the Holocaust.” He asks, “Why did it take until 1961– over 15 years after the end of the Second World War – for there to be even a single monument to the Holocaust in the United States?” He reminds us that the examples we’ve talked about so far have been tied to a place or a community, each with its own specific overstory, but overstories can hover over entire cultures and countries. “Can a story on that scale be rewritten and reimagined? I believe the answer is ‘Yes.’”
And so we are reminded that people simply didn’t know about the Holocaust for starters. “Historians were ignoring the subject. The survivors didn’t want to talk about it. Hollywood was largely silent. The Holocaust didn’t even have a name.” Accounts of the war hardly mentioned the concentration camps. Survivors were, in some cases, embarrassed by their tattoos, by their accents, by the unexplainable absence of family members. Some people referred to “the Nazi atrocities” or “the horrors,” but the word “Holocaust” in ordinary conversation in postwar years would have been met with puzzlement.
The change came around 1978 when two senior NBC executives wondered whether the American public might want to watch a miniseries about the Jewish experience in World War II. Their job was to give the viewing public what it wanted, what would engage viewers and draw them in. So they created the series and originally called it “The Story of the Family Weiss.”
The film crew itself did not believe such atrocities had actually taken place – even when they were taken to northern Austria to film on the site of an actual concentration camp! As the miniseries was coming together, someone at NBC wisely recommended ditching the title, “The Story of the Family Weiss” and just calling it “Holocaust.” And so, in early 1978, that word went from hardly ever being used to describe the Nazi atrocities to being used all the time. Gladwell says this shows “how the world could be changed by a television show.”
And there are more examples: In 1983, the finale of the sitcom M*A*S*H drew 106 million viewers – over 45% of the American public. The author says TV became the melting pot: “The more television people of all ideological persuasions watched, the more they started to agree... It’s the media creating the cultural consciousness about how the world works... and what the rules are.” He goes on to say, “Knowing how much television someone watched was a better predictor of how they saw current issues than knowing who they voted for in the last election.”
And then the author provides another relatable example: the subject of gay marriage. He describes the prevailing attitude about “male homosexuality” in the late ‘60s – disgusting, irresponsible, obsessive, ridiculous – hardly something fit for TV. And he asks: “If this is how an entire generation looks at the lives of gay men, how on earth do you fight for marriage equality?” As late as 2004 George W. Bush called upon Congress to amend the U.S. Constitution, “defining and protecting marriage as a union of a man and woman as husband and wife.” State legislatures around the country responded, passing their own amendments to make gay marriage impossible.
Within a decade, though, “opposition to gay marriage had withered away. In fifteen, sixteen years, support has gone up over one and a half times... across demographic and political groups.” Gladwell says “victory was just around the corner. They were looking for signs of change in all the wrong places.” He describes an early, rather pathetic TV show that depicted homosexuality as “a problem to be solved.” But the rules of the overstory were changing.
And then came “Will and Grace,” and someone asked: “What if the woman wasn’t the victim, and the man wasn’t punished?” And this NBC show became, “in its first iteration, from 1998 to 2006, one of the most popular and widely watched television shows of its generation.” We never saw Will in bed with another man. The AIDS epidemic was not put front and center – rarely mentioned. “The show’s daring premise had been so watered down that it was indistinguishable.” The New York Times called it “absolutely ordinary.”
But, the author says, “the consensus on ‘Will and Grace’ turned out to be wrong.” It was actually deeply subversive, he says, breaking every one of the accepted overstory rules. The message of “Will and Grace” was that he is normal – and he happens to be gay. So, how did this TV show change the overstory? “If change happened gradually, you could see that you were getting closer and closer to your goal – and you wouldn’t be surprised when you reached it... But it felt like they were losing... Up in the overstory things were quietly aligning in their favor...”
Gladwell says, “The tipping point for the cause was 2012.” That was the year that voters changed their votes from what they had committed to four years before. When asked why they had changed their minds so quickly, “by far the number-one reason was television.” For thirty years there was no change, “and then a television show came on the air called ‘Will and Grace.’ Gay marriage tipped. That surprised us. It shouldn’t have.”
The lesson of the opioid crisis
We all know something by now of the opium poppy and all the compounds it yields. “Eighty years after its discovery,” Gladwell explains, it was “reimagined by a company named Purdue Pharma.” From the oxycodone of the plant, they created the prescription drug, OxyContin, and it became “the most famous prescription drug in history.”
Now, the author says, we can understand the decisions and circumstances that led to the opioid epidemic. Only our country has had a truly catastrophic experience with OxyContin. It was an American problem, first gaining steam in 2006. An analysis of number of doses per person in a given year remind us of the small-area variation in medical treatment, as described above. But, to truly understand the overstory, we need to go back to 1939 and information I had never known before reading this book.
In 1939, the director of the California Bureau of Narcotic Enforcement, Paul E. Madden, “a zealot of the highest order,” persuaded the California legislature to amend the state constitution so that every time a doctor wrote a prescription for an opioid, they would have to write it on a special prescription pad: a triplicate pad. One of those three copies would go to the Bureau of Narcotic Enforcement. And so doctors began to comply. The first high-profile misbehavior by a prescribing physician involved 345 opioid prescriptions for 200 different patients by a man named Housman. Only four of those prescriptions had been sent to Madden’s office; Housman ended up in San Quentin. Madden was serious, and his rule became known as “Madden’s Law.” Now something as private as writing a prescription had become a public act, and an overstory began to emerge. “What began as one man’s idiosyncratic crusade turned into a national phenomenon.” States around the country bought in, becoming “triplicate states” and changing the overstory.
“Fifty years passed. And then a second overstory emerged,” told by a doctor named Ron Kanner who claimed he “does pain.” He said pain is a symptom, not a disease. You could actually treat a symptom without treating the disease. Kanner became a strong influence on Russel K. Portenoy, M.D. They met when the latter was a resident, and Portenoy began to practice “palliative medicine.” And he was not afraid to prescribe opioids. “He loved opioids. He called them a ‘gift from nature.’” Portenoy believed opioids could be used to treat pain for a long time with few side effects – and he did not foresee addiction or abuse problems. That, says Gladwell, “was Portenoy’s overstory.”
“Madden had worried about the dangerous few,” the author says. “Portenoy focused on the virtuous many.” And he “became a superstar... called the King of Pain.” He was more concerned about the risk of under-prescribing painkillers, and his ideas gained new followers. Now, remember those “triplicate states” mentioned above? They had mandated that special triplicate prescription pad so they could monitor opioid prescriptions in their state, as Madden had done. “By the middle of the 1990s the number of triplicate states was down to five. That’s the nature of an overstory: Most of us don’t bother to look up at the ideas circulating above in the forest canopy.”
But one company embraced the new overstory: Purdue Pharma. They’d “been in the painkiller business for years.” They tinkered with oxycodone, made the pill twice as powerful, raised the dosage. One of their directors, a member of the founding Sackler family, committed to market OxyContin to everyone. He called it “our ticket to the moon.” Purdue launched what Gladwell calls “one of the most sophisticated and aggressive drug-marketing campaigns the world of medicine has ever seen.” They targeted states without triplicate laws. “The triplicate and non-triplicate states were like night and day,” we are told. Therefore, “the opioid epidemic did not hit the entire United States equally.” It was a perfect example of small-area variation. The top five opioid consumers were in “Portenoy states, without a triplicate program.”
The result? “Illinois had one-third the opioid use of Nevada and West Virginia. New York had half the problem Tennessee did.” Gladwell calls the “triplicate-free zone” the “land of the Portenoy overstory,” with 60.8% of the addiction problems. He continues: “Overstories matter. Take Massachusetts and New York. The only relevant difference is that New York forced doctors to make two additional carbon copies of every prescription they wrote — and Massachusetts did not. Triplicate laws don’t apply to Chinese or Mexican drug lords and their American confederates. So you would think that the differences between triplicate and non-triplicate states would have faded away by now. Wrong! If Purdue sales reps put you on a certain path back in the late 1990s and early 2000s, you stayed on that path long after the reps had gone. These trends continue, even twenty years after the launch.”
Read the book
And so I conclude today’s story, having learned about overstories and monocultures and laws of the few and the very, very, very few. I see now how bank robberies and vaccination attitudes and physician behavior are influenced by very similar forces. I know about the Magic Third and the Magic Quarter and the unquestionable power of the media, not to mention the power of superspreaders and superemitters. I hope you have enjoyed my little overview of this amazing book. I’m sure you can find it wherever you buy your books. (Sorry. You can’t borrow my copy. I do all my reading on my Kindle.) Please feel free to leave a comment before you exit the Speakeasy to head to the bookstore.