Revenge of the Tipping Point: Book Review
Revenge of the Tipping Point [RTP]: Overstories, Superspreaders, and the Rise of Social Engineering, Malcolm Gladwell, 2024: destined to be another best seller, with the interesting Gladwell touch. Granted, he’s over the top some of the time, but he is a master storyteller. This was 25 years after his initial bestseller and times change. His thesis is little things can cause big differences: “a new set of theories, stories, and arguments about the strange pathways that ideas and behavior follow through the world” (p. xi).
Introduction: The Passive Voice. The art of apologizing in the passive voice for self-protection. In the original book, Gladwell created: the law of the few, the power of context, and the stickiness factor.
“If the world can be moved by just the slightest push, then the person who knows where and when to push has real power. … In the world of law enforcement, the word forensic refers to an investigation of the origins and scope of a criminal act: ‘reasons, culprits, and consequences.’ RTP is an attempt to do a forensic investigation of social epidemics” (p. 7).
Part One: Three Puzzles. Chapter One: Casper and C-Dog. Bank robbers were active in Los Angeles in 1983, one man hitting six banks in a day, one of several bank robbery epidemics. Criminal Casper determined to use others to do the robbery and would pick them up later, producing a lifetime bank robbery record of 175. “Social epidemics are propelled by the efforts of an exceptional few. … It was a reign of mayhem driven by a small number of people who robbed over and over again” (p. 23). Willie Sutton had been a famous robber in 1950. Sutton’s Law: “Why do you rob banks: that’s where the money is.” Sutton became an “index case.”
Medical doctor John Wennberg in 1967 noted extreme differences in spending in what should have been similar hospitals, including surgery rates, a finding over time and throughout the US. Where the doctor lived seemed to determine the kind of care given, producing “medical clusters. Where the doctors in one hospital district took on a common identity, as if they had all been infected by the same contagious idea” (p. 31). “The Boulder cardiologist turns into a Buffalo cardiologist” (p. 50). The same pattern turned up in other areas like the number of kinds in school receiving all their shots. From 100% to 22%, mostly specific types of public schools. Waldorf schools were low, although the focus is how to learn and want to learn. They were independent-minded and did not rely on experts about shots, but expressed skepticism.
Chapter 2: The Trouble with Miami. 2019: “The jury has found Philip Esformes guilty in one of the biggest Medicare fraud cases in American history” (p. 37). “Medicare … covers 67 million people. … A program that large represents a golden opportunity. … It’s a trust-based system” (p. 52). It requires patients, doctors and nurses to sign orders, but records can be falsified. “Medicare pays your fly-by-night company and you immediately withdraw the money, laundering it carefully so the banks don’t get suspicious. A good partner is a drug dealer” (p. 53). Total annual fraud is about $100 billion, with Miami a major contributor. Miami was dangerous, fueled by 1980 with drug money and a vast underground economy, plus accommodating banks. Plus, Castro dumped some 125,000 Cubans onto Miami.
Rick Scott was CEO of Columbia/HCA, which was raided by the feds for kickbacks, false billings, and illegal deals and Scott was forced to resign. Then he ran for governor, then senator for Florida.
There is a Medicare Fraud Strike Force in Miami, so fraudsters moved fast. Esformes became a target. He has a portfolio of nursing homes and assisted living and formed a partnership with a hospital, paying kickbacks. His homes were kept full and then Esformes would charge Medicare for both legal procedures and then super fraud, some $1 billion in total. He was convicted, then had his sentence commuted by Donald Trump in 2020, before leaving the White House. South Florida was the crime capital of America.
Chapter Three: Poplar Grove. This was a homogenous upper middle-class neighborhood focusing on achievement for the kids—especially academics and sports: “the myth of small-town America” or “life under pressure;” ergo, a social epidemic attached to a place when it’s a monoculture. Kids can’t be different, which does not fit the psychological differences of people. That reduces resilience. The result was suicides, creating what Gladwell called an epidemic. Mental health was an unexpected issue.
The cheetah seldom had babies in zoos and many couldn’t breed at all, unlike virtually all other zoo animals. Their genetics were the same, a monoculture. Animals can flourish with diversity. A bigger problem was when a cat got a contagious disease. It spread rapidly with a lack of resilience based on diversity.
A somewhat related problem was the Florida panther, who were malnourished as their prey was killed off by hunters. As the number of panther dwindled, inbreeding produced genetic defects. They brought in Texas female cougars and they breed with the panthers, resulting in stronger animals. “The best solution to a monoculture epidemic is to break up the monoculture” (p. 100).
Part II: The Social Engineers. Chapter Four: The Magic Third: a third of something as the tipping point. Black migrations out of the South meant moving North and the corresponding white flight. Community leader: “Let there be no mistake about it: No white Chicago wants Negroes” (p. 109). “For the vast majority of white Americans, a tip point exists. Once it is exceeded, they will no longer stay among Negro neighbors. … The tipping point was a threshold: the moment when something that had seemed immovable—that had been one way for generations—transformed overnight into something else” (p.110). Tipping points were associated with epidemics.
Sociologist Rosabeth Moss Kanter was a tipping point pioneer. She consulted for an industrial firm in the 1970s and noticed when women joined the sales team they did not do well. That meant, out of a team of 12, one was female—who did not feel seen and the other stereotypes about women (“a token”), as men dominated and made the decisions. A sales force of all women or half women did not have those problems. A key question was how many of a category are needed to change status to full membership? “Exact tipping points should be investigated” (p. 118).
Ursula Burns was a black woman, earned an engineering degree and went to work for Xerox, becoming CEO in 2009: “An outsider makes her way to the top by virtue of her ambition, determination, hard work, and intelligence. … At almost every step of her rise, she was the only one of her kind” (p. 114). Indra Nooyi, an Indian woman had a similar story at Pepsi, becoming CEO in 2006. [This was not a strong point for Gladwell’s “magic third.”]
What about schools? One head of a school system suggested 30% for blacks to perform equivalent to whites. When Black students made up a small percent of students they did poorly academically and the difference got worse moving from grade to grade, but blacks caught up above 25%.
Then Gladwell was back to the “Magic Third” for corporate boards. With multiple women on a board, they were more likely to ask difficult questions. Plus, they valued collaboration and were better listeners: like when there were at least three—a team.
Chapter Five: The Mysterious Case of the Harvard Women’s Rugby Team. Harvard has a lot of sports clubs on campus (as a percentage, four times more than Michigan), including a good women’s rugby team. Harvard has an academic track for smart students and an athletic track, some 30% of the student body. This is considered social engineering. In the 1920s it was too many smart Jews at Ivy League schools, some 40% of Columbia’s 1900 students were Jews, while the Ivy League traditionally attract the children of WASPs, particularly rich WASPs. Abbott Lawrence Lowell was president of Harvard from 1909 to 1933. He was determined to limit Jewish enrollment. Harvard used “subjective criteria” and developed a complicated scoring system.
Harvard and other schools faced a similar problem with Asian Americans from the 1990s. Caltech stuck with a meritocratic system and the rate of Asians went form 25% in 1992 to 42.5% in 2013. Harvard’s Asian enrollment went from 19% in 1992 to 18% in 2013, keeping a “complicated system” to keep proportions the same. Varsity sport was a process to do that, where athletes were mainly white.
In 2012 Abigail Fisher sued the University of Texas when she contended her credentials were enough for admission. UT argued that a critical mass of minority students was needed—one question being what was a critical mass? At the time Fisher sued, black students were at 4%. The Supreme Court ruled all affirmative-action programs were unconstitutional. Athletic affirmative action was basically excluded.
Chapter Six: Mr. Index and the Marriott Outbreak. A group meeting at a Marriott in Boston led to one of the first Covid outbreaks in the US in 2020. Some 300,000 people were infected after the meeting as the people flew back to countries around the world. It was a singular event, apparently caused by “Mr. Index.”
People specializing in aerosols determined quickly that Covid was spread by water droplets in the air, when the World Health Organization claimed it was spread quickly by coughing and sneezes or even talking, but not airborne. This reduced the effectiveness of Covid responses.
“Many of the social problems we deal with are profoundly asymmetrical” (p. 180). Just a few cars produced 100 times the carbon monoxide than average, the “Law of the Few.” There was a measles outbreak in the 1970s in New York caused by a “superspreader,” exceling at infecting others.
Part Three: The Overstory. Chapter 7: The LA Survivors’ Club. There were holocaust survivors in Los Angeles. They were angry and had personal items that reminded them of Auschwitz and other concentration camps. They did not want to keep them but couldn’t throw them away. They rented a building to house them that became the Martyrs Memorial Museum. Beyond that there were no other memorials anywhere in the US. “Why did it take until 1961—over 15 years since the end of WWII—for there to be even a single monument to the Holocaust in the US” (p. 207). Zeitgeist translates literally as time-spirit; zeitgeist has big overstories, a “rhythm of memory.” People in LA actually wanted to see this “museum.”
Remarque’s All Quiet on the Western Front was published 10 years after WWI. [Ditto, Hemingway’s A Farewell to Arms, 1928.] Books and films about WWII and Vietnam were similar. After WWII people didn’t know about the Holocaust unless involved—then PTSD set it and survivors didn’t talk about it.
In 1976, two senior executives from NBC spotted a book about Jewish experiences in WWII and decided to do the same as a TV series. A common approach to TV was “Least Objectionable Programming theory,” to not offend people, but what did people want to watch? They created the miniseries originally to be called Holocaust: The Story of the Family Weiss. The director: “Chomsky had to confront disbelief among the local crew. They had traveled all the way to northern Austria to film on the siter of an actual concentration camp, but the crew still couldn’t believe the story was real” (p. 219). The show was the first time most Americans had heard about the Holocaust, which aired in 1978. “it’s the media creating the cultural consciousness about how the world works and what the rules are” (p. 224). Over 4 nights 120 million people watched it.
The silence was even more widespread in Germany, dealing with its own shame. “In Germany, where the Holocaust happened, the effect was even more electric. In Germany, the statute of limitations for prosecuting former war criminals was about to expire. After Holocaust, the West German parliament changed its mind and abolished the statute of limitations. … Thousands of Holocaust memorials and museums have since been built across Germany.” (p. 231).
In the mid-1970s the USSR allowed Jews to emigrate, resulting in hundreds of thousands going to the US and Israel.
Chapter Eight: Doing Time on Maple Drive. The Soviet Union fell in 1991, after Eastern Europe—but caught the experts off guard, also communist leaders and common people. Roughly the same happened in the 1917 Russian Revolution, the sudden, unexpected collapse of czarist Russia and other dissident groups.
Evam Wolfson was gay and did not expect legal gay marriage. Different societies treated homosexuality differently, from tolerant to illegal and psychologically abhorrent. It was claimed by “experts” that it was only about spontaneous sex and lust, with no thought to lifetime commitment. Gay marriage was made unconstitutional in state after state, in expectation of a future amendment to the US Constitution. There was no hope for marriage.
Determining a prominent role for women proved equally difficult, although many women had amazing success despite the odds—think Jane Goodall or the “hidden figures” at NASA.
Then came the show Will and Grace (1998-2006). Sydney Pollack: “A love story is over after the boy and the girl kiss. So, it you can figure out a way to tell a love story where they don’t kiss, you can have a show that would run for a long time” (p. 248). The typical Hollywood way between a gay guy and a girl was to banish the guy and consider the girl a victim. Will was a gay lawyer and Grace a straight interior designer, sharing an apartment, joined by Grace’s assistant and Will’s gay friend. Initial premise: Grace was getting married and Will talked her out of it. The writers tried not to offend viewers and advertisers. It broke all the rules: gay people were not “a problem to be solved.” Will was normal, while also gay.
What was the tipping point? Gladwell says it takes 25% and with millions turning in attitudes were changing, but the gay community was not expecting the result of gaining rights. The claim was the tip happened in 2012 when they started winning in states. “Gay marriage tipped” (p. 257).
Part Four: Conclusions. Chapter Nine: Overstories, Superspreaders, and Group Proportions. Somehow “Conclusion” starts with habit-forming drugs becoming legal and abused. Dry the sap of the opium poppy and the result is opium. Morphine comes from poppies, then a little more chemistry and its heroin, then oxycodone (created in 1916 by German chemists). Purdue Pharma packaged oxycodone in extended-release tablets and marketed it across the globe as OxyContin. The Sackler family saw it as the legal means to make billions. Too bad it was soon obvious that it was addictive and abused.
Doctors were enthusiastic to relieve pain in patients, with the result that a 2019 paper was called “The Contemporary American Drug Overdose Epidemic.” It was the US that showed these extreme results. There was a lot of variation by state. It had to do with state regulations of drug use, beginning with the California Bureau of Narcotic Enforcement in California in 1939. “The opium and heroin addict ‘loses all sense of cleanliness, and, mentally, the power to differentiate between right and wrong” (p. 268). Painkillers were prescribed by doctors, but could be diverted for illegal use. A number of states adopted similar regulations, limiting narcotic use. Many doctors believed that treating pain was the first order of business, and opioids were the primary answer. Purdue Pharma agreed. That was the continuing debate.
Opioids were used by late-stage cancer patients, with the Sackler family pushing oxycodone and raising the dosage, then used extended-release tablets. Marketing was stressed to increase sales, claiming that OxyContin had no side effects and wasn’t addictive. They targeted states without the California-type regulations, so the opioid epidemic did not hit the entire US equally.
“Bureaucratic intervention evolves into an overstory—a narrative that says opioids are different, spurring the physician to pause. … Purdue tests it’s new painkiller in a triplicate state half a century later, it runs into a brick wall” (282). State regulation worked. The current opioid crisis has since moved to fentanyl. Drug use spilled over into increased crimes. Consulting firm McKinsey & Co. recommended Purdue “segment” physicians and have salespeople focus on “lifetime value” of doctors to “turbocharge” OxyContin’s sales, focusing on doctors prescribing massive amount of the opioid—the superspreaders, showering them with gifts, dinners, and more: 24 visits was the tipping point. Focus on the “candyman,” the super prescriber, the 1% of doctors accounting for almost half of opioid doses.
“The majority of doctors treated opioids with appropriate caution. … But that was not enough the prevent us from the worst overdose crisis in history” (p. 294). When the patent was ready to expire, they came up with OxyContin OP, not much different from the original. … A prescription-drug epidemic is powered by a company operating within the law, answerable to shareholders, and regulated by a government agency. … In the end, the weight of lawsuits and criminal proceedings pushed Purdue into bankruptcy” (p. 298). Then the drug users switched to heroin and fentanyl—and people killed increased many times over.
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