September 2009 Archives

It would be difficult to imagine a more eloquent and timely case for health care reform than the one being made by Barack Obama. He has staked his early presidency on fulfilling one of his major campaign promises. Everyone agrees -- not counting extremists -- that his recent address to Congress was masterful. Yet an ABC poll quickly showed that 78% of respondents don't believe the President's proposed reforms will help them personally, and over 80% don't believe it will lower their costs.

This fix-it President, who also has the gift of eloquence and an electoral mandate, has hit a wall. That wall has more to do with the future than just health care.

The wall has been put up by all kinds of people. Fear mongers on the right spoil for Obama to fail at anything and everything. Idealists on the left want far-reaching reform rather than a compromise plan. The indifferent middle doesn't want to be bothered. There are a dozen rationales to hide behind: The government is intruding too much into the private sector, the cost of the new plan is too high, cost-cutting won't happen, the deficit is already staggering, nobody wants to pay more for their medical care, and besides, we have two wars to contend with. I'm sure you can add more objections to the list, and we haven't even arrived at what would be a good or bad plan yet.

Let's say that all these objections have merit, since in fact they do. Even the extremists on the far right are trying to find a pulse in the moribund Republican party, and hating has worked well for them in the past. Whatever the merits for opposing health care reform, two points can't be overlooked. First, the system is broken and needs fixing. We elected a fix-it president at exactly the right time, and the adult in each of us knows that he's right to tackle this huge looming problem.

The second point is more dismaying. If the wall doesn't give and Obama's plan is watered down to the point that it turns into a giveaway for the insurance companies, what will that say about America? It will say that lobbyists own the government, that democracy has been sold down river. It will say that extremists, however absurd with their death panels and " the government can't run anything" have poisoned reasonable discussion. A double flaw in the national character was brought out during the Bush years: blind selfishness and moral indifference. That's what Obama is trying to reverse.

Will he succeed? There's no doubt that health care reform, in no small part, requires sacrifice. It also requires compassion, because the vast majority who already have health insurance are being asked to help cover the minority who don't. Obama has rightly pointed out that this isn't a subsidy. If you have medical insurance, you are already paying in boosted premiums for the uninsured. If a procedure costs $1,000 but some people get it for free (the indigent, the uninsured who rush to the ER, illegal immigrants, and the young, who have yet to think about insurance), then the extra cost gets passed along. To extend a compassionate hand is also to ask for justice. More people will be paying for their own health rather than depending on somebody else to foot the bill.

I hope these considerations of character and compassion make an impression. If reform fails, the presidency will survive. If reform is half-hearted, a victory will be claimed and everyone, except for a few harsh critics, will go back to the status quo. The economics will work itself out eventually, probably in a worse way than if we handled the problem today. But the failure of reform will prove that the era of fear-mongering, selfishness, extremist poison, and political hypocrisy is far from over. Let's hope that the opposite happens. It might be just the kind of turn-around we hoped for when this President was elected.

Published in the San Francisco Chronicle

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A new field of sociology is studying "social contagion," a deeply mysterious phenomenon that could change everything we think about our behavior. We all experience how fads and trends work. Out of the blue, everybody seems to be doing something new, whether it's texting, fleeing My Space for Twitter, or playing a new video game. Fads are contagious behavior. You catch them from other people. Yet no one knows how behavior goes viral. What makes a group of people all decide to act the same way?

This becomes a crucial medical question if you want a group to stop doing something harmful -- getting young people not to smoke, for example, or persuading a whole population to stop getting obese. The most advanced work on this question has come from two researchers at Harvard, Nicholas Christakis and James Fowler, whose new book, Connected, was previewed in a recent New York Times Sunday magazine article. Christakis and Fowler analyzed data from the nation's biggest heart study, which has followed three generations of citizens in Framingham, Mass. They looked into the behavior of over 5,000 people who were mapped into 51,000 social connections with family, friends, and co-workers.

Their first discovery was that when someone gains weight, starts smoking, or gets sick, close family members and friends are around 50% more likely to behave the same way. This reinforces a social-science principle that is decades old: behavior runs in groups. We have all experienced it as peer pressure, or by knowing families where everyone seems to be overweight or a smoker. The reverse is also true. If you run with a healthy crowd, you are more likely to adopt healthy behavior yourself. Not just health is involved; almost any behavior can be contagious. In a dorm at college, if you happen to room with someone with good study habits and high grades, your grades are likely to improve by association.

But the second finding from Christakis and Fowler was far more mysterious. They found that social connections can skip a link. If person A is obese and knows person B who isn't, a friend of person B is still 20% more likely to be obese, and a friend of that friend is 10% more likely. This "three degrees of connection" holds good for all kinds of behavior. A friend of a friend can make you prone to smoking, unhappiness, or loneliness. The statistics are there to prove it, even though you have never met this friend of a friend.

The findings of Christakis and Fowler suggest invisible connectors that run through a whole society. If their research olds up, think about the implications. The notion of a collective unconscious was posed almost a century ago by the Swiss psychologist C. G. Jung, who also claimed that we all have a shadow side that hides in the unconscious. Did Jung hit on invisible connectors long before data came along to support him? That's really a side question to the main once: What kind of connection can exist invisibly, without people talking to each other, watching how each other behaves, or even knowing about each other's existence?

While pondering this issue, I'd like to point out that the same questions apply to the brain. When your brain is engaged in a behavior, millions of neurons "catch" the same intention and behave in synch without visible connections. Different areas of the brain light up simultaneously. We don't see one neuron teaching another the new behavior, nor do we find a hidden telephone system that transmits the new intention -- such as deciding to get out of your chair and grab a glass of orange juice -- from a starting point in one part of the brain to other locations. Instead, every neuron gets on board at the same time to carry out your intention.

These are complex issues, and I'm giving only a hint of how mysterious they are. But the new research on social contagion is exciting, because it supports the notion that there is actually one mind that coordinates not just how people catch on to fads or decide to imitate each other, not just how distant brain cells know what other brain cells are doing, but far-flung phenomena like how a baby learns to speak and how twins separated by thousands of miles suddenly know what's happening to each other. These invisible connectors are showing up in many, many areas of life. Social contagion is making news because we all like to rely on data, but the possibility that we all participate in one mind challenges religion, philosophy, and the meaning of life itself.

Published in the San Francisco Chronicle

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The rise of incivility in this country is a symptom of mass psychopathology. Groups of people see other groups of people behaving badly, and this gives them permission to behave badly themselves. The same thing happens in families. If one...

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