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So, why do doctors and surgeons wear bowties? Well, that's one of many irreverent questions the Freakonomics boys like to address, and with surprisingly interesting answers, this the second book on the crazy world of things like probability economics, cause and effect, and 'externalities', amongst other mathematical oddities, this book how the world works according to quasi economists Steven Levitt and Stephen Dubner. An example of an 'externality', if you didn't know, is when you put a steering lock on your car and the thief decides to steal your neighbour's car instead. By doing the right thing you accidentally bring bad luck for someone else.
So does the Doc wear a bow tie to look interesting and important to pretty nurses or is it for practical reasons? Well the answer is probably a bit of both but the Freakonomic boys, both trained economists, always have an intriguing calculation on what they have calculated. Apparently the reason was mainly because deadly germs picked up on the wards and in the operating theatres were more likely to find a home on doctor's ties because they rarely washed them, the only item not to go into the weekly wash, the dangling item of clothing responsible for storing and then distributing those fatal germs around the wards. Most deaths in hospitals have always come from the so-called 'super bugs', like MRSA, which are distributed by poor hygiene from anyone who enters a hospital, especially doctors and nurses who don't wash their hands, so the bugs anything but super intelligent, why that lady was recently banned from wearing a Christian cross as a nurse. Even as recently as the 1980s an observational survey discovered that less than 14% of doctors did the required amount of hygiene on the wards to prevent the bugs festering, even though 70% of those same doctors claimed they did to those same observers. It was the doctor's arrogance and laid back attitude to work (and cost cutting on cleaners), not unknown bugs, that are and still killing patients with those high death rates, some 30,000 a year in the U.K alone. It wasn't the gruesome compound fracture that finished Coventry City player David Boosts career when playing against Manchester United but an infection picked up in the local grubby hospital. Surgeons can do these amazing life saving procedures but the Gods in white coats are too arrogant to wash their hands, those hands the biggest lifesavers but also life takers. My extra dimension to this is with NHS league tables and the pressure to keep beds open that are clogged up with elderly dementia patients, mainly because one third of council rest homes have now closed and so the old people have nowhere to go, causing a hospital log jam. Can we then assume that super bug prevalence can assure a certain amount of deaths to keep beds open and so the bugs perhaps deemed acceptable at some levels, why those deaths are still so high in this day and age when it's quite clear how to keep those deaths down? What Levitts book does most is expose the grey area of life.
The boys really do go into health in the book and there are some fascinating ideas. For instance, when you hear a news story involving abnormally high death rates in heart hospitals to one particular surgeon, as we did recently at Papworth, do you blame the surgeon or the hospital procedures? Well the boys make a simple but telling point - what if the apparent malpractice surgeon is the hospitals best surgeon and so gets the patients in the worse state and so more likely to die? That, in a nut shell, is what Steven Levitt and Stephen Dubner's book is all about. They also make a point about chemotherapy in their US private healthcare system, one that perhaps you shouldn't read if you or your friend has cancer, effectively making the point that chemo doesn't really work and is only subscribed by doctors in private healthcare because it's expensive and so makes their hospitals more money. You only hear about the success stories right? To prove how dangerous hospitals
can be the boys draw you to a recent medical strike where patients operations and treatments were cancelled and death rates actually fell for that month in the county due to zero exposure to superbugs and no botched operations. This type of probability equation follows through with the US military where 2,134 US troops were killed in 2005 that were not in a war zone but only 1,657 were killed in Iraq in the same period from the same number of soldiers. How can a war zone like Iraq be less dangerous? The answer was because soldiers take fewer precautions and take more risk on 'Civvy Street', things like seatbelts and messing around on the job far more prevalent. We are always told how brave firemen are so they should be paid more yet they have some of the lowest death rates on the job as healthy & safety, not bravery issues, prevents them taking that risk. They are not insured to rescue people in the most dangerous fires.
Inevitably global warming is drawn into the book and although the authors try to disprove a man made catastrophe they do agree the bad science of pumping CO2 into the atmosphere isn't a good idea. Their points are capricious, like the fact natural acts like volcanoes are able to bring down world temperatures by one degree pretty quickly and so plenty of counter forces out there, as proved the case with Mount Pinatubo. Just one or two big eruptions a century maybe enough to keep temperatures down to safe levels. Although air travel is blamed for 15% of those damaging emissions the contrails from the planes often offset the temperature rises by increasing cloud levels that act as a global coolant. In fact its clouds that have the biggest cooling effect on Earth by far. Immediately after 911 when all the planes were grounded, ground temps in the US rose sharply by two degrees in just 12 hours because the high altitude vapour trails were not reflecting the sun back into space anymore. The boys love to collate interesting and intimidating research like that to get you thinking on topics governments insist are true. Their thoughts on global warming are like mine and so I was engaged in this bit of the book, it's going to happen and so the only way to deal with it is soft engineering and try to live around it, man eventually inventing cleaner energies as they have no choice but to. He uses the example of horsepower in history to explain why new technologies, not catastrophes, will always win out. Before petrol and cars, horses did the work and because they shat everywhere in the big cities fatal diseases shot up as the rats and bugs had a field day and so it was vital to find a new source of energy, which they did, oil and gas king soon after. Its die or change.
As with all these books that talk about global warming, Hurricane Katrina is always pulled into the equation as if somehow the poster boy, when in fact, as the boys point out, these big storms are natural and they come in clusters. There's something called the 'Atlantic Multi-decadal Oscillation', a 60 to 80 year cooling effect in the said ocean, followed by a period of warming, cooking up these force five hurricanes in the Gulf, hence a huge category 5 storm that destroyed the New Orleans area 55 years ago. In the gap between the 'biggies' people forget and return and build on land that's way below sea level, hence the levies and bayous being built back up, thinking they have beaten nature. The poor people are placed in the worst areas that are at most risk and coupled with the oil and gas companies building on the vast wetlands its man and not manmade warming that made the city vulnerable again.
The boys also talk down the hype about immediate rising sea levels, naturally sinking coral atolls and silt costal erosion responsible. Sea levels have raised 8ft in a thousand years but no less people have been born because of it. In fact between 1945 and 1970 world temps fell at alarming rates, to the point where an ice age was forecast if the drop continued, Britain really freezing up badly in the post war period. Now it's gone the other way it's the other side of the coin and we are going to be 'microwaved', according to the same scientists. They were wrong then and they maybe wrong now. Surely it's better to deal with extreme heat over extreme cold anyway. I know which scenario I fancy.
If global warming gets the call up for the book then terrorism also, but here more subtle from a mathematical angle. The guys tell the story of an unknown British database fraud analyst who worked for an unnamed bank who, whilst rising up the structure of his bank generated and then deployed various algorithms in his work place to catch fraudsters. An algorithm is a complex sorting equation that tries to limit the possibilities so you can pick from a small pool of names or objects. He quickly discovered that most cheque and credit card fraudsters were West African, and the Eastern Europeans and South East Asians were the data stealers at the various call-centres and sorting offices around the world and in the U.K. Knowing this he could vector that into the system and his programs would 'flag up' likely bad guys and so helped the bank cut fraud. But, he thought, if he could find foreign and local fraudsters this way then could he find potential terrorists this way, his unique algorithm able to whittle down depositers to such a point where he reckoned he had an impressive 1-in-6 chance to find likely sleeper terrorists with accounts in his bank, and its was one single un-named banking action made by Muslim suspects, known as 'variable X', that dramatically whittled down the numbers to that 5 in 30 strike rate from something like 1-400. He doesn't say what that secret is although I suspect it's a benefit cheque or something like but he has been quietly awarded an MBE for his diligence and pointed out over 100 potential terrorists the police and security services might want to have a word with by his actions, resulting in many convictions. Its now used all around the western world as the 'War on Terror' grinds to a halt.
The authors are known for their more quirky ideas and calculations too, like the possibility that it's safer to drive home drunk from the pub than to be walk home drunk from the same pub, drunken pedestrians 13 times more likely to die walking home drunk. Few people realise that most people getting run over are the elderly and confused or people that are drunk. Far more drunk people die by being hit by cars than die driving drunk. Therefore, although highly illegal, it's safer to drive drunk! Obviously the boys would not condone that.
More serious studies look at the fatal economies of having a baby girl in India, 35 million more males than girls in India than there should be, simply because boys are worth a dowry and girls are not, children a simple commodity in the more rural areas. Apparently only 10% of families with two boys want another baby whereas 50% with just two girls do want another baby. A boy can bring up to $40,000 dollars from the bride's family through a dowry, a fortune in India, why many thought that the kidnapping of the little Pakistani boy in the news recently was suspicious. Some midwives in India in some areas are paid up to $5 to 'not' deliver young girls in private homes and modern day baby scanning machines are more common in India than in America, 'making sure' it's a boy. 100,000 Indian women a year set fire to themselves to avoid arranged marriages to much older men in pursuit of this dowry that seems to dictate Indian life and culture so much.
The final and rather long section on the economics of prostitution is rather boring though and feels like it has been hacked from another publication, stating the obvious that women go on the game because the moneys good and pro-rata far more than they will ever earn from the menial jobs they are suited to. They hate the job but for around 13 hours work over 7 days they can average $400 per week. As ever the boys use race and social class in many of their
Women want babies not careers?
equations and the book exposes how girls and clients of different colours charge different prices, black men the least likely to use condoms, white man the least likely to haggle over payment with black girls. As most of the girls sex acts don't involve intercourse they can turn many tricks an hour and make very good money, but spending that on their drug habit that helps to kill the pain of the job, the paradox
If you need to know a prostitutes clients needs:
55% want oral sex 17% want a helping hand 15% want sex 09% want 'other'
Feeding on from the unlikely emancipation of women though prostitution we get onto the male-female wage gap in the work place. This is interesting stuff and backs up what I have always said that its women's choice to have kids that kills their careers off and perhaps why they have kids in the first place. Feminist, who tend not to have kids for that reason; don't want to hear about a contrary opinion that it's the oppressive male of the species holding them down. For instance, fat women earn 13% less than fat men in the same line of work with both male and female bosses. We didn't need this book to tell us taller good looking people would be earning 7% more than employees classed as fat. But what of the statistic that only 2% of major CEO's in America are women yet 45% of the MBA's out there are held by females? The reason seems simple when you read it, those eligible intelligent women marrying likewise men with good jobs, meaning the women chose to have kids and so there are more positions left open for men up the ladder, a happy and secure family and not money the clear incentive for women and so making salary and position the mans duty.
I think its fair to say this book is not so much a rushed sequel but the finished article, its rather loose narrative feeling more like a collection of the boys stuff they didn't use for the first book, perhaps material that wasn't strong enough, than a fully researched project. They seem to have mixed in some topical subjects like terrorism and global warming to get your attention to buy another book in the series, trying tenuously to link it all up through various observations and scratchy research. The first book did good business so why not this one?
There are some nuggets here, most in my summary and so spoiling if for you guys somewhat, my talent for book reviews rather limited. Its also refreshing to see in print a counter examination of how the modern media sees it and maybe what you think is actually true and when you dig deeper into your cynical side you tend to nod in agreement with a lot of ideas in here, dawning on you that maybe the world is this even more of a complex and cynical place than you ever thought. If you think about the topics and subjects you could apply Levitt's unique economics to and it was allowed it would make for fascinating and controversial reading, which the boys don't quite achieve this time around, perhaps learning its lessons from the people it upset last time.
If you haven't read the first book then read that first and then by all means have a crack at this one. This has plenty of stuff you will enjoy though if it's your first bite and will make you think about things really differently afterwards. We are told things are either good or bad and so no real ambiguity going on when really everything is ambiguous but not that random, what math and economies are all about. Everything, how ever capricious, has structures and systems to make it function. If you could calculate who terrorists are purely them the time they come to the bank to pay their bills then you can see a whole new science going on that Levitt and co are tapping into. I find the whole subject fascinating and although it's meant to be theoretical in some cases it really does feel right. If you want someone to talk about some of those taboo and cynical thoughts going on in your head then this is the book for you.
Price - £10.31@ Amazon Price - £9.99@ Waterstones Price - £9.99@ Boots ( 2 for 1 hard back deal)