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Keisha E. McKenzie | communication | systems | social good

solutions

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Solutions that don’t work for problems that don’t exist

A mix of pills and tablets of various colors, shapes, and sizes, photographed from above.
Photo credit: Freestocks

“When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?

“LOL” is what The Atlantic writer David Epstein and ProPublica might have preferred to have written after this paragraph in their column about the gap between health research and “evidence-based” medicine. They share what happens to patients who receive unnecessary procedures, and crack open the system behind the mess.

It turns out that some prescription and treatment protocols are not evidence-based, even when they could be. Medics prioritize tradition rather than effectiveness, and the regulatory system doesn’t help them change.

A few weeks ago, I read a line from Roman Catholic essayist G.K. Chesterton: “Tradition,” he wrote, “is only democracy extended through time… It means giving votes to the most obscure of all classes, our ancestors. It is the democracy of the dead. Tradition refuses to submit to the small and arrogant oligarchy of those who merely happen to be walking about.”

Like religious people who shape a common tradition by passing stories, practices, and lenses across generations, scientists come to share a consensus of interpretations and inferences through the disciplines of repeating and confirming previous experiments and peer-reviewing the findings. This is a kind of tradition: as Epstein demonstrates, it’s the ideal medical researchers sometimes fall short of.

Like Chesterton, I can see tradition as admirable. Thanks to the ideals of science and the kind of journalism that calls it out, I’ve also learned to require that traditions be beneficial as well as long-lasting.

That’s the expectation the writers of the Atlantic/Pro-Publica article have about contemporary medicine. Read the article and share your thoughts about it with me on Twitter.

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The problem-solution cycle

Photo: a syringe with blue liquid inside.
Photo credit: Geoffrey Whiteway

During the heady days of post World War II science, German researchers noticed that thalidomide diminished morning sickness. It became so popular among pregnant women that pharmacies distributed it over the counter.

But when children began dying prematurely or being born with limb and organ deformities, the government had to restrict the drug. A solution designed to resolve a problem ultimately created new problems.

DDT, an early synthetic insecticide, was once hailed as the solution to diseases like malaria. Then Rachel Carson published Silent Spring and environmentalists started to rally.

The UN stopped promoting DDT for more than 20 years, and researchers tracked species declines where it was sprayed. Scientists and lay people debated whether it was a carcinogen, and by the 1970s, countries across the West were banning it entirely.

No one, least of all the scientist who earned a Nobel Prize for synthesizing this chemical, would have predicted it would eventually put the bald eagle at risk. But that’s what happened.

Problems inspire solutions, and those solutions produce new problems, which in turn inspire new solutions, and new generations of problems and solutions.

That’s the problem-solution cycle. It’s a way to describe the consequences of change, especially the kinds of changes designed to resolve individual, group, organizational, or social issues.

It’s not the same as the problem-solving cycle, the process that engineers and social makers use to define and develop responses to problems.

The problem-solution cycle simply acknowledges that because we can’t account for all consequences of change, even the good that we do will have outcomes we either didn’t or couldn’t plan for. Future problems—and there will be some—aren’t an argument for taking no action today at all.

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Working the substrate

Substrate (noun): a substance or layer that underlies something, or on which some process occurs, in particular. * the surface or material on or from which an organism lives, grows, or obtains its nourishment. * the substance on which an enzyme acts.
Image via Google.

So much of life is invisible: the roots that nourish plants below the soil surface, the nonverbal communication that conveys our thoughts and attitudes, the years of training that go into a 10-second Olympic sprint.

It’s so easy to be dazzled by whatever appears, and to miss the substrate that props it up.
But the world below the surface matters, and to resolve problems, we have to work that substrate.

Working the substrate might mean not reacting to others immediately, but first reviewing the experiences and assumptions that precipitate their choices and behavior. How did they get here? How did you get here? What’s the wider story, and how can your responses take that wider story into account?

Working the substrate might mean re-evaluating the way an intractable community debate has been framed, and emphasizing what’s possible rather than just what’s been consistent. Is a “problem” group really the source of the discord? Are there new ways you could perceive your contributions and responsibilities as you engage other group members?

Working the substrate might mean transcending the call to conversation entirely in favor of taking action with and for people who are actively harmed and under-served. What does the dialogue circuit require of you? What could you accomplish if you focused less on explaining to the doubtful and more on focused on acting with the willing?

Deal with what feeds the obvious—or work around it, and watch how what grows changes.