BRAIN CANDY

Twenty years ago, a political philosopher named James Flynn uncovered a curious fact. Americans—at least, as measured by I.Q. tests—were getting smarter. This fact had been obscured for years, because the people who give I.Q. tests continually recalibrate the scoring system to keep the average at 100. But if you took out the recalibration, Flynn found, I.Q. scores showed a steady upward trajectory, rising by about three points per decade, which means that a person whose I.Q. placed him in the top ten per cent of the American population in 1920 would today fall in the bottom third. Some of that effect, no doubt, is a simple by-product of economic progress: in the surge of prosperity during the middle part of the last century, people in the West became better fed, better educated, and more familiar with things like I.Q. tests. But, even as that wave of change has subsided, test scores have continued to rise—not just in America but all over the developed world. What’s more, the increases have not been confined to children who go to enriched day-care centers and private schools. The middle part of the curve—the people who have supposedly been suffering from a deteriorating public-school system and a steady diet of lowest-common-denominator television and mindless pop music—has increased just as much. What on earth is happening? In the wonderfully entertaining “Everything Bad Is Good for You” (Riverhead; $23.95), Steven Johnson proposes that what is making us smarter is precisely what we thought was making us dumber: popular culture.

Johnson is the former editor of the online magazine Feed and the author of a number of books on science and technology. There is a pleasing eclecticism to his thinking. He is as happy analyzing “Finding Nemo” as he is dissecting the intricacies of a piece of software, and he’s perfectly capable of using Nietzsche’s notion of eternal recurrence to discuss the new creative rules of television shows. Johnson wants to understand popular culture—not in the postmodern, academic sense of wondering what “The Dukes of Hazzard” tells us about Southern male alienation but in the very practical sense of wondering what watching something like “The Dukes of Hazzard” does to the way our minds work.

As Johnson points out, television is very different now from what it was thirty years ago. It’s harder. A typical episode of “Starsky and Hutch,” in the nineteen-seventies, followed an essentially linear path: two characters, engaged in a single story line, moving toward a decisive conclusion. To watch an episode of “Dallas” today is to be stunned by its glacial pace—by the arduous attempts to establish social relationships, by the excruciating simplicity of the plotline, by how obvious it was. A single episode of “The Sopranos,” by contrast, might follow five narrative threads, involving a dozen characters who weave in and out of the plot. Modern television also requires the viewer to do a lot of what Johnson calls “filling in,” as in a “Seinfeld” episode that subtly parodies the Kennedy assassination conspiracists, or a typical “Simpsons” episode, which may contain numerous allusions to politics or cinema or pop culture. The extraordinary amount of money now being made in the television aftermarket—DVD sales and syndication—means that the creators of television shows now have an incentive to make programming that can sustain two or three or four viewings. Even reality shows like “Survivor,” Johnson argues, engage the viewer in a way that television rarely has in the past:

I hope those 3 paragraphs convince you to read the entire book review. Long time readers know my love of Malcolm Gladwell’s work. He wrote this review, which I found outstanding. I may just have to pick up the book.

So what does this have to do with medicine? Perhaps nothing – afterall it is my blog, and I sometimes write about non-medical issues. But, I will make a connection. The type of intelligence that this review discusses – the intelligence of problem solving – is precisely the type of problem solving which we desire in our physicians. This problem solving explains why a physician wrote the Sherlock Holmes series.

The young medical student met a number of future authors who were also attending the university, such as for instance James Barrie and Robert Louis Stevenson. But the man who most impressed and influenced him, was without a doubt, one of his teachers, Dr. Joseph Bell. The good doctor was a master at observation, logic, deduction, and diagnosis. All these qualities were later to be found in the persona of the celebrated detective Sherlock Holmes.

– Sir Arthur Conan Doyle Biography

I will finish with an anecdote from my last ward month.

The patient is a 70 year old man admitted for pneumonia and CHF. After 2 weeks in the ICU, he was transferred to our ward team. He had had a full course of antibiotics, and even had had antibiotics stopped for apparent drug fever. Unfortunately he remained somewhat delirious. He also remained hypoxic.

His 4th day on our service his temperature increased to 100.7 F. At morning rounds the intern expressed her concern and said that she was considering antibiotic coverage. Because he was a hospitalized patient, she was considering a complex 3 drug regimen for hospital acquired pneumonia.

I was reluctant to start antibiotics without a clear diagnosis. Would the fever continue? Why was the WBC normal? What did the chest Xray show?

After my usual “sit down” rounds, we make walking bedside rounds. As we entered his room, the physical therapist asked if he could get the patient a wrist splint. Since I was unaware of any wrist problem, I asked what was the problem. Apparently the patient had had some wrist pain over the past week, which first improved, but now suddenly had worsened.

Examining the patient, he had a warm left wrist (clearly warmer than the right wrist). He guarded against flexion. The surrounding skin was normal.

So I made a presumptive diagnosis, and treatment solved the problem without antibiotics.

So now I will challenge your medical instincts. What was wrong with the patient, and what did we do?

I submit that this patient represents the intelligence that Gladwell’s review discusses. And even if not, I certainly enjoyed telling this anecdote. Please leave your thoughts in the comments section or if you prefer, email me directly. If you are puzzled but would like to know the answer, let me know and I will discuss the answer later this week.

For those who want to read more from Steven Johnson – he has a blog!!