Peter

I’m so glad you guys are doing this work. This is what is needed. Things have gotten worse regarding obesity, diabetes, anxiety. All of the death and despair that I write about. It’s gotten worse. So, it is understandable that you are discouraged. It’s like trying to go up a down escalator.

I figure that my activities in the arena of social medicine, neuroscience in the service of society and so on, have led to my lack of promotions. I figure it has cost me about one half million dollars over my career. However, I wouldn’t do it any other way. Imagine spending your life making one of four diagnoses. So, each of us have led very rich, but under-compensated and challenging professional lives.

Bill

The second (social interaction) strategy is relevant here. Perry and Peter are those who Everett Rogers would call “the innovators” (the “trouble makers’). The second group (“the early adopters’) are the people who will listen to Perry and Peter. These are the people who are convinced by evidence. These are the people (doctors) like Jeremy who read the books written by Perry and Peter. These are the people who say to Perry and Peter, “you should have been paid all the money.” These are the people who are convincible in terms of a good, new idea that is backed by evidence. But they constitute in the case of most good ideas about 10% of the population (the innovators being 1 or 2 %). The third group (“early majority”) are people who are not convinced by evidence. They are convinced by a good story. It is not the political group (“late majority’).

The early majority is convinced by a narrative of someone (often a family member or neighbor) who received good health assistance. The problem is that this takes social networking. And as Jeremy says, this takes cross-disciplinary teams. It is not the physician who convinces people. The physician must connect with the social worker, the local media, and many other people, because the physician only gets the early adopters. As Jeremy has said, significant reform is going to require a massive interdisciplinary endeavor and multiple interactions. Both a personal (neighborhood) and public (early majority) narrative is required.

This perspective is built on agent-based modeling and the “neighborhood” effect that is found in the flocking of birds and schooling of fish. People (as well as birds and fish) are strongly influenced by what the person (bird/fish) next to them is doing. The influence moves quickly across a “neighborhood” (flock, school, network). Agent based modeling was originally directed to the issue of housing integration. When does a community ”flip” and become all White or all Black? This is not gradual. A flip has occurred—a “tipping point”—and it is often irreversible.  Part of what we are talking about here is the blending of personal change with collective change. The primary issue here concerns how Perry finds a cluster of people who share his beliefs about health care reform –who come from many disciplines. They can engage a community in helping to bring about a tipping point – and then a flip. It is not gradual (evolutionary). It is revolutionary.