29 May Jonah Lehrer on The Stories We Tell Ourselves
Making “All The Rage” was a long and winding path. About 6 years into the process, when I was recovering from a second bout of frustration-induced back pain, I stumbled upon an article in Wired Magazine by Jonah Lehrer called, “Why Science is Failing Us“. The article was a profound revleation to me: it helped me articulate things that I had been struggling to find words for- for years. It was a dense yet easy to read narrative that detailed how the radonmized control trial had gone off track in regards to medicine. It was about how systems operate, often not seeing important information that should cause pause, because to see that information might invalidate many aspects of that system. This information was espeically dangerous to those who wield the most power in that system.
The article begins with a discussion of a drug called Torcibor that was designed to replace Lipitor which had been a blockbuster that was about to become a generic drug. Where Lipitor was designed to keep the “bad fat” from clogging artieres, Torcibor was aimed at stopping the body from even producing the bad fat. In trials, it worked and when announced that it was going to phase three, the value of the company skyrocketed. However, one piece of data that the reserachers had missed was that while it stopped the body from producing the bad fat, the test subjects were dropping like flies. No one had looked at that number. Once recognized, the trial was cancelled and the stock lost billions in value.
What really got me, though, was a later paragraph detailing how test after test had determined that herniated discs were not causally correlated with back pain, yet practice hadn’t changed. (** posting those paragraphs at the end) Again, the article was about how systems are often willfully blind to facts that challenge the system. This was something that I knew about herniated discs, but could not get anyone to accept. Friends or acquaintances had been told that something physical was wrong and there was no dissuading them from that fact. Lehrer goes on to cite other studies that explalin how we often are blinded by what we “see”. When people saw a herniation on an MRI – doctors included- they went, “Ah-ha! – that’s the reason for the pain…” However, they never did any randomized control trials to prove that the herniation was the problem. When they did do randomized control trials, they found that the herniationa did not predict pain. They did study after study, and never found a causal correlation. Practice did change- but for the worse: even more steroid shots at increasing cost were prescribed. The pain epidemic exploded. Practice continued on. The AMA said don’t do steroid shots: people died from contaminated shots. Shots increased, MRI’s increased. The Lancet just issued a scathing report on back pain and opioid prescription. Practice in general hasn’t changed…. but awareness is slowly growing.
Back to those other studies about how we are wired to tell stories about what we “see”. Lehrer cites a study about people who are shown a blue dot and a red dot moving across a screen. Almost all participants describe the situation as the red dot following the blue dot. They create a narrative. When the red dot is made larger it is now chasing the blue dot. In other words, we have an innate desire to make sense of the world. What this article did was weave together a series of different experiments- all making different points about the world- and use them in a way that creates a vastly expanded understanding of what the data tell us about how complex systems operate in relation to human behavior. Some of it is hard-wired, and some of it is culurally related. In other words, Lehrer used this data in a way that helped me make sense of the story we were trying to tell about data, stories we tell ourselves, and how our physical and emotional beings interact.
The writing was amazing, so I looked up Jonah Lehrer and found that we had a mutual friend on facebook- my brother. It turns out that Jonah had written a lot about social psychology, and done a lot with my brother’s work. I reached out to him and he graciously agreed to be interviewed. However, he was very busy. At the time, he was the youngest writer to ever be hired as a staff writer for the New Yorker, and he was constantly giving talks. I read his books and found them eye- opening and useful. He was more of a storyteller than he was a scientist, and he made the data relatable and he expanded the implications of that data into other areas. For me, he hit the sweet spot between data and story. Data without story is meaningless, and story without some kind of foothold in experience – or understanding- has less solidity.
However, there were a lot of people who thought that the way he took data and turned it into story was wrong. Science journalists often felt he twisted the data to fit his narrative and that he wasn’t a solid scientific journalist. Before we were able to interview him, a Bob Dylan scholar outed him for fabricating a Dylan quote. In short order, he was fired from the New Yorker, and he was widely denounced and discredited. He had played a little fast and loose with the rules and like Icarus, he had flown too close to the sun.
A few months later, we finally set up an interview, and it was great. His answers really helped us further shape our understanding of how ideas move through the world. We inserted many of his thoughts into the film. We even shot a follow up interview many months later. Again, the discussion proved to be extemely useful.
Ultimately, though, we knew that a film about Dr Sarno began on shaky ground in terms of people taking it seriously scientifically. Jonah suggested to us that it was probably not a good idea to include his interviews, as it would be easy grounds for people to attack the work. While we finally decided to leave his interviews out, they still had a powerful effect on the narrative. In this clip, Lehrer talks about the stories that we unconsciusly tell ourselves about oursleves, and how those stories clearly affect our physical beings. This idea is one of the first lines of voice over in the film. Further, we have also found that almost as with homeopathic medicine – that when we put something in the film, and then remove it, the essence of that idea still comes through in some way. The essence of Jonah Lehrer’s storytelling is certainly in the film. In the war between facts and story, I’m on Team Story.
The back pain paragraphs from “Why Science is Failing Us”
Back pain is an epidemic. The numbers are sobering: There’s an 80 percent chance that, at some point in your life, you’ll suffer from it. At any given time, about 10 percent of Americans are completely incapacitated by their lumbar regions, which is why back pain is the second most frequent reason people seek medical care, after general checkups. And all this treatment is expensive: According to a recent study in The Journal of the American Medical Association, Americans spend nearly $90 billion every year treating back pain, which is roughly equivalent to what we spend on cancer.
When doctors began encountering a surge in patients with lower back pain in the mid-20th century, as I reported for my 2009 book How We Decide, they had few explanations. The lower back is an exquisitely complicated area of the body, full of small bones, ligaments, spinal discs, and minor muscles. Then there’s the spinal cord itself, a thick cable of nerves that can be easily disturbed. There are so many moving parts in the back that doctors had difficulty figuring out what, exactly, was causing a person’s pain. As a result, patients were typically sent home with a prescription for bed rest.
This treatment plan, though simple, was still extremely effective. Even when nothing was done to the lower back, about 90 percent of people with back pain got better within six weeks. The body healed itself, the inflammation subsided, the nerve relaxed.
Over the next few decades, this hands-off approach to back pain remained the standard medical treatment. That all changed, however, with the introduction of magnetic resonance imaging in the late 1970s. These diagnostic machines use powerful magnets to generate stunningly detailed images of the body’s interior. Within a few years, the MRI machine became a crucial diagnostic tool.
The view afforded by MRI led to a new causal story: Back pain was the result of abnormalities in the spinal discs, those supple buffers between the vertebrae. The MRIs certainly supplied bleak evidence: Back pain was strongly correlated with seriously degenerated discs, which were in turn thought to cause inflammation of the local nerves. Consequently, doctors began administering epidurals to quiet the pain, and if it persisted they would surgically remove the damaged disc tissue.
But the vivid images were misleading. It turns out that disc abnormalities are typically not the cause of chronic back pain. The presence of such abnormalities is just as likely to be correlated with the absence of back problems, as a 1994 study published in The New England Journal of Medicine showed. The researchers imaged the spinal regions of 98 people with no back pain. The results were shocking: Two-thirds of normal patients exhibited “serious problems” like bulging or protruding tissue. In 38 percent of these patients, the MRI revealed multiple damaged discs. Nevertheless, none of these people were in pain. The study concluded that, in most cases, “the discovery of a bulge or protrusion on an MRI scan in a patient with low back pain may frequently be coincidental.”
Similar patterns appear in a new study by James Andrews, a sports medicine orthopedist. He scanned the shoulders of 31 professional baseball pitchers. Their MRIs showed that 90 percent of them had abnormal cartilage, a sign of damage that would typically lead to surgery. Yet they were all in perfect health.
This is not the way things are supposed to work. We assume that more information will make it easier to find the cause, that seeing the soft tissue of the back will reveal the source of the pain, or at least some useful correlations. Unfortunately, that often doesn’t happen. Our habits of visual conclusion-jumping take over. All those extra details end up confusing us; the more we know, the less we seem to understand.
The only solution for this mental flaw is to deliberately ignore a wealth of facts, even when the facts seem relevant. This is what’s happening with the treatment of back pain: Doctors are now encouraged to not order MRIs when making diagnoses. The latest clinical guidelines issued by the American College of Physicians and the American Pain Society strongly recommended that doctors “not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain.”