Is it Worth the Risk?

Gawande's article "The Checklist" addresses the issue of doctors being required to use a checklist when dealing with patients or in the transition period between patients.  The argument is whether or not doctors should be required to use such checklists or whether doing so would be a waste of time and resources in an industry that is already understaffed and low on time.  My assertion would be whether or not it is worth the risk to not require doctors to use such a checklist in the hospital.  While most doctors would point to their years of training and experience as justification for not needing a checklist, I believe that looking at other professions in which great risk is involved that employ the use of checklists will help add validity to their use in the hospital.  What comes to mind immediately for me is astronauts.  Astronauts train for almost a decade to do one mission.  They know exactly what they are going to do and when they are going to do it.  And yet the countdown procedure before take off lasts close to two hours as they check to make sure absolutely everything is in order, even if they know beyond a shadow of a doubt that it is.  In this case, the idea of a checklist is being used for the safety of the astronauts and probably also has to do with the monetary investment that has gone into the expedition.

To take the most seemingly harmless example from the article about the checklist, handwashing is something that a lot of doctors and nurses complain that they don't have time for, so having a checklist require them do it would be a waste of time.  My assertion is whether or not the risk of infection of a patient is worth that extra few minutes a doctor needs to make sure they are sterile before interacting with a patient, and I for one would say that it is not worth that risk. 

Checklist

Gawande does an incredible job on describing how there are thousands of steps to complete in the intensive care unit. These steps are not only the ones needed to save the patient but also to keep them stable for the time that they are held in ICU.

As Gawande says most actions taken in the ICU consist of brushing the patients teeth to prevent bacterial buildup, turning them in bed so that pressure ulcers don't form and many more daily routines that will not even come to mind when thought of. Along with the huge responsibility of being a doctor, a nurse, a surgeon how can people go by doing all of these steps without skipping one or making a tiny mistake? That is where the checklist steps in.

The checklist has proven to reduce the errors made in medicine. But as most of you have highlighted this is sometimes a matter of ego and self-confidence for doctors. Having been going through the same processes for years and years can make some doctors reluctant in wanting to use the checklist. But I think that no matter how good a doctor is or how many years he has trained, they have the chance to make mistakes every once in a while. So, to minimize the damage that might be done to the patient, the checklist should be used.

Ego

(After multiple technical errors and a faulty wireless connection…many attempts later)

As some people have mentioned already in their posts, it seems absurd that doctors would ignore results and refuse to use simple devices like checklists to save patients’ lives. 

This part of the article reminded me of Gawande’s section in Better about handwashing. He tells the story of the Viennese obstetrician Ignac Semmelweis who in 1847 figured out a way to reduce the leading cause of death from childbirth, childbed fever (puerperal fever). In hospitals, the maternal death rate was 20%, whereas for home births it was only 1%. With proper handwashing procedures, he got the rate in his ward to fall to 1%. However, colleagues were offended by the claim that they were the cause of these deaths and he in turn "took calls for proof as a personal insult" (16). On both sides, there seems to be an overly large problem of ego. His colleagues were offended by his theory and he was offended by their disbelief; a fairly absurd reason to endanger the lives of patients.

In Gawande’s account of the modern-day implementation of proper handwashing protocols, some similar problems arise. However, the solution of "finding solutions from insiders" (25) and looking for instances of "positive deviance" (25) seemed to be one possible solution to the problem of ego. When the hospital implemented this program, "it was the first time those people had been heard, the first time they had a chance to innovate for themselves" (26). This idea of innovating for themselves and change from within seems to help avoid the problem of ego to some extent. Having to worry about whether doctors will be personally offended and noncompliant when trying to save patients’ lives is seems to imply a much larger problem amongst those who pursue the medical profession today.

Also, for more interesting thoughts from Gawande: http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html

Are Doctors “Too Good” for a checklist?

   

          Gawande does a wonderful job describing the ways in which hospitals can remarkably reduce error via checklists. Despite the stunning evidence and substantial difference a simple checklist can make, I am baffled as to why hospitals across the nation have yet to adopt such system. Although Gawande touches upon such reasons, I wonder if physicians are not taking these checklists seriously because of egotistical reasons. They are undoubtedly effective and empirically proven so why not? It is possible that doctors’ reluctance steams from overconfidence. Going through decades of education and training and then having to use a checklist to tell them the things they already know may fell demeaning. Below is an excerpt from the article that led to my assumptions:

It’s ludicrous, though, to suppose that checklists are going to do away with the need for courage, wits, and improvisation. The body is too intricate and individual for that: good medicine will not be able to dispense with expert audacity.

          Although understandable, I think this is a foolish reason not to use an empirically proven device that significantly reduces error. It is not a question that many doctors are competent experts, however, they also are human and make mistakes. Adhering to checklists does not indicate incompetence, in my opinion, it is indicative of responsibility and conciseness and is the epitome of competence. Furthermore, as an aspiring physician, I would feel so much better if I can turn to a checklist or have a nurse point out something that I forgot to do. To achieve good medicine, there is no room for pride and I believe so much more can be accomplished via a team effort without the added pressures of making simple mistakes. 

The Human Body: Modern or Moronic

Atul Gawande's "The Checklist" portrays a very frustrating push- pull relationship about the lengths and limits of human beings. On the one hand, you have doctors who have the luxury of saying survival in hospitals is a commonplace thanks to the technical achievements made by human intelligence and creativity. On the other hand, it sounds like these technical achievements are making survival too robotic. The first example in the article describes the surreal incident of doctors being able to go to extraordinary lengths in order to save a girl's life who ordinarily would have been pronounced dead upon arrival to the hospital. The chance of her being able to not only survive, but regain the quality of her life was turned around 180 degrees in a matter of two weeks thanks to both modern machinery and the doctors' knowledge about it. This story spoke highly of doctors acting as real life superheroes, but they were only allowed to have such a success story because of the machinery available throughout the hospital. In fact, when the girl's story of recovery was being shared, it sounded more like someone was building a Frankenstein robot rather than saving a human's life. In one way it sounds like less of a triumph because the doctors forced recovery upon a body which could not heal, with the help of doctors, on its own. In another way it says that people should be proud that technology allows doctors and patients to have more control over the safety and progress of their recovery because patients deserve to live as long as they can. In no way do I think that a person's life should be cut short when there are so many modern options that could go so far as bring someone back from practically the dead, but I question if people want to prevent death and disease so much, they will recreate their bodies with pumps and tubes and metal in order to add years on. Why not take advantage of all the medical choices we have waiting to help us; I just question the quality of a person's life being improved when part of them was built in a laboratory.

So Many Obstacles

In his New Yorker article, “The Checklist,” and his book Better: A Surgeon’s Notes on Performance, Atul Gawande speculates on various strategies, which doctors and nurses can undertake to increase the quality and success of medical care. For example, he explains that simply using checklists can dramatically decrease the risk of making errors that cause death.  If doctors and nurses were more diligent about washing their hands they would be able to lower the amount of deadly infections that patients can get.

I think that Gawande explains very effectively why using methods like these are beneficial to patients. However his article and book also make it clear how challenging it can be to implement these new techniques.  It’s difficult to find time to wash ones hands every single time. Checklists can seem tedious. More complex problems, like how to provide care for a patient who doesn’t have the right insurance, are also an obstacle to most doctors (putting aside that horrendous doctor who charged patients in cash and made 2 million a year).

I think we have focused a lot on the types of errors doctors and nurses make. Gawande talks about that, but he also makes it clearer to me as to why these errors are occurring, and why it’s difficult to implement methods to discourage them. It seems to me that a lot of the problem had to do with the current structure of our health care system. For example, there aren’t enough doctors and nurses. As a result hospitals are understaffed so doctors and nurses don’t have time to wash their hands and care for patients. Additionally Doctors have to battle insurance companies to provide their patients with proper medical care.  I just feel like the health care system needs to be seriously restructured to address these obstacles.  The AMA could allow for more doctors to enter the system so hospitals would be less understaffed. I know I always come back to this, but a public health care system that eliminates private insurance companies, would make both the question of doctors salaries and how to treat low-income patients less of an issue. If structural changes are put into place it might be less of a challenge to implement the checklist system. 

standardization is just step 1

Standardization in any industry does seem like a common sense tool. In the medical/ health industry it is crucial. "The Gold Standard" mentions how terminology and notes are a vital part of this standardization. Of course all doctors keep notes, anyone providing regular service to someone in any field, weather a mechanic, accountant, or doctor should. But this idea of standardization is not enough. I saw a youtube clip of an American Nurse working in a modern hospital in India recently. She was outraged and spoke against the common practice of boiling needles and then reusing them on patients. No one saw a problem with this and believed it killed att bacteria, germs, and viruses.
Differences like this occur in the US and other modern nations, although not to the same extreme. Doctors in one place spend more time, have more or less hygenic practices (as was clear to me when I visited clinics in England), and there is no formal regulation. The idea of standardization is just the first step.

I mean, isn't a lot of this obvious?

           Although I felt that The Gold Standard by Timmermans and Berg was a thoughtful and informative book, I could not help feeling frustrated while I was reading parts of it because some of the their examples of standardization seemed so obvious to me. For example, when it comes to record keeping, I get very frustrated when I read about medical errors resulting from errors in record keeping. There are loads of other institutions in the United States that have to keep track of massive amounts of information, like libraries, that do not have the same issues as medical institutions. Why wasn't there a medical version of the dewey decimal system earlier? And why have electronic medical records not been introduced yet in the United States? To me, instances of non-standardization such as this are so egregious and obvious that I can't help but feeling angry at the state of health care system in the United States.
         On the other hand, I understand that there are many situations when the reasons for and results of standardization are not so obvious. There is much ambiguity in medical practice that stems from the fact that it is centered around human to human interactions. There are so many uncontrollable factors in the interactions between doctors and patients that standardization is nearly impossible in many areas, and this is compounded by the fact that many physicians are resistant to taking up standardized procedures even when they are implemented or recommended.
           This reminds me of an article that I read in the New York Times several months ago called "If Health Care Is Going to Change, Dr. Brent James's Ideas Will Change It" (<http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?pagewanted=all>). In this article, hard evidence was put forth for the benefits of standardization of medical practice in the Intermountain Healthcare network of hospitals and clinics in Utah and Idaho. The key to the success of standardization in Intermountain was that the standardized procedures were developed by the doctors for themselves. Thus, they were not as resistant to implement the procedures. Also, even when doctors were resistant to implement standardized procedures, Dr. James would show them hard evidence proving that the standardized procedures were in fact, more effective, and most doctors accepted the procedures once they were faced with the hard facts. To me, it seems that this is the way standardization should occur. 

A Better System

The Gold Standard by Timmermans and Berg depicts standardization in health care, its importance, the history and the nuances of the practice. I think that the book approaches standardization from two different perspectives. There is standardization out of practical necessity and the other comes from regulating patient-doctor interaction or diagnoses. There were basic benefits of bringing hospitals and doctors up to a certain norm. The change that occurred in hospitals in the US during the twentieth century was absolutely critical. It was important for hospitals to have a central system, organized patient records, a standard of cleanliness and a standard of doctor accountability. It places the focus back on the patients who are indeed the most important aspect of treatment. However, I think Timmermans and Berg correctly point out that however important the implementation of standards is, that this process can also be political.

I am concerned with the point brought up in the book about the attempt to turn the art of medicine into a science and the push of money into more academic medicine. I agree that academic aspects of medicine help discover new treatments and ways for doctors to approach medical situations, but I also think that no administrator can make the process of doctoring into one basic set of rules. I was troubled to read that certain medical decisions or tests that a patient could receive have already been predetermined by a committee hoping to set a standard for specific types of patient care. The standardization through evidence-based guidelines is a good idea but can at times be problematic.  The example used in the book about the decision to cut down on ultrasounds given to pregnant women because it may not find anomalies and the decision made to stop doing herpes screening for pregnant women makes sense statistically but I feel that these treatments may be necessary for some women. Standardizing basic procedure may save money but I think it should be up to a doctor’s and patient’s discretion to decide what tests are superfluous rather than a beurocratic advisory board. Standardization has very practical uses, but if this moves into all medical practices it could end up hurting the same patients it tried to save through the process. 

Standardization

Stefan Timmermans and Marc Berg's The Gold Standard: The Challenge of Evidence-Based Medicine discusses evidence-based medicine, why it came about, and how medical professionals use it. I particularly enjoyed his section about standardization in medicine. When he wrote about the history of medical recording standards, I was reminded of my experience working as an administrative intern with a clinic in Tel Aviv, which provided basic medical care at no cost to people without health insurance. The way they dealt with medical records was very problematic because they had few standardized systems and guidelines set up for opening medical files and storing them after patients had seen the doctor. Because many of the patients were from Eastern Africa and entered the country as asylum seekers, many had no identification and could not write in characters that the staff could understand, we were often unable to locate files from previous visits as names had been misspelled, addresses had been changed, volunteers had filed them in the wrong place, or patients had taken files home after misunderstanding instructions about the files due to the language barrier. This, among other inefficient factors, led to a lot of wasted time and frustration for patients, doctors, and staff. If the clinic had a greater level of standardization including rules about the number of translators employed, and a system for collecting and filing records after each patient saw the doctor, we would have been much more effective in helping patients. While standardization can be problematic, as pointed out by Timmermans and Berg, as well as Groopman, it is necessary in many administrative and organizational aspects of medicine.

I also thought the section in the introduction where the authors talk about Taylorism was particularly interesting in the context of medicine and medical professionals. In their discussion of Taylorism, Timmermans and Berg highlight several studies that were done in the quest for a more efficient workplace. The one that caught my attention was Taylor's observation that in many cases, productivity decreased after laborers work for a certain amount of time, as people grow tired; Therefore, it was more practical to have more people working fewer hours, than to have a small number of laborers working for many hours (19). One would think that this would also be true of doctors. As we discussed after reading Charles Bosk's Forgive and Remember, doctors work brutally long hours and are often sleep deprived, which greatly increases the probability the they will make mistakes. As Bosk points out, these errors can be catastrophic for both patients and doctors. I do not know a great deal about regulations on the number of hours doctors are allowed to work over a given period of time, but I suspect that the number of medical errors, particularly technical, judgmental, would greatly decrease if the number of hours doctors were allowed to work without rest decreased.

Pros and Cons for Standardization

In The Gold Standard, Stefan Timmermans and Marc Berg show the importance of standardization in health care. It is easy to recognize the benefits gained from the four types of standards. They are interrelated, each kind of standards boosting the effectiveness of the others. The first chapter shows how these different kinds of standards helped improve the health care system. In the past, doctors had sparse notes on their patients. It is beneficial for hospitals to keep records of each patient instead of searching through multiple doctor's notebooks to find the notes. This type of design standard make the system more efficient and effective in the long run. Furthermore, doctors would have to use similar terminology once the patient's records are more systematize so that other doctors will understand the notes. As mentioned in the chapter, through creating these records, we will then have a big picture view allowing us to create performance standards. This is shown through once they started to compile patient records, they can adequately judge a doctor's performance.

The authors point out that there are also dangers to standardization. They point out there are claims stating procedural standards may restrict doctors and dehumanize health care. When they use evidence based medicine, clinical practice will be based on clinical trials and the creativity in the process will be lost. These concerns remind me of what Jerome Groopman discusses in How Doctors Think. He claims medical students are being taught with an algorithm like method where the questions asked leads to a diagnosis. These questions are typically "yes" or "no" type of questions, which may lead to an incorrect diagnosis. He advocates for the doctor to listen to the patient and avoid asking these "yes" or "no" type questions to make a better diagnosis. There needs to be some stands regarding procedure, like what must be done to declare an operating room is ready to be used, however the treatments patients receive should not be wholly based on clinical trials. While I believe that being familiar with other people's research is important, an effective doctor should be able to mix in research with personal experience instead of valuing one over the other.

Guns, Germs, Steel and Agriculture

Guns, Germs and Steel is thought provoking and challenging in the sense that it brings such easy concepts, like racial or geographical domination, into context and complicates them bringing the reader to a whole new main idea. According to Jared Diamond, the environment and geographic differences among certain cultures brings them a step forward compared to others, not racial differences or intelligence. He puts great importance on the way agriculture helped Eurasian societies develop and survive throughout all these years. Eurasian societies have developed and improved on a much faster pace than other societies and Diamond relates this to the agricultural evolution. With the help of their geographical place on the map, these societies were abundant in animals they could tame and use for producing their crop products and nutrients. This brought with it, specialization of labor, sufficient and healthy food, trading and commerce for Eurasian societies. Sufficient and healthy food brought together with it the advantage of overcoming certain diseases and illnesses. With the proper nutrition, the immune system of the society has improved compared to other societies with poorer nutrition. Trading and commerce between people and societies has made Eurasians richer in social intelligence and actual wealth. Therefore, they are a product of opportunity, not of genetics or intelligence.

I think that Diamond comes to very realistic conclusions in his book but he basis his results on facts without knowing if they are real facts. Biology versus environment, nature versus nurture becomes an issue in this book too. Although Diamond is a fan of nurture and the environment, there is definitely biology involved in the evolution and development of human civilizations, specifically Eurasians. 

On Guns, Germs, and Steel

Jared Diamond's Guns, Germs, and Steel is an attempt to explain why Eurasian societies have consistently been able to survive and come to dominate other societies by examining the environmental factors that first allowed these societies to develop. He explains that key developments such as the specialization of labor and agriculture were naturally aided by geographic advantages, for example the large amount of tamable species for domestication in Eurasia.  Diamond that these environmental factors have been the key reason why Eurasian societies have been able to thrive throughout history.

I thought this book was incredibly interesting, especially when Diamond outlined the differences in agricultural opportunities between North America and Eurasia, but I thought that Diamond's analysis of the last few centuries of human development and activity was a little lacking. For example, Diamond posits that early farmers in Eurasia had a natural advantage over those in North America, who had to work maize. But over the last century, corn has become the basis of the industrial food chain from which the majority of American meals are derived. Diamond also gives little attention to some of the most important social and political developments over the last couple of centuries, including colonialism, capitalism, and the Industrial Revolution.

While Guns, Germs, and Steel certain provides a unique perspective on history worth considering, I don't think that Diamond gave enough weight or attention to some of the most impacting developments in recent human history.

GGS

I really enjoyed Jared Diamond’s story of human evolution and the inequalities that naturally arose from geographical and not biological determined factors. At first, it was really refreshing to read Diamond’s version of evolution, as he made it abundantly clear that our vast inequalities had absolutely no racial premise. His account of our evolution illustrated how environmental and geographical differences led to disparities in success in various human domains. However, as I continued reading, I started to wonder is there a racist undertone to this reading? Let me begin by stating, Diamond did a great job of summing-up 13,000 years of human evolution in one book. However, we started this class talking about how the environment and genes interact and lead to evolution (very lightly stated). Furthermore, if the environment was vastly different in different parts of the world (enough to predict success), would it have led to biologically or genetic differences in the different human populations today? I am just confused about the biological implications of these vastly different human trajectories. Did they only affect our social success (empires, advanced civilizations, etc.) or did they also predict the current biological disparities? In other words, initially it may have been the environment that caused the discrepancy or a “head start” but can it be argued that those environmental differences led to biological differences? I don't know exactly where I stand on the issue but that is thought I had while reading this book. 

Importance of Agriculture

“Guns, Germs, and Steel” by Jared Diamond examines the reasons for why the Western world progressed faster and was able to conquer the people such as the Native Americans and the New Guineans. Diamond uses a scientific approach to analyze this history, Many points he made were interesting and possibly viable. It makes sense that environmental factors can affect how fast a country can progress. For example, if it takes a longer time to produce food in one place than the other, the place that takes shorter time to produce food will have more free time to spend on activities and learning that can help them progress faster. The human race began as a solitary race, with several small groups foraging together for wild plants and animals to eat. The beginning of modern civilization has its roots in agriculture. In terms of agricultural factors, there is a vast disparity between the resources that the Eurasians possessed and those of other civilizations. Eurasians had multiple kinds of large mammals to domesticate while the rest of the world wasn’t even able to domesticate more than one species of mammal. Also, Eurasia possesses massive landmasses where many crops could be planted and large groups of animals could be domesticated for food. Eurasians also were able to diversify the crops they could grow. Barley, wheat, and other sources of protein were planted in contrast to maize, which doesn’t provide nearly as much nutrition. The variety of resources available meant that Eurasians were able to allocate labor in separate groups. This division of labor allowed for the foundations of a modern civilization to be built. With these new resources available, countries were then able to trade with other nations. There are less significant barriers to trade in Europe when compared to other countries (ie. Japan). Therefore, the development of iron and the spread of modern agriculture accounted for the rise of the west.

Guns, Germs, Steel, and Faith

Diamond's book Guns, Germs, and Steel is obviously a very thorough and important historiographical account of human history, but reading it, I felt that Diamond was missing a fourth element in his conquering formula: the issue of religion.  Diamond touches on this a little in the text, but I feel it is an aspect of conquering societies that is as potent if not more so than guns, germs, and steel.  I feel funny bringing this up because this doesn't seem to be on the topic of the class, but it was my main takeaway from the book.

I will use the Native Americans and Europeans as my example, since it is the one I am the most versed in, but there are other examples of the issue of religion playing an important role in the conquest of one society by another, most notably in the Fertile Crescent. 

My main point is the difference between the faith of the Native Americans, a polytheistic, more spiritual approach with a feature of a sort of modesty with respect to humanity's role in the environment, and the faith of the Europeans, which I would describe as an aggressive monotheism with a more egocentric view of humanity as the "chosen ones" and viewing other faiths as being destined for eternal damnation.  This is grossly simplified, but I believe that the faith of the Europeans was instrumental in their conquering of the Native Americans because, in keeping with the concept of Manifest Destiny, they saw it as their god given duty. 

There is a reason why some of the most important parts of the army during these days of conquest were the missionaries, and seeing the spread of the same type of aggressive monotheism all over the world to the point that it has I think is a demonstration of how important the issue of religion is in the context of human history.

Gun, Germs, and Steel

      The essential purpose I determined for Jared Diamond’s book, Guns, Germs, and Steel: A Short History of Everybody for the Last 13,000 Years, is to ask: Why did Eurasian societies develop much more rapidly than all other societies? I found Diamond’s most intriguing argument to be that some geographic areas had a “head-start” in development over others, before the so-called “rise of civilization” even began.  Did the time of settlement give certain regions an advantage over others?  How about the time of adaptation?  There is evidence that Africa would have had the greatest “head start,” being the most genetically diverse, but as history panned out, it is evident that societies on the African continent remain in developing stages, despite their extremely long existence.  What it ultimately comes down to is "History followed different courses for different peoples because of differences among peoples' environments, not because of biological differences among peoples themselves."   Diamond exemplifies this in his discussion on how the development of Polynesian islands differed due to their distinct environments from one another in Chapter 2.  While some islands remained hunter-gather societies, others emerged as “proto-empires.”

         The heart of Diamond’s quest to find the reason for such social divergence across continents lies in the importance of food.  As he describes in the books second section, a basal point for social development is the evolution from a hunter-gatherer lifestyle toward food production.  Food production has led to some of the most severe stratifications in social order, accounting for the subordination of Native Americans by European conquerors and the perceived demand for African slaves.  Diamond goes on to explain that agricultural societies we able to generate food surpluses, which permitted these societies to support full-time artisans who did not need to grow their own food.  Consequently, these societies developed more advanced technologies and governments, increasing rates of survival. Hunter-gatherer societies had far more localized political systems, based around the needs of the immediate tribe rather than more widespread and specialized sects of a larger community.  Thus, agricultural societies, namely in Europe, began to develop intricate governments that could sustain military forces, exploration voyages, and innovative tools, all of which contribute to their exponential rise to power.

         I will admit that I have not yet completed this (extremely long) book, but I could imagine that things get really interesting when he starts talking about the impact on guns, because that changes the conflict from human versus human to human versus armed human.  I personally find this book interesting, though I do not see it’s direct pertinence to this class.  The most relevant topic was on the evolution of germs and how they influenced dense populations.  However, I think we were adequately exposed to this subject in Dr. Sharon Moalem’s book, Survival of the Sickest.

History as Science?

In the epilogue of “Guns, Germs, and Steel,” Diamond brings up an interesting argument. He believes that history should be studied more scientifically and be viewed as a scientific subject. While he acknowledges that cultural factors and unpredictable actions of individuals can make this difficult, he concludes, “ I am thus optimistic that historical studies of human societies can be pursued as scientifically as studies of dinosaurs…(425).”

In some cases I think that a more scientific view of history is beneficial. For example, Diamond uses science to explain how Europeans conquered Native Americans and their land and not the other way around. He methodically explains that environmental differences between the two continents lead to disparities in food production and so forth, which allowed Europeans to conquer. In this instance, scientific explanation was valuable.  It effectively shut down racist arguments that Europeans were able to conquer because they were genetically superior.  It illustrates clear causal factors as to why Europeans were able to conquer that have been ignored or glossed over, in previous historical accounts that I’ve read.

However, I don’t know if it’s possible for history to be an entirely scientific pursuit. For me, history seems extremely subjective and political. The way history is told is dependent on the historian and historians disagree with one another constantly. One historian’s account of the Vietnam War or the Regan presidency will differ dramatically from another historian’s depending on their ideology. Howard Zimmerman’s’ “A People’s History of the United States” will differ from U.S history as accounted for in a Texas elementary school’s textbook.

In short, history is much more up for interpretation that something like neurobiology and I don’t think it’s possible for it to be a completely scientific subject. Still, it’s obviously valuable to look at historical events in as scientific of a way as possible the way Diamond does.

Holy Crop

I thought that for a physiologist obsessed with birds, Jared Diamond was incredibly insightful as an evolutionary historian. Although, the point of reading this particular book in order to advance our understanding of the class is still slightly confusing to me, I thought that naming the development of food production as the root for modern inequality was bold and interesting point to discuss. The secret to certain civilization’s success was all thanks to geographic luck, according to Diamond. Even though the New Guineans are “more intelligent, more alert, more expressive, and more interested in the things and people around them than the average European or American” their way of surviving, even in this modern age, is through hunting and gathering, burdening their quality of health. All I know is, if I’m left in the middle of a forest and told to make my own housing and find my own food, I’m not going to make it the week, but I have technology to thank for my ignorance of basic survival skills.

I went along with this part of the book because Diamond presented a valid argument that we are well off today because our ancestors lucked out with having the advantage of crops, like wheat, that are more nutritious, have a better shelf- life, and can be used in countless products. The plants in New Guinea, however, never had this power and their crops take longer to harvest and have little nutritional value, leaving a large portion of the population with protein deficiency, something uncommon to us. After thinking about it more, I also agreed with the claim there are about 148 plant eating mammals that are over 100 pounds, perfect for domesticating. Unfortunately, in over 9,000 years, only about fourteen have ever been successfully domesticated, most of which are originally from Europe (horses, ox, cows, goats, donkeys) and few every made it to New Guinea (one of the only ones being the pig, which does not supply milk, fur, or muscle strength for labor). Just another reason why western society had the upper hand.

As much as I enjoyed this read, I am still skeptical that plants had so much power that they determined the status of certain societies before they were ever even erected. It reminded me of an article from The Onion, which is a satire, but still pokes fun at the significance food is given in our culture. Maybe it requires more reflection, but I have trouble walking through New York City looking at all of the transportation and impressive architecture and think that it all started with having better crops than someone else.

http://www.theonion.com/articles/healthy-nutritious-food-would-have-saved-the-titan,27923/