¶ … Tipping Point Gladwell's The tipping point is, as stated in the subtitle, a book about "how little things can make a big difference." The "tipping point" of Gladwell's title is the moment when a situation tips over -- as he says, "the moment of critical mass, the threshold" (12). But Gladwell's way of examining this phenomenon is primarily sociological. The book is, in fact, an investigation as to how ideas spread "like viruses" among populations (7). Gladwell uses an elaborate public health metaphor to describe these kinds of mass movements in the public consciousness as "social epidemic[s]" (33).

Gladwell's analysis focuses on three pivotal factors which enable a social epidemic to spread and take hold. The first, from an actual public health standpoint, would be described as the vectors of transmission -- in other words, those people whose social function enables the spread of new ideas. Gladwell describes these as Connectors, Mavens and Salesmen. The first type is a person who -- like the real-life Chicago personality Lois Weisberg, described in this portion of the book -- somehow manages to keep a mental list of all possible acquaintances based on their area of interest, and can make appropriate connections. These are the people who enable the "six degrees of separation phenomenon, described by Gladwell in a famous test by Yale psychiatrist Stanley Milgram. Milgram discovered that a letter, given to a complete stranger in California and told to send it to the likeliest person to know a recipient on the east coast, only required a seeming maximum of six connections to reach its destination. Gladwell notes that this phenomenon is largely enabled by the Connectors. Mavens are experts in a given topic, described by Gladwell as "information brokers" by broadcasting new developments on one particular subject (69). And Gladwell's final category is "Salesmen," who are essentially persuasive people with a combination of charisma and the ability to bring people to a sense of agreement: he notes that the seeming "trustworthiness" of a network news broadcaster is a way of harnessing these indefinable traits. These three personality types permit the spread of a new idea among the population.

Gladwell's next section addresses, in very basic and tentative terms, the way in which an idea's form may enable it to spread. This would, in an actual epidemic, correspond to the identification of the virus or infectious agent involved. But Gladwell is here content to address the issue in terms of generality, since the particular quality he wants to discuss is, as he calls it, "stickiness." In other words, what is it that permits a meme to take hold in the human mind? Gladwell points out that information is not simple enough: he compares the famous "midnight ride" of Paul Revere with a similar ride conducted by a man named William Dawes. The towns where Dawes spread the news of a British invasion did not mobilize -- the towns where Paul Revere spread the news famously did. Gladwell hypothesizes that Revere was more socially astute: he knew the right people to give the information to. But there is also the fact that there doesn't have to be an inherent newsworthiness for an idea to be "sticky" -- he describes "a really cheesy idea" used by executive Lester Wunderman to promote the Columbia Record Club. In 1970, Wunderman bought TV advertising telling viewers between midnight and dawn to find a newspaper and look at their print advertising. If the coupon attached to the print ad contained a gold box, the viewer won a free record. Somehow the mere novelty of a TV ad that asked people to look closely at a print ad resulted in large numbers of people actually signing up for the product.

Gladwell's final factor to enable the spread of a social epidemic is, as he puts it, "context." This is his way of describing the way in which apparently inexplicable behavior can actually be explained and understood through an examination...

The example Gladwell uses here to great effect is the famous story of Kitty Genovese, which he expects his readers to be familiar with. (I myself had heard the story before.) Genovese was the New York City woman who was stabbed to death on the street in front of her building while thirty-eight witnesses watched from their windows. As the story was reported at the time, in the media, the fact of thirty-eight witnesses who watched the crime -- none of whom called the police -- seemed to indicate that New Yorkers were particularly callous and uncaring. In reality, as Gladwell points out, interviews and examination by psychiatrists revealed that all of the thirty-eight witnesses were aware of the crime and also of the presence of other witnesses -- most made the assumption that one of the others had called the police. In other words, as Gladwell puts it, Genovese died on the street not "despite" the 38 witnesses, but "because" of the 38 witnesses: "with just one witness, she might have lived." (28).
Gladwell's book even offers some examples which directly relate to actual public health epidemics. Gladwell suggests that, in terms of public health efforts to curb tobacco usage, that public-service advertising may actually be counterproductive. He suggests that from a policy perspective it would make more sense for the government to divert the money used on anti-smoking campaigns for teenagers to develop alternative strategies, such as drugs like Zyban which have demonstrated effectiveness in smoking cessation. But he also thinks the government should be promoting other types of solutions as well, such as the development of low-nicotine cigarettes. However, in Gladwell's "Afterword" he offers a paradoxical observation from a professional epidemiologist specializing in AIDS. Gladwell quotes this doctor as saying "I wonder if we would have been better off if we had never discovered the AIDS virus at all" (261). Gladwell explains that the man did not mean this literally, he was attempting to summarize an important fact in handling a public health epidemic: the vectors of transmission are essentially social, and reflect the social context to the degree that a disease like AIDS "spreads because of the beliefs and social structures and poverty and prejudices and personalities of a community." What the epidemiologist was trying to describe for Gladwell was the notion that an epidemic disease could only be effectively combated from the standpoint of attacking these things -- that identifying the virus without changing the "beliefs and social structures" (or at least addressing their role in facilitating transmission) is hardly effective.

But overall Gladwell's examination -- although it courts comparison with the idea of epidemic diseases -- is much larger, and has greater applicability to health care beyond his own examples which specifically refer to medical issues. The tipping point is, in some sense, a more scientifically minded version of Hillary Clinton's childrens' book, "It Takes A Village." Gladwell is interested in the way that communities -- and specific individuals within those communities -- bring about social change. This can be a minor change, such as a surprising fashion fad. (Gladwell examines the sudden resurgence of interest in a type of mens' shoe called "Hush Puppies," which became a fad in New York City that he observed first hand, and then researched as a journalist.) But it can also be a large-scale idea, and to a certain degree Gladwell is fascinated by the way in which misinformation can be spread, or good information can be inexplicably ignored. To a certain degree, Gladwell's analysis could be used to describe almost any kind of social movement or fad that intersects with medicine in some way. This could be an actual medical matter -- for example, Gladwell's way of understanding social transmission of ideas could be used to explain the dramatic and troubling rise in popularity of what is…