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In Revenge of the Tipping Point, Malcolm Gladwell examines the factors that cause social epidemics and considers whether the tipping-point events that start epidemics can be controlled. The Introduction includes court transcripts from a judicial hearing (which is revisited at the end of the book). In the transcripts, the defendants accept no accountability for a widespread epidemic. 

Chapter One starts by examining the epidemic of bank robberies in Los Angeles in the 1980s and early 1990s. Gladwell describes several prolific bank robbers and their impact on the bank-robbing culture of the time. Strangely, there were far more robberies in Los Angeles than in other urban areas. The next topic is an analysis of disparities between the ways in which doctors prescribe treatment within the same state. Small geographic regions have different tendencies, despite the regions having similar demographics. A similar situation is examined with different schools within the same town that have wildly different vaccination rates for their students. These phenomena are known as small-area variation and are the first of three puzzles that Gladwell explores.

Chapter Two examines the pattern of pervasive Medicare fraud in Miami, Florida. The first half of the chapter describes the criminal activities of Philip Esformes (one of the greatest defrauders of the Medicare and Medicaid systems). He ran hundreds of nursing homes and assisted living facilities. When he was tried for his crimes, many of his friends and family insisted that Miami had changed him. Gladwell explores the Medicare fraud culture of Miami and finds that such a claim is somewhat plausible. The Medicare Fraud Strike Force takes Gladwell on a ride-along in Miami, and he sees firsthand that entire business complexes are filled with fake offices, fronts for medical companies that exist only to commit fraud. In Miami, the fraudulent companies do not even try to hide their crimes. This leads to Gladwell’s second puzzle: Can an environment—what Gladwell calls an “overstory”—influence a person’s moral behavior?

Chapter Three, “Poplar Grove,” looks at a small town in the United States that was investigated by two sociology researchers. (The name of the community has been changed.) The local high school regularly ranks as one of the best in its state in both athletics and academics, and in general the culture of Poplar Grove is one of intense pressure to succeed. The unfortunate side effect is that it is a monoculture, which is very susceptible to epidemics. The town’s various social crowds do not differ enough to allow for true diversity. Gladwell compares Poplar Grove to a population of cheetahs bred in captivity. Due to a lack of genetic diversity, the animals are all susceptible to the same diseases. The epidemic afflicting Poplar Grove is a pattern of suicides that spans over a decade. Can anything be done to change the town’s culture, to end this tragic epidemic? This is the third puzzle: Are members of a community able to control or create an overstory?

Chapter Four examines how ratios within a group can dictate how a group will function. Gladwell offers several examples, including integrated neighborhoods, women on corporate boards, and minority students in classrooms. When a minority population makes up a small portion of a group, they are viewed as different by the rest of the group. The members of the minority population will often act differently, as well. What Gladwell finds is that once the minority exceeds 25 percent and approaches 33 percent, the dynamic will change. This rule appears to apply in many different, unrelated scenarios. Gladwell calls this pattern the “Magic Third.” In Chapter Five, Gladwell examines Ivy League Sports. Harvard, specifically, recruits athletes to sports that are more popular with affluent families (tennis, rowing, squash, etc.) to ensure a majority-white athlete population and to keep all of the minority groups from reaching the Magic Third threshold.

Chapter Six follows a specific individual responsible for spreading the COVID-19 virus to many other people. A meeting of 175 corporate employees in early 2020 included a “superspreader,” one of the few people in any population who transmit airborne diseases more effectively than the rest. Largely because of this person’s presence, the corporate meeting led to the eventual infection of more than 300,000 people. This chapter expands on the concept of the Law of the Few from The Tipping Point (2000), where Gladwell states that a small number of people will be responsible for a large amount of social change.

Chapters Seven and Eight examine how large overstories can be changed. Gladwell describes how television changed the perception of the Holocaust and how people were willing to talk about it. Decades later, television again influenced the fight for the legalization of gay marriage. Gladwell states that in many instances, people do not see the signs of change along the way, because they are looking in the wrong places. Anyone wanting to observe cultural change as it happens should keep a close eye on pop culture and the media.

Chapter Nine, the conclusion, uses overstories, superspreaders, and group proportions to analyze the opioid epidemic in the United States. The trial transcripts from the Introduction are revisited. They are the testimony of the family behind Purdue Pharma, the company that made OxyContin. Purdue Pharma worked around an overstory of regulation and identified potential superspreaders to push their product as efficiently as possible. After OxyContin was reformulated (and made more difficult to crush and snort recreationally), the opioid epidemic accelerated and pushed people to use street drugs instead of prescription medication. Noting the deliberate nature of Purdue Pharma’s tactics, Gladwell points out that understanding the moving parts of an epidemic can give people the ability to influence epidemics, a power that should be used to make the world better. 

Previous section Part Four: Conclusion (Chapter Nine)

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