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Ben Goldacre is a physician in the UK who writes with energy and humor about his field: medicine. He is a sort of anti-Malcolm Gladwell. Instead of spinning mythic narratives about the wonders of science, he explains how hard doing good science is and how common it is for scientists--including physicians and medical researchers--to get things wrong. This book is over a decade old, so it may be less surprising to hear in 2023 that institutions--even those as solid as medical research--have a tendency towards suppression of dissent. But it still felt fresh to read about the many ways that medicine has taken wrong turns in evaluating evidence and assigning treatments. Science makes progress, but it's often not in a straight line.

This book connects with the broader rise of Evidence-Based Medicine as a movement in the late 1990's. Goldacre shares some surprising statistics about how much of standard medical guidelines are actually based on rigorous, peer-reviewed science as opposed to intuition and tradition (around 25%, based on the research he cites). That's a shocking number, and it's a good corrective for the tendency to view physicians as infallible and always making The Right Call based on Science. Viewed as an early summary of the impetus behind that movement, this book is a valuable bit of history: "here's how we viewed medicine in the middle of early reform efforts."

Of course, there are modern critiques of Evidence-Based Medicine (critiques that could also be applied to modern "replication crisis" reform in social science) that don't get addressed. Doing a double-blind randomized clinical trial is a great way to make absolutely certain that a treatment works. But doing a double-blind RCT for every possible treatment--or variation on treatment--that physicians might recommend is implausible. Instead, a deeper appreciation of underlying theory, and how that theory makes some effects and mechanisms plausible (or implausible!) is needed to sort out what ultimately gets the RCT treatment.

Overall, however, I thought the book was engaging, well-written, and full of surprising facts that made me more aware of the holes in our medical knowledge. I'd recommend it to fans of the podcast Maintenance Phase: people who are happy to see myths about healthcare exploded with a sense of humor.

This is science fiction as commentary in its highest forms. Across four stories, Doctorow paints vivid portraits of how current social and technological trends could easily lead to dystopian social conditions. In each case, it's really just a way of amping up the volume on existing practices and problems in a way to better dramatize the problem.

Kim Stanley Robinson gives the cover blurb, and that choice is perfect: Doctorow is operating in the same tradition as Robinson, but in a more immediate and accessible way. While Robinson has elements of sprawling, high literature in his novels--including length!--Doctorow has more of a page-turner style, like a fun escapist sci-fi story with the intellect amped up. He gets to the point quickly, making you care deeply about the characters immediately. It's easy to see how "normal" people get swept up in destructive social and technological systems.

Another good comparison point is Black Mirror. There is a similar format--stories about problems created by technology--and a similar focus on the human elements in these stories. But I'd say that Doctorow has a slightly more thoughtful and articulate vision of what's right, and why things are wrong, in these technological dystopia. It's not "look how crazy technology is making us!" It's "look how the way that fundamental social tensions around capitalism, class, and race are being fought in this new terrain of a higher tech society."

Special shout-out to the last story in the collection, which follows a super wealthy Wall Street guy who creates a doomsday bunker and continually opines about how much smarter, better, and more deserving he is than everyone else suffering from societal collapse. It's got "Neoreaction a Basilisk" vibes, in a very good way.