John Snow, public health, and innovating in teams

I thought yesterday’s newsletter from author Steven Johnson was spot on. Lightly edited text below..

Last week a combination of work and family vacation brought me back to London for a few days. As often happens when I visit the city, I found myself back in Soho, at the site of the 1854 cholera epidemic that was the subject of my book, The Ghost Map—now almost fifteen years old!

For those of you who don’t know the story, the Soho outbreak famously involved a pump, located at 40 Broad Street, that provided public drinking water for the neighborhood. In late August of 1854, the well water became contaminated with the bacteria that causes cholera, and the community was quickly devastated by the disease. At the time, health authorities believed that diseases like cholera were transmitted through noxious vapors, but a local doctor named John Snow—now considered one of the fathers of epidemiology—had developed a theory that cholera was transmitted via water, and he created a map of the outbreak that showed an unusual concentration of death around the 40 Broad Street pump, ultimately convincing the authorities to remove the pump handle—a true milestone in the history of public health.

For many years, a replica of the pump commemorating the events of 1854 had stood a block or two east of its original location on Broad (now Broadwick) Street. But a few years ago, the pump was relocated to what would have been 40 Broad, next to the corner pub that is now known as The John Snow. I‘ve spent a lot of time walking the streets around Soho, and loitering next to the pump, but this was the first time that I’d visited the area during a family vacation. Somehow seeing the pump in the context of other London tourist landmarks made me see it in a new light.

So many of the grand public memorials in big cities like London are devoted to military events and heroes: think of Lord Nelson towering above Trafalgar Square, or the civil war monument in Grand Army Plaza near our place in Brooklyn. But I was hard pressed to think of another urban monument to a public health breakthrough. (I’m sure some are out there — if you happen to know if one, I’d love to hear about it.) And of course the pump memorial is to scale and almost entirely invisible unless you happened to be standing right next to it; you could walk down Broadwick on the other side of the street and not even notice the thing.

There is something off kilter about the ratios here: both the number and scale of the war memorials, compared to the pump on Broadwick Street. Don’t get me wrong — the lives lost at the Battle Of Trafalgar or during the American Civil War deserve the memorials we have given them. But the pump, in a way, reminds us of a different kind of history: it is a memorial to lives saved, to the hundreds of thousands or millions of people who didn’t die of cholera in part because a local physician in a poor neighborhood saw a pattern in the mortality data and changed our understanding of epidemic disease. The history of the last two centuries is filled with comparable triumphs, breakthroughs that shape our day to day existence in incalculable ways, particularly in large metropolitan areas where epidemic diseases were a daily reality just a few generations ago. Why not celebrate those triumphs as visibly as we celebrate the military victories?

Seeing the pump restored to its original spot reminded me of another idea I’ve been mulling lately. One of the lessons of The Ghost Map is that the classic story of the lone scientific genius is almost always a fiction, condensing down a much more chaotic and collaborative process of discovery into a narrative dominated by a single protagonist. John Snow had always been presented as that kind of heroic scientist in the accounts of the Broad Street outbreak, but it turned out that his idea required the help of a number of other people for it to make a difference in the world: most importantly the local vicar Henry Whitehead, who helped with his investigation, and the statistician and demographer William Farr, who had campaigned for more detailed “open source” mortality reports that supplied Snow with important data. For me, the Ghost Map story was the beginning of an idea that I developed further in Where Good Ideas Come From five years later: that transformative ideas almost always come out of diverse networks, not individuals.

But if you believe in the network model of innovation, that raises a further question: how does a society reward and celebrate those networks, particularly in fields like public health where market-based rewards are more elusive. One primary tool we have are prizes. (If the Nobel prize had been around in the 1850s, it’s entirely possible than Snow would have received one for the waterborne theory of cholera.)

But most prizes — however valuable they are in terms of financial reward and professional status — tend to reinforce the lone genius model, and not just in the case of the “Genius Grants” that MacArthur awards every year. The Nobel Prizes, for instance reward one or two discoverers who hit upon an idea, rather than the loose assemblage of researchers — often in different fields — who contribute pieces of the puzzle that ultimately takes on a coherent shape. The whole architecture of our prize system is designed to celebrate the achievements of the alpha dog who towers above the rest in intellectual achievement. It would be nice to have some prizes that for once tried to celebrate the pack.

Two powerful observations that I hope will be applicable to how we attempt to make progress on climate change.