• What We’re Reading This Winter 2020

    Senior ophthalmologists share the best of what they’re reading this Winter. Share what you’re reading and send your review to scope@aao.org

    By Malcolm Gladwell
    Reviewed by Marcia D. Carney, MD

    “Outliers: The Story of Success,” authored by Canadian journalist Malcolm Gladwell, outlines the lives of high achievers … the best and the brightest successful people and how they became successful.

    Gladwell methodically dissects success whose core is task, ambition and intelligence. He also, however, outlines the needed ingredients to add to these core elements to truly become successful. He opens with a discussion of the strange pattern in hockey players’ birth months and leaves you initially searching for a point, leaving you asking the question, “How can our birth month determine our destiny?” Eventually, he makes the point that cultural forces that determine success may initially be hidden.

    Most of us live with the concept that success is derived from talent and hard work alone. In the book, Gladwell identifies several avenues to success in our work. He analyzes the lives of people, such as the Beatles, Microsoft CEO and co-founder Bill Gates and Bill Joy, the co-founder of Sun Microsystems, examining their circumstances as outliers, i.e., intelligence or hard work.

    Although talented and motivated, these people happened to be in the right place at the right time. Gladwell also notes that although it is important to be intelligent, it is just as important what you do with the intelligence. In looking at these high achievers and musical achievers, Gladwell summarizes that success is affiliated to a particular task and to achieve mastery of the task or product of study, it takes 10,000 hours of work in that field to achieve mastery. He infers that success depends on intelligence, but also what you do with it in a minimum of 10,000 hours of dedication to learning or perfecting your tasks or knowledge.

    The Beatles, for instance were talented musicians. However, they played long hours in Hamburg before exposure to the United States, thus perfecting their music style and content. Ability or talent is nothing unless combined with the 10,000-hour rule according to Gladwell.

    Bill Joy had access to the university computer systems. It took him 10,000 hours to practice and write computer programs which are still used today. Gladwell points out that there is something “profoundly wrong with the way we make sense of success.” We often attribute success to a rare and triumphant collection of individual qualities — talent, motivation, genius — when, in fact, success stories (successful outliers) feature people who are “the beneficiaries of hidden advantages, extraordinary opportunities and cultural legacies” that enable their success, as opposed to those whose path to success is more obvious.

    Gladwell’s purpose for writing “Outliers” was to inform readers on how successful people achieve success through the help of others, practice and opportunity. This may change the way that society views outliers as becoming successful people. They may not be outliers. Some of them just have the opportunity, timing and 10,000 hours to practice as keys to success rather than sheer talent.

    Born in 1963, Gladwell made a name for himself with other books on the best seller list as “Blink: The Power of Thinking without Thinking,” and “The Tipping Point.”

    It was a good read. And for those interested, Malcolm Gladwell will also be the keynote speaker at the Academy’s opening session during AAO 2020 in Las Vegas.

    The German War: A Nation Under Arms, 1939-1945
    By Nicholas Stargardt
    Reviewed by Alfredo A. Sadun, MD, PhD

    Why do we need another book about World War II? What would make it so compelling? Because this book describes the events of WWII from German eyes. 

    Stargardt, a professor of history at Oxford University, compiled a new collection of research files and, more importantly, presented a very humanized perspective that, to me, was very different and transfixing.

    The sources are German newspapers, German radio broadcasts, German historical files, German diaries and interviews with German soldiers and citizens. I was flabbergasted. I already knew about the main events, invasions, battles and bombings, but now I saw it from another perspective.

    The German citizens did not regard WWII as a new war. For many of them, it was a continuation of World War I. Most Germans actually believed that theirs was a defensive war. Adolf Hitler and Joseph Goebbels had told them, and they believed it, that Jews and communists were designing to destroy Germany, and this war was their best defense.

    Even the German invasions of Czechoslovakia, Poland and France were, from the German civilian perspective, preemptive strikes to prevent invasion from the British on the West or the Soviet Union from the East.

    This book was not fun to read. It is well known that the war was a disaster and tragedy for much of the world and that this included Germany as well. That German soldiers, citizens and cities suffered greatly came as no surprise. But mixed with their anguish, this book provided voices of victimhood that shocked me.

    Most Germans had become aware, but did not object to the German atrocities. For most, the realization came slowly, so they rationalized to avoid guilt. They accepted Hitler’s vision and justified the atrocities Germany perpetrated as necessary to avoid their own victimhood.

    At the end of the war, only a few Germans faced up to their own culpability, and they interpreted the bombings of Dresden and Hamburg as both logical and moral consequences. But most didn’t see it that way. Hitler was widely admired by the German populace and the ideology of a world Jewish conspiracy was widely shared.

    Stargardt's work frightened me as he showed how well Nazi propaganda resonated with the German people and gave them a feel-good narrative. It was that narrative of Germans as the true victims, that, for most Germans, justified their atrocities.

    Today, we see how easily politicians stoke fear and hatred. But I now appreciate how easily politicians convince the public that they are the victims. From there it’s not hard to obscure the moral boundaries. I was left with these somber reflections: 1) Propaganda is about harnessing feelings, not controlling thoughts; 2) He that sows the wind, shall reap the whirlwind.

    This book was an eye-opener and a cautionary note for our times.  

    Four Friends: Promising Lives Cut Short
    By William D. Cohan
    Reviewed by J. Kemper Campbell, MD

    William D. Cohan is an investigative journalist and writer whose previous works involved institutions and members of the financial world. His latest book demonstrates he is equally adept at empathizing with flawed individuals.

    “Four Friends” begins at the Phillips Academy in Andover, Mass., one of the nation’s most elite and prestigious prep schools. Both former President George W. Bush and his father President George H.W. Bush matriculated at Andover and the school has funneled generations of primarily WASP students into Ivy League universities.

    Cohan, who graduated from Andover in 1977, became interested in writing this book after he discovered one of his classmate’s death in 1979 at age 39 was related to an automobile accident caused by another inebriated classmate. Cohan then realized that four other schoolmates had died under tragic circumstances in their late 30s and early 40s before achieving the level of success which had been assumed in prep school.

    One of the four was John F. Kennedy Jr. and another was a grandson of President Harry Truman. Cohan’s adolescent ties to these men allowed him access to the intimate friends, family and business acquaintances which permitted his remarkably candid portraits of each man.

    Each of these unfortunate individual’s strengths and weaknesses are described unflinchingly, and their abruptly truncated and unfulfilled lives will linger with the reader. Though the details of JFK Jr.’s demise will be known to most readers, Cohan’s glimpses of his lifelong struggle with fame elevate the book above the Kennedy voyeurism of tabloids. Interestingly, the fates of the lesser-known men become equally compelling in Cohan’s hands.

    Classic American writers, from Thornton Wilder to F. Scott Fitzgerald, have wrestled with the issue of whether divine intervention or karma plays any part in an individual’s fate. Cohan simply allows readers to draw their own conclusions from his memorable book. The reader will now hope that Cohan will use his considerable talent to describe victims on the streets of Chicago.

    Three Laws Lethal
    By David Walton
    Reviewed by Thomas A. Harbin, MD, MBA

    On Nov. 6, 2019, the Ars Technica website featured an article by Timothy Lee: “How terrible software design decisions led to Uber’s deadly 2018 crash.”

    In it, the National Transportation Safety Board had a telling observation: The system involved in the accident “did not include consideration for jaywalking pedestrians.”

    How much thought have you given to the algorithms of self-driving cars? How much do you really know about AI?

    If you enjoy science fiction and want to be challenged to think hard about self-driving cars as well as learn something about AI, this is the book for you. It’s also a great story.

    The book begins with a self-driving car turning away from a fallen tree into a motorcyclist, killing him but saving the two occupants of the car from a fatal crash into the tree.

    What set of instructions wired into the car made it turn away? Did the car detect the fact that a motorcycle with a human driving it was in the way? Who wrote the software and did any regulator review it? How much transparency is there in the current version of self-driving cars?

    These questions and others we may not have thought about permeate the book.

    The story goes from the “accident” to the tale of four graduate students who start an auto-driving car company with AI as the architect of their cars’ systems. Murder, lawsuits, bitter disputes and danger from the cars spice up the story, keeping you turning the pages.      

    This book has stayed with me longer than most and makes me very hesitant to put total trust into a self-driving car. It seems to have predicted just the sort of tragedy discussed in the headline above.

    By Tara Westover
    Reviewed by Samuel Masket MD

    Educated is a longstanding New York Times bestselling autobiography by Tara Westover, a young woman who was raised on an Idaho mountainside by devout Mormon parents who were also survivalists.

    Like the people of Ruby Ridge, the Idaho community that was the site of an FBI siege in 1992, Westover’s father had intense paranoia regarding the government, formal education, western medicine, hospitals, etc. Westover, who never attended school until she was 17 and lacked a genuine birth certificate, came to realize that there was a world external to hers when an older brother who left the fold encouraged her to seek a formal education.

    The motivated author began a long and arduous path, self-educating at the outset, but eventually she was accepted to Brigham Young University, where it became evident that she knew nearly nothing of the “real world,” given her cloistered rearing. In her childhood environment her father “ruled the roost” with an iron hand and intimidated his children, forcing them to work the scrap and salvage yard that he owned, risking serious injuries that occurred all too often.

    Westover was also tortured physically and psychologically by a disturbed brother, Shawn, who was always supported, most often inappropriately, by her parents, in keeping with their male-dominated fundamentalist family.

    Nevertheless, Westover managed to get into BYU, received a degree and was highly encouraged to attend Oxford University for a PhD program. However, from time to time along the journey to an education, Westover would return to Idaho, seemingly to understand and gain comfort with her roots, only to repeat negative experiences with Shawn, her parents and other family members. Succeeding at Oxford, albeit with intermittent personal crises she earned a PhD and went on to a post-doc at Harvard.

    Despite achieving a remarkable education both in and out of the classroom, we sense that Westover remains chronically troubled by real and self-imposed ties to her past. Although there are obvious similarities to “Hillbilly Elegy” by J.D. Vance, those familiar with his book will note a difference in how the two authors have managed their past.