The Undercover Economist Strikes Back: by far the worst thing about it is the title

Tim Harford's book reviewed.

Tim Harford is perhaps the best popular economics writer in the world. This is both less and more of an achievement than it sounds: less because he has little in the way of competition for the title and more because the reason there is so little competition is that doing popular economics well is very hard.
 
There are other economists who write for a wide audience. By far the most prominent is Paul Krugman, the Nobel laureate and prolific blogger/columnist for the New York Times. Yet while Krugman might have intended to explain economics to the masses when he started his NYTgig, his column rapidly became highly political and he became a polarising figure. In any case, he doesn’t seem to care much about explaining economics in his columns except in so far as doing so helps him to make a broadly political point (usually that the Republicans are wrong and the Democrats should spend more).
 
There are also some commentators on economics, foremost among them Martin Wolf of the Financial Times, who play an invaluable role in helping to frame and explain – and sometimes adjudicate – the important debates taking place at the intersection of economics and policy. Wolf is erudite, well sourced and highly influential but to call him “popular” would be pushing things too far. His columns are dense, difficult things, written in large part with an audience of senior policymakers in mind. If you’re already an economics sophisticate, then you can learn a lot from them. If you are not, they will verge on the incomprehensible.
 
Harford takes a very different tack. He is in many ways most similar to the “two Steves” of Freakonomics – the economist Steven D Levitt and the journalist Stephen J Dubner. The Freakonomics project seeks to make economics accessible, looking at the way that it manifests itself in everyday life and calling out interesting findings from microeconomic literature. The impetus is praiseworthy but the results can be exaggerated, contentious, oversimplified, or just plain sensationalist.
 
Harford, by contrast, keeps his feet on the ground. He has a breezy writing style and an infectious sense of humour – but he doesn’t let himself go further than a sober, conservative economist would be comfortable going. He’s trustworthy in a way that most other commentators on economics aren’t. He is not particularly interested in political arguments or in imposing his views on others – instead, he just wants to explain, as simply and clearly as possible, the way in which the economics profession as a whole usually looks at the workings of the world.
 
Harford, like Levitt, is a microeconomist by training and by avocation; he is most comfortable when faced with questions such as: “Why does a return train ticket on British rail cost only £1 more than a single?” Hence his Undercover Economist franchise: the conceit is that he’s an economist spying on the world, explaining things – and answering readers’ questions – in a way that only an economist would.
 
With The Undercover Economist Strikes Back, however, Harford has taken a leap out of his microeconomic comfort zone. By far the worst thing about it is the title. There is none of the Undercover Economist about this book, unless you include the dialogue style of writing that Harford has perfected in his FT column. And he’s not striking back at anything at all: no entity was attacking him in the first place. Even the subtitle (How to Run – or Ruin – an Economy) is problematic. No one is going to come away from reading this book convinced that they know how to run an economy.
 
Instead, what Harford has achieved with his new book is nothing less than the holy grail of popular economics. While retaining the accessible style of popular microeconomics, he has managed to explain, with clarity and good humour, the knottiest and most important problems facing the world’s biggest economies today.
 
He is no fatalist when it comes to macro: it is important; there are things we know are true; there are things we know are false; what we do can and does make a tangible difference to how wealthy and happy we become. He explains these things in an unprecedentedly accessible way, making liberal use of quotations from The Hitchhiker’s Guide to the Galaxy and Dr Strangelove.
 
By the end of it all, you will understand everything from liquidity traps to the Lucas critique – and your eyes won’t glaze over when reading about such things. Harford has written the “macroeconomics for beginners” book we have all been waiting for; I just wish that it had been published as such, and not as something targeting only Harford’s existing audience.
 
Felix Salmon is a writer on economics and a Reuters blogger
Photograph: Getty Images

This article first appeared in the 09 September 2013 issue of the New Statesman, Britain alone

Flickr/Michael Coghlan
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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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