What Gets Left Out

I would imagine that writers the world over, especially non-fiction writers, look back at their published work and think about what got left out. In my experience, there are two categories of omissions, and they are generally particular to their medium.

The first category is in book writing. When writing a book, you aren’t all that limited by space. Even though some books are way too long, and even though some books do get cut a lot, anyone who says they couldn’t fit something into a book is, in my opinion, either not trying all that hard or is confused about what ground the book is meant to cover. So what does get left out of a book? Generally, it’s an idea you hadn’t thought of or objection you hadn’t considered — things that, by their nature, come to you after the book is done. (FWIW, the new expanded edition of Freakonomics isn’t very heavily revised; most of the edits were pretty minor except for the section on Stetson Kennedy. A lot of people have asked if, or supposed that, we revised the sections about the link between legalized abortion and crime and the bit about John Lott’s gun research, but we didn’t. The new edition does, however, include Levitt’s blog response on challenges to the abortion research.)

Then there is journalism, where things do legitimately get left out for space. That’s because a) an article is obviously much shorter than a book; and b) because an article has to fit a particular page layout, and depending on the art and the ads, it’s not uncommon for a 5,000-word article to be cut to 3,500 words at the last minute. There’s also the fact that there are a lot more cooks in the kitchen with journalism, so in responding to the queries of several editors, fact-checkers, copy editors, etc., you may end up with an article that’s missing quite a bit of what you intended to write.

(I won’t go into space limitations, or the lack thereof, when writing for the web, but if you’ve read this far, you can probably figure it out for yourself. Suffice it to say that I’m grateful the web exists to accommodate the very type of writing I’m committing right here.)

Which finally brings me to the true subject of this post: the Freakonomics column we write for the N.Y. Times Magazine. (These days, we generally write one every two months.) These columns are usually about 1,300 words long. Depending on the complexity of the topic, that isn’t much space. In one recent column, on the need to cut down bacterial infections in hospitals, we included a sort of coda that, in retrospect, I’m very happy about. It was a brief acknowledgment that even though getting medical personnel to regularly wash their hands is an important means to combat the problem, it would behoove everyone if a more global and long-term outlook were considered — e.g., using more anti-microbial surfaces in hospitals. (I also posted here recently about a new study on the effectiveness of hand hygiene.)
There is a similar coda I wish we had been able to include in an earlier column on organ donation, which discussed options to the current system that allocates organs for transplantation, a system that even its supporters admit is tortured. One of the people I interviewed for that column, a doctor who is among the most prolific transplant surgeons in the country, made the point that increasing organ donation, whether through altruistic or market channels, will never satisfy the demand. The best future, he said, lies in technology that will produce reliable artificial organs. I was reminded of this when I recently read of another future scenario, this one proposed by the evolutionary geneticist Bruce Lahn, who foresees the day when surplus human organs can be incubated in non-humans.

These possibilities are at least as important as the current debate over whether there should be an open market for transplantable organs. And, to my mind at least, they are more interesting. Looking back, I really wish we had made the space to explore such scenarios. But we had so much work to do in those 1,300 words that it just didn’t happen. I didn’t even quote that transplant surgeon at all, even though he spent a lot of time with me on the phone and was extraordinarily knowledgeable and helpful.

In 50 years, I hope people will look back at the current debates about organ transplantation and see them as a necessary means of wrestling with an ultimately crude solution to a problem that has since been solved by superior technology. Hopefully Levitt and I will get to revisit the subject someday, maybe in our next book, and if we do I promise we won’t run out of space.


snubgodtoh

Speaking of running out of space: Earth. In the absence of disease and war (sadly).

Andy from Houston

As someone who is virtually obsessed with washing his hands, I often laugh at my coworkers who insist that whatever doesn't kill them makes them stronger - they don't need to wash their hands after using their bacteria infested keyboard and mouse for 4 hours.

I might be a bit paranoid, but then again I haven't taken a sick day in over a year. Must be doing something right!

egretman

A good editor is priceless, Mr. Dubner.

nashat

A lot of people haven't really been sick for a year or so. I am a strong believer in whatever doesn't kill you makes you stronger. Andy, you might want to look into research about why children nowadays seem to have way more allergies than previous generations and it's only partly because of better/earlier detection.

Andy from Houston

Nashat: I have not had a cold or bacterial infection for over 3 years. I did get a food poisoning which made me feel like I wanted to die. Does that count? Sticking to my guns. Frequent handwashing is very beneficial to overall health.

As for allergies, the hygiene hypothesis is just that - hypothesis. There isn't a plethora of evidence to back it up and actually some evidence contravening its validity (wikipedia.com -->"hygiene hypothesis"). Furthermore, it involves the susceptibility of children. Most children I know don't really care if they wash their hands. I know I didn't.

Finally, everyone I know who is allergic to something is allergic to an outside agent like ragweed or a particular type of food.

So, I will continue my handwashing ways :P

saturninesylph26

I feel like there won't be a need for artificial organs until half the world's population is knocked out. Medicine is advancing way too fast. If the concept of hygiene had never been introduced, we would still have minimal population growth due to the frequent death of children. Even though death causes pain, human lives are insignificant things if we look at the numbers.

JeffreyDaniel

About the solid tissue transplant technology check out this company www.tissera.com they are in research and development phase and hope to contemplate human trials in a year and a half if things go well and results from primate studies are consolidated. There is a great article in Nature magazine about how they grew a kidney with human tissue in a mouse - it produced a diluted urine.
If the same idea works with pancreatic tissue (my favorite horse in the race) treatment for diabetes is around the corner. Still issues with immune supressing drugs, though, as well as the converse (immune system attacking the new organ).
Thanks for the great blog. I like reading articles to my high school statistics classes.

ricobravo

SJD - just put down the book finally (after a few hours) congratulations on its success.

On the subject of transplants, I would be surprised if you have not stumbled upon the story of Dr. Anthony Atala at Wake Forest University who is using adult stem cells to engineer the development of actual organs for implant - organs created from cell tissue of the same person in need of the transplant. He had successfully used this technique for bladder implants with at least 7 children (all of whom are doing well). See NY Times article:

http://www.nytimes.com/2006/07/11/health/11prof.html?pagewanted=2&ei=5070&en=01bbd0e54c754f1c&ex=1168059600

agrainofNaCl

I'm really glad you brought up the discussion about organ donation never meeting demand. As a biomedical engineer, and more specifically a tissue engineer, I couldn't agree more about organ donation being only a temporary solution. And to add to the previous posts, while Dr. Atala does great work, there are thousands of others doing similar research and on various organs and tissues. We currently grow tissue engineered skin and ligaments in our lab, and bioengineered skin is already on the market (http://www.organogenesis.com/products/bioactive_woundhealing/apligraf.html).

However, there are still numerous hurdles in developing these technologies, especially for extremely complex organs, like the heart, and with tissue that don't naturally regenerate when injured (again the heart). So in all honesty, while I hope the the discussion of organ transplantation will eventually be obsolete, I'm not sure it will any time soon.

Read more...

sinisterdexterity

I wonder if you've ever read this story, which fascinated me (in a horrific way) as a child:

http://en.wikipedia.org/wiki/A_Planet_Named_Shayol

snubgodtoh

Speaking of running out of space: Earth. In the absence of disease and war (sadly).

Andy from Houston

As someone who is virtually obsessed with washing his hands, I often laugh at my coworkers who insist that whatever doesn't kill them makes them stronger - they don't need to wash their hands after using their bacteria infested keyboard and mouse for 4 hours.

I might be a bit paranoid, but then again I haven't taken a sick day in over a year. Must be doing something right!

egretman

A good editor is priceless, Mr. Dubner.

nashat

A lot of people haven't really been sick for a year or so. I am a strong believer in whatever doesn't kill you makes you stronger. Andy, you might want to look into research about why children nowadays seem to have way more allergies than previous generations and it's only partly because of better/earlier detection.

Andy from Houston

Nashat: I have not had a cold or bacterial infection for over 3 years. I did get a food poisoning which made me feel like I wanted to die. Does that count? Sticking to my guns. Frequent handwashing is very beneficial to overall health.

As for allergies, the hygiene hypothesis is just that - hypothesis. There isn't a plethora of evidence to back it up and actually some evidence contravening its validity (wikipedia.com -->"hygiene hypothesis"). Furthermore, it involves the susceptibility of children. Most children I know don't really care if they wash their hands. I know I didn't.

Finally, everyone I know who is allergic to something is allergic to an outside agent like ragweed or a particular type of food.

So, I will continue my handwashing ways :P

saturninesylph26

I feel like there won't be a need for artificial organs until half the world's population is knocked out. Medicine is advancing way too fast. If the concept of hygiene had never been introduced, we would still have minimal population growth due to the frequent death of children. Even though death causes pain, human lives are insignificant things if we look at the numbers.

JeffreyDaniel

About the solid tissue transplant technology check out this company www.tissera.com they are in research and development phase and hope to contemplate human trials in a year and a half if things go well and results from primate studies are consolidated. There is a great article in Nature magazine about how they grew a kidney with human tissue in a mouse - it produced a diluted urine.
If the same idea works with pancreatic tissue (my favorite horse in the race) treatment for diabetes is around the corner. Still issues with immune supressing drugs, though, as well as the converse (immune system attacking the new organ).
Thanks for the great blog. I like reading articles to my high school statistics classes.

ricobravo

SJD - just put down the book finally (after a few hours) congratulations on its success.

On the subject of transplants, I would be surprised if you have not stumbled upon the story of Dr. Anthony Atala at Wake Forest University who is using adult stem cells to engineer the development of actual organs for implant - organs created from cell tissue of the same person in need of the transplant. He had successfully used this technique for bladder implants with at least 7 children (all of whom are doing well). See NY Times article:

http://www.nytimes.com/2006/07/11/health/11prof.html?pagewanted=2&ei=5070&en=01bbd0e54c754f1c&ex=1168059600

agrainofNaCl

I'm really glad you brought up the discussion about organ donation never meeting demand. As a biomedical engineer, and more specifically a tissue engineer, I couldn't agree more about organ donation being only a temporary solution. And to add to the previous posts, while Dr. Atala does great work, there are thousands of others doing similar research and on various organs and tissues. We currently grow tissue engineered skin and ligaments in our lab, and bioengineered skin is already on the market (http://www.organogenesis.com/products/bioactive_woundhealing/apligraf.html).

However, there are still numerous hurdles in developing these technologies, especially for extremely complex organs, like the heart, and with tissue that don't naturally regenerate when injured (again the heart). So in all honesty, while I hope the the discussion of organ transplantation will eventually be obsolete, I'm not sure it will any time soon.

Read more...

sinisterdexterity

I wonder if you've ever read this story, which fascinated me (in a horrific way) as a child:

http://en.wikipedia.org/wiki/A_Planet_Named_Shayol