Do you have a uterus?

If you answered yes and were a post-menopausal female in my practice roughly a decade ago, odds are I’d have talked you into taking combination hormone therapy.

Besides the fact you’d probably feel better, having ditched those inconvenient hot flushes without hugely altering your lifestyle, I was after bigger fish. I’d embraced the preventive mindset, and the Nurses’ Health Study said I’d be protecting your heart and nervous system, not to mention your bones.

Expert opinion backed me, too, and by that I mean brilliant people who’d read the same studies and reached the same conclusions. Good local clinicians. The type of person you could call in the middle of the night to say, “I have a feeling I’m in trouble with this delivery,” and there’d be no second-guessing. They’d show up in ten minutes flat with bed-head and a willing heart. The sort who wouldn’t let an incompetent resident through the system, even if the cost of being a whistle-blower was time and vilification by colleagues. No shortcuts for these folks.

As for me, I was passionate and persuaded. Since there’s little more compelling than a doctor without an agenda, other than the betterment of their patients’ health, I was extraordinarily effective at winning compliance.

Then the Women’s Health Initiative came out.

The promise: hormones would protect a woman’s vascular system.

The reality: an increase in heart attacks and strokes significantly above baseline levels.  To add insult to injury, in the two years following, as millions of North American women shucked their medication, the incidence of breast cancer declined by 2-3% per year. If hormones weren’t causing the outright development of breast cancer, even in properly screened patients, they certainly seemed to ignite its growth.

Lots of data, lots of expert opinion, lots of misery and fatalities in the name of preventing suffering.

Therapeutic whiplash.

Was this an unusual experience in medicine? I wish. I recall a long list of new sleeping agents that weren’t going to be addictive, except when they were. I remember the weight loss drugs that got you skinnier while damaging your heart valves; the lipid-lowering drugs that improved cholesterol numbers while increased rates of death.

You’ll notice I’m not even discussing issues like falsified results, suppressed data, or bought experts—in other words, fraudulent science. I’m only addressing the fact that even under the best of terms, even with thousands of data points and a team for analysis, evaluation has its limitations.

“Prescriptions” in the literary world

By now you’re saying, “Fine, Jan. We’re done with hearing stories about your ancient youth. What does this have to do with writing?”

And I’d ask, what are discussions like these, except attempts to diagnose, treat, or prevent literary malaise?

  • I’m a hopeful novelist. Should I blog, and if so, how often should I post? What should I write about?
  • If you have a blog, should you turn off comments altogether? Or should you minimize barriers to conversation, even if that means time spent deleting hundreds of spam comments a day?
  • Should a writer join Klout, then change their Twitter strategy and whom they follow based upon its scoring system?
  • Will you make more sales if you sign people up for your newsletter the minute you have their email address, or should you only ever ask them to opt in?
  • Nobody’s buying paranormals. We won’t be able to sell this book. Write me a dystopian.
  • I have $500 for promo. What measures will give me the best bang for my buck?

So, fellow writers, as you’ve read and listened to advice in the writing world concerning prescribed actions for your career, have you noticed the lack of consensus? Have you seen that the staunchest opinions can fluctuate over a period of months, even within the same individual? Have you noticed the quality of data which bolsters most points of view, if provided, is at best anecdotal and incomplete? (That is, not remotely as detailed or comprehensive as in the Nurses’ Health Study, which still got it wrong.)

Developing Your Own Criteria for Assessing Advice

Does this mean there’s no point to listening to advice? That if publishing/ blogging/ marketing experts can only advance opinions based upon small amounts of data and experience, culminating in intuition, we shouldn’t bother to listen?

Absolutely not. For one thing, we all know people who could stand in a feedlot during a tornado, stretch out their arms and snag two fistfuls of posies.

The trick is to learn to find these way-showers and stand next to them, if not become them ourselves. For just as we learn to filter critique advice through our own increasingly sophisticated knowledge of craft, self-identity, and story sense, we’re capable of learning strategies to evaluate “treatments.” We can determine patterns, evade the more obvious pitfalls.

I believe this because by the time I left practice, through sheer repetition and experience, I’d developed:

  • a healthier and realistic skepticism about the evolution of the Next Best Thing, and an understanding of its predictable cycle. (Wildly hopeful reception > generous and off-label use > development of unanticipated side effects > recall or significant narrowing of its scope of deployment.)
  • a better way of distinguishing the sound from the fury, so that fewer of my patients became the evidence of an intervention’s harm.
  • an improved sense of when I was being sold versus when I was being educated and emancipated.

Apply What You Already Know

I left medicine. I started writing. For reasons I should probably explore with a therapist, I unconsciously checked all that knowledge at the door. What could medical research and the search for quality evidence have to do with this world?

Maybe more than I thought.

That’s what I hope to explore in Part II of this series, in which we’ll look at some ways of evaluating writerly advice through a medical lens.

For now, here are a few conclusions:

  • Good, diligent, and intelligent people can still have poor understanding of a situation because of flawed data, flawed understanding of causality, or imperfect application. You cannot turn off your brain just because they are nice.
  • Good, diligent, and intelligent people can still prescribe wrong action, because they’re answering questions that are irrelevant to your goals. You cannot turn off your brain.
  • Data is sexy, and though we seek it with a real and primal urgency, the wrong data is worse than no data at all. It can get you pregnant with ideas you didn’t want or need.
  • Once in a rare while, you’ll meet someone who’ll try to blind you with “facts” or the force of their personality. Their motive might be money, jealousy, personal ambition, or compensation for their small organ size. I dunno. I don’t understand this mentality. Point is, your career decisions are always on you. You cannot afford to turn off your brain, especially when it comes to picking experts to whom you’ll defer.
  • If you’ve got expertise about evaluating data in non-writing situations, don’t assume your critical-thinking skills are defunct in this world.
  • Finally, all these cautionary tales apply doubly to me. I’m unpublished, unagented. Just because I’m under the WU masthead, that doesn’t mean I know squat about your career.

Have you brought an analytic skillset from another world that guides your writing decisions? If so, give us a sense of how they intersect.

Photo of Dr. Alice Hamilton (1869-1970) is from Smithsonian Institution, on Flickr. She was the first woman on the faculty of the Harvard Medical School, remaining there until her retirement in 1935.



About Jan O'Hara

Jan O'Hara left her writing dreams behind for years to practice family medicine, but has found her way back to the world of fiction. Currently the voice of the Unpublished Writer here at Writer Unboxed, she hopes one day soon to become unqualified for the position.