Stop Feeling Like an Author Wishbone: First Do No Harm

If you’re a writer who mostly listens to your own counsel and it’s working for you, this post probably won’t help. In fact, turn away. I urge you to leave. There’s nothing for you here.

To everyone else, especially if you’re feeling yanked hither and yon by expectations about building platform, here’s a recap of Part I:

The impetus for this series was the realization I had been making many of my writing decisions based upon expert advice. (Where “experts” means agent, editors, marketing and publicity experts, and publishing insiders. “Decisions” often meant business-y things, such as whether to build a platform as I composed my fiction and if I did so, to what extent and where.)

In essence, I defaulted to the way I learned in the education system which, because of my medical background, was a protracted-but-enjoyable experience. However, the longer I’ve been around, the more I’ve observed that:

  • Experts in the same field seldom reach consensus, implying lack of universal truth.
  • The industry’s cumulative expectations can be unrealistic. (And that’s for the relatively privileged me. How could a single parent of small children be expected to work full time, write 1-3 books a year, tweet, keep a presence on a blog, Google+, Facebook, and do this on a sustainable basis?)
  • The publishing industry has the same cycles I witnessed in medicine when a new procedure or drug came along. For example, in the last half year I’ve witnessed this evolution of advice coming from admired and articulate publishing insiders:

To break in as a writer, you must keep a blog a minimum of three times per week. Aim for a minimum subscriber list of X.

You probably should have a blog.

Don’t keep a blog at all. They’re a waste of your time. Instead, comment on already established blogs in your genre and keep a mailing list.

Ultimately, I was growing increasingly unhappy and distrustful of my own instincts, which in turn stalled my writing.

I began to think about the quality of evidence supporting many of these opinions.

In most cases, it’s inferior to the evidence available in medicine, which as we noted in Part I, can still get it spectacularly wrong. To complicate matters further, the industry is in flux, so what little data is available to a single author might well be antiquated by the time it’s received.

How do we proceed when evidence is poor quality? When trends are disrupted by the time we know we’re in the midst of one? When the little data that’s accessible might not be specific to our situation? Is there a systematic approach to making decisions in the face of uncertainty?

It turns out one principle can be helpful in both entrepreneurship and medicine. It involves some Latiny goodness.

Primum Non Nocere

[Read more…]


Stop Feeling Like an Author-Wishbone at a Table of Industry Experts (Part I)

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?

[Read more…]