Success consists of going from failure to failure without loss of enthusiasm. —WINSTON CHURCHILL (Location 51)

evidence of treatment effectiveness to physicians. A good doctor, it is presumed, scans the journals for the results of these studies to see what works and what doesn’t on which patients, and how well and with what risks, modifying her practices accordingly. Does it make sense to prescribe an antibiotic to a child with an ear infection? Should middle-aged men with no signs of heart disease be told to take a small, daily dose of aspirin? Do the potential benefits of a particular surgical intervention outweigh the risks? Studies presumably provide the answers. In examining hundreds of these studies, Ioannidis did indeed spot a pattern—a disturbing one. When a study was published, often it was only a matter of months, and at most a few years, before other studies came out to either fully refute the findings or declare that the results were “exaggerated” in the (Location 89)

sense that later papers revealed significantly lesser benefits to the treatment under study. Results that held up were outweighed two-to-one by results destined to be labeled “never mind.”1 (Location 95)

life. I think by now most of us have at some point caught ourselves thinking, or at least have heard from people around us, something along these lines: Experts! One day they say vitamin X / coffee / wine / drug Y / a big mortgage / baby learning videos / Six Sigma / multitasking / clean homes / arguing / investment Z is a good thing, and the next they say it’s a bad thing. Why bother paying attention? I might as well just do what I feel like doing. Do we really want to just give up on expertise in (Location 138)

life-expectancy gains. It’s hard to claim we’re floating on an ocean of marvelously effective advice from a range of experts when we’ve been skirting the edges of a new depression, the divorce rate is around 50 percent, energy prices occasionally skyrocket, obesity rates are climbing, children’s test scores are declining, we’re forced to worry about terrorist and even nuclear attacks, 118 million prescriptions for antidepressants3 are written annually in the United States, chunks of our food supply periodically become tainted, and, (Location 161)

well, you get the idea. Perhaps a reasonable model for expert advice is one I might call “punctuated wrongness”—that is, experts usually mislead us, but every once in a while they come up with truly helpful advice. (Location 165)

stuff. And, by the way, if experts are so comfortable with the notion that their efforts ought to be expected to spit out mostly wrong answers, why don’t they work a little harder to get this useful piece of information across to us when they’re interviewed on morning news shows or in newspaper articles, and not just when they’re confronted with their errors? (Location 184)

experts…” These are what I would call “mass” or “public” experts, people in a position to render opinions or findings that a large number of us might hear about and choose to take into account in making decisions that could affect our lives. Scientists are an especially important example, but I’m also interested in, for example, business, parenting, and sports experts who gain some public recognition for their experience and insight. I’ll also have some things to say about pop gurus, celebrity advice givers, and media pundits, as well as about what I call “local” experts—everyday practitioners such as non-research-oriented doctors, stockbrokers, and auto mechanics.* (Location 192)

In early 2008 I happened to catch a television news story mentioning new guidelines for performing cardiopulmonary resuscitation, or CPR, aimed at saving some of the 325,000 lives lost to sudden cardiac arrest every year in the United States alone, not to mention those from trauma, drownings, and shocks. The new guidelines hold that you are no longer supposed to bother with the breathing part of CPR—just keep pumping the victim’s chest nonstop, and the oxygen will take care of itself. Having some years ago spent the better part of a day pounding on and blowing air into mannequins (Location 223)

to get my CPR certification from the American Red Cross, I did a little digging and discovered that while the change was endorsed by the American Heart Association and the European Resuscitation Council, the Red Cross continues to train the public in the breathing-and-pumping technique. To further complicate the picture, there’s a growing call in some circles to switch from chest compressions to abdominal compressions, which may pump more blood andavoid rib damage. So I dropped in on Paul Schwerdt, an interventional cardiologist at Norwood Hospital in Norwood, Massachusetts, who restarts hearts all the time. He told me to forget about CPR, because even trained laypeople almost never do it well enough to make a difference. If you want to save someone with a stopped heart, he said, find an automated external defibrillator, or AED—a highly portable, easy-to-use device that is becoming available in more and more public places, offices, and even many homes. Sure enough, I turned up a 2008 article in the New York Times stating that the immediate availability of a defibrillator raises the cardiac arrest–survival rate for those outside hospitals from as low as 1 percent to as high as 80 percent1—an astounding difference. Case closed? Well, not quite. Later I came across a study that found home AEDs didn’t increase cardiac-arrest survival a whit compared to homes where someone was capable of performing CPR.2 (Location 228)