A book review of Incognito

I just finished reading Incognito by David Eagleman, a book about neuroscience and social psychology. It is one of a number of books I have read recently on this topic. I was expecting it to repeat the information published by others, it surprised me by offering new insights.

What struck me about Incognito is the focus on predictive behavior. He spends the majority of the book laying out the nature versus nurture argument, and then setting it aside by not diving into an analysis of past actions. Instead he looks at what actions might occur in the future. For a health care leader the book provides intriguing questions about the role of education and patient participation.

In the book, Eagleman talks about how small pieces matter while considering the larger issues. For example, a person who has a new diagnosis such as diabetes needs to learn about the disease process and the relationship between food, exercise, and lifestyle management to successfully cope. None of the individual properties in these elements explain the emergence of the disease or its management. The combination of changes can introduce something entirely new, as Eagleman calls it “emergent properties”. Implications for health care leaders include an understanding that education needs to go beyond the basics and modifications of behavior; instead it is complex and dynamic.

When considering patient participation we understand from Eagleman that people are neither the product of biology nor the environment alone. A genetic variation creates certain probabilities and the environment can provide the adverse experiences to increase the probability of occurrence. What does this mean in patient participation? Perhaps it means that ability to participate along with willingness is part genetic and part environment. Our society tends to fault people who don’t do what science might define as necessary to prevent health crises (exercise, eat healthy, sufficient sleep, etc.). The effort necessary to accomplish these efforts varies between individuals and as health care leaders we need to look toward what is possible given the cards dealt to a person.

So where does that leave us? Eagleman has described nature and nurture in a way that brings current research forward and helps us better consider the complexity. Reductionism has us focus on the small parts, genes and chemical changes that result in personality and large system outcomes. However, the parts are not the sum of the whole and the environment can’t be ignored. Health care leaders have an important role to play in keeping the delivery of care current on research and sensitive to what we understand about humans. Eagleman has helped with that in his book Incognito. I recommend it to my colleagues.