Book-Blogging: The Teacher Wars, by Dana Goldstein

teacher-wars-cover picLearning about the past is useful for a lot of reasons, but it’s perhaps best for tamping down hubris – for bringing some needed skepticism to the “Great New Idea” to solve the seemingly-intractable problem of the day. Many Great New Ideas aren’t great or new, and a failure to appreciate the past imperils the future.

American education reformers are perpetually in thrall to this or that Great New Idea, as Dana Goldstein shows in her fantastic new book, The Teacher Wars. From the birth of the modern education system in the 19th century to today’s fights over tenure and value-added pay-for-performance, individuals and organizations have always brought forth teacher-centered reforms meant to improve the quality of American education – and have generally failed to create the change they seek.

As Goldstein puts it, “The history of American education reform shows not only recurring attacks on veteran educators, but also a number of failed ideas about teaching that keep popping up again and again, like a Whac-A-Mole game at the amusement park.”

And in American education, no Great New Idea has failed as many times as rating teacher effectiveness:

“For over a century, school reformers have hoped that tweaking teacher rating systems would lead to more teachers being declared unfit and getting fired, resulting in an influx of better people into the profession. But under almost every evaluation system reformers have tried—rating teachers as good, fair, or poor; A, B, C, or D; Satisfactory or Unsatisfactory; or Highly Effective, Effective, Developing, or Ineffective—principals overburdened by paperwork and high teacher turnover ended up declaring that over 95 percent of their employees were just fine, indeed.”

The current reformers – technocrats like Bill Gates, Arne Duncan, and President Obama – want to use the test scores of students to evaluate teacher effectiveness, employing “value-added measurement” to do so*.

At first pass this sounds reasonable, but Goldstein lays out a few problems with doing so. Perhaps most importantly, American society has always expected way more from teachers than they can reasonably accomplish:

“Effective teachers can narrow, but not close, achievement and employment gaps that reflect broader income, wealth, and racial inequalities in American society. This reality was demonstrated by the most celebrated value-added study ever conducted. Economists Raj Chetty, John Friedman, and Jonah Rockoff tried to figure out if teachers who were good at raising test scores were also good at improving their students’ long-term life outcomes—in other words, if value-added was a good proxy for some of the other goals, aside from raising test scores, that we want teachers to fulfill… One finding was that the current achievement gap is driven much more by out-of-school factors than by in-school factors; differences in teacher quality account for perhaps 7 percent of the gap.”

That critique isn’t limited to value-added measurement, of course, but it’s worth making clear: we spend a disproportionate amount of time and energy worrying about teacher effectiveness when the vast majority of the achievement gap is wholly out of their control. Any reform movement that doesn’t address a variety of socioeconomic factors is bound to fail to have a meaningfully large effect.

More to the point, it’s not clear that reforms centered on value-added measurement will even improve student outcomes:

“Research from the National Center on Performance Incentives at Vanderbilt University found that where teachers had been eligible for bonuses according to value-added ratings, whether $3,000 per teacher in New York City or $15,000 per teacher in Nashville, student outcomes did not seem to improve.”

Another reform championed by many progressives is to end, or at least severely restrict, teacher tenure.  While I’m still sympathetic to this idea, Goldstein’s book convinced me that it is largely a distraction – something that takes up too much space on the reformist agenda and that emits more heat than light. Teacher tenure has outlived its original use (more or less to protect teachers from prejudice and the whims of patronage), but it’s not obvious that ending it would actually improve the academic outcomes of children.

(To be clear: I still think there’s a case for ending teacher tenure – especially the contracts that give tenure after an unusually short amount of time teaching – but it seems to me that the most salient benefit of doing so is that it would simply move the conversation away from tenure and to issues of greater importance)

Whatever the teacher-centric reform du jour, changes based on the assumption that there is a large cohort of bad teachers simply haven’t led to the types of large-scale improvements that reformers seek. There is no question that bad teachers exist – and they should be identified and potentially removed – but there are far more good and teachable teachers that can be made better. Or, put another way: any reform that doesn’t focus on turning good teachers into great teachers is wholly missing the point and – in contrast to the high-minded Helen Lovejoy-like rhetoric and appeals to “think of the children!” – shows that some reformers are more comfortable appealing to equity and fairness in the adult job landscape.

One piece of today’s education reform that Goldstein leaves out of the book is the role that technology and innovation is playing now, and may play in the future, for teachers and students alike. This makes sense, of course – the book is a history book focused on human teachers, and, well, the teaching profession has been a bit slow on the uptake – but it’ll likely be a new front in the “teacher war” that’s worth exploring and understanding now. Some efforts, like the Los Angeles Unified School District’s attempt to bring iPads to all the students in its district, have failed pretty spectacularly. But others won’t.

Goldstein ends the book by offering a number of ideas to improve the education system, including paying teachers more – and sooner; allowing more opportunities for teachers to grow and develop new skills and responsibilities while still being able to teach; focusing on principals, too; using tests and value-added measurement as tools but not the tools; and getting rid of archaic and unnecessary last-in first-out (LIFO) teacher layoff policies. All are common-sense reforms that, though politically difficult, put the focus on promoting an environment that will produce better teachers and, hopefully, better student outcomes.

The Teacher Wars is a great book that I highly recommend. Goldstein synthesizes a wealth of knowledge about the American education system** into a fair, balanced, and nuanced look at today’s education system and its reformers, and shows how history is, as ever, repeating itself. She neither deifies nor vilifies teachers and reformers – judging by most coverage and rhetoric, not an easy thing to do – and instead offers concrete, data-based recommendations for moving the conversation to more productive ends.


*To lay out my bias, I would also consider myself a technocrat, though a skeptical one

**Goldstein’s trenchant and useful analyses of the history of teacher unions, Teach for America, urban teacher residencies, and the charter school movement are left out of this review because of length, but are excellent, too

Book-Blogging – Rabid, by Bill Wasik and Monica Murphy

RabidIt’s a disease that crawls in you a centimeter or two every day, slow and steady. Once you feel it – a twitch of your finger, maybe, or a headache – it’s already too late. You are dead. But only after you become viscerally terrified of water (hydrophobic). Before you die, you may bite a caretaker on the way out.

Worst of all? You probably got it from Man’s Best Friend. Your Best (non-human) Friend.

It’s rabies. To be fair, unless you’re one of the 55,000 unlucky people who die from it each year (mostly in low-income countries in Asia and Africa), this isn’t, strictly speaking, you anymore. You’re vaccinated, or at least post-exposure-vaccinated before you show symptoms, just in case.

As Bill Wasik and Monica Murphy, the authors of Rabid: A Cultural History of the World’s Most Diabolical Virus, put it,

“Rabies has always been with us. For as long as there has been writing, we have written about it. For as long, even, as we have kept company with dogs, this menace inside them has sometimes emerged to show its face to us”

Almost unique among diseases, the virus is virtually 100% fatal without pre-exposure or post-exposure-but-pre-symptom vaccination (HIV is another).

Unfortunately, the book is not as fascinating as the disease; while it starts out strong, it flags after the discussion of Pasteur’s vaccine (which is really fascinating), and never really picks back up (though the tale of Jeanna Giese and Dr. Rodney Willoughby, which can also be heard on Radiolab, is great).  It would be better as a 5,000-word magazine feature.

Because of our intimacy with dogs, and their intimacy with rabies, the first half of the book explores how they came about – how the wolf transformed into Man’s Best Friend. It was because of our waste, actually:

“Scientists theorize that the indispensable hearth of domestication was the human garbage pile, with the wolves that scavenged there some fifteen thousand years ago becoming gradually more tame.”

The book delves into man’s relationship with rabies, too: it was a disease of rage, and madness, and one that turned the ever-thoughtful, ever-tame Man into Beast:

“The French word rage is a derivative of rabies, which in Latin served as a rough equivalent of lyssa. As with that Greek term, rage in French begins its life both as a horrible disease and as something more profound, a sort of animalistic fury tinged with madness.”

In medieval times, the medicine practiced was Hippocrates’s and Galen’s; little changed for hundreds of years. It sounds pretty strange to modern ears. We now know that rabies isn’t curable or treatable by any medicine known to man, ever, but at the time medieval medicine men tried just about everything:

“’Other men pull all the feathers from around a live rooster’s anus and, hanging the poor bird by the neck and wings, set the anus on the bite wound, on the theory that said anus would suck forth the poison. If the rooster swells up and dies, then the hound is mad, but the man will be healed; that is, the book avers, “many men say” this is the case, but “thereof I make no affirmation.”

(My favorite part is how the prescriber doesn’t explicitly endorse the  treatment himself. “I’m just saying I heard it from a guy who knows a guy.”)

The authors then touch on how rabies affected literature – werewolves and vampires galore – which is interesting but feels forced

For an anecdote collector, the book holds a few gems, like those cited above, but overall I was a bit disappointed by it.

If you’re really interested in rabies, pick up this book. Otherwise, I’d recommend you read Spillover instead.

Book-Blogging: Spillover, by David Quammen

Spillover 2If you remember one thing from this short review: stay away from bats and try not to eat exotic animals (e.g., apes, monkeys, civets) if you can help it. Both are excellent ways to become the next Patient Zero for a brand-new zoonosis.

You could be forgiven for not knowing the word “zoonosis,” but, without question, you know zoonoses: HIV. Influenza. Ebola (recently back in the news*). Rabies, and dozens of lesser-known diseases – they’re all zoonoses: animal infections transmissible to humans.

And when The Next Big One – a global pandemic that causes untold suffering and remarkable morbidity and mortality – descends upon the earth as one of the Four Horsemen of the Apocalypse, it’ll almost certainly be a zoonosis. This has happened in the past: a simple flu in 1918 killed something like 50 million people. This is happening in the present: HIV’s toll is 25 million and counting. And it will happen again, probably sometime soon; The Next Big One will spill over from an animal population into a human population, and it’ll wreak havoc.

Spillover – as in a moment, an event, a noun – is an evocative word. It brings to mind something vaguely chaotic, worrying, and uni-directional; once it has occurred it can’t un-occur. Spillover is, in other words, an excellent title for David Quammen’s fantastic book on zoonotic diseases.

Quammen is an engaging, lucid, and often very funny writer. He is transparently curious and intelligent-without-trying-to-seem-intelligent, and he has a potent ability to distill complicated scientific jargon to something more palatable for the lay reader.

Spillover is the end result of years of reporting that took Quammen around the world, from the humid jungles of Malaysia to the humid jungles of the Democratic Republic of the Congo to the humidity-controlled laboratories of America’s most precautionary disease research institutes.

What he finds is both deeply distressing and mildly encouraging. The bad news: The Next Big One is coming. Full stop. The good: when it does, the world is more prepared than any other time in history to address it.

And it should be; as Quammen outlines, we’ve had a number of (relatively) dry runs to learn and improve.  Take SARS, the early 21st century disease that traveled from China to the rest of the world on airplanes. A muffled reaction by the Chinese government no doubt led to excess deaths (there were 774 in total around the world, from about 8,000 cases), but the disease was contained and eventually squelched out – for now. As Quammen puts it, SARS was bad but ultimately “an outbreak, not a global pandemic.”

Why? What made SARS The Next One but not The Next Big One? For starters, the outbreak started in China and spread to Singapore, Vietnam, and Canada – not Bangladesh, the Democratic Republic of the Congo, or other infrastructure-poor countries. Quammen writes,

“If the virus had arrived in a different sort of big city—more loosely governed, full of poor people, lacking first-rate medical institutions—it might have escaped containment and burned through a much larger segment of humanity”

As bad as the virus was (is), symptomatically it could have been much, much worse. The mortality rate was about 10% (though in other environs this could have been much higher), and, crucially, with SARS,

“symptoms tend to appear in a person before, rather than after, that person becomes highly infectious. The headache, the fever, and the chills—maybe even the cough—precede the major discharge of virus toward other people.”

A 90% chance that you’ll live isn’t encouraging, but at least with SARS your family and your neighbors know you’re sick before you can infect them.

Imagine a nasty strain of influenza that was as infectious and as lethal as SARS, but that breaks out in Nairobi or Lagos – a dense city with health infrastructure not up to the task of a mass outbreak that also has all kinds of international flights – and has time to infect before it presents symptomatically. That is the Next Big One.

But step back from any individual spillover and ask a larger question: why do spillovers happen at all? Because they’re inevitable, provided humans interact with animals; viruses (especially RNA viruses) mutate – evolve – constantly, and every once in a while they do so in a way that allows a human to become infected.

We’re making it worse, though. Increases in human population and the resultant erosion of natural “walls” between man and beast (so to speak) are putting humans in ever closer contact with animals, and globalization is inexorably accelerating the ability of one human to affect another. This is one of Quammen’s main points: diseases, and outbreaks, have an ecology to them, and in our razing of the rainforests and regular forests we’re building the perfect environment for spillover events.

Read the book.

*If you’re reading this in 2014, the ebola outbreak in West Africa is probably on your mind. Unless you live in West Africa – or, for that matter, East Africa – you simply don’t have anything to worry about. Ebola isn’t contagious in the same way that, say, influenza is contagious – by droplets in the air – and it’s too deadly and quick-to-incubate to cause sustained horror. It burns itself out. What’s happening in West Africa is horrible, but it isn’t The Next Big One.

Book-Blogging: All of Sam Kean’s Books

disappearing spoon

A nagging running injury has kept me elliptical-bound for the better part of six weeks, so lately I’ve been Hoovering books on my Kindle.

You’ve probably never heard of Sam Kean (he doesn’t have a Wikipedia page). If you know the name, it’s probably because you know the voice from Radiolab, where he’s talked about everything from a man who invented technology that has saved and killed a remarkable number of people (that’s Fritz Haber, of the Haber process for producing nitrogen and the “Father of Chemical Warfare” Haber) to the man who survived both atomic bombings, Tsutomu Yamaguchi.

If there’s anything I’m evangelical about, it’s Radiolab, and I liked the way Kean told these stories, so I picked up Kean’s first book, The Disappearing Spoon. And then I read it. Quickly. And then I quickly picked up his next two: The Violinist’s Thumb and The Tale of the Dueling Neurosurgeons.

Each deals with a separate science topic – elements, genetics, and neurology, respectively – and is driven by historical anecdotes followed by in-depth explanation. Each is a delightful read.

And that’s more impressive than it sounds. It’s not easy to make the periodic table (in and of itself) all that interesting; genetics is a difficult topic to truly understand, and so is neurology. Kean combines genuinely fascinating stories (see: Haber and Yamaguchi) with a writing style that’s colloquial without attempting “Talk Hip With the Kids” and lucid without being shallow.  (To wit, from The Disappearing Spoon: “As a metal, polonium is useless. It decays so quickly it might have been a mocking metaphor for Poland itself.” Which, if you know anything about the history of Poland, is both funny and sadly true.)TDN

VTScientists have an undeserved reputation as boring, stodgy, and all-around uninteresting. This could not be further from the truth – it seems like every major invention has a major backstory full of backstabbing, deceit, indifference, and cunning – and it is Kean’s obvious affection for these scientists and their stories that gives otherwise dense material the padding to flourish.

The books are goldmines of interesting tales and facts; I picked a random paragraph in my book notes  of The Disappearing Spoon and this is what came up:

 But the taste buds for sweet and sour are easy to fleece. Beryllium tricks them, as does a special protein in the berries of some species of plants. Aptly named miraculin, this protein strips out the unpleasant sourness in foods without altering the overtones of their taste, so that apple cider vinegar tastes like apple cider, or Tabasco sauce like marinara. Miraculin does this both by muting the taste buds for sour and by bonding to the taste buds for sweet and putting them on hair-trigger alert for the stray hydrogen ions (H+) that acids produce.

Which is pretty interesting. Each of the books is a wealth of factlets like that, without devolving into a book of anecdotes. Not easy to do.

I could go through each book individually, but really they’re all excellent, and you should just start with whichever topic you think you’d find most interesting.

Ebola is in the United States. Here’s Everything You Can Do to Protect Yourself.






If you’ve watched the news in the past week or so, you’ve heard about ebola, a cunning virus with a high mortality rate (this outbreak: about 60%) currently rampaging through West Africa.

Now, it’s in America.

You may be wondering what you should do to protect yourself from this deadly, haunting disease:

  1. Nothing. Stop worrying about ebola in the United States. You cannot protect your family from ebola because it is not at risk from ebola.
  2. Donate to MSF or another organization working tirelessly to protect and save those actually at risk of contracting ebola, even as they’re attacked and vilified by scared, confused communities
  3. Get a flu shot and, if you have kids, make sure they have all of their childhood vaccinations

That’s it.

Foundation-Owned Social Enterprises: A New Way Forward? (My article at the Stanford Social Innovation Review)

Screen Shot 2012-11-27 at 11.54.58 AM

I wrote an article for the Stanford Social Innovation Review on Gradian’s unique business model, Foundation-Owned Social Enterprise:

A recent evaluation of the Rockefeller Foundation’s Program-Related Investment Fund concluded that it has “generated modest financial returns for the Foundation, contributed to investees’ financial sustainability and generated positive social returns on a variety of fronts,” and that “the Rockefeller Foundation has contributed to the rapid evolution of the PRI field for the last two decades.”

Program-related investments (PRIs) can be powerful social investment tools. They also take many forms, including purchases of passive debt and active equity. The health care social enterprise I work for, Gradian Health Systems, benefits from a very promising active equity investment: It’s wholly owned by a family foundation.

Read the rest here.

John Green Goes to Ethiopia

John Green recently went to Ethiopia with the Bill & Melinda Gates Foundation (and possibly with Save the Children too?). He just posted his first video about the experience, in which he visits Yekatit 12 Hospital (a hospital I visited earlier this year) in Addis Ababa, Ethiopia’s capital: It’s worth quickly shading in a few things:

  • The “jerry-rigged” CPAPs – basically devices that, in this context, keep babies’ airways open – require a source of oxygen to function; Yekatit 12 buys large oxygen canisters from a local supplier in Addis Ababa. Unfortunately, that local supplier is currently the only supplier of canister oxygen for the entire country. I visited the production site – which was recently privatized after years of being owned and operated by the government – and found it to be run by a nice, bright, passionate team. But oxygen compressors are difficult to maintain and, at some point the compressor will break down. When it does, hospitals like Yekatit 12 will be without their only source of oxygen canisters; hospitals hours away from Addis Ababa will be in an even worse position. Compressed oxygen is an absolutely critical medical supply; it’s needed for, among other things, anesthesia machines (shameless promotion: well, most of them, anyway). Without it, patients suffer. This is an extremely under-discussed problem with too few decent solutions for East Africans
  • Green highlights Kangaroo Mother Care, which is fantastic – it’s really, really great. The incubators in Yekatit 12? Not so much. They look old, were almost certainly donated secondhand, and require a constant source of electricity. While in Uganda, I wrote about an alternative: the Embrace BabyWrap, a bright blue bag with a warming pack that keeps a baby warm for hours
  • According to Green, there are seven neonatologists in Ethiopia, a country of something like 94 million people. Keep in mind, all seven neonatologists almost certainly live in one of the large population centers – probably Addis Ababa, maybe Bahir Dar or Jimmy or Hawassa – meaning that the neonatologist-to-nurse ratio is much lower in the rest of the enormous country
  • I need to mention the troubling political situation in Ethiopia, a country that imprisons journalists and bloggers on account of “destabilizing” the country
  • Finally, it’s worth being at least a little skeptical about Ethiopia’s child mortality statistics, for many reasons, two of which I’ll quickly touch on. First, these figures are really hard to collect, and they are, by their very nature, speculative and gameable. Just as importantly, check out the date his graph starts: 1994, just after the Derg (led by Mengistu Haile Mariam), a junta that put almost no effort into building the country’s health infrastructure, were ousted by a rebel group. Therefore, the mortality statistics are almost certainly “artificially” high compared to peer countries: a relatively small investment is likely to yield a relatively high ROI. This isn’t to say that Green is wrong when he says that the Ethiopian government has put a lot of effort into improving its health system; when I met with leaders of the MoH, hospital administrators, and regional health directors, it was obvious each had a passion for the job, and the country has extremely ambitious plans and goals. As always, it’s worth viewing data with a skeptic’s eye

7 Must-Read New Yorker Articles on Global Health

I made this short list for Gradian’s blog and figured it was worth reposting here. Seriously: read these articles.


The New Yorker opened its archives this week as part of a website redesign. If you’re a regular reader – or, let’s be honest, like most of us you just try to keep up with it – you know how fantastic its articles are.

If you’re not a subscriber, we’ve got you covered. Here are a few of our favorite global health/surgery/anesthesia pieces; check them out and let us know yours!

M0000173 First demonstration of surgical anaesthesia, 16th Oct 1846.

The first demonstration of surgical anesthesia, in 1846 (via)

Slow Ideas, by Atul Gawande (July 2013) - “Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century”


HIV virus particle (via)


The Doomsday Strain, by Michael Specter (December 2010) - can scientists and researchers catch the next spillover disease before it spread? (I also wrote about Oxitec here)

A (non-genetically-modified) mosquito (via)

A (non-genetically-modified) mosquito (via)


The Mosquito Solution, by Michael Specter (July 2012) - can we eradicate a deadly disease by genetically modifying mosquitoes? Should we?

In 1944, a U.S. Army serviceman sprays an Italian woman with DDT (via)

In 1944, a U.S. Army serviceman sprays an Italian woman with DDT (via)

The Mosquito Killer, by Malcolm Gladwell (July 2001) - DDT was an integral component of the American effort to eradicate malaria in the states. The story of Fred Soper, the inventor of DDT

Turkeys - a vector for avian flu (via)

Turkeys – a vector for avian flu (via)

Nature’s Bioterrorist, by Michael Specter (February 2005) - on avian flu


A poster warning of Tuberculosis and influenza (via)

A poster warning of Tuberculosis and influenza (via)

A Deadly Misdiagnosis, by Michael Specter (November 2010) - tuberculosis is a really, really hard disease to kill. Why?

A vial of smallpox vaccine (via)

A vial of smallpox vaccine (via)

The Demon in the Freezer, by Richard Preston (July 1999) - the story behind the eradication of smallpox

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