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The Three Rules of Epidemics

In the mid-1990s, the city of Baltimore was attacked by an epidemic of syphilis. In the space of a year, from 1995 to 1996, the number of children born with the disease increased by 500 percent. If you look at Baltimore's syphilis rates on a graph, the line runs straight for years and then, when it hits 1995, rises almost at a right angle.

What caused Baltimore's syphilis problem to tip? According to the Centers for Disease Control, the problem was crack cocaine. Crack is known to cause a dramatic increase in the kind of risky sexual behavior that leads to the spread of things like HIV and syphilis. It brings far more people into poor areas to buy drugs, which then increases the likelihood that they will take an infection home with them to their own neighborhood. It changes the patterns of social connections between neighborhoods. Crack, the CDC said, was the little push that the syphilis problem needed to turn into a raging epidemic.

John Zenilman of Johns Hopkins University in Baltimore, an expert on sexually transmitted diseases, has another explanation: the breakdown of medical services in the city's poorest neighborhoods. "In 1990-91, we had thirty-six thousand patient visits at the city's sexually transmitted disease clinics," Zenilman says. "Then the city decided to gradually cut back because of budgetary problems. The number of clinicians [medical personnel] went from seventeen to ten. The number of physicians went from three to essentially nobody. Patient visits dropped to twenty-one thousand. There also was a similar drop in the amount of field outreach staff. There was a lot of politics ? things that used to happen, like computer upgrades, didn't happen. It was a worst-case scenario of city bureaucracy not functioning. They would run out of drugs."

The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire. Just as a single sick person can start an epidemic of the flu, so too can a small but precisely targeted push cause a fashion trend, the popularity of a new product, or a drop in the crime rate. This widely acclaimed bestseller, in which Malcolm Gladwell explores and brilliantly illuminates the tipping point phenomenon, is already changing the way people throughout the world think about selling products and disseminating ideas.