The Matthew Effect

Dr. Hasan Yazıcı - Professor Emeritus, Istanbul University, Cerrahpaşa Faculty of Medicine

"For to everyone who has, more will be given, and he will have abundance; but from him who does not have, even what he has will be taken away." (Matthew, The Bible)

It was years ago. I was a student at the medical school. I had read it in the newspaper. There was an economic crisis again, and an American economist—I remember the location well—argued at a meeting at the Marmara Hotel that our way out of the crisis was the view I have used as my title, that is, the Matthew (Matthew) effect. The newspapers the next day left no insult unsaid toward this arrogant American. Or was the fellow just mocking us?

Throughout my rheumatology residency training, I heard about the Matthew effect very often. My mentor, the British-born PD Saville, was both a famous osteoporosis researcher and quite sharp-tongued.  He was a critic of the total. One piece of knowledge I first learned from him, which I have passed on to my students for years and which still serves me well while treating patients, was the relationship between cortisone use and the Matthew effect. You may have heard of it. When used correctly, cortisone is a very beneficial drug, but when used incorrectly, it is often harmful. By the way, let me state immediately: especially in rheumatological diseases, in some cases, a change in the cortisone dose of 1-2 mg per day can make a huge difference between a patient benefiting from or being harmed by the medication.  I say this with a bit of shame, but low-dose cortisone tablets, which have been available in advanced Western countries for nearly half a century and make patient care much easier, are still not available in our country.  Returning to the main topic, an important side effect of cortisone is not osteoporosis, but rather a lack of bone density. This is where the Matthew effect comes into play. Let's say you have a petite, 70-year-old female patient, 1.50 meters tall and weighing 45 kg,  with rheumatoid arthritis (the most common type of inflammatory rheumatism). If you give this patient roughly 5 mg of prednisolone (a commonly used cortisone derivative) per day, it will be very good for your patient, and you can use this medication for long periods with almost no side effects. However, if the 5 mg dose does not alleviate the same patient's complaints and you increase the dose to, say, 7.5–10 mg per day, within a few months, your patient's bone density will begin to decrease, and the moon face, a specific side effect of cortisone use, will emerge. On the other hand, consider a 40-year-old male, 1.90 meters tall, weighing 80 kg, with well-developed muscles. If you cannot control this patient's rheumatoid arthritis  with 5 mg of prednisone per day, you will observe that when you increase the dose to 10 or even 20 mg per day, your patient both recovers and remains almost entirely immune to the troubles that befell the previous petite, 70-year-old lady.

There is probably no profession that knows the injustice of nature as closely as medicine. The short story I just told you is an example of this. The physician's main pursuit and effort is to find a remedy for this injustice  as much as possible, or at least to some extent   to be an obstacle to it.     

On the other hand, do a quick search on the internet. You will immediately see that the business world, industrialists, holding companies, and naturally, economists are very familiar with the Matthew Effect. As far as I can understand, they are also absolutely aware of this injustice of nature. However, if they will forgive me, let me say what comes to mind without hesitation: instead of opposing this injustice of nature I mentioned, they unfortunately often set out to take advantage of it.    

Let us return  to the Matthew Effect. The rule in question is found in the Bible in the Gospel of Matthew.  It is among the Gospels. Matthew presents these gospels as narrated by Jesus. As far as I can understand,  Jesus is essentially saying, 'Accept that there are rich and poor people among humanity, and that over time the rich will become richer and the poor will become poorer, and—my own deduction—do not raise much objection to this order created by God.' Indeed, also among these Gospels of Matthew, again in the Bible, “Blessed are the meek, for they shall inherit the earth.” is also present. This is a clear and explicit warning not to oppose the established order. What must not be forgotten is that the day being patiently awaited is the Day of Judgment, when the meek will eventually be rewarded.   

I should not finish without mentioning this. As the main reason for our current and profound cost-of-living crisis, the misguided Nas (religious decree) policy was implemented. I wonder, could the famous rule voiced by the infidel Matthew—heaven forbid—be at least an equally significant cause of what has befallen us? There you have it, I say, a perfect external power. What do you think? If our only way out of this predicament is, perhaps, to truly heed Matthew's words and become meek in national unity and solidarity!?