07 January 2011

It ain't the stupid people's fault; it's the smart ones who oughta know better, but don't

I can't remember where I read it, who said it (I seem to recall it was a 19th century American) or exactly how the quote goes, but it amounts to "The bad state of the world ain't the stupid people's fault; it's the fault of the smart ones who oughta know better, but don't."

When I was growing up, I labored under a blissful illusion: somewhere, somehow, a bunch of really smart people were out there making the world a better place, and doing so at a steady, methodical pace using rigorous scientific means. To take one example: I always thought medicine was the paragon of such scientific (and beneficent) efficiency. In my imaginary world, when you went to the doctor, the doctor examined each symptom, checked the results against some impressive (but, as it turns out, entirely imaginary) database, went through checklists and arrived at both a diagnosis and a treatment based on the best available data from the world of medicine. In turn, s/he logged the results of this diagnosis, treatment and outcome into this fictional database, strengthening the field of medicine with ever more data. As I reached adulthood, this illusion was slowly destroyed, replaced with the reality that (again, to pick on medicine) doctors basically just muddle through as best they can, relying on their training and whatever attempts they care to make at staying abreast of current trends in their field.

So as an adult, I have slowly come to learn what a rather inefficient, unproductive world it is that we occupy. Even in areas where one expects competence and intelligence, too much digging results in disappointment. Picking on medicine here again, take the example of back pain. For decades (if not centuries), the standard treatment for 'throwing out one's back' has been bed rest. In fact, it has been conventional wisdom for so long, few bother to question it. Doctors to this day routinely tell their prostrated patients to take it easy, stay in bed. There's only one problem. Scientific evidence suggests that not only is bed rest not a good idea, it can actually prolong the problem. Moderate exercise, though initially uncomfortable, is considerably more effective a treatment. I can attest to this through personal experience: after reading this rather astonishing screw-you to conventional wisdom, I acted on it. I throw my back out a couple of times a year. I used to just lie in bed waiting for the pain to pass. Now, I drag myself out the door and, painful as it is at first, I walk. It's a little embarrassing since I am bent over a good 45 degrees or so, and I creep along at around one mile per hour. But sure enough, after 10-20 minutes, I am walking upright and the pain is all but gone. The old 'cure' of lying in bed left me prostrate for at least the whole day.

This is not meant to suggest that doctors are incompetent or even, for that matter, that they universally prescribe bed rest for back pain! The point is, why aren't we as a society doing a better job of simply documenting, compiling and cross-referencing our experiential data and then rationally acting on the results? In medicine, science, public policy and, yes, religion and ethics, we consistently fail to act on the evidence we accumulate so easily. I can forgive religion: it's entirely premised on accepting things blindly on faith. But what's science's excuse? And medicine's? Healthcare workers aren't even utilizing the humble checklist routinely, a simple 'no-brainer' that could save countless lives.* And what is the excuse of public policy 'experts' when they continue to prescribe courses of action that have failed repeatedly, ignoring policies that have proven to be successful? The easy answer is that people are just foolish. The harder but more worthwhile answer is that we have a lot of work to do in educating even the 'smart' people to follow a more rigorous approach to their respective endeavors.


*Yes, checklists. That most basic of things. You'd be surprised how rarely it is used. Imagine if every significant procedure at a hospital required a checklist. 'Did you check for contraindications? y/n; if y then proceed; else, check' 'Did you cross-reference the bed chart with the computer records before performing the procedure? y/n; if y then proceed; else, cross-reference'

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