Keep it flowing
Heart disease remains the leading cause of death for most people groups around the world, despite significant discoveries that today extend life and even restore patients to full function after events that previously would be unsurvivable.
Research into surgical intervention has been particularly fruitful. A now-common tool in the cardiologist’s arsenal is the placement of a stent, which is a miniature metal scaffold carefully threaded up the arteries leading to the heart and embedded at the site of a blockage, holding the vessel open as if bracing a pipe at risk of collapse.1 Such stents are now used routinely and quite profitable for both their manufacturers and the physicians who have built practices around placing them.
The logic behind the stent appears impeccable: patients complain of chest pain or some associated symptom, imaging reveals a blood flow issue somewhere in the network of cardiac arteries, so the obvious next step is to remedy the blockage—the fact that those involved stand to divvy up a total fee that can reach tens of thousands of dollars is a happy side effect.2 The ubiquity of stenting has made the procedure a default treatment in a range of cases, ranging from full-blown heart attacks to more stable but persistent chest pain.
The only problem with this practice is that careful research has shown that, for certain indications, a stent accomplishes exactly nothing.
There’s no discernible effect on mortality or quality of life compared with other less-invasive treatments. What’s worse, the placement of the stent brings its own risks, with studies predicting about two percent of recipients will suffer meaningful complications that can include death.
Yet specialists faced with data proving ineffectiveness in these situations often just persist in their set patterns of care and place the stent anyway. After all it makes intuitive sense, other doctors are doing it, patients have come to expect it, and the risk of lawsuits makes edge cases into the norm.
This combines to create a form of mutually reinforcing social contagion, where bad practice persists even after it’s been proven incorrect and the information demonstrating this is available to anyone who cares to find out.
Something recapitulates nothing
In the 1800s scientists were formulating more complex theories to explain the nature of life, and biologist Ernst Haeckel was especially captivated by the idea that embryos of different species traversed what looked like a common sequence of progenitor organisms before assuming their final body plan. This theory gained traction among those seeking patterns that wove the history of various animals together.
Haeckel found what he was looking for, popularizing a series of diagrams that purported to show how several species went through the same transitional forms. For instance, humans were shown passing through a fish-like stage in utero, complete with what looked a lot like gills.
The idea was a persistent one, eventually becoming common in biology textbooks, often featuring a reproduction of Haeckel’s image showing a grid of diverse embryos aligned by developmental stage to highlight their striking similarities.
Unfortunately for the idea’s advocates there were in fact no such correlations, only specious rationalizing. The so-called biogenetic law was dropped by scientists as a misleading dead end by the 1970s, though the evidence against it had been mounting for decades previously. General science educators took much longer to come around. Even near the turn of the 21st century Haeckel’s theory was still being taught to biology students in sophisticated, well-resourced schools.
Adults not yet in middle age today can still remember being quizzed on the concept captured in the memorable but ultimately meaningless phrase “ontogeny recapitulates phylogeny”—it most certainly does not, and there’s also little conceivable purpose for why it might.3 String together lengthy words with a veneer of scientific depth, and through hypnotic repetition you end up with bad ideas that reverberate long after they’re revealed to be wrong.
Compounding the error, it turns out Haeckel manipulated his findings, fudging the diagrams where necessary and ignoring the qualms of peers with greater experimental insights. The idea he helped popularize endured because it felt true.
This wasn’t the only miss that continues to ding the reputation of experts. The popular classification of humans into three body types—ectomorphs, mesomorphs, and endomorphs—continues to have a hold on the public imagination much like phrenology of a century earlier.4 The fact that the prefixes have no meaning and the categories are arbitrary has only slowed it down a little. It seems to fit what we observe, arising from the same miasma that generated other stereotypes.
Comedian Stephen Colbert captured this phenomenon through his tongue-in-cheek coinage of the word “truthiness,” referring to ideas where superficial plausibility or a desire for them to be true overwhelms any evidence to the contrary, even when that evidence is quite strong.
Forget the lessons
For high schoolers studying biology the stakes for bad ideas may not be as high as they would be for a patient who unnecessarily undergoes a heart procedure, risking a complication that outweighs any potential benefit. But in both cases bad ideas continue to color one’s view of the world, and the consequences of seeing things wrongly leads down paths that constrain you.
Like skeuomorphs that stubbornly persist as reminders of a feature of the tangible environment that has long since ceased to be relevant, conventional wisdom guides and constrains decision making in a range of disciplines. Sometimes it channels it in directions that are flat wrong. Try three things to help break through this fog:
- Blow up your mental model. You can’t create a new, completely fleshed-out worldview for every initiative. Nevertheless, be quick to discard what’s outdated or more importantly what was never true to begin with. Some stand-up comedians put this into practice by tossing out their entire set and starting afresh, realizing that the way to stay close to the cutting edge is by rebuilding each time. If you’re an educator, is it true that lectures in a classroom are the best way to impart knowledge? For a retailer, are you sure the reason customers choose you is the product feature you’ve invested so heavily in?
- Get as close to the source as you can. You may not have the technical depth or inclination to test the conventional wisdom against original research, but you might be able to go one level deeper than where you are now. The more you probe, the more you may discover shaky foundations for some received idea. Are you sure that you understand what your customers value, or does your organization coast on rails that were laid down in another era? Is the theory of cause and effect that drives your work proven or just assumed?
- Incentivize a broader focus. In medicine, heart stenting—plus countless other practices like prescribing certain drugs or performing joint surgeries—are used far beyond their measured effectiveness. Each time the system gets rewarded with cash, and the larger consequences are hidden or left for some other party to deal with. There have been some halting steps to begin paying for health outcomes rather than procedures, which would begin to address these misaligned incentives. As a leader, if you require a narrow focus from your teams, what more systemic problem could you be missing?
Your world is likely full of concepts that are unfounded, and perhaps already known to be so. How are you making sure to root them out?
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References
ProPublica conducted an in-depth exploration of evidence-based medicine and the U.S. healthcare system’s shortcomings in this area.
Haeckel’s Law courtesy of a high-school biology textbook that I really hope has been replaced.
- One variant is even coated in medication that slowly seeps into the patient’s bloodstream at the site of the blockage. ↩
- To paraphrase the common saying, it’s difficult to get someone to understand something when their income depends on their not understanding it. ↩
- Sorry to my 9th grade biology teacher Mr. Erlick who taught me this. I know you were just going with what the textbook said. ↩
- Phrenology lives on the expressions “high-brow” and “low-brow”, as those with more elevated foreheads were supposed to be more sophisticated than the lumbering men with more prominent brow ridges. ↩