Richard Smith: Beware the snares of “Conventional Wisdom,” with implications for the pandemic and much else

The most famous part of J K Galbraith’s famous book The Affluent Society, which was published in 1958, is the chapter in which he exposes the constant failure of what he calls conventional wisdom. He was writing particularly about the ideas that have shaped economic thinking, but conventional wisdom prevails in all social life (and perhaps more than Galbraith recognises in science and medicine as well). As I read his chapter, I thought of the pandemic and death, two phenomena that are more social than medical, but are dominated by medical thinking.

Social life, of which economic life is a part, points out Galbraith, “does not conform to a simple and coherent pattern…it often seems incoherent, inchoate, and intellectually frustrating.” In modern jargon, social life is a “complex, adaptive system.” But we feel a need to find explanations for these phenomena, and Adam Smith and David Ricardo were the first to do so compellingly in economic life.

The problem with explanations for social phenomena are that—in contrast to physical phenomena—”they yield few hard tests of what exists and what does not.” We might call these “hard tests” experiments. Thinking about the pandemic we can test experimentally what works as a treatment for patients with severe covid-19, but we cannot test experimentally the response to the whole pandemic, a social phenomenon.

The paucity of hard tests means that the individual trying to make sense of social phenomena “may hold whatever view…he finds most agreeable or otherwise to his taste.” This freedom leads to “a persistent and never-ending competition between what is right and what is merely acceptable.” The test for the explanations that prevail is “audience approval” not truth, and “audiences of all kinds most applaud what they like best.” And the “ideas which are esteemed at any time for their acceptability,” Galbraith names “conventional wisdom.”

He then unpicks what makes ideas acceptable. Firstly, they “closely accord with [our] self-interest and personal wellbeing.” They won’t dislocate our lives. Secondly, we like ideas that contribute the most to our self-esteem. Thirdly, and “most important of all, people approve of what they best understand.” Social issues, including pandemics, “are complex, and to comprehend their character is mentally tiring.” We understand best what is most familiar, and “vested interest in understanding is more preciously guarded than any other treasure.” I agree: I think what Galbraith calls vested interest in understanding but might include a theory, method, or world view is more powerful than most financial interests, but conventional wisdom in medical journals puts financial conflict of interest first.

Politicians of both left and right are mostly content to stick with conventional wisdom. “To proclaim the need for new ideas has served,” Galbraith observes with his wit that runs through the book, “in some measure, as a substitute for them.” Politicians who take seriously the need for new ideas are likely to find themselves in “serious trouble.”

Scholars too are wise to stay with conventional wisdom. The way to the academic summit is to put “old truth in a new form” and play with “minor heresies.” The result of this academic endeavour is that “accepted ideas become increasingly elaborate,” developing “even a mystique.” Those who challenge the conventional wisdom can then be dismissed as not understanding its intricacies. Once conventional wisdom has been made “more or less identical with sounds scholarship, its position is virtually impregnable.”

Although, as Galbraith argues, scientific ideas should be constantly tested and made vulnerable by experiment, what he describes for scholarship in social science seems to me to fit with Thomas Kuhn’s idea on how science advances: the tendency is to keep on patching up the old paradigm (the conventional wisdom) until it collapses in a heap. In this way Aristotelian physics gives way to Newtonian physics, which in its turn gives way to Einstein’s theories of relativity—and so on.

Galbraith also makes me think of pearls of conventional wisdom like journals are essential for the dissemination of science; peer review is the best form of quality assurance; medical records should belong to health professionals not patients; death is best managed by doctors, preferably palliative care specialists; and science will save us from the pandemic.

The reward for promoting conventional wisdom is to be appointed to high office, from where the gospel must be preached. “The high public official [perhaps a chief scientist or president of a college] is expected…to expound the conventional wisdom.” Its articulation is “a religious rite…like reading aloud from the scriptures.” That the official proclaims the conventional wisdom means that he or she “is assumed to be gifted with deep insight.”

“The enemy of the conventional wisdom,” writes Galbraith, “is not ideas but the march of events…The fatal blow…comes when the conventional ideas fail signally to deal with some contingency to which obsolescence has made them palpably inapplicable.” I think of the British government being scored highly (second only to the US) for its preparation for the pandemic we all knew was coming, and it, together with most governments, failing to mount a strong, sustainable response to the pandemic that is close to killing a million (and in fact has killed many more). I think too of belief in progress, that things “can only get better,” which is deep in modern thinking, including in medicine, but is beginning to look like the delusion of conventional wisdom.

Richard Smith was the editor of The BMJ until 2004.