{"id":48765,"date":"2020-10-09T11:42:22","date_gmt":"2020-10-09T10:42:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48765"},"modified":"2020-10-09T11:52:43","modified_gmt":"2020-10-09T10:52:43","slug":"richard-smith-beware-the-snares-of-conventional-wisdom-with-implications-for-the-pandemic-and-much-else","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/09\/richard-smith-beware-the-snares-of-conventional-wisdom-with-implications-for-the-pandemic-and-much-else\/","title":{"rendered":"Richard Smith: Beware the snares of \u201cConventional Wisdom,\u201d with implications for the pandemic and much else"},"content":{"rendered":"

The most famous part of J K Galbraith\u2019s famous book <\/span>The Affluent Society<\/span><\/i>, 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.<\/span><\/p>\n

Social life, of which economic life is a part, points out Galbraith, \u201cdoes not conform to a simple and coherent pattern\u2026it often seems incoherent, inchoate, and intellectually frustrating.\u201d In modern jargon, social life is a \u201ccomplex, adaptive system.\u201d 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.<\/span><\/p>\n

The problem with explanations for social phenomena are that\u2014in contrast to physical phenomena\u2014\u201dthey yield few hard tests of what exists and what does not.\u201d We might call these \u201chard tests\u201d 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.<\/span><\/p>\n

The paucity of hard tests means that the individual trying to make sense of social phenomena \u201cmay hold whatever view\u2026he finds most agreeable or otherwise to his taste.\u201d This freedom leads to \u201ca persistent and never-ending competition between what is right and what is merely acceptable.\u201d The test for the explanations that prevail is \u201caudience approval\u201d not truth, and \u201caudiences of all kinds most applaud what they like best.\u201d And the \u201cideas which are esteemed at any time for their acceptability,\u201d Galbraith names \u201cconventional wisdom.\u201d<\/span><\/p>\n

He then unpicks what makes ideas acceptable. Firstly, they \u201cclosely accord with [our] self-interest and personal wellbeing.\u201d They won\u2019t dislocate our lives. Secondly, we like ideas that contribute the most to our self-esteem. Thirdly, and \u201cmost important of all, people approve of what they best understand.\u201d Social issues, including pandemics, \u201care complex, and to comprehend their character is mentally tiring.\u201d We understand best what is most familiar, and \u201cvested interest in understanding is more preciously guarded than any other treasure.\u201d 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.<\/span><\/p>\n

Politicians of both left and right are mostly content to stick with conventional wisdom. \u201cTo proclaim the need for new ideas has served,\u201d Galbraith observes with his wit that runs through the book, \u201cin some measure, as a substitute for them.\u201d Politicians who take seriously the need for new ideas are likely to find themselves in \u201cserious trouble.\u201d<\/span><\/p>\n

Scholars too are wise to stay with conventional wisdom. The way to the academic summit is to put \u201cold truth in a new form\u201d and play with \u201cminor heresies.\u201d The result of this academic endeavour is that \u201caccepted ideas become increasingly elaborate,\u201d developing \u201ceven a mystique.\u201d Those who challenge the conventional wisdom can then be dismissed as not understanding its intricacies. Once conventional wisdom has been made \u201cmore or less identical with sounds scholarship, its position is virtually impregnable.\u201d<\/span><\/p>\n

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\u2019s 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\u2019s theories of relativity\u2014and so on.<\/span><\/p>\n

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.<\/span><\/p>\n

The reward for promoting conventional wisdom is to be appointed to high office, from where the gospel must be preached. \u201cThe high public official [perhaps a chief scientist or president of a college] is expected\u2026to expound the conventional wisdom.\u201d Its articulation is \u201ca religious rite\u2026like reading aloud from the scriptures.\u201d That the official proclaims the conventional wisdom means that he or she \u201cis assumed to be gifted with deep insight.\u201d<\/span><\/p>\n

\u201cThe enemy of the conventional wisdom,\u201d writes Galbraith, \u201cis not ideas but the march of events\u2026The fatal blow\u2026comes when the conventional ideas fail signally to deal with some contingency to which obsolescence has made them palpably inapplicable.\u201d I think of the British government being scored highly<\/a> (second only to the US) for its preparation for the pandemic we all knew was coming, <\/span>and it, together with most governments, failing to mount a strong<\/a>, sustainable response to the pandemic that is close to killing a million (and in fact has killed many more). <\/span>I think too of belief in progress, that things \u201ccan only get better,\u201d which is deep in modern thinking<\/a>, including in medicine,<\/span> but is beginning to look like the delusion of conventional wisdom.<\/span><\/p>\n

Richard Smith<\/strong>\u00a0was the editor of\u00a0<\/em>The BMJ\u00a0until 2004.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The most famous part of J K Galbraith\u2019s famous book The Affluent Society, which was published in 1958, is the chapter in which he exposes the constant failure of what […]<\/p>\n

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