Until Knowledge Becomes Perfect

Ignorance must be excused in the human existence because human knowledge can rarely be perfect.  But it’s hard to excuse ignorance when it’s a deliberate choice or arrogantly lorded over those who seek to find and offer a more perfect knowledge. And while human history is chock full of examples, we tend to relegate them to a place called our ignorant past, all the while blind to our current ignorance, which has yet to be exposed. 

The story of Peptic Ulcer Disease (PUD) is a notably recent and poignant example.  For the bulk of the 20th Century, the predominantly accepted causes of PUD were stress, diet, and excessive stomach acid production.  Medically accepted treatments were stress reduction, antacids, acid blockers, and dietary modifications. Yet the efficacy of these treatments was so poor, it should have been obvious we were missing something. 

Evidence points to knowledge of the real culprit as early as 1875, when gastro bacteriologists G. Bottcher and M. Letulle demonstrated the correlation of bacteria and gastric ulceration.  However, it fell largely on deaf ears because no one wanted to believe bacteria could survive, let alone thrive in the highly acidic environment of the human stomach (in spite of a report from a pathologist in 1881 [C. Klebs] showing the significant presence of bacillus-like organisms in the gastric system).  

In the early 20th Century, the belief that stress and acid overproduction was the root cause of PUD seems to pick up steam, in spite of the occasional publication of successful treatments with antibiotics such as penicillin. Then in 1954 a study is published claiming that no bacteria are found in the stomach, which essentially enshrines the belief for much of the remainder of the century.  As it turns out, the study failed to use a method that would have indeed shown the culprit bacteria.

In 1958 a general practitioner in Greece by the name of John Lykoudis cured his own gastroenteritis with antibiotics. He then began successfully treating his patients suffering the same and perfected a combination of antibiotics (called Elgaco), which he eventually patented in 1961. However, his Greek peers took a very dim view of his success and he was fined 4,000 Drachmas by the disciplinary committee of the Athens Medical Association.  He was also indicted in the Greek courts for something akin to malpractice. The outcome is not entirely clear, but it is said many of his former patients testified on his behalf and he was never incarcerated.  He died in 1980, never knowing his vindication.

In the early 1980’s two Australians, Robin Warren (a pathologist) and Barry Marshall (a young gastroenterologist), began collaborating when Marshall expressed interest in Warren’s observations about the significant presence of a particular bacteria (H. pylori) in the stomach of a person with gastritis. They successfully treated a patient with antibiotics and begin to make the case for the bacterial cause and antibiotic treatment for PUD.  Naturally, their assertions and evidence were met with criticism and ridicule. In July of 1984 a medical correspondent for The New York Times published an article identifying the potential link between H. pylori and PUD. The author, Dr. Lawrence Altman, recalled “I’ve never seen the medical community more defensive or more critical of a story…"

In his frustration to prove the connection, Marshall himself ingests H. pylori and documents his subsequent illness and successful treatment with antibiotics.  He published those results in 1985.  It will take another 10 years before the world’s medical community will finally acknowledge the correlation. And 20 years for the bestowment of a Nobel Peace Prize to Marshall and Warren for their longsuffering work. Indeed, there is no irony in the prize, as so many will attest to the lack of peace while suffering from PUD.

From Geocentricity (earth as center of the universe) to Alchemy, from Phlogiston to Spontaneous Generation, human knowledge has an opaque and thorny past.  It begs the question, is the future of human knowledge really any better than its past?  Is our knowledge becoming more or less perfect?  From the point of view of refining our past knowledge, perhaps yes.  But when we take into account the exponential proliferation of knowledge (it’s said to be roughly doubling every 12 months now) and consider much of that knowledge is likely very immature or highly imperfect, then probably not.  Consider when the staple breakfast foodstuff eggs were declared “bad” for us and then later declared “good” once again (while the egg never truly changed, only in our minds). Consider the USDA nutrition guidelines, which have had four major revisions in its 70 plus years, and are still highly controversial. And it seems every day we are informed of another “study” that contradicts the findings of other recent studies. It’s hard not to be just a wee bit cynical about everything new we hear and see.

How shall we then think in a world of proliferating yet imperfect knowledge?

 We should start by rethinking how we really think, or more accurately – fail to think.  Daniel Kahneman, author of Thinking Fast and Slow, makes a convincing case that we are actually quite lazy when it comes to thinking.  Kahneman identifies two distinct modes or “agencies” of thinking which humans use – fast thinking (System 1) which is automatic and nearly effortless (2+2=4, detecting the closer of two objects and people’s moods); and slow thinking (System 2) which is conscious thought requiring some level of focused attention (calculating 57x34, identifying a sound, parallel parking). Much of what we say and do is a result of System 1 and is thinking only in that System 2 has programmed (automated) prior thinking into System 1 for speed and efficiency.  But there are scads of biases that compromise System 1 (and 2) and System 2 is responsible for verifying System 1 results.  System 2 is like Sergeant Schultz guarding Stalag 13 (speaking primarily for myself of course).  But conscious thought requires effort, and unfortunately, System 2 lets System 1 run the show far more often that it should. As Kahneman puts it, “The defining feature of System 2… is that its operations are effortful, and one of its main characteristics is laziness, a reluctance to invest more effort than is strictly necessary.” He calls System 2 “the lazy controller”.  Is it any wonder ignorance rules the day?

How shall we then behave in a world where thinking is work and knowledge imperfect?

I believe it starts with embracing real open-mindedness to new thoughts and ideas that are contrary to what we currently hold as true. Make no mistake, I’m not talking about blindly accepting every new notion that comes along, but it’s not rejecting it outright either.  An open mind is exclusively a System 2 function. We need to stop being intellectually lazy or expedient, and make the effort to use critical thinking skills (fully engaged System 2) to examine new ideas while reexamining old ones.  We need to discuss the ideas with people who also care about them, while doing so responsibly, respectfully, and with humility.  This may necessitate a willingness to (albeit temporarily) let go of some familial and/or group associations, as they are a significant influence on our beliefs and attitudes.  We tend to think our beliefs are ours alone, but this is largely not true.  Our beliefs often come from some mix of the groups we associate ourselves with (i.e. our families, race, gender, religious affiliations, political parties, industry or avocation, etc.). We should resist the natural pull to simply adopt what the people within our group(s) think (hence the term “group-think”).  It’s lazy and it’s not critical thinking.  Be very wary of those advocating strict adherence to only that which is “tried and true” or “best practice.”  

If they do your thinking for you, will they mow your lawn too?

I recently read a LinkedIn post which was receiving some attention in my network.  While I agreed with the overall objective of the post, I had some concerns about some of the (self-serving I suspect) supporting assertions it made.  The author offered her (or her organization’s) definition of Business Process Management (BPM) which included the phrase “…drawing upon well-established process-improvement methodologies such as Lean and Six Sigma.” It sounds like a reasonable and wise approach, but let’s think about it critically.  Doesn’t every “well-established” methodology start out in the world as a lesser-known and unproven methodology?  How does it become well-established unless people try it out during its unestablished newness?  Are those who use it when it’s unknown and unproven also undisciplined and unwise?  If only disreputable rebels and unwise scofflaws try obscure and unproven methodologies, how can any reputable results possibly come of it?  Furthermore, why would anyone ever, ever, ever try anything new?  If nothing new is ever tried, how can a methodology ever become well established?  If we follow this to its logical conclusion, the status quo is forever enshrined and new and better knowledge will never have a chance to emerge from its incubator.  If today’s medical professionals actually followed this convention, they would likely still be practicing “bloodletting” using leeches while regaling us of the Four Humors.  Indeed, what had the appearance of wisdom and good practice actually turns out to be impractical and ill advised.

We need to get over our reluctance to fully engage System 2.  We must practice asking the really hard questions of ourselves and others when it comes to what we think we know.  We need to be gut honest and straightforward about our inconsistencies, biases, and fallacies.  Do this with yourself first and then with others, yet with kindness and genuine respect. 

Let’s call it what it is, but as nicely as humanly possible

You know I’m being nice when I say our knowledge is imperfect. A more accurate adjective is likely much harsher. But that harshness doesn’t help us, particularly when it relates to our fellow knowledge seekers. Always keep in mind that WE humans struggle greatly with being logical, rational, and reasonable, and as Dan Ariely has shown with great eloquence, predictably so.  Therefore, let’s hold one another accountable for an ever more perfect knowledge, but with kindness and humility as we are all navigating the darkness together.

*Note: For those readers under the age of 45, Stalag 13 was the setting for a television sitcom called Hogan’s Heros (168 episodes from 1965–1971) and the very talented actor John Banner played the affable Sergeant of the Guard, Hans Schultz. His most frequent and laughable line is, “I?—?see?—?nothing!” and so by that perhaps you can understand the correlation to our decidedly blind System 2. But if you have the means, I highly recommend watching a few episodes.

This post originally appeared here on Medium.com.