Range - David Epstein Page 0,113

professional panel in 2016, a copanelist and editor of the New England Journal of Medicine (an extremely prestigious and retraction-prone journal) countered that it would be absurd to add more training time to the already jam-packed curricula for doctors and scientists. “I would say keep the same time, and deemphasize all the other didactic material,” Casadevall said. “Do we really need to go through courses with very specialized knowledge that often provides a huge amount of stuff that is very detailed, very specialized, very arcane, and will be totally forgotten in a couple of weeks? Especially now, when all the information is on your phone. You have people walking around with all the knowledge of humanity on their phone, but they have no idea how to integrate it. We don’t train people in thinking or reasoning.”

Doctors and scientists frequently are not even trained in the basic underlying logic of their own tools. In 2013, a group of doctors and scientists gave physicians and medical students affiliated with Harvard and Boston University a type of problem that appears constantly in medicine:

If a test to detect a disease whose prevalence is 1/1000 has a false positive rate of 5%, what is the chance that a person found to have a positive result actually has the disease, assuming you know nothing about the person’s symptoms or signs?

The correct answer is that there is about a 2 percent chance (1.96 to be exact) that the patient actually has the disease. Only a quarter of the physicians and physicians-in-training got it right. The most common answer was 95 percent. It should be a very simple problem for professionals who rely on diagnostic tests for a living: in a sample of 10,000 people, 10 have the disease and get a true positive result; 5 percent, or 500, will get a false positive; out of 510 people who test positive, only 10, or 1.96 percent, are actually sick. The problem is not intuitive, but nor is it difficult. Every medical student and physician has the numerical ability to solve it. So, as James Flynn observed when he tested bright college students in basic reasoning, they must not be primed to use the broader reasoning tools of their trade, even though they are capable.

“I would argue, at least in medicine and basic science where we fill people up with facts from courses, that what is needed is just some background, and then the tools for thinking,” Casadevall told me. Currently, “everything is configuring in the wrong way.”

He compared the current system to medieval guilds. “The guild system in Europe arose in the Middle Ages as artisans and merchants sought to maintain and protect specialized skills and trades,” he wrote with a colleague. “Although such guilds often produced highly trained and specialized individuals who perfected their trade through prolonged apprenticeships, they also encouraged conservatism and stifled innovation.” Both training and professional incentives are aligning to accelerate specialization, creating intellectual archipelagos.

There is a growth industry of conferences that invite only scientists who work on a single specific microorganism. Meanwhile, a complete understanding of the body’s response to a paper cut was hampered because hyperspecialists in hematology and immunology focus on pieces of the puzzle in isolation, even though the immune response is an integrated system.

“You can do your entire career on one cell type and it’s more likely you keep your job by getting grants,” Casadevall told me. “There is not even pressure to integrate. In fact, if you write a grant proposal about how the B cell is integrating with the macrophage [a basic interaction of the immune system],* there may be no one to review it. If it goes to the macrophage people, they say, ‘Well, I don’t know anything about it. Why B cells?’ The system maintains you in a trench. You basically have all these parallel trenches, and it’s very rare that anybody stands up and actually looks at the next trench to see what they are doing, and often it’s related.”*

Substitute a few specific terms, and the system of parallel trenches he described could fit many industries. While I was researching this book, an official with the U.S. Securities and Exchange Commission learned I was writing about specialization and contacted me to make sure I knew that specialization had played a critical role in the 2008 global financial crisis. “Insurance regulators regulated insurance, bank regulators regulated banks, securities regulators regulated securities, and consumer regulators regulated consumers,” the official told me. “But the provision of credit