by Carl V Phillips

As a tribute to Aaron Swartz, Lifehacker republished this essay by him from a few months ago. In it, Swartz gives some nice tips about how to avoid falling into certain self-defeating traps about self-knowledge and external honesty, leading off with a nice recounting of the story of Ignaz Semmelweis. (His youthfully naive optimism — failure to recognize why some people cannot just take that advice — as well as the bit about Semmelweis’s ultimate demise make for quite the sad irony also.)

Swartz observes about the reaction to Semmelweis’s discovery that physicians were frequently killing birthing mothers and their babies (and many others) by not washing their hands:

You’d think doctors would be thrilled by this incredible discovery. Instead, Semmelweis was ridiculed and attacked. He was fired from the hospital and forced out of Vienna. “In published medical works my teachings are either ignored or attacked,” he complained. “The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected.” Even in his native Vienna, hundreds of mothers continued to die every year. … Cognitive dissonance psychologists have proven in dozens of experiments that people don’t like bad news about themselves: Force students through an embarrassing initiation to take a class, and they’ll insist the class is much more interesting. Make them do a favor for someone they hate, and they start insisting they actually like them. Have them make a small ethical compromises [sic] and they’ll feel comfortable making bigger and bigger ones. Instead of just accepting we made a mistake, and shouldn’t have compromised or done the favor or join the class, we start telling ourselves that compromising isn’t so bad—and when the next compromise comes along, we believe the lies we tell ourselves, and leap at making another mistake. We hate hearing bad news about ourselves so much that we’d rather change our behavior than just admit we screwed up. It doesn’t help much when our friends point out what we did wrong. If we’re so scared of hearing from ourselves that we made a mistake, just imagine how much we hate hearing it from someone else.

It is quite remarkable how little the medical industry (and medical publication) have changed. Technology and knowledge and improved enormously, of course, so the worst mistakes from back then are avoided. But the unwillingness to admit mistakes is as ingrained as ever. This is one of the several reasons why anti-THR lies are perpetuated: those who vociferously opposed THR out of ignorance mostly would rather keep killing smokers than admit their error. They try desperately to find some way to vindicate their position, clinging to absurd claims such as how all tobacco use will be eliminated by 2000 2010 2020 2075, and the myth that this will actually be better for public health than THR.

Swartz’s essay goes on to point out how those who admit mistakes are often (but not always, of course — he naturally cherrypicks) praised for having done so. I have to admit it is rather annoying to observe how some commentators treat reformed former members of the tobacco control industry — people who opposed THR and then admitted they had screwed up — as the most credible supporters of THR, rather than given that credit to those of us who got the analysis correct from the start. But I understand the urge to praise the rare honest admissions. I have no such sympathy in those cases where someone never admitted he had been wrong, and now tried to quietly ignore his past errors, however; this also fits nicely into Swartz’s analysis.

But one thing about inherent tendencies that we frail individuals fall into, is that institutions — both private and public — should be intentionally designed to overcome them. Ideally there is an evolution that favors institutions that do just that. (A related aside that also relates to the themes of the essay: Those who strongly support government interventions tend to reinforce their biases by finding private-sector institutions that fail to do this, while those who habitually oppose government reenforce their biases by finding public-sector examples of such failures. In both cases, there is a tendency to pointedly ignore the examples where the institutions work.)

The medical industry, and even worse, the “public health” industry, and the related publishing industries fail badly as institutions in this respect. They tend to reward the natural human failings, or at least insulate them from any pressure to improve. In fairness, there are important and often influential corners of the medical profession that are acutely aware of this problem and try to do something about it (that was basically my job description once, and I think what we were doing did help). That does not seem to be the case in “public health”, especially when it comes to topics like tobacco.

I could write a very long post as a point-by-point of how the “public health” institutions discourage every potentially productive suggestion in Swartz’s essay, but if you want to just read the essay, I suspect you can just do that in your head as you go. I realize that doing so is a rather odd tribute to a champion of information freedom, but it is a nice tribute to the general insightfulness of a mind like his.