the power of inaction and the importance of outliers

#20 – The Laws of Medicine by Siddharta Mukherjee 

Last week’s book was thick and juicy so I opted for something less meaty. But still delicious. Published by TED Books (the same people behind the TED conference), this book is “long enough to explore a powerful idea but short enough to read in a single sitting”.

I’m struggling to find the powerful idea in this book. The closest I can think of – medicine is imperfect and uncertain.

After weeks of reading business books with their frequent dispensation of rules and principles, I welcome this invitation to explore flaws and doubt.

The Power of Inaction

“before the 1930s, you would be hard-pressed to identify a single medical intervention that had any more than a negligible impact on the course of any illness”

For a long time, medicine was useless. What doctors did was to prescribe placebos (this practice still continues) to improve their patients’  psychological and (when it works) physical well-being. They gave palliative drugs such as morphine and opium to relieve suffering; and laxatives and other medicine to relieve constipation and disgorge poison. That was about it.

In the face of “the absolute uselessness—and the frank perniciousness—of most nineteenth-century medical interventions”, medicine only advanced when a generation of doctors decided to do nothing much but observe.

They would put patients in hospitals and watch “illness unfold in real time”. They recorded their observations which include measurements of “breaths, weights, and heights”; how patients’ hearts and lungs sounded; and the dilation and contractions of patients’ pupils.

By observing, they learnt how diseases evolved and later were able to find a better way to treat these diseases based on this information. For example, they were able to understand heart failure as the inability of the heart to pump properly and hence identify an effective solution – “removing a few pints of blood from the veins to ease the straining heart”.

In the business world, a “bias for action” is the norm. The competition is on your tail. There is no time to lose. Leaders act. Decisively. And they get rewarded for that.

I’m thinking of an experiment. What if a company hires an outsider to spend a year observing inside the company. Unlike a consultant, this person merely observes and does not make recommendations. How we communicate. How we talk to one another. How we talk to the clients. How we deal with service delivery issues.

There is the difficulty that when we are observed, our behaviour changes. Which is why I think a year is necessary – it’s hard to keep up with appearances over time. I would also recommend that names of individuals are omitted during these observations. Enforcing and communicating that would help people behave “normally”. To further encourage that, observations should be shared among staff to instil confidence that this exercise is not about “going after” individuals or business lines.

At an individual level, I am going to spend a week writing observations of how I live and work. There will be no analysis. I will start sentences beginning with “I like…”, “I hate…” , “This is easy – “, “She doesn’t like me doing this…”, etc.

Let’s see how it turns out.

(By the way, related to inaction – Atlantic has a long but insightful, unmissable article on Obama’s foreign policy (link). It ends with this: “George W. Bush was also a gambler, not a bluffer. He will be remembered harshly for the things he did in the Middle East. Barack Obama is gambling that he will be judged well for the things he didn’t do.”)


A New Way of Thinking – The importance of outliers

Medical trials sometimes produces outliers. for example –

“Only 1 woman in a trial of 1,000 women might experience a near complete disappearance of all the metastatic lesions of breast cancer—while 999 women experience no response. ”

These outliers have traditionally been ignored and derided as “single patient anecdotes”. But doctors who have paid attention to and studied these outliers have been rewarded with medical breakthroughs and insights leading to new trials and drugs.

So the lesson for us – pay attention to the rare thing that works or fails, that you like or dislike.

Questions like these are worth exploring – why does this person hate me when most like me? Why is this client so easy to please while others are difficult? Why do I play this one sport while I hate others?

This week, a significant event happened – AlphaGo, an artificial intelligence system built by Google thrashed one of the world’s top players at Go. Wired has a great article on it which I highly recommend (link).

One of the major talking points at the tournament was a highly unusual, unexpected move by AlphaGo that confounded the experts, including its human opponent who left the room in response (“If you can’t take the heat, stay out of the…”).

It was an outlier.

I believe studying this move would advance the game of Go. One of the players who was involved in training AlphaGo saw his ranking rise from the 600s to the 300s in the world.

Do not dismiss outliers. To progress, we need to think different.


I’m inspired by Mark Zuckerberg’s annual projects and decided to have one of my own.  Read a non-fiction book every week and write about it. Subscribe to my newsletter.

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