The Undoing Project: A Friendship That Changed Our Minds

by Michael Lewis

The problem was not what they knew, or didn’t know. It was their need for certainty or, at least, the appearance of certainty. Standing beside the slide projector, many of them did not so much teach as preach. “There was a generalized mood of arrogance,” said Redelmeier. “ ‘What do you mean you didn’t give steroids!!????’” To Redelmeier the very idea that there was a great deal of uncertainty in medicine went largely unacknowledged by its authorities. There was a reason for this: To acknowledge uncertainty was to admit the possibility of error. The entire profession had arranged itself as if to confirm the wisdom of its decisions. Whenever a patient recovered, for instance, the doctor typically attributed the recovery to the treatment he had prescribed, without any solid evidence that the treatment was responsible. Just because the patient is better after I treated him doesn’t mean he got better because I treated him, Redelmeier thought. “So many diseases are self-limiting,” he said. “They will cure themselves. People who are in distress seek care. When they seek care, physicians feel the need to do something. You put leeches on; the condition improves. And that can propel a lifetime of leeches. A lifetime of overprescribing antibiotics. A lifetime of giving tonsillectomies to people with ear infections. You try it and they get better the next day and it is so compelling. You go to see a psychiatrist and your depression improves—you are convinced of the efficacy of psychia...