Dare to disagree Margaret Heffernan

in Oxford in the 1950s there was a

fantastic doctor who is very unusual

named Alice Stewart and Alice was

unusual partly because of course she was

a woman which was pretty rare in the

1950s and she was brilliant she was one

of eight at the time the youngest fellow

to be elected through our College of

Physicians she was unusual too because

she continued to work after she got

married after she had kids and even

after she got divorced and was a single

parent she continued her medical work

and she was unusual because she was

really interested in a new science the

emerging field of Epidemiology the study

of patterns in disease but like every

scientist she appreciated that to make

her mark where she needed to do was find

a hard problem and solve it the hard

problem that Alice chose was the rising

incidence of childhood cancers most

disease is correlated with poverty but

in the case of childhood cancers v

children who were dying seemed mostly to

come from affluent families so what she

wanted to know could explain this

anomaly now Alice had trouble getting

funding for her research in the end she

got just a thousand pounds from the lady

Tata Memorial Prize and that meant she

knew she only had one shot at collecting

her data now she had no idea what to

look for this really was a needle in a

haystack sort of search so she asked

everything she could think of had the

children eaten boiled sweets had they

consumed colored drinks to the eat fish

and chips

did they have indoor outdoor plumbing

what time of life had they started

school and when her carbon copied

questionnaire started to come back one

thing and one thing only jumped out with

a statistical clarity of a kind that

most scientists can only dream of by

rate of two to one the children who had

died had had mothers who had been

x-rayed when pregnant

now that finding flew in the face of

conventional wisdom conventional wisdom

held that everything was safe up to a

point a threshold it flew in the face of

conventional wisdom which was huge

enthusiasm for the cool Newton

technology of that age which was the

x-ray machine and it flew in the face of

doctors idea of themselves which was his

people who helped patients they didn’t

home them nevertheless Alice Stewart

rushed to publish her preliminary

findings in The Lancet in 1956 people

got very excited there was talk of the

Nobel Prize and Alice really was in a

big hurry to try to study all the cases

of childhood cancer she could find

before they disappeared in fact she need

not have hurried it was fully 25 years

before the British and Medical British

and American medical establishments

abandoned the practice of x-raying

pregnant women the data was out there it

was open it was freely available but

nobody wanted to know a child a week was

dying but nothing changed openness alone

can’t drive change so for 25 years Alice

Stewart had a very big fight on her

hands so how did she know that she was

right well she had a fantastic model for

thinking she worked with a statistician

named George Neill and George was pretty

much everything that Alice wasn’t so

Alice was very outgoing and sociable and

George was a recluse Alice was very warm

very empathetic with her patients George

frankly preferred numbers to people but

he said this fantastic thing about their

working relationship he said my job is

to prove dr. Stewart wrong he actively

sought discontent

Meishan different ways of looking at her

models at her statistics different ways

of crunching the data in order to

disprove her he saw his job as creating

conflict around her theories because it

was only by not being able to prove that

she was wrong that George could give

Alice the confidence she needed to know

that she was right it’s a fantastic

model of collaboration thinking partners

who aren’t echo chambers I wonder how

many of us have or dare to have such

collaborators Alice and George were very

good at conflict they saw it as thinking

so what is that kind of constructive

conflict to require well first of all it

requires that we find people who are

very different from ourselves that means

we have to resist the neurobiological

Drive which means that we really prefer

people mostly like ourselves and it

means we have to seek out people with

different backgrounds different

disciplines different ways of thinking

and different experience and find ways

to engage with them that requires a lot

of patience and a lot of energy and the

more I’ve thought about this the more I

think really that that’s a kind of love

because you simply won’t commit that

kind of energy and time if you don’t

really care and it also means that we

have to be prepared to change our minds

Alice’s daughter told me that every time

Alice went head-to-head with a fellow

scientist they made her think and think

and think again my mother she said my

mother didn’t enjoy a fight but she was

really good at them

so it’s one thing to do that in a

one-to-one relationship but it strikes

me that the biggest problems we face

many of the biggest disasters that we’ve

experienced mostly haven’t come from

individuals they’ve come from

organizations some of them bigger than

countries many of them capable of

affecting hundreds thousands even

millions of lives so how do

organizations think well for the most

part they don’t and that isn’t because

they don’t want to it’s really because

they can’t and they can’t because the

people inside of them are too afraid of

conflict in surveys of European and

American executives fully 85% of them

acknowledged that they had issues or

concerns at work that they were afraid

to raise afraid of the conflict that

that would provoke afraid to get

embroiled in arguments that they did not

know how to manage and felt that they

were bound to lose 85 percent is a

really big number it means that

organizations mostly can’t do what

George and Alice so triumphantly did

they can’t think together and it means

that people like many of us who have run

organizations and gone out of our way to

try to find the very best people we can

mostly fail to get the best out of them

so how do we develop the skills that we

need because it does take skill and

practice to if we aren’t going to be

afraid of conflict we have to see it as

thinking and then we have to get really

good at it

so recently I worked with a an executive

named Joe and Joe worked for a medical

device company and Joe was