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