Anomalies and Paradigm Shifts

THE MYSTERY OF THE HOMEOPATHIC HOSPITAL

London in the 1850s was a frightening place to live. Every few years, a new outbreak of cholera racked the city, killing hundreds or thousands at a time. Otherwise healthy people would notice a slightly upset stomach, then be found dead within days—or even hours.

The government commissioned a council of scientists to survey the city’s hospitals, record what methods they were using to treat the disease, and figure out which treatments seemed to be more effective. The results weren’t encouraging. The mortality rate among the hospitals’ cholera patients was 46 percent, no better than the mortality rate among untreated cholera sufferers. None of the standard “cures,” which included opium, chalk, and castor oil, seemed to make a difference.

But there was one hospital that was intentionally excluded from the survey. The London Homeopathic Hospital was a small institution established a few years earlier, funded by wealthy donors who were fans of a trendy new approach to medicine called “homeopathy.” Homeopathy drove mainstream doctors in the nineteenth century up the wall, very much as it does today. Its central claim flouts scientific sense: if you dilute medicine until it’s physically indistinguishable from pure water, it will still retain the “spiritual force” of the drug it once was, and it will have become more potent, not less.

To the council’s surprise and annoyance, the London Homeopathic Hospital reported a cholera mortality rate of only 18 percent, less than half the mortality rate at mainstream hospitals. The council resolved to leave the London Homeopathic Hospital’s data out of the survey.9 After all, homeopathy was nonsense! Their data would only muddle the survey’s conclusions. Even worse, it would be an insult to science and to reason itself.

It’s too bad. If the council had investigated the surprising result instead of suppressing it, the history of medicine might have been forever changed for the better. That’s because the homeopaths’ success was real—it just didn’t have anything to do with homeopathy. It turns out that the leaders of the homeopathic movement had, somewhat by accident, hit on two keys to treating cholera. One key was the importance of good hygiene—they urged their doctors to sterilize the blankets of the sick before reusing them. Second, they recommended that cholera patients drink whey, which helped replenish the patients’ fluids and electrolytes. That’s essentially an early version of what we now call oral rehydration therapy, something that didn’t become a standardized treatment for cholera until the 1960s.

Neither of those recommendations was derived from the central theory of homeopathy. They were just based on good and lucky hunches about how to help people get better. If the council had gotten curious about the homeopaths’ surprising results, those hunches might have become medical orthodoxy decades earlier than they actually did, saving millions of lives as a result.

That’s the thing about surprising and confusing observations. You don’t know in advance what they’ll teach you. All too often, we assume the only two possibilities are “I’m right” or “The other guy is right”—and since the latter seems absurd, we default to the former. But in many cases, there’s an unknown unknown, a hidden “option C,” that enriches our picture of the world in a way we wouldn’t have been able to anticipate.

A single puzzling observation can change your worldview. Often, though, a change of view follows an accumulation of puzzling observations—a paradigm shift. By now the phrase paradigm shift has become an overused buzzword in business, referring to a big change of approach (or, more often, to a small change that someone is trying to spin as a big change). Originally, however, it referred to a specific way in which science makes progress, described by the philosopher Thomas Kuhn in The Structure of Scientific Revolutions.

A paradigm shift starts with a core belief, or paradigm, that everyone assumes is true. Gradually, some people observe anomalies, things that don’t seem to fit with that paradigm. At first, scientists shrug off those anomalies as exceptions or mistakes, or they modify their paradigm a little bit at a time to accommodate the new observations. But the more anomalies accumulate, the more confused the scientists become, until someone eventually develops a new paradigm that makes everything make sense again.

The rule for paradigm shifts in life is the same as it is in science. Acknowledge anomalies, even if you don’t yet know how to explain them, and even if the old paradigm still seems correct overall. Maybe they’ll add up to nothing in particular. Maybe they just mean that reality is messy. But maybe they’re laying the groundwork for a big change of view.