Dare to disagree - Margaret Heffernan

[Music] In Oxford in the 1950s, there was a fantastic doctor who was very unusual named Alice Stewart. 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 the, at the time, the youngest fellows to be elected to the Royal 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, what 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, the 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 $5,000 from the Lady Tarta 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? Did they eat fish and chips? Did they have indoor or outdoor plumbing? What time of life had they started school?

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 a rate of 2:1, 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 new technology of that age, which was the X-ray machine. And it flew in the face of doctors' idea of themselves, which was as people who helped patients; they didn't own 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 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 Neil, and George was pretty much everything that Alice wasn't. 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 disconfirmation, 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 does that kind of constructive conflict 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 experiences, and find ways to engage with them. That requires a lot of patience and a lot of energy.

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 acknowledge 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.

Eighty-five 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 too.

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 an executive named Joe, and Joe worked for a medical device company, and Joe was...