Progress

Imagine that you are a doctor, visiting an undiscovered tribe for the first time.

After living with the tribe awhile, you discover that their system of medicine is entirely based on dance. They have medicine men (and women) whose role it is to dance whenever someone falls ill. There are different dances for different illnesses. They have gatherings where they discuss and compare different dances. There is a lively debate about effective technique.

How would you convince them to shift to modern medicine?

You might imagine that it is simply a matter of evidence. But it’s not that simple – firstly, how will you provide evidence for the effectiveness of your approach? You point to books that mean nothing to them; they see your biological science as some kind of elaborate tribal mythology. You explain that you will need to inject people with a vaccine – at which point someone remarks that since you are literally stabbing someone with a needle, your approach is clearly more harmful than dancing. 

Somewhat taken aback you resolve, instead, to demonstrate the ineffectiveness of their current approach. The problem is, 95% of the people you survey believe the approach to be effective. And it gets worse: when you compare people treated with dances against people who aren’t, there is a small but significant difference – most probably, you believe, due to the placebo effect, or to income levels (the dances cost money).

Gradually you realise that your hopes of modernising medicine will not be achieved so easily. The barrier is primarily emotional: people have spent a lifetime believing in the power of dance. For some it is their livelihood. It doesn’t seem to matter that your approach has deep theoretical underpinnings – the dance has a complex set of rituals. You realise that people are more comfortable with familiar conventions than with struggling to understand your obscure medical volumes.

You have to start persuading people one by one. Usually the people who turn to you are desperate; people for whom the dance hasn’t worked – people at death’s door – and for this group there is often little you can do.

After decades of slow process, the thought that haunts you is that this tribe would rather die out than accept progress.