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Saturday, March 23, 2013

Where can we have private conversations?

I read Sheldon Richmond's essay on Chuck Hegal's confirmation hearings and he raises a series of interesting concerns. I know little about Chuck Hagel prior to his confirmation hearings and really don't know much more at this point. However the gist of what Sheldon Richmond says is that Hagel sounds like someone who speaks his mind, may be wrong when he takes contrary stands, but has not shied away from raising concerns when they are not popular. The problem with people like this is you never quite know whether they are crazy or insightful (or perhaps both). As Sheldon Richmond sees the current approval process, it is less about vetting ideas as opposed to being beholden to sacred and unquestionable positions.

There was a time where prominent people could take unconventional stands or raise private concerns in private conversations and expect that these to remain private. There is utility in these situations. It is not unusual for me to be disturbed by something in conventional wisdom but initially not quite fully understand or be able to articulate my concerns. In order to work through such positions it is essential to run your ideas past other parties, looking for elements where others may be blind to flaws or where you might have significant blind spots. It is increasingly difficult to do so. Everything is increasing in the public domain.

Ideas can be old or new. They can evolve and change, often to the betterment of those affected by those ideas. Creating and floating new ideas involves taking risks. Create a world where the risks of creating and pushing new ideas become prohibitive, new ideas come less frequently. If everything new idea is quickly vetted in a very large public domain, it creates new and larger risks for those who are conceiving and pushing those ideas.

This has real implications in medicine particularly where new ideas may challenge medical dogma which has financial implications. There might have been a time where discussions within professional societies remained relatively private and disagreements, even very intense ones, could remain in a private realm for extended periods of time. Given the right people and the right environment sheltered from the drive to float all test ideas to the entire world from their inception, and the requisite amount of time for reflection, ideas and approaches could evolve and mature. Not all ideas are ready for prime time from their inceptions. There must be a venue for this to happen where it is not necessarily in a completely open public domain until some smaller group has had a chance to critique.

Within the world of medicine, I am not sure that such an environment exists.

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