Exercises: Field Autopsy — Medicine

Part A: Comprehension and Application

A.1. The chapter argues that medicine did not save more lives than it took until approximately 1865. Explain the structural feature — not individual incompetence — that sustained 2,000 years of harmful treatment. What methodological innovation eventually broke the cycle?

A.2. Map the germ theory revolution onto the Correction Speed Model. Score all eight variables and compare your scoring to the chapter's analysis. Does the model predict the actual ~40-year correction timeline?

A.3. The chapter identifies five failure modes active in the opioid crisis. For each, explain how medicine's correction infrastructure (RCTs, Cochrane, guidelines) should have caught the problem — and why it didn't.

A.4. Define "medical reversal" and give three examples (from the chapter or your own knowledge). What common pathway leads to medical reversals — from initial adoption to eventual reversal?

A.5. The chapter describes "eminence-based medicine" as persisting within the evidence-based medicine framework. Explain how the authority cascade operates through new channels (guidelines, key opinion leaders) even after EBM was designed to eliminate it.

Part B: Analysis

B.1. Apply the "era mapping" from the Project Checkpoint to your own field. Which era of medicine does your field most closely resemble? Justify your assessment with specific parallels.

B.2. Medicine's "17-year gap" between definitive evidence and widespread adoption is striking. Identify the specific failure modes (from Parts I and II) that contribute to therapeutic inertia. Rank them by importance and explain your ranking.

B.3. Compare the opioid crisis to the lobotomy era. What structural similarities exist? What structural differences? Which failure modes operated in both cases?

B.4. The chapter argues that "correction infrastructure that addresses only evidence quality, without addressing evidence production incentives, is structurally incomplete." Design a correction mechanism that addresses evidence production incentives. What would it look like? Who would resist it?

Part C: Synthesis and Evaluation

C.1. Medicine is described as "the benchmark" — the field with the most correction infrastructure, against which other fields should measure themselves. Is this a fair benchmark? Could another field (aviation? engineering?) serve as a better benchmark for a different reason?

C.2. The chapter identifies algorithmic medicine as introducing "new failure modes that medicine's existing correction infrastructure is not designed to address." Design a correction framework for algorithmic clinical decision-making that addresses training data bias, opacity, and algorithmic authority cascades.

C.3. If you could implement one structural change to accelerate correction in medicine, what would it be? Justify your choice using the Correction Speed Model, and identify the barriers to implementation.

Part D: Mixed Practice (Interleaved)

D.1. A new cancer treatment has been adopted based on a small trial and expert endorsement. It is now standard of care at major hospitals. A larger RCT shows the treatment is no better than existing alternatives. Using the frameworks from this chapter AND Chapter 9 (sunk cost) AND Chapter 14 (consensus enforcement), predict the trajectory of the correction. How long will it take? What resistance will it face?

D.2. A patient advocacy group is campaigning for faster approval of a promising new treatment. Using the frameworks from this chapter AND Chapter 21 (overcorrection), advise the advocacy group on how to push for faster access without creating regulatory overcorrection risk. What calibrated position would you recommend?

D.3. Construct a "field autopsy" outline for your own field, modeled on this chapter's structure: historical arc, major errors, correction mechanisms, current failure modes, and Correction Speed Model assessment. You don't need to write the full autopsy — just the outline with key points for each section.

Part E: Deep Dive Extensions

E.1. Read Vinayak Prasad and Adam Cifu's research on medical reversal. Write a 500-word analysis of the most consequential medical reversal you can identify — measuring "consequential" by the number of patients affected and the duration of the wrong practice.

E.2. Research the Choosing Wisely initiative. Evaluate its effectiveness using the Correction Speed Model: which variables does it address, and which does it miss? Why has adoption been slow despite the initiative's support from major medical organizations?

E.3. The chapter draws parallels between Galen's authority cascade and algorithmic authority in modern medicine. Research one specific AI/ML tool currently used in clinical practice and analyze the authority cascade dynamics: how do physicians interact with the tool's recommendations? Is there evidence of inappropriate deference or appropriate skepticism?