Quiz: Field Autopsy — Medicine

Q: What structural feature — not individual incompetence — sustained 2,000 years of harmful medical treatment? (a) Physicians were poorly educated (b) The absence of controlled comparison — without a control group, every recovery confirmed the treatment and every death confirmed the disease's severity (c) Religious authorities prevented medical progress (d) Patients refused to participate in trials

(b) Without a comparison group, there was no way to distinguish the effect of treatment from the natural course of disease. This made humoral medicine unfalsifiable in practice.

Q: Approximately what date does the chapter suggest medicine first saved more lives than it took? (a) Ancient Greece (~400 BCE) (b) The Renaissance (~1500 CE) (c) Approximately 1865 (Lister's antiseptic surgery) (d) Approximately 1950 (the antibiotic era)

(c) Based on historian David Wootton's analysis, the net effect of medical intervention on the human population was negative until approximately 1865.

Q: What primarily drove the decline of lobotomy? (a) Rigorous RCTs demonstrated it was harmful (b) Public outcry over patient harm (c) The introduction of chlorpromazine (antipsychotic medication) — an alternative that made lobotomy unnecessary (d) Government regulation banning the procedure

(c) Lobotomy declined primarily because an alternative appeared, not because the evidence against it became overwhelming. This illustrates the "alternative availability" variable in the Correction Speed Model.

Q: What percentage of rigorously tested medical practices are estimated to be "reversed" (found to be no better than alternatives or actually harmful)? (a) ~5% (b) ~15% (c) ~40% (d) ~70%

(c) Research by Prasad and Cifu estimates ~40% — a staggering figure given that medicine has the most sophisticated correction infrastructure of any field.

Q: The chapter identifies a critical limitation of medicine's correction infrastructure (RCTs, Cochrane, guidelines). What is it? (a) The tools are too expensive to use (b) The tools address evidence quality but not evidence production incentives — when evidence is generated by interested parties, the tools are helpless (c) The tools are only applicable to drug research, not surgery (d) The tools require too much training to implement

(b) RCTs can be designed to favor sponsors. Systematic reviews can only synthesize existing studies. Guidelines can be written by conflicted experts. The tools assume good-faith evidence production; when that assumption fails, as in the opioid crisis, the tools are ineffective.

Q: How long does research estimate it takes from publication of definitive evidence to widespread adoption of correct practice in medicine? (a) 2-3 years (b) 7-8 years (c) 17 years (d) 30 years

(c) The "17-year gap" is a widely cited estimate of therapeutic inertia — the delay between evidence and practice change, even in the field with the best correction infrastructure.

Q: "Eminence-based medicine" refers to: (a) The highest quality of evidence-based practice (b) Medical practice driven by the authority of prominent physicians rather than systematic evidence evaluation — the authority cascade operating within the EBM framework (c) Medicine practiced at eminent institutions (d) The historical period before evidence-based medicine

(b) Despite EBM, much practice remains driven by expert authority through informal channels: grand rounds, mentorship, and "how we do it here" culture. This is Theme 9: the correction mechanism (EBM) has become a new landscape in which the old failure mode (authority cascade) operates.

Q: Pierre Louis's numerical method (1830s) showed that bloodletting did not improve pneumonia outcomes. The medical establishment's response was: (a) Immediate acceptance and abandonment of bloodletting (b) Acknowledgment of the methodology combined with continued bloodletting — arguing that clinical judgment outweighed "mere numbers" (c) Rejection of the methodology as pseudoscience (d) A controlled trial to verify the findings

(b) The claim that individual clinical experience outweighs systematic evidence is medicine's most durable defense against correction. It was articulated against Louis's numerical method and has been repeated against every evidence-based reform since.

Q: The chapter argues that medicine is "the benchmark" for other fields. Why? (a) Because medicine is the oldest profession (b) Because medicine has the highest stakes (lives) and the most correction infrastructure — if medicine still gets ~40% of tested practices wrong, fields with less infrastructure likely have higher error rates (c) Because medicine has the fewest errors of any field (d) Because medical research receives the most funding

(b) Medicine has both the highest stakes and the most sophisticated correction tools. Its ~40% reversal rate and 17-year implementation gap set the benchmark: any field with less correction infrastructure should assume its error rate is higher and its correction speed is slower.

Quiz: Field Autopsy — Medicine

Test your understanding of Chapter 23. Try to answer without looking back at the text.

Q1. What structural feature — not individual incompetence — sustained 2,000 years of harmful medical treatment?

(a) Physicians were poorly educated (b) The absence of controlled comparison — without a control group, every recovery confirmed the treatment and every death confirmed the disease's severity (c) Religious authorities prevented medical progress (d) Patients refused to participate in trials

Answer

**(b)** Without a comparison group, there was no way to distinguish the effect of treatment from the natural course of disease. This made humoral medicine unfalsifiable in practice.

Q2. Approximately what date does the chapter suggest medicine first saved more lives than it took?

(a) Ancient Greece (~400 BCE) (b) The Renaissance (~1500 CE) (c) Approximately 1865 (Lister's antiseptic surgery) (d) Approximately 1950 (the antibiotic era)

Answer

**(c)** Based on historian David Wootton's analysis, the net effect of medical intervention on the human population was negative until approximately 1865.

Q3. What primarily drove the decline of lobotomy?

(a) Rigorous RCTs demonstrated it was harmful (b) Public outcry over patient harm (c) The introduction of chlorpromazine (antipsychotic medication) — an alternative that made lobotomy unnecessary (d) Government regulation banning the procedure

Answer

**(c)** Lobotomy declined primarily because an alternative appeared, not because the evidence against it became overwhelming. This illustrates the "alternative availability" variable in the Correction Speed Model.

Q4. What percentage of rigorously tested medical practices are estimated to be "reversed" (found to be no better than alternatives or actually harmful)?

(a) ~5% (b) ~15% (c) ~40% (d) ~70%

Answer

**(c)** Research by Prasad and Cifu estimates ~40% — a staggering figure given that medicine has the most sophisticated correction infrastructure of any field.

Q5. The chapter identifies a critical limitation of medicine's correction infrastructure (RCTs, Cochrane, guidelines). What is it?

(a) The tools are too expensive to use (b) The tools address evidence quality but not evidence production incentives — when evidence is generated by interested parties, the tools are helpless (c) The tools are only applicable to drug research, not surgery (d) The tools require too much training to implement

Answer

**(b)** RCTs can be designed to favor sponsors. Systematic reviews can only synthesize existing studies. Guidelines can be written by conflicted experts. The tools assume good-faith evidence production; when that assumption fails, as in the opioid crisis, the tools are ineffective.

Q6. How long does research estimate it takes from publication of definitive evidence to widespread adoption of correct practice in medicine?

(a) 2-3 years (b) 7-8 years (c) 17 years (d) 30 years

Answer

**(c)** The "17-year gap" is a widely cited estimate of therapeutic inertia — the delay between evidence and practice change, even in the field with the best correction infrastructure.

Q7. "Eminence-based medicine" refers to:

(a) The highest quality of evidence-based practice (b) Medical practice driven by the authority of prominent physicians rather than systematic evidence evaluation — the authority cascade operating within the EBM framework (c) Medicine practiced at eminent institutions (d) The historical period before evidence-based medicine

Answer

**(b)** Despite EBM, much practice remains driven by expert authority through informal channels: grand rounds, mentorship, and "how we do it here" culture. This is Theme 9: the correction mechanism (EBM) has become a new landscape in which the old failure mode (authority cascade) operates.

Q8. The opioid crisis is compared to which other crisis from earlier in the book?

(a) The Challenger disaster (b) The 2008 financial crisis — both involved sophisticated correction infrastructure that failed because incentive structures were more powerful than correction mechanisms (c) Psychology's replication crisis (d) The fall of France in 1940

Answer

**(b)** Both the opioid crisis and the 2008 financial crisis involved real, sophisticated correction infrastructure (EBM / financial regulation) that was overwhelmed by incentive structures (pharmaceutical marketing / financial industry lobbying). In both cases, the crisis produced reform but left the underlying incentive structures largely intact.

Q9. Pierre Louis's numerical method (1830s) showed that bloodletting did not improve pneumonia outcomes. The medical establishment's response was:

(a) Immediate acceptance and abandonment of bloodletting (b) Acknowledgment of the methodology combined with continued bloodletting — arguing that clinical judgment outweighed "mere numbers" (c) Rejection of the methodology as pseudoscience (d) A controlled trial to verify the findings

Answer

**(b)** The claim that individual clinical experience outweighs systematic evidence is medicine's most durable defense against correction. It was articulated against Louis's numerical method and has been repeated against every evidence-based reform since.

Q10. The chapter argues that medicine is "the benchmark" for other fields. Why?

(a) Because medicine is the oldest profession (b) Because medicine has the highest stakes (lives) and the most correction infrastructure — if medicine still gets ~40% of tested practices wrong, fields with less infrastructure likely have higher error rates (c) Because medicine has the fewest errors of any field (d) Because medical research receives the most funding

Answer

**(b)** Medicine has both the highest stakes and the most sophisticated correction tools. Its ~40% reversal rate and 17-year implementation gap set the benchmark: any field with less correction infrastructure should assume its error rate is higher and its correction speed is slower.

Scoring Guide

9-10 correct: Excellent. You've internalized the medical field autopsy and can apply the framework comparatively.
7-8 correct: Good. Review sections on medical reversal (23.5) and the correction toolkit limitations (23.4).
5-6 correct: Fair. Revisit the structural analysis — focus on WHY the failure modes persist despite correction infrastructure.
Below 5: Re-read the chapter focusing on the structural forces rather than the historical narratives.