A Halsted vs. Dwight Eisenhower Investor - Over Confident vs Healthy Confident - Risk vs Opportunity

A Halsted vs. Dwight Eisenhower Investor - Over Confident vs Healthy Confident - Risk vs Opportunity

Write Two Letters   Feb 22, 2022 by Ted Lamade Collaborative Fund

Guest post by Ted Lamade, Managing Director at The Carnegie Institution for Science

So, what differentiates someone with a healthy amount of confidence from someone with too much of it? In my experience, people with the right amount of confidence share the credit when they succeed, but more importantly, accept the responsibility when they fail. This combination translates into an ability to admit when they’re wrong and change direction if needed.

Overconfidence is everywhere in life. In finance, it is what caused John Merriweather, Dick Fuld, and Jeff Immelt to destroy billions in shareholder value. In sports, Barry Bonds, Roger Clemens, and Pete Rose are three of the greatest baseball players of all-time, yet none are in the Hall of Fame because of it. In entertainment, Martha Stewart, Michael Eisner in his last few years at Disney, and John Antico at Blockbuster all fell victim to it. In politics, the list is simply too long to get started.

William Halsted is widely regarded as one of the “Fathers of Modern Surgery.” He is also known for being an extremely confident surgeon, co-founding Johns Hopkins Hospital, creating multiple surgical techniques, introducing sterilization procedures in the operating room, helping develop anesthesia, and creating the first formal surgical residency training program in the United States.

One of the notable surgical techniques Halsted pioneered was the “radical mastectomy”, which was a novel approach to treating breast cancer. Designed to go well beyond the breast tissue, the procedure would remove pectoral muscles, the mammary gland, lymph nodes under the armpit, and even extend down to the ribcage if necessary in an attempt to more effectively rid the patient of malignant cells.

The radical mastectomy quickly became the preferred method for treating breast cancer and would remain so for decades. There was just one problem. It didn’t work. Halsted was wrong.

Instead of curing breast cancer, the radical mastectomy was overly invasive, debilitating, and ineffective for most patients. Yet, Halsted failed to acknowledge this reality. In fact, he and countless other surgeons continued to perform it even as studies increasingly showed that the ultimate survival from breast cancer had more to do with how extensively the cancer had spread before surgery than how extensively a surgeon operated.

The logical question then is, why did Halsted continue performing and promoting the radical mastectomy in the face of disconfirming evidence?

As Siddhartha Mukherjee describes in his seminal book on Cancer, “The Emperor of all Maladies,”

The Gospel of the surgical profession was ideally arranged to resist change and to perpetuate an orthodoxy. Rather than address the real question raised by the data – did radical mastectomy truly extend lives? – they clutched to their theories even more adamantly. Where others might have seen reason for caution, Halsted only saw opportunity.

Halsted was blinded by what he wanted to believe. Instead of seeking the truth, he sought confirming evidence. When the results weren’t what he had hoped for, he would often make the case that he simply needed to go further.

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