stupid ideas and dead people

You may remember my obsession with the Cochrane Collection Collaboration. I've been pursuing this on the actKM list with all the ferocity of a man trying avoid a major deadline around a difficult client report. Anyway, we got into a big discussion of measurement and causality and stuff - but the vibe I got from a few people was "this is just too hard, we will never produce anything as rigorous as medical science". They may well be right. Knowledge managers are not doctors.

But if you compare the Cochrane Collection with The Old Operating Theatre in London then some perspective comes into play. I was at the Operating Theatre a few months ago (there's nifty picture of me getting my leg cut off that I've go somewhere) and, although they'd tidied it up a bit, you could imagine what a dirty, dingy, deathly place it must have been. If you got a broken limb then you were probably dead. And if you weren't dead then you were certainly due an amputation.

How has medical science advanced? Simple: stupid ideas and dead people. There have been lots of stupid ideas in the history of medicine. Often not completely wrong but not right either. And these stupid ideas meant lots of dead people. And at various points in history, medics have decided (whether for reasons of humanism or greed or pride or whatever) that working out which ideas are the least stupid will mean less dead people. This is not a linear narrative of progress. This is messy. There were (and are) mistakes, blind alleys, and maddening gaps.

One of the most interesting things for me are the articles in the Cochrane Review that say "there is insufficient evidence to come to clear conclusion on this". That speaks of an ambition to eventually find out what works and to improve health.

In my own discipline, we need that ambition. Lots of catastrophes have a knowledge dimension (or more frequently an ignorance dimension). But to be honest, most of my work is about the alleviation of small problems that make working lives miserable and organisations less effective than they could be.

We need to be more reflective and critical of our own practice. We need to find ways of sharing our failures as well as our successes. And we must not loose the focus on results. Most of all, we need to understand that our first efforts in this will be partial, messy, crude. We don't get to start in a gleaming, hi-tech surgical lab. We are rummaging around in the darkness and grime of garret. Tough - that's where you start.

We may not have as many dead people but I'm sure we can make up for that with stupid ideas.