Wednesday 30 August 2017

Stupidity: A trite but elusive word. What is stupidity?

       Stupidity: A trite but elusive word. What is stupidity? 


                                         Dr KS Dhillon



‘Yea also, when he that is a fool walketh by the way, his wisdom faileth him, and he saith to every one that he is a fool’. – Ecclesiastes 10:3

“Only two things are infinite, the universe and human stupidity – and I’m not sure about the universe.” -- Albert Einstein



What is stupidity?

The word stupidity dates back to 1541 (1).The Oxford dictionary defines stupidity as ‘behaviour that shows a lack of good sense or judgement’.The Cambridge dictionary defines stupidity as ‘the state of being silly or unwise’. The Merriam-Webster dictionary defines the word stupid as being ‘slow of mind, given to unintelligent decisions or acts, acting in an unintelligent or careless manner and lacking intelligence or reason’. The Merriam-Webster dictionary provides 25 synonyms and a large number of antonyms and related words to describe stupidity (1).

Introduction to the history of human stupidity.

Walter B. Pitkin (2) in 1932 published a book entitled ‘A short introduction to the history of human stupidity’. He says that the precise number of stupid people in the world is unknown and difficult to know but he believed that ‘at least three out of every four members of our species are, in some respect, stupid enough to deserve dishonorable mention here’.  There is no doubt that there are intelligent people in the world but Pitkin believed that ‘for every enlightened act in human history, there have occurred fully a million deeds injurious to the race because of dull prejudice, a single-track mind, laziness, faulty reasoning,forgetfulness, pride, or malice’. It is easy to act stupid but difficult to act intelligent because intelligent behaviour involves the arduous time consuming task of  observing, analyzing, and finally organizing the details. A stupid act on the other hand does not involve any logic, analysis and organization and is easily carried out.
Is there any salvation from the hunger, sufferings,wars,environmental destruction, malice, greed, superstitions and ignorance brought about by stupidity?  Buddha came close to answering the question. He believed that there were three cardinal sins, sensuality, malice and stupidity. Salvation he believed could only come about through dying out (nirvana) of this sins. He formulated a eightfold pathway of self discipline through which man must conquer himself to gain Jivan Mukti or salvation. Unfortunately very few can change their nature and the stupid without doubt cannot since they cannot perceive their dullness. History shows that neither compulsion nor education can achieve this goal.
Carlo Cipolla, in his analysis of the subject of stupidity, came up with five basic laws that governs stupidity.

Cipolla’s Laws of Stupidity

Carlo Cipolla a professor of economic history at the University of California in Berkeley, USA, defined a stupid person as ‘a person who causes losses to another person or to a group of persons while himself deriving no gain and even possibly incurring losses’. Cipolla believes that there are 5 basic laws which govern stupidity (3).

1.The first basic law of human stupidity.

According to the first law of stupidity, everyone ‘always and inevitably’  underestimate the ‘number of stupid individuals in circulation’.It is not possible to put numerical value to the number of stupid people in society since any numerical estimate will be an underestimation. Often we come across people who we thought were rational and intelligent but they turn out to be stupid. These stupid people can appear suddenly and unexpectedly at any time and any moment.

2.The second basic law of stupidity.

The second law of stupidity states that the ‘probability that a certain person be stupid is independent of any other characteristic of that person’.Cipolla firmly believes that stupidity is a genetic trait and not a trait attributable to nurture. Stupidity he says is an indiscriminate privilege which is equally distributed among all human groups. The frequency of stupidity and the percentage of stupid people remains the same irrespective the group size. Education has nothing to do with this probability because the percentage of stupid people is the same among the blue-collar workers, the white-collar employees, the students, the administrators, the professors and even of the Nobel laureates.The percentage remains the same irrespective of the nation you belong to, in developed or underdeveloped country.


3.The third (and golden) basic law of stupidity.

The third law of stupidity states that ‘a stupid person is a person who causes losses to another person or to a group of persons while himself deriving no gain and even possibly incurring losses’. Human beings according to Cipolla fall into four basic categories i.e ‘the helpless, the intelligent, the bandit and the stupid’. An intelligent person’s action brings gain to both parties, a helpless person’s action brings loss to himself and gain for the other party. A bandit is a person whose action brings gain to himself and a loss for the other party and a stupid person is one whose action brings loss to other parties while bringing no benefit or causing loss to himself.  Unreasonable behaviour of stupid people is difficult for reasonable people to fathom. Most people do not behave consistently all the time. A person can under certain circumstances behave intelligently and under different circumstances the same person can be helpless. However a stupid person on the other hand is perfectly consistent in his behaviour all the time in every endeavour.
A bandit's actions are rational and predictable whereas those of a stupid person do not conform to the rules of rationality. A bandit wants to take away something for his gain which causes a loss to another person. It is not possible to organize a defence against stupid behaviour because the actions of a stupid person are unpredictable, erratic and irrational.

4.The fourth law of stupidity.

Cipolla’s fourth law of stupidity states that ‘non-stupid people always underestimate the damaging power of stupid individuals’ and that non-stupid people tend to forget that dealing with stupid people under any circumstance turns out to be a costly mistake. Often people believe that a stupid person will harm himself but it is not true. Stupid people cause harm to society in general.



5.The fifth law of stupidity

 The fifth law states  that ‘a stupid person is the most dangerous type of person’. Stupid people cause losses to society with no counterpart gain for themselves and hence society becomes improvised. The percentage of stupid people in progressive and nonprogressive society are the same. However in progressive countries there is an unusually high percentage of intelligent people who keep the stupid people at bay and at the same time they produce enough gains for themselves and for society whereby they ascertain progress in their society.
In non-progressive countries the percent of stupid people is the same but the composition of non-stupid is different with more bandits and helpless people than intelligent people.

Cipolla’s assertion, of how dangerous and harmfull stupid people are, is supported by other authors. Livraghi believes that stupidity is the greatest destructive force in the world.

Power of stupidity

Giancarlo Livraghi (4) in his book ‘ The power of stupidity’ states that ‘stupidity is the greatest destructive force in all the evolution of mankind’  and that it is surprising why such a serious problem is hardly understood. It is a topic that is generally avoided because it uncomfortable and disturbing and hence scarcely studied and poorly understood.
Stupidity cannot be cured or prevented but if we knew how stupidity works and how it causes harm, then we can take steps to reduce its harmful effects.
The study of stupidity is difficulty because of the scarcity of literature on the subject. However let us try to understand stupidity. Surprisingly even smart people can stupid.

Why Smart People Can Be So Stupid

Robert J. Sternberg (5) in his book ‘why smart people can be so stupid’ questions why majority of the theories in psychology including theories of intelligence neglects the subject of stupidity but institutions spend vast amounts of money on intelligence and ability research. It is puzzling that society devotes nothing to find out why intelligence is ‘squandered by engaging in amazing, breathtaking acts of stupidity’.
 He argues that smart people, including smart leaders and academic administrators are highly susceptible to fallacies in thinking which promote foolish behavior.
Professor Sternberg lists seven such fallacies. The first fallacy is ‘unrealistic optimism’ which makes one believe that one is so smart and any idea one has must be good. The second is ‘egocentrism’ where one’s leadership is all about one’s self advancement. The third fallacy is ‘unrealistic omniscience’ which makes one believe that one knows everything there is to be known. The fourth is ‘unrealistic omnipotence’ which makes one believe that one has unlimited power. The fifth is ‘unrealistic invulnerability’ where one starts to view oneself as invincible (like superman). The sixth is ‘sunk-cost fallacy’, where one goes down a path of investment of time, effort, and money, even though one comes to realize that it is a wrong path, one continues on the same path and does not correct one’s mistake and go down a better path. The last fallacy is ‘ethical disengagement’, which makes one believe that ethics is
extremely important for other people and not for them self. Failed leader most likely commit several or all these fallacies.
The question this poses is, why do smart people fall for such fallacies?To answer this we need to understand stupidity.

Understanding stupidity

James Welles (6) in his book ‘understanding stupidity’ highlights the history of Western stupidity and modern American stupidity as well as probes the future of stupidity. The historical adventure of Western culture began in Greece. Those days the Kings had too much arbitrary power and there were no laws to safeguard against abuses.As the Greek culture continued to develop and flourish, it became clear to everyone that excess of power led to a comparable amount of stupidity.
Welles believes that the ‘Greeks were stupid in their philosophical ways, Romans were stupid in pragmatic, practical ways’. The Romans were not thinkers but were simple doers. They were short range opportunist and had no long term plan as has been demonstrated by Julius Caesar. The fall of the Roman empire was due to ‘socio-economic imprudence compounded by a monumental measure of self-induced ignorance and was a grand example of applied stupidity—the reciprocity of ignorance and misguided power’. They were insensitive to the social aspects of trade and finance. The history of the Roman empire has been described as a ‘case study of the neurotic paradox in action, with cravings for quick profits blinding those with naught but short-term gains on their minds to the social ills they were creating’. The elite enjoyed slavery, brutality and materialism and lived for the moment with no care about tomorrow.
With the end of the political empire of the Romans, came the spiritual empire of the Catholic church. The spiritual empire was culturally stagnant for some thousand years till the crusaders brought terror and destruction to the holy land. The religious zeal brought excessive cruelty and violence and there was no internal check to limit its excesses.
This was followed by secular renaissance. While for the previous 10 centuries stupidity had been limited to scholastic arguments and monastic debates, it was now everywhere, stupidity in exploration, stupidity in invention, stupidity in statecraft, medicine, art and war.
This was followed by the British colonial rule with policies which were ‘an irrational, subconscious assertion of the nobility's right to suppress the rising commercial interests in England’. The policy was damaging to the merchants. The policies produced discontentment in the colonies and it cost British about £100 million to lose the colonies.
Then came the era of french stupidity and the french revolution. Napoleon's career serves as ‘an example of the positive correlation of power and stupidity’. He was logical, mathematical, retentive but unscrupulous and insensitive to misery and suffering. As his power grew, his judgment weakened and he made a fatal mistake of not anticipating that the Russians would not give him a decisive battle in 1812 which lead to a fall of the Napoleon empire.
In the 1800’s the popular theory was that illness was an expression of God’s wrath against sinners and also breathing bad air can cause illness. In the late 1840's, Dr Semmelweis’s germ theory of disease was greeted with vituperous denunciations. He however insisted that doctors wash their hands between performing autopsies and examining patients. With this simple measure the mortality rates dropped from 18% to 2% within 2 months.
His success was too much for his critics and he lost his job. He then went to Budapest where he repeated his performance and also wrote a book on the subject. However both the book and author were ignored, rejected and disdained, which lead to Dr Semmelweis death in a mental institute.
In the next twenty years the work of Lister, Koch and Pasteur put an end to such debate and established the germ theory as an explanation for disease.
Drs. Ronald Ross and Colonel William Gorgas battled fancy beliefs and demonstrated that mosquitoes and not filth conveyed malaria and yellow fever. By 1990 the germ theory had become established despite the high orthodoxy.
World war I was a grand fiasco and a fine example of stupidity where all the players matched each other blunder for blunder. All sanity was lost and millions of mad men exhibited their stupidity. The four years of carnage lead to the death of 16 million people.Stupidity of the liberals during the Tsars rule in russia allowed the communist to take over Russia. Under the Tsars, living conditions were so terrible that the liberals believed that things cannot possibly get worse but the Communists prove them wrong. Not only the living conditions got worse, the communists also totally suppressed liberalism.
Before Stalin and his communist party came to power, after the Russian revolution, the land used to belong to the people. Stalin however took the land back from the people and restored them to serfdom. This move has been described as a stupid move because ‘collectivization is simply not an efficient way to organize agriculture’.
Although the myth persisted that after the revolution everything improved, the reality was that things were worse off under Communism than it had been under the Tsars.
The Russian Revolution happened around the same time as World War I. It was the most stupid event ever in history. The war caused great suffering and was a colossal economic disaster for Europe. The war not only destroyed people, rulers and states but it also improvised people. It cost about thirty-three times all the gold money in the world at the time. Most of this money was devoted to the art and science of destruction.
After World War I the French policy towards Germany has been described as a classic example of fear and stupidity. The signing of the Versailles treaty by the French out of fear of the Germans not only failed to stop German militarism but it provided a basis for propagandistic rationalizations by Adolf Hitler to come into power. Hitler was only interested in power and not in improving the livelihood of the people. He knew that to get power he needed to tell the German people what they want to hear. He provided people with a way out of the misery which followed World War I and people only realised much later that the way out he provided was a ‘way down to a cultural carnage that would have shamed the Devil himself’.
The disaster at Pearl Harbor,Vietnam war, Bay of Pigs invasion and Watergate were all prime examples of American stupidity according to Welles.
 According to Welles the pluralistic nature of American society not only made tolerance a necessity but it also gave American stupidity its anarchistic flavor. Each of the immigrant groups contributed to ‘ the caldron of idiocy and made diversity america’s greatest weakness’. The laziness of Hispanics contrasted with the arrogance of Germans. The prudish behaviour the English contrasted with behaviour of emotional  abandonment of the African immigrants.
Welles believes that America was populated by people who had failed in their own land. When they came to America they failed in all areas including farming, mining, business and battles. They invented ships that would sink, shovels that would not dig and boilers that would explode, and built fire traps that were unsafe. Slums rose in the cities and they built railroads to nowhere and cleared land which lead to erosion of the topsoil. Promoters mislead the unwary into settling along the ‘wrong-of-way so that they could be more easily exploited later’.
There is a belief in America that the American government works for the people but this belief is myth. The root cause of this belief is political stupidity. The reality is that people are working for the government.The average American works, one out of every three working days which is to say four months a year, for the government because the earnings from 3 months a year goes to taxes. Most governmental agencies are working for themselves and not for poor tax payer. The original idea of a government was that it will help people realize themselves but the government has become supreme and is strangling the people it was designed to serve. The people however continually struggle to support the government.
The people working in public services find that institutional stupidity prevents them from effectively carrying out their duties to serve the public.
Institutional organization guidelines are a hindrance to carrying out the task they are hired for. Hospital staff including nurses spend a lot of their time filling out forms and writing reports rather than attending to patients. Similarly teachers spend much time doing administrative work and patrolling instead of teaching. The military is not allowed to win a war because the weapons used or tactics used may create ‘bad press’ for the government.
The media plays an important role in keeping the public in democratic societies misinformed and uninformed because it is in the vested interest of people in power. Public are informed just enough so that they conform and criticism is trivialized. The truth of the matter is that the leaders need stupid followers. They cannot afford to have intelligent, informed and concerned citizens who are qualified to criticize the imbalance of power in society. Educational institutions produce and the media maintains, a pliant and compliant public so that there can be stability in the government.
America and the Western world represents the most recent civilization that has failed to live up to its own expectations. In fact all civilizations have in the past failed and failure appears to be a consistent feature. The profession of Archaeologists appears to be to study failure and historian explain failures.
Welles believes that no amount of information, learning or technological expertise seems to alter the fundamental human constant that we all are pretty stupid. Society seems to have ‘ready-made, socially condoned, psychologically acceptable explanations’ for every event significant event that happens in our life but what remains unexplained is why things continue to go wrong despite our best efforts. We tend to contribute to failure by explaining away both the inexplicable and the explicable.
We reassure ourselves that we have answers to every question even if we have make them up. This prevents us from finding valid answers to question that arise. The most important question which need to be answered is why our best efforts are not enough?
Unfortunately our so called best efforts are not the best because we are biased towards a particular way of doing things. This bias inhibits improvement and people with marginal abilities support the incompetent so that when they themself are incompetent others will support them when their turn comes. Weak people tend to support corrupt people. Inept people regard efficiency as a threat and accuracy of perception and analysis is regarded as a threat by powerful people.
Now that we have some understanding of stupidity, let us look at why things go wrong in organisations. Parkinson has some answers to this common  problem.

Parkinson’s law

While there is scarcity of literature on the depth of thinking about stupidity, there are some good studies about ‘why things go wrong’. One of the good studies on this topic is ‘Parkinson’s law--the pursuit of progress’ by Cyril Northcote Parkinson (7). Parkinson’s law is defined as “Work expands so as to fill the time available for its completion”.What it means is that there a tendency for the amount of work required to do  something increases so that it consumes all the time allocated to it. There is a tendency for all available capacity in a given system to be used up. This means that no matter however extensive your resources, the demands on the resources will continue to grow till they are depleted. For example in any organization the financial outlay will continue to increase till available budget is exhausted, software continues to expand till system memory is full and the volume of data tends to grow till storage capacity is full. Financial outlay will increase to exhaust any usable budget.
The main problem with organizations is that they are like living organisms which have an inherent urge to grow and reproduce itself. This is not good for businesses, institutions, private and public services because they should only grow and expand if they are productive and there is need for more and they should shrink or disappear if they have outlived their usefulness.The reality is that this does not happen in the real world.
Another observation by Parkinson is his Law of Triviality which states that the amount of time and attention given by the management to a particular problem is inversely proportional to its real importance. Simply put it means that people spend a lot of time on trivial tasks and very little or not enough time on matters that are important and critical. Parkinson illustrates this law with an imaginary tale where a company’s executives meet to discuss two new projects i.e a nuclear reactor and a company bike shed.
The reactor is complex, expensive and the executives know nothing about reactors, hence no discussion takes place to avoid embarrassment, and the project gets approved in two and half minutes. The bike shed on the other hand is something everyone knows about and everyone has an opinion. The bike shed, Parkinson writes, "will be debated for an hour and a quarter, then deferred for decision to the next meeting, pending the gathering of more information".
Parkinson in another of his book (8) talks about the law of delay. It says that ‘delay is the deadliest form of denial’ and that ‘if there is a way to delay an important decision the good bureaucracy, public or private, will find it’. It is common to find people in charge, when confronted with urgent, serious, complex, and taxing problems, avoiding responsibility by delegating, delaying, doubting and hesitating till the problem becomes unsolvable.
There is a common tendency to decide on things, in a hurry, that need more deliberation and thinking while putting off things that need to be decided at the right time. This leads to a vicious cycle of more blundering and build up of problems, which makes things worse. If things are handled properly this mess can be avoided.
Parkinson in another of his books, ‘Parkinson’s Law and other Studies in Administration’ (9) introduces another of society's ills which he calls ‘Injelititis or palsied paralysis’. The first sign of danger, according to Parkinson, is the appearance of an individual with a certain concentration of  incompetency and jealousy, into an organisation.These two elements apparently fuse to produce a substance called ‘Injelititis’. The presence of such an individual is obvious when you find someone who has achieved nothing remarkable for his department but is constantly interfering with other departments to gain control in the central administration. The secondary or next stage of infection in this illness is when this individual gains complete or partial control at the central organisation.The presences of such an individual is easy to recognise from his persistent efforts get rid of and prevent promotion of individuals who are more able than him. As a result of this the central administration gradually gets filled up with people who are stupider than this individual who is now the chairman, director or manager. It makes sense that if the head is second rate, he will make sure that his immediate staff are third rate and their subordinates will be fourth rate.
The next or tertiary stage of the disease is when there is no bright spark left in the organization from the top to bottom. At this stage the organisation is for all practical purpose is dead or in a coma.
Now that the disease has been described what are the symptoms of Injelititis? At the initial stage or stage one it may be difficult to see the symptoms. However it may be noticeable at the initial phase when one finds that the standards in the organization have been set low. Only low standards are acceptable and lower standards are also acceptable. Third-rateness become the principle of the organization’s policy. The chief symptom of the second stage of the disease is smugness and that of the last stage is apathy.
Although stupidity is not mentioned in any of the Parkinson’s laws, it is obvious that the analysis as to why things go wrong is full of destructive behavior which is indeed very stupid.
Mats Alvesson and Andre Spicer (10) have studied another aspect of stupidity which is prevalent in organisations and he introduced the term functional stupidity.

Functional stupidity 

Functional stupidity in an organization is best described as when smart people are discouraged from thinking  and reflecting at work. It is ‘characterized by an unwillingness or inability to mobilize three aspects of cognitive capacity: reflexivity, justification, and substantive reasoning’.
Lack of reflexivity involves inability or unwillingness to question norms, rules, routines, dominant beliefs and expectations. Employees are expected to not question organizational (im)morality and they are expected to follow the instructions from above. There is repression of skill of employees to reason, scrutinize and criticize aspects of the organization.
The second aspect of functional stupidity is lack of justification. This involves not demanding or providing reasons and explanation for what is going on in the organization. This reduces the amount of dialogue among employees and it means that there is no need to account for a decision or action. Significant critical scrutiny is bypassed and companies can adopt new practices with few or no good reasons beyond the fact that they make the company ‘look good’. Not asking for justification beyond ‘managerial edict, tradition, or fashion, is a key aspect of functional Stupidity’.
The third aspect of functional stupidity is a lack of substantive reasoning. This happens when reasoning is based on a small set of concerns that are defined by the organization and does not span the whole issue. The common example of such lack of substantive reasoning is the myopic approach where organizations focus all their efforts on achieving certain objectives with little or no questioning of the objectives themselves.
Functional stupidity involves both cognitive as well as affective issues. The affective issues have both motivational as well as emotional components.The motivational aspect is characterised by an unwillingness to use one’s cognitive capacities which is reflected by a lack of curiosity, closed-mindedness, identification of oneself as the ‘organizational person’ or a ‘professional’ who does not question the occupational paradigm. The emotional aspect is characterised by anxiety and personal insecurity at work which affects the way we relate to others.
Although this kind of organization supported stupidity can have harmful long term consequences for the organization, it can have some short term benefits. This form of functional stupidity allows for smooth running of the organization with members playing along and not asking difficult questions.
The ungrounded faith in the visions, goals, strategies, and practices of the organization helps members to control their doubts.
Organizations promote skilled incompetence among its staff by reinforcing defensive routines. The fact that some issues are undiscussable helps managers to avoid surprise, embarrassment and threat. This lack of discussion prevents the managers from learning from inquiry into difficult questions. This lack of willingness to learn and process knowledge is also stupidity just as a lack of knowledge is stupidity.
Hence functional stupidity can be defined as ‘ an inability and/or unwillingness to use cognitive and reflective capacities in anything other than narrow and circumspect ways. It involves a lack of reflexivity, a
disinclination to require or provide justification, and avoidance of substantive reasoning’ (11).
Mats Alvesson and Andre Spicer in their book ‘The Stupidity Paradox: The Power and Pitfalls of Functional Stupidity at Work’ (10) describe functional stupidity in the workplace as when intelligent people are discouraged from thinking and reflecting at work. This in the long term can be catastrophic, leading to organizational collapse and disaster. However a dose of functional stupidity in the short term can be useful because it can bring about harmony and encourage people to get on with the job. This is the paradox which the authors talk about in the book.
The authors investigated why smart firms with intelligent people did such stupid things. They found that organization would hire intelligent people and than discourage them from thinking and asking questions. This was done sometimes in subtle ways and at other times in not so subtle ways. They were often told things like 'don't think about it, just do it', and 'don't bring us problems, just bring us solutions'. So the smart people realised that thinking and asking questions will lead to awkward confrontation with the seniors. The workers very quickly realised that the best option was get on with the job at hand.
They came across many stupefying processes which discouraged workers from thinking too much. There were policies and processes which were mindlessly being enforced. They also found ‘corporate window dressing’ which were symbolic with no substance. Many of the companies were imitating other firms and copying their culture thoughtlessly.
There were however some benefits of not using one’s intelligence. Lot of time was saved by avoiding conflict which allowed these individuals to quietly work their way up the corporate ladder.
Despite some short term gain of such a culture, the long term consequence can be disastrous when people start overlooking problems and the problems continue to build up. This has been illustrated by the last financial crisis (2007-8) and also by what happened to Nokia when it did not keep up with Apple’s iPhone. Public services everywhere continue to add policies and procedures which are pointless and do not improve delivery of services.
Organizational disease has been further studied by Laurence Peter and Raymond Hull (12) They coined the term “Peter Principle” and wrote about why things always go wrong in an organization.


The Peter Principle

It is essential to understand the Peter Principle in order to fathom organizational disease. The principle states that ‘in a hierarchy every employee tends to rise to his level of incompetence". The book introduces a new science called hierarchiology i.e the study of hierarchies. In a hierarchy a higher up vacancy is filled  by a person who is currently competent in his present position below in the hierarchy. Sooner or later an employee will be promoted to a position where he is no longer competent. He will remain there because he will not get a promotion, since promotions are only for competent people. This level where the employee stagnates is knowns as  Peter's Plateau.
According to Peter, in a hierarchy "every post tends to be occupied by an employee who is incompetent to carry out its duties" and that "work is accomplished by those employees who have not yet reached their level of incompetence". Over time, however, every position in the hierarchy will be filled by someone who is not competent enough to carry out his or her new duties. Dr Peter in his book clarifies that the person has not become incompetent because the new job is tougher but the incompetence is due to the fact that the new role requires new skills and competencies which the person does not possess and is unable to develop.This then leads to failure. He succulently sums up his observation as “the cream rises until it sours”. So by extrapolation, this means that almost everyone in a management level position is incompetent.
For those interested in the study of stupidity, Peter’s principle would mean that a person, who isn’t stupid (is competent) in a specific task , is moved
to a situation where he or she becomes “stupid”,  because of “incompetence” in a new role, which would mean that all at the managerial level become stupid because of the meritocratic hierarchy. As a result of this those who have not yet been promoted and are still competent are hindered in their work by reporting to those who are incompetent.
People at the top of the organization often ignore Peter’s teachings, because people at the top don’t like to be told that they have been wrong in promoting their staff and also it makes them uncomfortable that they themselves have reached an irreversible level of incompetence.
In 1996 Scott Adams generated a corollary of “The Peter Principle” which he called The Dilbert Principle which states that ‘The least competent, least smart people are promoted to where they can do the least damage: management’.
Giancarlo Livraghi believes that the situation today is worse than it was in 1969 when Peter defined his principle. The concept of merit according to him is more and more confusing. People get ‘“promoted” (or chosen) because of protection by oligarchic power, superficial appearance, intrigue and other reasons that have little, if anything, to do with “competence”’.
In an attempt to solve some of the high level incompetence problems consultants have suggested several maneuvers.

1.‘The Percussive Sublimation’ - where a hopelessly incompetent person who is creating a bottleneck is moved upstairs so that he will be out of the way.

2. ‘The Lateral Arabesque’ - where an incompetent employee is given another new and longer title and an office in a remote part of the building.

3. ‘Peter's Inversion’ - refers to professional automatons aka Peter’s Inverts who are minor officials with no discretionary powers in whom we see an obsessive concern with getting forms filled out correctly, irrespective of whether the forms serve any useful purpose or not and no deviation, however slight, from the routine is permitted. Such actors always obey and they never make decisions. This according to hierarchy is competence and Peter’s Inverts are eligible for promotion. He will continue to rise till he reaches a position when he has to make decisions and he find that he has reached his level of incompetence.

4.Hierarchal Exfoliation - refers to expulsion or dismissal of a super competent person who is brilliant and productive. Such a person cannot get a promotion because in most hierarchies super competence is more objectionable than incompetence. Ordinary incompetence is a bar to promotion but not grounds for dismissal. Super-competence disrupts the hierarchy and thereby ‘violates the first commandment of hierarchal life: the hierarchy must be preserved’.
This sort of maneuvers maintain stupid people at the upper end of the hierarchy in highly visible roles. The criteria to be placed on top of the hierarchy has little to do with competence and merit. Rewards often go to people who support the winning party and not to the deserving party.
Livraghi has introduced three corollaries which describe  the complexity of stupidity, how rapidly it multiplies and spreads, and how easily stupidity combines.

Livraghi’s corollaries

Livraghi believes that people who are responsible and generous are
usually aware of how they behave, malicious and nasty people
know what they are doing, and even people who are weak know that something is not right. Stupid people on the other hand are not aware that they are stupid and this can make them extremely dangerous. Passing IQ test does not guarantee that one is smart and not stupid. Most people believe that there is a neat separation between smart and stupid people. However, life experiences show that this distinction is not so clear and simple.

Livraghi’s First Corollary

‘In each of us there is a factor of stupidity, which is always larger than we suppose’. This “inside factor” of stupidity is very complex and difficult to explain. In addition to ours and other people's stupidity there are several other variables including behavioural factors which can combine in several ways. We can essentially forget the intelligent factor because there is not much of it around and think of the other factors since even ‘ the most generous person can sometimes behave like a “bandit”, if only by mistake’.

Livraghi’s second Corollary:

‘When the stupidity of one person combines with the stupidity of others, the impact grows geometrically – i.e. by multiplication,not addition, of the individual stupidity factors’.
The sum of stupidity factors in individuals increases as a square of the number of individuals which explains why crowds as a whole are more stupid than an individual in the crowd. Stupid behaviour and thinking can reproduce, multiply and spread so rapidly and dangerously that it can even infect intelligent people who will not realise that they have been influenced by collective stupidity. It is disturbing to know that stupidity is characterised by consistency and continuity and that nobody is totally immune to it.


Livraghi’s third corollary:

‘The combination of intelligence in different people is more difficult than the combination of stupidity’.
Livraghi believes that the causes of stupidity are multiple and complicated and the power of stupidity is usually underestimated and its consequences are unpredictable. With stupidity thinking is not involved, there is no need for planning and getting organised and this makes combination of stupidity a simple job. Hence stupid people can instantly form a ‘super-stupid’ group. Intelligence is a much more complex process, where intelligent people can only work together when they know each other and have worked together before. Organizations and communities with high number of intelligent individuals are likely to have a long term survival provided they avoid the short term impact of shared stupidity which can have a significant and devastating effect on non-stupid people.
People in power, tend to keep those interested in their own welfare and that of restricted group of people with similar interest, at the top of the pyramid. These group of people are not interested in the welfare of everyone. They  favour and protect stupidity and keep the intelligent people as far away as possible.
Giancarlo Livraghi in his book ‘The Power of Stupidity’ further elaborates his take on the topic of stupidity where he discusses the stupidity of power, power of stupidity,the association between stupidity and ignorance, whether stupidity is harmless and he answers the question of whether stupidity is growing.





The Stupidity of Power- Giancarlo Livraghi

The problem of stupidity in society is already huge with all sorts of consequences which are difficult to identify. This stupidity problem becomes different when we are dealing with stupid people who are in power and control the destiny of many others below them in the hierarchy.

Power, “large” or “small”.

Power is everywhere and everyone has power over others and others have power over us. How much power one wields over another is relative, some have more than others. The person on top in the hierarchy has a lot of power which he can wield on others below him. In a democracy we expect that the people in power should be subject to control by the rest of the people and in an organization there should be no bureaucracy, centralization or formal discipline. There should instead be leadership, motivation, distributed responsibility, sharing and personal empowerment. In reality this does not happen in a democracy or in an organization. The reason behind this is that in reality majority of the people feel that responsibility is a burden which requires hard work to deal with. The majority of the people would rather be followers and let others lead, be it managers, opinion leaders, gurus, rulers, politicians or celebrities, who can do the thinking and whom we can blame when we are unhappy. In this group of leaders there are some who enjoy the power that they have achieved. The stark reality however remains that the percentage of stupid people among those in power and the rest of humanity remains the same and there are always more than we think there are. Two things however are different i.e relationship and the attitude of those in power and the rest below in the hierarchy.



The power of power.

There is no question about the fact that people in power are more powerful than others. Real power leads to uneven relationships where some people have greater influence over circumstances than others and at times this can lead to situations where a few people with power can do good or harm to many people. The effect of the behavior of people in power whether it is good or harmful should be measured from the point of view of the person affected by the behaviour.There is always a need for separation of powers so as to avoid exaggerated concentration of power (absolute power) which can lead to conflict and violence. This concentration of power leads to ‘The Power Syndrome’.


The power syndrome

There are various ways in which people gain power. Occasional it is entrusted on someone by others because of his natural leadership qualities, his sense of responsibility and because he can be can be trusted by others. This process produces intelligent power which is rare. Such people do good for themselves but they do a lot more for others.They even sometimes do deliberate sacrifice where they do harm to themselves for the benefit of others. They deliberately place common good over personal interest. Such examples are however rare. Why?
The reason is that there is intense competition to gain and maintain power and sometimes this craving for power can be troubling, very aggressive and even fearsome. The person with intelligent power usually does not have the time and energy to gain more power or hold onto power. Those who have greed for power on the other hand concentrate all their efforts on the power struggle without regards for the impact on society.
Most people are placed somewhere in between the two ends of the spectrum of responsibility and power mongering. The manipulating individuals however predominate. Often even the generous individual over time tends to dedicate more energy to increasing power at the expense of the people around them.
Things sometimes get worse because there are megalomaniacs in position of power. For these people power is an addictive drug and they believe that they are smarter, wiser and better than people around them. Sycophants, followers and exploiters often surround the megalomaniac and they enhance the delusions of megalomaniacs.
Power is sexy they say. Instinctively humans are sexually attracted to people who are powerful but these powerful people usually do not have time to care for love, affection or emotion.
This megalomaniac power syndrome not only affects the powerful people but the disease affect all their followers and everyone else the powerful person interacts with. There is stupid symbiosis between the powerful and the people around them and this complicates the stupidity of power.
In this power mechanism it is not only the ordinary people who suffer, sometimes the people on the top can also become the prisoners of the followers. History shows us that in a revolution when the tyrant falls the power does not go to the people but goes to people who are similar to the one who was deposed.
The colonial system is a good example of this. When the colonial masters left, the power fell in the hands of people who were the same or worse than the the colonial masters.
There is a strong relationship between stupidity, ignorance, fear and habit, as we will see.

Stupidity and Ignorance

Of the many attitudes and circumstances that contribute to making us stupid, three are particularly important. These include ignorance, fear and habit. Ignorance can breed fear and fear can also breed ignorance. Habit is often the nourishment or excuse for ignorance and stupidity. Often all four can join forces and they can be exploited by whoever has power or leverage.
Unlike what many believe, not all ignorant people are stupid and not all stupid people are ignorant. Fear can be seen in both smart and stupid people. Habits again can good and harmless or they can be dangerous. These factors can all intermingle and interact to varying degrees. There is no direct linear correlation between stupidity and ignorance but when they combination the outcome can be disastrous. People who never notice they are stupid are actually very stupid and people who never know that they do not know are very ignorant. We keep reassuring ourselves that we are in the age of information but unfortunately we are poorly informed because information is deliberately manipulated and information management is usually careless, repetitive and shallow. The information is handled by people who are ignorant on the subject and instinctively lazy to check their source as deeply as they should.
In society there is a mischievous reciprocity of ignorance where people mutually adjust to other people's real or assumed ignorance and with that the level of dialogue spirals downwards. The amount and the quality of information exchanged spirals down to zero or becomes negative, thereby reinforcing the false or distorted notions and increasing prejudice.
We often fall back on comfortable misconceptions, that find easy agreement, to avoid the effort of thinking. Sometimes it is the path of habit and at other times it is the fear of having to tackle a difference of opinion for which we are not prepared.
Traits such as ‘arrogance, presumption, egotism, selfishness, envy, carelessness, servility, imitation, gossip, prejudice, meanness, unwillingness to listen and to understand’ are all unpleasant friends of stupidity and ignorance.  They lurk in every corner of human behavior
and communication.
There are times when we are led to believe that information from authoritative source is unquestionably accurate and believable. This principle of authority can sometimes be dangerous. Assumed authority is not synonymous with real competence because the opinions of experts are often biased by their cultural or scientific perspectives. This bias is legitimate and unavoidable but we must remember that there is no such   thing as a totally “objective” opinion.
The only way out of ignorance is insatiable curiosity which involves active
questioning, searching and understanding even when at first glance it appears unnecessary.
Albert Einstein once said: ‘I have no special talents. I am only passionately
curious’. And he explained: ‘The important thing is to never stop
questioning. Curiosity has its own reason for existing. One cannot help
but be in awe when he contemplates the mysteries of eternity, of life,
of the marvelous structure of reality. It is enough if one tries merely to
comprehend a little of this mystery every day. Never lose a holy curiosity’.
Instinctive curiosity and an ability to listen is a lively, amusing and pleasant friend of intelligence and a strong antidote to stupidity.
With the world population growing at a rapid pace, is stupidity constant or is it following the trend of population growth.


Is Stupidity Growing?

‘A sort of melancholy, and regret, seizes us every time we meet a sophisticated, adulterated idiot. Oh the nice fools of yestertime! Genuine, natural. Like homemade bread’. Leonardo Sciascia.
It is often said that ‘the sum of intelligence on the planet is a constant, while the population is growing’. It is also a common belief that the ‘percentage of stupidity’ remains constant although it will be impossible to prove it. It would be nonsensical to believe that a small (and proportionally decreasing) number of people has a monopoly of intelligence and that everyone else is stupid.
There is a widespread belief, without basis, among people in power that they have some sort of superior intelligence as compared to others and it makes things worse when these people are lulled into believing that it is true.
The question as to whether human intelligence is growing is silly because there is no reliable way of measuring or comparing intelligence. There are however some so-called “scientific” studies which says, yes, human intelligence is growing though there is no proof of it. The so called “IQ” standards are highly questionable and some would say totally meaningless.

Anthropologist define “intelligence” as a human “characteristic”. The scientific frontiers of knowledge have over the last four centuries, even
more so in recent years, expanded at a bewildering and fascinating pace.Though our perceptions are advanced our perspectives remain biased. It is not certain whether this is making us smarter or more confused and stupid.
When we look around us, we see on a daily basis, small and big events, which confirms the dismal effects of human stupidity. Most of the time we notice that things seem to be getting worse. We always talk about good old times. Although things appear to have been better before, the fact remains that we are as stupid as we have ever been. The only sign that we are not completely stupid is the fact we have survived and expanded despite the appalling mistakes we make.
There is a widespread feeling that stupidity is becoming more devious and it has been so in the past but an abundance of information available nowadays makes it more obvious.
Four hundred years ago, Michel de Montaigne said ‘Nobody is exempt
from saying stupid things, the harm is to do it presumptuously’. There is a growing tide of arrogant stupidity which is inundating us to extend that it is becoming obsessively irritating. The power of stupidity is multiplied by confusing cunning with intelligence. Francis Bacon once said that ‘there is nothing more damaging to a country than shrewd people passing themselves off as being intelligent’. It’s worse when we share this delusion on a large scale.
Frequently we find that people who are supposed to be wise and bright are actually awfully stupid. This tide of stupidity catches up with us wherever we head. The size of globalised stupidity is appallingly and obnoxiously large. We allow simple problems to grow till they become so large and entrenched that it is difficult to find a solution. A good example was the last global financial crisis.
Despite the fact that stupidity factor is a constant, human stupidity is growing simple because the population is increasing. Just like infectious diseases, stupidity also spreads rapidly. Though we are not becoming more or less stupid, the power of stupidity is increasing. The vastness of the consequences of stupidity has never been so large and the speed of its multiplication has never been so fast. Though we cannot uproot stupidity we can try to understand it and thereby reduce its impact.
 We need to remember that stupidity is not harmless.

Stupidity Isn’t Harmless

Livraghi believes that though many people perceive stupidity as
“Harmless”, in reality it can be quite dangerous. Although there are no surveys trying to measure how many people think that stupidity is harmless or dangerous and why, the fact remains that stupidity is not harmless. It is a fact that stupidity is contagious and infected people usually are not aware of their disease, hence it becomes very difficult to control the epidemic.
The people in power with their monopoly over the communication media  spread stupidity and make it appear harmless.
Many believe that stupid people are non achievers and hence can be ignored and laughed at about their miseries. This is not necessarily true and doing so can be a serious problem. Stupidity is poorly understood and not well studied because many people believe it is irrelevant and non stupid people think it is a blessing for them since they can take advantage of other person’s stupidity and even exploit it.
We find comfort in contemplating other people’s stupidity and other people's stupidity usually makes us feel cleverer. This is often the content of gossip which many people engage in.
Humour and irony apparently can be an effective remedy against stupidity provided we don’t forget that it’s a serious and dangerous problem and we can’t understand it by just laughing about it.
Studies show that there is a reliable negative relation between intelligence and religiosity. If smart people are less religious and stupidity is the opposite of intelligence then there should be a positive relationship between stupidity and religiosity. However the relationship between stupidity and religiosity has not been studied whilst that between intelligence and religiosity has been extensively studied.

Religion and intelligence

Gottfredson (13) defined intelligence as the “ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience”. Religiosity on the other hand can be ‘defined as the degree of involvement in some or all facets of religion’ (14).
There have been many studies published which show the relationship between intelligence and religiosity. As early as 1916 Leuba (15) reported that among randomly selected scientist in the USA, 58% expressed disbelief in, or doubt regarding the existence of God. Among eminent scientist the figure rose to 70%. Larson and Witham (16) in 1998 reported similar results, in an article titled “Leading scientists still reject God.”
Zuckerman et al (14) did a meta-analysis of 63 studies to study the  relation between intelligence and religiosity. They found that there was a reliable
negative relation between intelligence and religiosity. The relation between intelligence and religiosity was similar at the college level was comparable with that at the non-college level. The relationship between intelligence and religiosity remained negative irrespective of whether religiosity measures assessed religious beliefs or religious behavior. Intelligence appears to affect religiosity rather than the reverse.
Zuckerman et al (14) proposed three reasons for the inverse relation between intelligence and religiosity.

1.Atheism as nonconformity

 Studies indicate that intelligent people are less likely to conform to religious orthodoxy. Atheism is characterized by nonconformity in the midst of religious majority and intelligent people are generally less likely to conform. The prevalence of religiosity varies widely among countries and cultures, with more than 50% of the world population considering themselves religious. Figures as high as 89.9% of believers in the world has been bandied around and the numbers of believers in the USA has been reported to be around 89.5%.
Generally people who grow up in a religious environment tend to become religious. However intelligent people are more likely to become atheists
in religious societies, because intelligent people tend to be nonconformists and they are less likely to accept a prevailing religious dogma.


2.Atheism and Cognitive Style

One of the main explanation for the inverse relation between intelligence and religiosity is that intelligent people do not accept beliefs that do not stand up to logical reasoning and have not been subjected to empirical testing. One does not need a lot of cognitive ability to understand that religion does not arise from scientific discourse. Believers will always admit that their faith is not based on fact or logic but they will still continue to have religious beliefs. Analytical thinking among intelligent people leads to lower religiosity and it makes them more resistant to religion.

3.Functional Equivalence

Religious beliefs and practices apparently satisfy a number of needs in humans, and this need-fulfillment is one of the reasons for adopting and maintaining religious beliefs. There is a possibility that the needs fulfilled by religion can be fulfilled by other means. Intelligence may be able to confer some of the functions of religion and in this respect religion and intelligence may be functionally equivalent.
Zuckerman et al (14) proposed that religion may provide the following four functions: ‘compensatory control, self-regulation, self-enhancement,
and attachment’. They also proposed that higher intelligence can provide these four benefits and hence intelligence lowers one’s need to be religious.

Religiosity as compensatory control.

 Religiosity can provide a sense of external control which gives the person the perception of an orderly and predictable world as opposed to a random and chaotic world. Religiosity also provides a sense of personal control for believers when they feel empowered by their personal relations with God.
Studies show that threatening a sense of personal control increased people's beliefs in God. Apparently people who lose personal control take comfort in religion because to them God controls everything in this world.
Studies also show that individuals whose personal control is threatened become more convinced about the superiority of their religious believes and are more determined live in accordance with their faith. In essences,  religiosity provides compensatory control when a person’s personal control beliefs are undermined.
There are many studies which show that Intelligence also confers a sense of personal control. Higher intelligence is also associated with greater self-efficacy and a belief in one’s ability to achieve valued goals. This higher personal control, self-efficacy and belief in one’s ability reduces the need for the sense of control offered by religion.

Religiosity as self-regulation.

Studies show that religiosity promotes self-control and facilitates the completion of each and every component of the self regulation process including ‘goal setting, monitoring discrepancies between one’s present
state and one’s goals, and correcting behavior to make it more compatible with one’s goals’. There is some evidence that ‘religiosity is associated (albeit weakly) with positive outcomes, including well-being and academic achievement’.

Intelligence on the other hand is also associated with better self-regulation
and self-control abilities. The intelligent individuals opt for large delayed rewards instead of small immediate rewards, which reflects the intelligent person’s self control ability. There is also a negative correlation between intelligence and impulsiveness. The better self-regulation and/or self-control capabilities in intelligent individuals makes them less reliant on need for the self-regulatory function provided by religiosity.

Religiosity as self-enhancement.

Studies show that ‘people are motivated to self enhance’ and to see themselves favourably. Intrinsic religiosity is ‘positively related to self-enhancing responses although extrinsic religiosity is not’. Religious cultures ‘approve of being religious as an end in itself, which can turn
intrinsic religiosity into a source of self-worth’. Religious cultures however
‘disapprove, of using religion as a means to secular ends, which may explain the disassociation between extrinsic religiosity and self-enhancement’. Believers attain an elevation of their status by having a personal relationship with God.
Like religiosity, intelligence also can provide a sense of higher
self-worth. There is relation between intelligence and high scores on the general personality factors such ‘high self-esteem, emotional stability,
agreeableness, conscientiousness, and openness’, all of which are strong positive attributes. Intelligent individual who possess such attributes, will not need the self-enhancement function of religion.

Religiosity as attachment.

Religious beliefs provides an attachment to God whose omnipresence provides security and servers as refuge and safe haven in times of distress.
Religious people turn to God when they experience loss due to separation, death of loved ones, and other dire circumstances. People also extend to God the same attachment system that they have developed with close ones. Religiosity increases after bereavement and, is associated with less grief. There is also evidence that religiosity increases after people are exposed to threat of loneliness and a relationship with God reduces loneliness.
Intelligence also reduces loneliness but through its effects on marital relations. Evidence shows that intelligent people are more likely to get married and remain married. The prevalence of marriage in people with high IQ exceeds that in general population. It has been found that as intelligence increases the likelihood of marriage increases. Intelligent people generally tend to get married later in life as compared to less intelligent people. Studies also show a negative correlation between intelligence and likelihood of divorce.
Intelligent people are able to plan more effectively, act less impulsively and adapt to change more effectively and remained married. Hence if intelligent people can remained married they do not need religion to overcome loneliness.







References


  1. Merriam-Webster at https://www.merriam-webster.com/dictionary/stupidity. Accessed on 6/7/17.
  2. Walter B. Pitkin.1932. A short introduction to the history of human stupidity at https://ia801605.us.archive.org/8/items/in.ernet.dli.2015.218548/2015.218548.A-Short_text.pdf.
  3. Carlo M. Cipolla. The basic laws of human stupidity at https://archive.org/details/The_Basic_Laws_of_Human_Stupidity_by_Carlo_M._ Cipolla.
  4. Giancarlo Livraghi . 2009. The Power of Stupidity.
  5. Robert J. Sternberg. Why Smart People Can Be So Stupid. Yale University Press, 2002
  6. James F. Welles. Understanding Stupidity, 1986 at http://www.mensch.net/stupidity/story2/index2.htm.
  7. Cyril Northcote Parkinson.Parkinson’s law--the pursuit of progress’ . Published by John Murray London, 1958.
  8. Cyril Northcote Parkinson. The Law of Delay: Interviews and Outerviews. Ballantine Books (March 12, 1972)
  9. Cyril Northcote Parkinson. PARKINSON'S LAW AND OTHER STUDIES IN ADMINISTRATION. Houghton Mifflin Cornpony, Boston, Mass. 1957.
  10. Mats Alvesson and Andre Spicer. The Stupidity Paradox:The Power and Pitfalls of Functional Stupidity at Work. Profile Books. 2016.
  11. Mats Alvesson and André Spicer. A Stupidity-Based Theory of Organizations. Journal of Management Studies 49:7 November 2012 doi: 10.1111/j.1467-6486.2012.01072.x.
  12. Laurence J. Peter, Raymond Hull. The Peter Principle Why Things Always Go Wrong. 1969. Harper Collins.
  13. Gottfredson, L. S. (1997). Mainstream science on intelligence: An editorial with 52 signatories, history, and bibliography. Intelligence, 24, 13-23. doi:10.1016/S0160-2896(97)90011-8.
  14. Miron Zuckerman, Jordan Silberman, and Judith A. Hall. The Relation Between Intelligence and Religiosity: A Meta-Analysis and Some Proposed Explanations. Personality and Social Psychology Review. 2013;17(4): 325–354.
  15. Leuba, J. H. (1916). The belief in God and immortality: A psychological, anthropological, and statistical study. Boston, MA: Sherman, French.
  16. Larson, E. J., & Witham, L. (1998). Leading scientists still reject God. Nature, 394, 313. doi:10.1038/28478.





Cipolla’s banditry among medical professionals

                  Cipolla’s banditry among medical professionals

                                                             Dr. KS Dhillon




Introduction

Doctors are supposed to be intelligent people. Students with best grades at the end of high school are selected to enroll in medical schools. After 5 to 6 years at medical school, they undergo several years of Houseman and medical officer training before they can go into general practice. Those who get selected for postgraduate training spend another 4 years as postgraduate trainees. After getting the postgraduate diploma or degree the specialist spends several years horning the specialty skill. After more than about 15 to 20 years of training, a doctor becomes a consultant in his specialty, either in government or private sector.
This highly educated and skilled doctor is supposed to be very intelligent. The question is whether this assumption is true?

Types of human beings

Cipolla (1) a professor of economic history at the University of California at Berkeley, USA, believes that there are basically four types of human beings i.e ‘the helpless, the intelligent, the bandit and the stupid’. According to him an intelligent person’s action brings gain to both parties, a helpless person’s action brings loss to himself and gain for the other party. A bandit is a person whose action brings gain to himself and a loss for the other party and a stupid person is one whose action brings loss to other parties while bringing no benefit or causing loss to himself.
Most humans do not behave consistently all the time. They behave intelligently under certain circumstances and under different circumstances, the same person can be helpless. However, a stupid person, on the other hand, is perfectly consistent in his behavior all the time in every endeavor.
A bandit's actions are rational and predictable whereas those of a stupid person do not conform to the rules of rationality. A bandit wants to take away something for his gain which causes a loss to another person.
It is not possible to organize a defense against stupid behavior because the actions of a stupid person are unpredictable, erratic and irrational.
Cipolla believes that ‘non-stupid people always underestimate the damaging power of stupid individuals’ and that non-stupid people tend to forget that dealing with stupid people under any circumstance turns out to be a costly mistake. Often people believe that a stupid person will only harm himself but that is not true. Stupid people cause harm to society in general.
In which category does a doctor fall?

Conflicting and irrational behavior among medical professionals

In the last few decades, there has been an unprecedented interest, among doctors, in newer medications to treat diseases. This interest has been generated by the pharmaceutical industry and not by unprecedented new discoveries. There exists a widespread conflict of interest in the relationship between physicians and the pharmaceutical industry.
In 1999 Merck introduced a new Cox-2 inhibitor, Rofecoxib (Vioxx), as a safe and efficacious alternative to other non-steroidal anti-inflammatory drugs (NSAIDs) for treatment of osteoarthritis. Krumholz et al (2) were able to access Merck’s documents as a result of a tort ligation which showed startling conflicts of interest. In 1996-97, a Merck sponsored study revealed that Rofecoxib reduced urinary metabolites of prostacyclin in healthy individuals by half. Prostacyclin and its analogs are potent vasodilators and they possess antithrombotic activity. At the request of Merck, the authors altered the manuscript to say that ‘Cox-2 may play a role in the biosynthesis of prostacyclin’ instead of saying that the biosynthesis of prostacyclin synthesis was reduced by Rofecoxib (2). Despite the fact that Merck knew of the cardiovascular side effects of Rofecoxib, Merck in its new drug application to FDA in 1998, presented interventional studies that were ‘generally small, had short treatment periods, enrolled patients at low risk of cardiovascular disease, and did not have a standardised procedure to collect and adjudicate cardiovascular outcomes’ (2).
In January 1999, Merck launched its Vioxx gastrointestinal outcome research (VIGOR) study, involving over 8,000 patients to show its gastrointestinal (GI) safety compared to Naproxen in the treatment of rheumatoid arthritis. In this study, the first non-endpoint safety analysis of Vioxx showed a ‘79% greater risk of death or serious cardiovascular event’ in one treatment group compared with the other (2). Despite this finding, the safety monitoring board, which had some members on the board with conflicts of interest, allowed the study to continue till its GI endpoint. The study showed that Vioxx was not more effective than Naproxen in the treatment of Rheumatoid arthritis but the GI adverse effects were reduced by half. The outcome of the VIGOR trial was published in the New England Journal of Medicine in Nov 2000. The authors concluded that the incidence of myocardial infarction was lower in the Naproxen group but the rate of death from cardiovascular causes was the same in both groups (3). Only 5 years later, in Dec 2005, an editorial appeared in the same journal expressing concern, after more data was available from a tort litigation, that there were inaccuracies and deletions in the data regarding the cardiovascular risk of Vioxx, submitted to the journal in the original VIGOR manuscript (4). In fact, Mukherjee et al had in 2001 raised the ‘cautionary flag’ that the ‘annualised myocardial infarction rates for Cox-2 inhibitors (Vioxx and Celebrex) were significantly higher than that in the placebo group’ (5).



Merck, however, continued to investigate the use of Vioxx for other indications. In Feb 2000 the Adenomatous Polyp Prevention on Vioxx (APPROVe) trial began, to evaluate the reduction of risk of recurrent adenomatous colorectal polyps. It was a randomised, single blinded, placebo controlled trial. The study was terminated in September 2004, three months before the completion date because of increased incidence of myocardial infarcts and ischemic cardiovascular events (6). Five of the authors of this study were Merck employees and the remainder who received consultancy fee asserted that the increased risks of cardiovascular events were seen only after an 18 months period. Further analysis of the data after publication showed that a flawed methodological approach was the reason for this conclusion (3). In 2006, more than a year after the publication of the APPROVe study in 2005 in the New England Journal of Medicine, a correction was published in the same journal to remove the statement that the increased risk of cardiovascular was apparent only after 18 months (7).
There were glaring failures of the peer review process of the medical journals. Flaws, mistakes, and inaccuracies of Merck sponsored Vioxx publications escaped the peer review process of the New England Journal of Medicine which published both the VIGOR and the APPROVe studies. Articles favoring Vioxx, some of which were ghost written, appeared in several journals including the Annals of Internal Medicine and the journal Circulation (3). Conflicts of interest were obvious but there was little outrage among the academics in this Vioxx saga which was ‘bad news for the industry, academics, journals, and the public (3). In September 2004 Vioxx was withdrawn from the market while litigations and settlements between Merck and consumers were ongoing (8).
In fact, before the APPROVe trial began in early 2000, a Pfizer sponsored trial, the adenoma prevention with celecoxib (APC) trial had begun recruiting patients in November 1999. It was a large randomised controlled study to assess the effectiveness and safety of a Celecoxib 200 mg twice a day, Celecoxib 400 mg twice a day and placebo in reducing the incidence of colon and rectal polyps. After the findings of the APPROVe trial were known and the withdrawal of Vioxx in 2004, APC data and safety monitoring board, and the steering committee of APC requested a reassessment of data on cardiovascular safety by an independent committee. Based on the findings of the independent committee the use of Celecoxib in the remaining patients in the trial was stopped. The review of available data showed that there was a dose related increase in the risk of cardiovascular events including deaths from myocardial infarcts, stroke and heart failure in patients on Celecoxib (9).

How would Cipolla categorize such medical professionals involved in these studies and these publications and not to forget the peer reviewers of the leading medical journals in the world? Without a doubt, Cipolla would classify such medical professionals as bandits, who do things for personal gain and harm the poor patients who seek treatment, from the so called ‘highly educated and respected professionals’.

The most scandalous failure of the peer review process was the case of Scott Ruben, a Professor of Anesthesiology in Boston, USA. He allegedly published 21 fraudulent articles, based on fabricated data, in leading peer review journals, including Anesthesiology, Anaesthesia and Analgesia, and the Journal of Clinical Anaesthesia, among others, over a span of 13 years. The publications promoted the use of drugs such as Celebrex, Vioxx, Ketorolac, Oxycodone, and Pregabalin, mainly in patients undergoing orthopedic surgical procedures, while he had ties with the pharmaceutical industry (10). In Feb 2010 he pleaded guilty to one count of health care fraud and the US Attorney’s Office announced in June 2010, that Ruben was sentenced to 6 years in prison followed by 3 years supervised release and a $5,000 fine, restitution of $361,932 and forfeiture of $50,000 (11). This effectively ended his career as a doctor.
Such scandalous behavior can only be described as doltish or stupid. Surely it can not be described as intelligent behavior.

Gifts, free lunches, and the pharmaceutical industry


Something is amiss in our healthcare system, which is highlighted by a complex, controversial and maybe unhealthy pervasive interaction between doctors and the pharmaceutical industry. This relationship starts in the medical school and continues through postgraduate training and last the lifetime of a physician (12).
Moynihan has registered 15 forms of entanglement between the doctor and the pharmaceutical industry, ranging from trivial gifts (pens, pads), free meals, travel and accommodation expenses for ‘educational’ meetings, entertainment, trips, speaking honoraria, consultancy fee, and ghost writing of publications to name a few. Even medical journals and many medical societies interact and depend on corporate sponsorship (13). This entanglement between doctors and industry is very widespread. Studies show that 80 to 90% of the doctors around the world regularly meet drug representatives and studies have also shown that the prescribing behavior is influenced by gifts however trivial they are (13).These interactions lead to a greater use of newer more expensive drugs and less use of generics despite lack of evidence of the superiority of one over the other. It also leads to irrational and incautious prescribing behavior (12).  Continuing medical education (CME) tops the list of ways in which the pharmaceutical companies interact with the doctors. In the US, close to a billion dollars annually are spent by pharmaceutical companies on CME for doctors (12).
The Pharmaceutical companies claim that the cost of drugs is high because of the high cost of research and development (R&D). Such claims appear to be untenable. Large drug companies apparently spend between 15% to 17% of their income on R&D. The actual figures are not disclosed by the companies (14). However, after deduction of corporate tax, the actual cost for R&D should be lower. In the US, a major part of the initial research is done by academic centers, the government and other public and nonprofit organizations. The National Institute of Health (USA) in 1995 found that 16 of the 17 key scientific papers that lead to the discovery and development of the five top selling drugs were from outside the pharmaceutical industry (14). Most of the new drugs entering the market are modifications of older drugs which are already in the market (called the ‘me-too’ drugs) (14).
More money is spent by pharmaceutical industry on marketing than on R&D. Up to about 36% of the big pharmaceutical company’s budget is spent on marketing and distribution and this can be as much as 12 to 15 billion dollars annually according to some estimates (14). Here is where the expenses for the entanglement between doctors and industry come from. In the USA there were 88,000 sales representatives, according to a 2002 estimate, who were paid about 7 billion dollars a year to promote drugs directly to doctors in the hospitals. This raises a question as to whether doctors really need to be educated about the use of the drugs by these representatives when all the information is readily available on the web at the touch of a button. It is not so much about the information the doctor receives from sales representatives but it appears to be more about the gifts, free lunches and other inducements which influence doctors prescribing behavior. CME meetings are also a major platform used by the industry to advertise their products to doctors.
Intelligent individuals do not exhibit such prescribing behavior because such behavior brings benefit to the doctor but not the patient. Such behavior would probably fit the definition of a banditry.


 The influence of the industry does not end here but extends to other areas of medical practice. Doctors in their daily practice have to make clinical decisions about the most appropriate way to handle specific clinical circumstances based on valid scientific evidence and critical evaluation of the evidence. Such decisions can sometimes be difficult due to time constraints and the extensive volume of scientific literature available in a given field. Clinical practice guidelines can fill the void by providing the best available evidence, which will fulfill the needs of most doctors when they are faced with decisions about the most appropriate healthcare intervention.

Doctors and clinical guidelines


Clinical practice guidelines are ‘systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances’ (15). In clinical practice these guidelines ‘influence patient and physician decision about health care intervention…’, hence they should be based ‘on valid scientific evidence, critical assessment of that evidence and objective clinical judgment’ (1). Practice guidelines were first proposed by the Institute of Medicine in 1990 (16). Since then the number of clinical practice guidelines (CPGs) has grown rapidly. Currently, the US national guideline clearinghouse contains 2,564 individual guideline summaries on various topics (17). These guidelines have to be updated on a regular basis to remain relevant.
Clinical guidelines must be based on the highest level of evidence with the elimination of financial or other bias and they should not become a ‘marketing tool for device and pharmaceutical manufacturers’ (18). When the biomedical and pharmaceutical industry and medical experts with affiliations to the industry, are involved in the development of clinical practice guidelines there can be conflicts of interest which may not be in the best interest of the patients and the health care providers.
In 2011, Norris et al did a systematic review of conflict interest in clinical practice guidelines development to ‘describe the extent of conflict of interest (COI), both financial and intellectual, in clinical practice guidelines (CPGs) and to examine the effect of COI on recommendations within CPGs’ (19). Their review included studies where there was a prevalence of conflict of interest, industry relationships, funding, or sponsorship in CPGs or among guideline panel members and authors, or there was the effect of such conflicts on guideline recommendations. They were only able to identify 12 studies which met the criteria and this reflects the paucity of studies on this topic. However, their review found ‘a high prevalence of non-disclosure of COI among authors across a variety of clinical specialties’, and where there were disclosures a high percentage of CPG authors reported COI (19). The authors recommended that users of CPGs ‘need to critically appraise CPGs considered for implementation, read disclosures and consider how they may have influenced recommendations, and seek to move forward research on unanswered questions’.
Other studies have also found conflicts of interest in the development of clinical practice guidelines. Bindslev et al, in a study on conflicts of interest in the development of clinical practice guidelines, found that disclosures were rare and conflicts of interest were common (20). Choudhry et al in a survey of 192 authors of 44 CPGs found that there was considerable interaction between CPG authors and the pharmaceutical industry (21).
The development of clinical practice guidelines can be a very sensitive issue, especially when the guidelines are created by a reputable state agency. The US Congress in 1989 created the Agency for Healthcare Policy and Research (AHCPR) after John Wennberg’s research showed practice variation in the medical field and RAND studies showed a widespread inappropriate use of common surgical procedures. The AHCPR was tasked with research on the outcome and effectiveness of treatment. One of its tasks was to produce clinical practice guidelines based on ‘review and synthesis of available research, analysis of practice variations and patient outcomes’ (22). Such research was conducted by Patient Outcome Research Teams (PORTs). One of the reasons for the near demise of such a useful agency was the result of conclusions of the PORT on low back pain. The PORT on back pain concluded that there was no evidence to support spinal fusion surgery for low back pain and that such surgery was frequently associated with complication (22). The North American Spine Society attacked the literature review and initiated political lobby which resulted in ‘rechristening’ of AHCPR to the Agency for Healthcare Quality and Research (AHRQ) and the new agency withdrew from developing clinical practice guidelines (15).
Why do medical professionals participate in such deception? The answer appears to be a personal gain at the expense of others, which Cipolla describes as banditry.

Physician Prescription Behavior (PPB)


There is no doubt that the physician can do a lot of harm to the patient if his/her prescribing practices are influenced by the pharmaceutical industry. Waud (23) did not mince his word when he said " [f]rom the press, one can get an idea of what it costs to buy a judge or a senator - generally, thousands of dollars. But you can buy a physician for a pen or some pizza and beer for a departmental meeting."Colette DeJong et al (24) did a study to answer the following question: ‘Is the receipt of pharmaceutical industry-sponsored meals by physicians associated with their prescribing the promoted brand-name drug at higher rates to Medicare beneficiaries?’ They did a cross-sectional study of 279,669 physicians and found that ‘receipt of industry-sponsored meals was associated with an increased rate of prescribing the promoted brand-name medication to Medicare patients’. Ninety-five percent of payments were in the form of a meal with a mean value of less than $20. When more meals were received and the meals cost more than $20 there were relatively higher prescribing rates.
Ashley Wazana (25) did a literature search to identify ‘the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians’. He found that ‘physician-industry interactions appears to affect prescribing and professional behavior’. He also found that physician interactions with pharmaceutical representatives were generally endorsed. Meetings with pharmaceutical representatives are often associated with ‘requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice’. Continuing medical education (CME) sponsored by drug companies preferentially highlighted the sponsor's drug(s) compared with other CME which is not sponsored by drug companies. Higher rates of prescription of sponsor’s medications were associated with attending sponsored CME events and accepting funding for travel or lodging for educational symposia. Attendance at presentations given by pharmaceutical representative speakers at such symposia was also associated with nonrational prescribing (25).
In 2004 the pharmaceutical companies in the United States spent about US$57.5 billion, or 24.4% of their revenue, on promotion (26). Why would pharmaceutical spend so much of their budget on drug promotions if they can not get significant returns? Obviously, their promotions have a significant influence on medical professional's prescribing behavior. Why would doctors not prescribe what is good, safe and cheap for their patients?The answer appears to be a personal benefit which would come under Cipolla’s definition of a banditry. Why would medical professionals fall for such cheap rewards and why can they be bought for a ‘pen or some pizza and beer’ as Waud (23) succinctly put it. That would be due to stupidity.

Surgery and the medical device industry
There is a close relationship between the surgeons and the multi-billion dollar medical devices manufacturing industry. The physician-industry interaction has led to increasing conflicts of interest with diminishing scientific objectivity. New implants are being introduced into the market at a very rapid pace over the last few decades. The design and introduction of new implants into the market is the result of industry physician interaction which is often tainted with conflicts of interest. The new implants provide financial rewards for the industry and the surgeons involved, but unfortunately, the patient becomes the victim of these innovations. Many surgeons are swayed by industry sponsored opinion leaders who travel around the world as guest lecturers. Many of these implants are introduced into the market without adequate laboratory testing and clinical trials.
Despite excellent results with traditional hip replacements, new prostheses with fashionable design features and with theoretical superior performance continued to be launched into the market without extensive clinical testing.
Many hip and knee prosthesis introduced into the market have had early failures. The saga of metal on metal hips with a disastrous outcome is still fresh in many people's minds.Despite the previous failure of metal on metal prostheses and the known toxicity of metal ions that result from wear, new designs for metal on metal resurfacing hip continued.
A systematic review by Person et al (27) showed that in England and Wales, 24% of all hip replacement implants available to the surgeons have no evidence of their clinical effectiveness.
Not only for the hip and knee, newer implants are being introduced by device companies for the spine, and most other joints in the body, which are being aggressively promoted by doctors to their patients.
This symbiotic relationship between medical professional and the devices industry is necessary but when it is poorly regulated it causes tremendous harm to the patients. However, it brings a lot of financial benefits to the players on both sides at the expense of the patients. Such behavior among the medical professionals would be classified under the category of banditry. However, there are other doctors who will do irrational things such as using untested implants because their peers do it and they don’t ‘want be left behind’. This would be classed as doltish or stupid behavior.

Unnecessary invasive procedures and surgery

There are several definitions for unnecessary surgery. Stahel et al (28) have defined it as ‘any surgical intervention that is either not needed, not indicated, or not in the patient’s best interest when weighed against other available options, including conservative measures’. L L Leape (29) has defined an unnecessary operation as ‘one that is useless’, one that ‘does not benefit the patient’, one that ‘does not do what it purports to do, or at the most, carries benefits so small that they are outweighed by the costs in terms of risks, morbidity, disability, and pain’ and ‘the patient is not better off’.
One wonders why do surgeons do unnecessary invasive procedures and surgery. Two possibilities exist, one is that they do it out of ignorance and the other is that they do it deliberately. Those who do it deliberately are unscrupulous individuals who out of greed perform surgery on unsuspecting victims (29).
As far back as the 1950s, Dr. Paul Hawley, the Director of the American College of Surgeons (ACS), stated that “the public would be shocked if it knew the amount of unnecessary surgery performed (…)” (30). The growing numbers of unnecessary surgeries became a concern for the American Medical Association (AMA) which in 1976 called for a congressional hearing on unnecessary surgery. They claimed that there were “2.4 million unnecessary operations performed on Americans at a cost of $3.9 billion and that 11,900 patients had died from unneeded operations (…)”(31). That was 41 years ago, one wonders what the figures would be now.
Until now (2017) there appears to be no change in the behavior of doctors as far as unnecessary surgery is concerned. High quality multiple clinical trials show that spinal fusion for back pain does not improve long term outcome as compared to conservative treatment (32,33), yet the number of spinal fusions continues to rise dramatically in the USA (34).
Another good example is arthroscopic partial meniscectomy, one of the most commonly performed surgical procedures in the world (35). In the United States, about 700,000 arthroscopic partial meniscectomies are done every year despite the fact that high level (level I) evidence shows that this operation is no better than a sham operation (36). No operation should be considered as routine and safe considering the possibility of morbidity and mortality which can be associated with any surgery.
Pharmaceutical drugs undergo ‘strict’ scrutiny of testing for safety and feasibility in phased trials followed by prospective randomized controlled trials prior to approval by the Food and Drug Administration (FDA) (34). However, for surgical procedures, no such regulations exist.

A lot has been written in recent years about economic motivation for invasive procedures and surgeries. Physicians in private practice have been characterized as "income maximizers" (29). There is evidence that patients in fee for-service systems have more operations overall than those in prepaid plans and this has widely been accepted as evidence that economic motivation leads to increased provision of services including invasive procedure and unnecessary surgeries (29). Provision of a service is known to enhance income and it does influence a physician's decision. A rapid proliferation of endoscopic procedures in recent years suggests that this phenomenon is not confined to those who wield the scalpel alone (29).
In 1969, Lewis (37) showed a link between surgical utilization to the availability of both beds and surgeons. He came up with 'a medical variation of Parkinson's Law: patient admissions for surgery expand to fill beds, operating suites and surgeons' time". There are others who have found a strong relationship between bed supply alone and surgical utilization.
There was a landmark Study of Surgical Services in the United States in
1975 which reported an almost linear relationship between the number of
surgical specialists and the number of operations performed per 10,000
Population (38). A logical analysis will support the belief that an underemployed surgeon will create more work and hence more unnecessary procedures.
Cipolla would classify this senseless indulgence in unnecessary surgeries which is going on around the world for financial benefits as banditry.
Those who do unnecessary surgery out of ignorance should be classified as doltish or stupid. When there is groundbreaking research published we should not be ignorant about it.

The list of actions of medical professionals which reflects banditry and doltish behavior is long and it is difficult to provide a comprehensive list of such actions. More important than the list, is the question as to why such behavior exists among ‘intelligent’ professionals.



Why banditry among professionals?


‘Whoever loves money never has enough; whoever loves wealth is never satisfied with their income. This too is meaningless’. Ecclesiastes 5:10

The ancient Greek philosopher Aristotle, said that money cannot bring true happiness and fulfillment in life because it is only an ‘instrumental good’ i.e it is good only for what we can get (buy) with it. Nothing is wrong with the desire to have more money to meet our needs. What is bad is an excessive desire (greed)  for money.

Psychologist Harvey A. Kaplan defined greed as "the selfish desire
to acquire for the sake of acquisition without regard for others."(39). In other words, greed is a selfish desire for more than one needs or deserves. Others have defined it as an ‘excessive love or desire for money or any possession’.
There is a point up to which the pursuit of wealth and belongings is a normal, healthy behavior. Such pursuit of materialism to a degree is necessary to generate economic growth. It is okay to care about money and possessions, but caring too much about them is tantamount to greed.
 A greedy person, however, gets very attached to his things and his money and continues to desire more of the same in an excessive manner. Greed generates anxiety and restlessness when we long for some possession, and we hope that once we attain it, we will be at ease and be satisfied. However, that does not happen when we are greedy. We believe a bit more would be better and a vicious cycle is established. It is well known that a person suffering from greed is usually not satisfied by his acquisition, and he always wants more. Medical professionals often resort to performing unnecessary investigations, procedures, and surgeries as well as dishonest billing to increase their income, without regard for the erosion of professionalism that results. Greed becomes the precursor of banditry.


Human beings manifest materialism to different degrees, some people acquire just enough for creature comforts for personal satisfaction and do not harm others but there are others who are so obsessed with materialism that they become toxic and socially destructive.
Psychologists have, for some time now, recognized the existence of an increasingly visible and widely destructive phenomenon in the society which is created by a ‘passion for selfish gratification in the amassing of wealth, and the worship of money, through fraudulent and deceptive tactics’ (40).
Arthur Nikelly describes it as a "pleonexic personality disorder’ and he proposed the following criteria for the diagnosis of this disorder:
‘Lack of a sense of boundaries .... Increasing wealth becomes a race without a finish .... a morbid quest for money that defies the rules of reason .... Disregard of how financial transactions affect others .. . . lacks an
understanding of what is more essential in life. Judges self by possessions, not by accomplishments. Emotionally detached .... Inane competition to surpass adversaries’ (41).

We see more and more greed around us with the passage of time. But why? What are the triggers of personal greed? Several reasons have been postulated (42).

1. ‘Insecurity and Modeling of Materialism’

Many studies show that emotionally and/or financially insecure people turn to acquisitions as a solution to their insecurities. They develop what is known as "materialistic value orientation, or an MVO’. Growing up in ‘unfortunate social situations’ such as neglect in childhood by family, threats of death, and experiences of poverty can lead one to adapt by becoming more materialistic. In layman’s term, it can be summed up as ‘an unhappy childhood may produce a materialistic adult’. Cultures which over-value material acquisitions also have a great influence on making someone more materialistic.

2. Mental Disturbance

Preoccupation with the material acquisition is known to be associated with mental disorders in some individuals. Studies show that adolescents who are highly materialistic often have ‘depression and anxiety, conduct disorders, narcissism, drug use, and personality disorders’. They avoid friendship and intimate relationships and are usually less empathetic. They like to compete and are less cooperative. An element of insecurity in such people pushes them to be more materialistic so that they can prove they are successful.

3.Fear of Death

Money has now been labeled as a new ideology of immortality (43). There has been an increasing interest in the ‘purchase of luxuries under salience conditions’ (44). Mortality salience increases one’s expectations for more material wealth and also increases an individual's greed for money. Money and other possessions somehow help humans distance themselves from the realization that we are destined for death.  There is evidence which suggests a direct link between death anxiety and materialism. Material acquisitions seem to provide a sense of security against ‘existential insecurity and sense of mortality’ (45). We aspire to survive beyond our death by acquiring lots wealth and property which can be passed on to our heirs who continue to enjoy the wealth and possessions. In this sense, we continue to live after our demise. Those who are more fearful of death are more greedy and they have a greater desire to acquire more.

4.Fear of Loss

Fear of losing what one has acquired is another trigger for greed. This is closely related to fear of death. The desire to acquire more is a hedge against loss. This has been eloquently explained by Professor David Levine who said "greed expresses the fear of loss, and the effort to defend against it. The greedy person is constantly aware of the threat of loss, and because of this is driven to attempt to take from others lest they take from him first." (46).


Conclusion

Now to answer the question whether the highly educated and skilled doctor is intelligent or not. If intelligence is measured by one’s ability to find and solve problems or by the use of psychometric instruments such as I.Q. test, it is likely that many medical professionals will be classified as intelligent people. However, if Cipolla's classification of an intelligent person is used then many doctors will not make the mark to be labeled as intelligent. Cipolla’s definition of an intelligent person is one who, with his actions tends to create advantages for himself and also creates benefit for others.
However as we have seen in the foregoing discussion, many doctors cannot be classified as intelligent. They more likely fall under the category of bandits or in some circumstances under the category of stupid people.






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