Not every anchor's safe

My friend Fabio, from Italy, tells me an interesting story.

For many years, his father, as well as being physically unwell, suffered some mental ill health. So Fabio took him to one of the best neurological departments in Italy.

“One of the best?” he corrects me. “It’s in the main teaching hospital in Italy’s most advanced city, Milan. It’s not one of the best. It’s the best.”

That may be right. And if it really is Italy’s best neurology department, then what happened is still more striking. And worrying.

“It all went wrong,” Fabio explained, “when they took his family history. They discovered that his sister had died of myopathy. That was it. They knew that must be the problem with him too. Same genes, same disease.”

“But,” I wondered, “wouldn’t a test confirm or undermine that diagnosis?”

“For years – years and years – they did test after test. None of them showed any indication of myopathy. But they’d had the idea and they weren’t going to change it.”

That lasted until Fabio’s Dad had to be hospitalised in another city. Where they decided an MRI scan might be useful, something that had never occurred to the Milan neurologists, because it wouldn’t have been relevant to myopathy. 

What did the scan show? Wait for it. Imagine a drum roll. Fabio’s Dad wasn’t suffering from myopathy all. The problems was hydrocephalus. That’s a build-up of fluid in the skull putting the brain under pressure. 

Italy’s best neurologists had missed that.

That reminds of the old saying that the difference between God and doctors is that God doesn’t think he’s a doctor.

Neurologists: not to be confused with gods

However, there’s something more fundamental at stake here, as Fabio, who collects examples of bias like a connoisseur, patiently explained to me.

“What misled the neurologists is what’s known as the anchoring bias.”

Now bias is a concept with which we’re all familiar, in the everyday sense of a prejudice, usually based on self-interest.

My mother only ever told me one joke. It was about a medical student at the prestigious London medical school of St Bartholomew’s, generally known as Barts. He was a good footballer, and the peak of his sporting career came when he turned out for Barts against their great rivals from King’s College Hospital Medical School, in a crucial match, the final of a cup competition.

In the dying moments of the game, with the scores tied, King’s gave away a penalty. Our young man stepped forward to take it. He placed the ball on the spot, stepped back, eyed the goal and the keeper, and then ran up and drove the ball with stunning precision, straight past the keeper, into the top left corner of the net.

He’d given Barts the victory!

Sadly, however, his pleasure in the win was tempered by a doubt that, just before he struck the ball, it had rolled off the spot. It was a doubt that would haunt him right through his life. A blameless life, otherwise, that of a fine General Practitioner and family man.

Eventually, he died to the great grief of his family and friends, and turned up moments later at the pearly gates. There he was received, as you’d expect, by a tall figure in a long white robe and with an equally long and equally white beard.

“Come in, come in, my son,” said the saint, “it’s a pleasure to welcome into heaven a man who so manifestly deserves it.”

But the doctor hesitated.

“I have a problem on my conscience,” he admitted. “Years back, I took a penalty in a match against King’s, and to this day I’ve never been sure whether the ball didn’t roll off the spot before I scored the goal and won the match.”

“Nonsense,” says the saint, “it was an excellent strike and a wonderful win. Well deserved. Beautifully played.”

The doctor sighs with relief.

“Ah, you don’t know what a weight you’ve lifted off my mind. I'm so grateful to you, St Peter.”

“St Peter?” comes the reply, “I’m not St Peter. I’m St Bartholomew.”

Now that’s bias in the everyday sense of the word. But there’s another more technical sense. That’s an obstacle to reasoning which leads to conclusions against logic. The anchoring bias is one such (confirmation bias, where someone only sees evidence that seems to confirm their own view, and simply dismisses any that suggests the opposite, is another and even more common one).

Anchoring occurs, say, when you go out to buy something on which you’re prepared to spend a certain amount of money. Let’s call that sum 100. You see something which really attracts you, but it costs 200. You reject it as too expensive. But then you see something else for 150 and you decide that you could afford to buy it instead. You feel that way even though it’s still way above your original budget

That’s anchoring. The figure 200 has shaped your thinking, setting a new benchmark for you to assess prices against. That reasoning makes 150 sound OK to you. Your initial decision to stick to 100 gets lost in the process. 

Isn’t that what happened to those fine neurologists? They might have checked for a number of conditions, carried out a wide range of tests. But then they heard of the myopathy. That in effect took control of their thinking. Everything they did afterwards was guided by that first idea. Their reasoning was trapped, as it were, inside the myopathy rails and nothing could budge it.

It happens a lot more often than one might imagine. 

It happened in Britain, when the Brexit campaign announced that leaving the EU would save £350 million a week to invest in the National Health Service. The claim was entirely untrue, as has become bitterly clear since Brexit, but the lie became the anchor point of debates on Brexit. There were savings to be had. Brexit would make Britain richer. The premise was false but it framed the debate.

The same thing happened in the US, with Trump’s claim that the 2020 election had been stolen from him. It’s as false as the claims about Brexit or the myopathy diagnosis for Fabio’s Dad. But it too set the terms for the debate, making it an argument about individual accusations of electoral irregularities, not about the disgraceful behaviour of Trump in refusing to concede.

Why, it seems it may be about to happen in Italy itself. Giorgia Meloni is the leader of the hard right Brothers of Italy movement, now leading the polls for a snap election due in September. She too has been framing the debate. Appearing at a congress of the far-right Spanish party Vox, she declared in a splendidly Trumpian way, “Yes to the natural family! No to LGBT lobbies!” 

Russia using force to impose its will on other nations? The globe relentlessly heating? A pandemic which may turn out to be only the first of a series? No, none of that matters. What’s at the core of our problems is that abortion is freely available and some of us believe that LGBTQ+ people have the same rights as anyone else. And, of course, in Meloni’s world view, there are too many immigrants. She wants to frame a debate towards those non-problems and duck the real ones.

The trouble with bias is that, as with alcoholism, to solve the problem you have to start by admitting you have one in the first place. We all have our biases – I do, Fabio does, you do. And we can pay a serious price for them if we don’t arm ourselves against them.

The world’s still paying for Trumpism. It infected Britain through Johnson. It looks set to infect Italy through Meloni. Such infections can become deadly serious if they’re not treated.

As Fabio’s Dad’s case shows.