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Problems with career pyramids
  1. Philip D Welsby
  1. Edinburgh, UK
  1. Correspondence to Dr Philip D Welsby; philipwelsby{at}

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There are four problems with career pyramids. First, those ascending within career pyramids are often too involved and committed to their pyramid to challenge its conventional wisdom. Second, although in theory everyone pays lip service to freedom of expression in practice independent thought is supressed because it may undermine the pyramid, especially if exhibited at the base of the pyramid which is where whistle blowers are often to be found. Even some experts higher within such pyramids will find they are side-lined or ejected if they challenge conventional wisdom. Third, some achieve high pyramidal levels by virtue of high IQs and highly retentive ‘filing cabinet’ type memories and often did not need to have developed the flexibility and imagination required to ‘think outside the pyramid’ and this can lead to stagnation. In any event attempts to influence the conventional wisdom pyramid structures tend to be ignored or dismissed and awkward people with ideas outside the pyramid are not likely to progress1 despite George Bernard Shaw warning that ‘The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man’. Fourth, the originator of the term conventional wisdom (John Kenneth Galbraith) noted that the conventional wisdom ‘accommodates itself, not to the world that it is meant to interpret but to the audience’s view of the world.2

Intellectual pyramids are associated with physical career pyramids: those at the top tend to be opinion leaders who hand down conventional wisdom to those lower in the intellectual structures. Medical conventional wisdom mostly derives from clinically based trials, meta-analyses and guidelines. However trials may be flawed.1 Particularly suspect trials that report observational results as gospel truth, report associations that may or may not be causal, use …

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  • Contributors I am sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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