Islon Woolf MD
Intelligence vs critical thinking; how to choose your medical experts
Updated: May 27, 2022
In this email I will be showing you the difference between intelligence and critical thinking, and how to identify these traits in the experts you use. This is essential to determine, so you know what to expect from them. Experts with intelligence tend to be good at generating and defending new ideas, but are often wrong. While experts with critical thinking tend to be good at distinguishing which ideas are likely to be true, but are limited and mundane in their recommendations. As long as you know what to expect, you can find value in both.
Intelligence and critical thinking defined
Although intelligence and critical thinking, at first glance, seem to be describing the same trait, they are two very different traits indeed. Granted both are difficult to precisely define, I am nonetheless going to explain their core properties and differences.
Intelligence is primarily a collection of cognitive skills. Skills such as: memory, learning, processing speed, creativity, attention, language, and pattern recognition. The products of intelligence are new ideas, which lead to beliefs.
Critical thinking, on the other hand, is primarily a virtue. A self-monitoring process that attempts to unbias ourselves from pre-existing beliefs. It leverages flexibility, humility, and honesty to prioritize truth over ideology, and truth over our need to be right. It teaches us to weigh the entirety of evidence, even the evidence against our beliefs. The products of critical thinking are beliefs that are more likely to be true.
In summary, intelligence is a skill to help us form new beliefs, whereas critical thinking is a virtue to helps us determine if the beliefs are true. Because these are two very different kinds of traits, it is possible to possess one, and not the other, or any combination of both.
Intelligence is a skill to help us form new beliefs, whereas critical thinking is a virtue to helps us determine if the beliefs are true.
The high-intellect/low-critical thinking phenotype generates weird beliefs
Of the combinations of intelligence and critical thinking, people who possess high intelligence and low critical thinking are the most interesting and the most conspicuous. I call this combination the high-intellect/low-critical thinking phenotype. These are the “smart people” you know, that believe “weird things”. (You probably have discovered you knew more of them than you realized during the pandemic.) They are the ones who make confident claims that sound too good - or too bad - to be true; like this claim from functional medicine guru Mark Hyman, “70% of all cancers are caused by sugar”.
Let me explain how these intelligent people end up believing weird things. People start out with a claim, such as, “70% of all cancers are caused by sugar”, “The earth is flat”, “Evolution is wrong”, or “Vaccines cause autism”. Maybe they heard it from a trusted source, or maybe they have an intuition that it is true? If they possess critical thinking, they immediately begin to self-monitor. They examine the evidence fairly, both for and against the claim, and reserve judgement until the process is complete.
Those without critical thinking, however, will allow ideology, emotion, or other conflicts of interest to bring them to a premature conclusion. They believe first, and then work backwards to prove they were right. They do this by collecting evidence in such a way as to ensure the conclusion. They will use any means necessary, even resorting to conspiracy theory or metaphysics, as long as it can support their belief. This is known as confirmation bias; the evidence in favor of the belief is sought out and lauded, while the evidence against the belief is ignored and criticized.
The more intelligent the person, the better they are at confirmation bias. Case in point, I challenge you to conjure up more than one technical reason why the earth is flat, or why evolution is wrong. It is hard! It requires a deep understanding of physics and biology, the ability to see subtle details and patterns, and a very creative mind. I couldn’t defend these points myself, I’m not intelligent enough. Intelligent people are just better at justifying beliefs they wanted to believe in the first place. Without the mental policing of critical thinking, highly intelligent people can convince themselves of just about anything. Therefore, weird beliefs are not defects of intelligence, they are the products of intelligence, and defects of critical thinking.
Weird beliefs are not defects of intelligence, they are the products of intelligence, and defects of critical thinking.
Doctor Oz is the poster-child for this phenotype. When he started pushing dubious weight loss supplements, practicing energy healing in surgery, and bringing faith-healers and medical mediums on his famous TV show, people started asking, “How could such a smart guy, a professor of heart surgery at Columbia, believe such weird things?” The answer: he has no critical thinking. You may think I am in danger of committing libel, or being unkind, but Doctor Oz has publicly admitted he does not believe in critical thinking. According to him, in medicine, everything is true. As he puts it, “It’s my fact versus your fact”.
The high-intellect/low-critical thinking phenotype is common in social media
The high-intellect/low-critical thinking phenotype, like Dr Oz, is over-represented in social media. In fact, I would guess, judging from their content, that the majority of popular social media health experts are this kind of thinker. These are the health "influencers" with podcasts, TV shows, books, and millions of subscribers, like: Mark Hyman, Deepak Chopra, Tony Robbins, Joseph Mercola, Eric Berg, Michael Greger, Peter Attia, and David Sinclair, to name a few.
Apart from the indisputable charm and excellent communications skills of the above mentioned, let me explain why social media favors this kind of thinking. First, their high intelligence affords them the ability to rapidly generate, process, and communicate new ideas in medicine. This is the currency of social media. “This diet will cure cancer”, “This supplement will make you live longer”. The kinds of claims clickbait dreams are made of. However, in reality, the claims are based on small amounts of weak, cherry-picked evidence.
Their high intelligence affords them the ability to rapidly generate, process, and communicate new ideas in medicine. This is the currency of social media.
Second, the humility and critical thinking that would normally kick-in and prevent most of us from moving forward with claims based on weak evidence, is missing. Instead, their intelligence and communication skills are leveraged to further convince themselves and their audience that their claims are based on strong evidence.
Social media not only favors this kind of thinking, but actually plays a part in reinforcing it. It is often the case that many health influencers start out with relatively conservative claims, and get more speculative and “weird” with time. This phenomenon occurs because a larger audience makes them desperate to produce new content, and at the same time, gives them more self-confidence. They must be right because they have so many followers.
However, they are ultimately engaging in a game of self-deception. The way to truly gain confidence in science is to convince your peers and other experts in the field. Instead, they gain confidence by bypassing their peers, and convincing non-experts on social media. In reality, most of their audience is already primed to accept any idea they have to offer. This is because social media algorithms have preselected and directed people with similar ideologies; such as: “Big business (Pharma) is bad”, “Big government (CDC or FDA) is bad”, or “We are being oppressed by the powers that be (scientists).
The high-intellect/low-critical thinking phenotype is common in medical research
The field of medicine requires a diversity of minds to make progress. Even the high-intellect/low-critical thinking phenotype, which is likely responsible for the lion‘s share of misinformation on social media, can be useful in medical research. They are not only excellent at generating new ideas, they possess the tenacity and confidence to pursue these ideas despite a low likelihood of success.
The unfortunate truth behind medical research is that our discovery rate is exceptionally low. For example, only one percent of Big Pharma's most promising drug candidates turn out to be safe and effective. And these are our BEST ideas. The ones big Pharma is willing to gamble hundreds of billions of dollars. Any individual with a new idea has a very low likelihood of success in medicine. Medical research makes progress, instead, as a whole. It sacrifices thousands of losers to produce a single winner. The losers get nothing for trying, and the winner takes it all. Knowing these rules and the odds, most of us would be justified in quitting right out of the gate; those of us with critical thinking that is.
Consequently, medical research relies on the high-intellect/low-critical thinking phenotype. It relies on their blind faith in weak ideas, and their tenacity to carry them out despite low likelihoods of success. Medical research has a robust population of these kinds of thinkers, and many of our past discoveries are fueled by them. For example, against medical dogma in the 1980’s, Nobel laureate Barry Marshall (pictured below) speculated that stomach ulcers were caused by the bacteria H. Pylori, and not stress. He tirelessly worked on this for decades and actually drank a vial of the bacteria himself to prove his point. It turns out he was right.
However, for every Barry Marshall, there are a thousand equally intelligent scientists from the eighties that you have never heard of. Why? Because they were wrong; and if we went back to the eighties in a time machine, neither you nor I, would be able to tell who was going to be right. An analogy can be drawn to start-ups in business. For every Amazon, there was a thousand failed startups. Could you tell in the nineties that Amazon was going to rise above all the other internet start-ups?
Many of the past discoveries in medicine were fueled by the blind faith and shear persistence of overconfident doctors with weak ideas.
Furthermore, just because a scientist speculated once and was correct, it does not make the rest of their speculations correct. The likelihood that Barry Marshall will be correct about a speculation outside of H. Pylori is about the same as his peers - very low. Lightening rarely strikes twice. In fact, countless Nobel prize winners have made very weird and shockingly stupid claims outside of their one brilliant idea.
A pragmatic approach for selecting experts in medicine
With the above in mind, when choosing an expert, it is essential that you determine what kind of thinker you are dealing with. Especially if your goals are to be self-empowered to make health decisions. Be aware that the high-intellect/low-critical thinking phenotype is common, both in social media, and in medical research. If you are having a hard time determining what kind of thinker you are dealing with, please ask me. I would be more then happy to help you out. In my opinion, this is one of the core functions of good primary care.
Once you have determined what kind of thinker you are dealing with, you can match their degree of speculation to your degree of tolerance of speculation. For example, some of you may not want to speculate with your health. This is a reasonable decision considering the dismal success rate of speculation in medicine. If this is the case, you should probably stay away from the high-intellect/low-critical thinking phenotypes and stick with the critical thinkers. But be aware, critical thinkers are hard to find, and the number of truths currently in medicine are small, so their recommendations will be limited and mundane.
Some of you, on the other hand, may want to speculate, regardless of the low rates of success. For example, maybe you are a biohacker, maybe you have an incurable condition, or maybe you just enjoy hearing new medical ideas like myself. If this is the case, find an expert with the high-intellect/low-critical thinking phenotype, and explore their ideas. Just be aware that the likelihood of success will be exceptionally low, regardless of how confident they are about their ideas. Furthermore, if you give all of the speculators in medicine a chance, your options will be too numerous to count. The number of untruths and weak ideas in medicine far outnumber the truths. For instance, there are about 80,000 supplements in the US, each one of them claims to work. Combined with the fact that many of these claims will contradict each other, it will make it hard, if not impossible, to know which to choose. Finally, almost nothing in medicine comes without the potential for harm; especially if we include opportunity costs. As they say, “There is no such thing as a free lunch”, and this certainly applies to health.
If you give all of the speculators in medicine a chance, your options will be too numerous to count. Combined with the fact that many of these claims will contradict each other, it will make it hard, if not impossible, to decide which to choose.