community had been keener to question its misleading generalizations.
One evening in 1974, I was shopping for bread at a supermarket in a small
Swedish town when I suddenly discovered
a baby in a life-threatening
situation. In a stroller in the bread aisle. The mother had turned her back and
was busy deciding which loaf to buy. An untrained eye couldn’t see the
danger, but fresh out of medical school, I heard my alarm bells go off. I
restrained myself from running, to not scare the mother. Instead I walked over
to the stroller as quickly as I could and I lifted up the baby, who was asleep on
his back. I turned him over and put him down on his tummy. The little fellow
didn’t even wake up.
The mother turned toward me with a loaf in her hand, ready to attack. I
quickly explained to her that I was a physician
and I told her about the so-
called sudden infant death syndrome and the new public health advice to
parents: not to put sleeping babies on their backs due to the risk of suffocation
from vomiting. Now her baby was safe. The mother was both scared and
comforted. On trembling legs she continued her shopping. Proudly I
completed my own purchases, unaware of my huge mistake.
During the Second
World War and the Korean War, doctors and nurses
discovered that unconscious soldiers stretchered off the battlefields survived
more often if they were laid on their fronts rather than on their backs. On their
backs, they often suffocated on their own vomit. On their fronts, the vomit
could exit and their airways remained open.
This observation saved many
millions of lives, not just of soldiers. The “recovery position” has since
become a global best practice, taught in every first-aid course on the planet.
(The rescue workers saving lives after the 2015 earthquake in Nepal had all
learned it.)
But a new discovery can easily be generalized too far. In the 1960s, the
success of the recovery position inspired
new public health advice, against
most traditional practices, to put babies to sleep on their tummies. As if any
helpless person on their back needed
just
the same help.
The mental clumsiness of a generalization like this is often difficult to spot.
The chain of logic seems correct. When seemingly impregnable logic is
combined with good intentions, it becomes nearly
impossible to spot the
generalization error. Even though the data showed that sudden infant deaths
went up, not down, it wasn’t until 1985 that a group of pediatricians in Hong
Kong actually suggested that the prone position might be the cause. Even
then, doctors in Europe didn’t pay much attention. It took Swedish authorities
another seven years to accept their mistake and reverse the policy.
Unconscious soldiers were dying on their backs when they vomited. Sleeping
babies, unlike unconscious soldiers, have fully functioning reflexes and turn
to the side if they vomit while on their backs. But on their tummies, maybe
some babies are not yet strong enough to tilt their heavy heads to keep their
airways open. (The reason the prone position is
more dangerous is still not
fully understood.)
It’s difficult to see how the mother in the bread aisle could have realized I
was putting her baby at risk. She could have asked me for evidence. I would
have told her about the unconscious soldiers. She could have asked, “But dear
doctor, is that really a valid generalization? Isn’t a sleeping baby very
different from an unconscious soldier?” Even if she had put this to me, I
strongly doubt I would have been able to think it through.
With my own hands, over a decade or so, I turned many babies from back
to tummy to prevent suffocation and save lives. So did many other doctors
and parents throughout
Europe and the United States, until the advice was
finally reversed, 18 months after the Hong Kong study was published.
Thousands of babies died because of a sweeping generalization,
including
some during the months when the evidence was already available. Sweeping
generalizations can easily hide behind good intentions.
I can only hope that the baby in the bread aisle survived. And I can only
hope that people are willing to learn from this huge public health mistake in
modern times. We must all try hard not to generalize across incomparable
groups. We must all try hard to discover the hidden sweeping generalizations
in our logic. They are very difficult to discover. But when presented with new
evidence, we must always be ready to question our previous assumptions and
reevaluate and admit if we were wrong.
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