Three’s Company, Ten’s a Crowd

Under the right circumstances, groups are remarkably intelligent, and are often smarter than the smartest people in them. —James Surowiecki, The Wisdom of Crowds

More Undoctored Wisdom:

Let’s take that further: “Groups are remarkably intelligent, and are often smarter than the smartest people in them” . . . including doctors.

Mass panic, stampedes, shoppers trampled on Black Friday—crowds in a panic or seized by anger or greed can be frightening. But what about crowds quietly contemplating a question, each individual applying his or her unique insight and experience? Can we obtain answers by harnessing the collective wisdom of crowds?

It’s not an entirely new concept. A rudimentary form of crowd wisdom is already part of the legal system that assembles courtroom juries of a dozen peers. We also see crowd wisdom playing out in online sites that, for instance, allow crowds of people to rate hotels, restaurants, or movies.

Would you bother seeing a movie rated 7 percent by Rotten Tomatoes? Collect diverse insights and experiences of groups of people, all weighing in on the same question (putting aside polarizing social issues such as those in politics), and something wonderful happens: We obtain answers that, in many cases, exceed the accuracy of answers provided by individual experts—the wisdom of crowds, or collective intelligence. While the accuracy of answers improves with groups as small as three participants, groups of 10 dramatically improve accuracy, with additional improvements as crowds grow to the hundreds or thousands. The more the crowd allows each participant to express views, the greater the accuracy. And accuracy is also largely independent of the individual intelligence of the participants; smarter groups do not always provide smarter answers.

Mr. Surowiecki recounts the story of the West of England Fat Stock and Poultry Exhibition of 1906 in which a contest to guess the weight of an ox was conducted. This was observed with interest by famous British scientist Francis Galton, cousin of Charles Darwin. Galton gathered the 800 written votes cast, expecting to demonstrate how terribly inaccurate the guesses were. While few participants individually guessed anywhere near the correct weight, when he averaged all the guesses, to his great surprise, he found that the group as a whole guessed that the ox weighed 1,197 pounds, a pound off from the real weight of 1,198 pounds. A mix of people, some uninformed and unsophisticated, collectively guessed darned close to the to the exact right answer, more accurate than guesses offered by ox experts.

Do we really always need experts to answer our questions for us? In the case of health care, what if the “experts” are often not really experts anyway but dispensers of outdated ideas, limited by individual abilities, reliant on flawed information sources, swayed by conflicting interests?

The online program PatientsLikeMe is a pioneer in health tracking and health empowerment. The first clinical effort to explore whether lithium carbonate was effective for treating Lou Gehrig’s disease, or amyotrophic lateral sclerosis (ALS ), as limited preliminary evidence suggested, did not come from a deep-pocketed drug company. It came from 150 people with ALS who collaborated through the PatientsLikeMe online site, took the recommended dose of the drug, and then tracked their experiences using an ALS symptom rating scale. They demonstrated that the drug did not have any effect on the progression of ALS symptoms, a finding later corroborated by four conventional clinical trials—formal scientific methods proved the crowdsourced answer correct.

Imagine what we might achieve as we expand and apply such crowd-powered efforts to other questions in health, all facilitated in unprecedented ways by new information tools.

Can we discover answers to individual health questions through group interaction?

Can we derive answers that exceed the quality of answers provided by experts?

I believe the answer to these questions is yes, and it returns control over many aspects of health back into individual hands and frees us from the limited wisdom of the sole practitioner. I continue this discussion in Undoctored the book and Undoctored Inner Circle.