Richard Armitage is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on twitter: @drricharmitage
For thousands of years, thinkers and practitioners across various domains – from philosophy and psychology to theology and literature – have sought for an understanding of the concept of wisdom. In more recent times, especially since progress in machine learning capability, a corresponding search for a definition of intelligence has revealed various opinions on this widely used notion. Rather than striving for consensus on the meaning of these terms, I will try to shed light on their features by contrasting their differences, and argue that while our intelligence is accelerating rapidly, our wisdom is lagging with a much lower growth rate. The widening gulf that expands between these concepts – which I shall refer to as the intelligence-wisdom gap – is markedly evident across many domains of life. Concerningly, the existence and growth of this gap in medicine and healthcare poses enormous challenges to the success of our profession, and constitutes a problem – arguably the most pressing of all problems – that must be urgently addressed.
Intelligence and wisdom: working definitions
A wide variety of theories of intelligence have so far been proposed, which have collectively generated a large and substantially overlapping patchwork of major characteristics.1,2 ,3 These include features such as the ability to acquire knowledge and learn, to deploy abstract reasoning, logic and rationality, to build mental models, to solve problems in novel environments, to competently and efficiently complete the task at hand, and to maximise a production function with ruthless execution.
In a similar fashion, many characterisations of wisdom have been forwarded to date, including those from Aristotle,4 Plato,5 and René Descartes.6 Unlike intelligence, however, the concept of wisdom is largely concerned with the question of knowing how to, and succeed at, living well.7 In stark contrast to intelligence, which measures the extent to which goals can be optimally achieved, wisdom is concerned with which goals should be chosen. As a recognised virtue within virtue ethics theory,8 and a cardinal principle of Stoic normative ethics,9 wisdom openly recognises Hume’s is-ought problem – that an ought-judgement cannot be inferred from a set of ‘is’ premises, and that to do so would be to commit a fallacy of logic.10 In other words, while intelligence is occupied with questions of can, wisdom is concerned with questions of should.
In other words, while intelligence is occupied with questions of can, wisdom is concerned with questions of should
To further distinguish between these two concepts, consider entertainment as a contemporary example. The Netflix algorithm is highly competent at suggesting, with an alarming degree of accuracy, which movie you would be likely to enjoy watching next. The algorithm has nothing to say, however, on whether what you should do next is watch a movie, or on what other activities might be a better use of your time. As another example using widely adopted technology, Google maps provides its users with real-time updates and the fastest means of travelling from point A to point B. The app is unable, however, to suggest which destination should constitute point B, or whether making a journey is the best use of one’s time.
To summarise the differences between intelligence and wisdom: intelligence can be considered as being able to tick boxes, while wisdom is concerned with knowing of which boxes are worth ticking. The two may be correlated, but not inherently so, and may even be inversely related within particular individuals.
The intelligence-wisdom gap
While intelligence and wisdom are clearly distinct entities, there appears to be a gap in their relative magnitudes. This seems to be the case across a wide range of scales, and may be due to inherent differences in the potential for each entity to grow: while intelligence can propagate at exponential rates, wisdom seems to be destined to enjoy only linear, and also slow, advancements. An obvious example is the smartphone in your pocket, which contains orders of magnitude more memory and computational power than the guidance system that took Apollo 11 to the moon.11 The speed of this progress in technological competence (which falls firmly in the domain of humanity’s intelligence) is contrasted by the wisdom of our political leaders, who seem destined to repeat the same oversights and errors that previous generations of politicians made before them, and also choosing the same goals that led their predecessors to faulter. As such, while intelligence increases at astronomical rates, wisdom lags behinds to an embarrassing degree, and the gulf stretching between them becomes increasingly broad.
In an individual’s personal life, the intelligence-wisdom gap often plays out in its signature forms relating to place, career, and personal relationships. For example, a person may take a promotion and an attractive higher salary in a far-away city that takes them away from their home, but then long for the familiarity and sense of belonging that their hometown community can uniquely provide. A daughter whose parents are barristers and solicitors, and whose wider family members are also legally trained, may have the learning ability, communication skills, and analytical mindset to successfully apply to a high-ranking law school, but may only realise that she chose law for ill-considered reasons after completing her training and starting work in the profession. Childhood sweethearts may decide to marry young, only to realise shortly after that they deny each other’s independence. In the realm of personal lives, the fabled midlife crisis may be an inevitable outcome of the intelligence-wisdom gap on an individual level.12
The intelligence-wisdom gap is also recognisable on much larger, societal and civilizational scales, especially in the domain of technological advancements. All progress in science and digital technology is considered to be inherently and unquestioningly good, and progress is erroneously synonymised with that which must be implemented. The result is that new technologies are deployed indiscriminately and without careful prior analysis of what we do and do not want in the world. Yes, we can produce 50 megaton thermonuclear weapons, but should we? Yes, we can create unfathomably complex and risky financial instruments, but should we? Yes, we can insert gene drives into malaria-carrying mosquitoes and immediately release them into their natural environment, but should we? Yes, we can build a digital town square for millions of active users and allow voices to be promoted by their ability to stoke outrage, but should we? Yes, we can create social media apps that are so enormously addictive that our teenagers succumb to them over a hundred times per day, but should we? Edward O. Wilson’s warning that our “Paleolithic emotions, medieval institutions and godlike technology” will lead to disaster on catastrophic scales points to the inherent danger of an intelligence-wisdom gap that is already yawning and continuing to grow rapidly.
The intelligence-wisdom gap in medicine and healthcare
Doctors are widely considered to be intelligent professionals. Indeed, we are selected to the profession by our ability to signal intelligence: through the achievement of consistently good grades, the acquisition of adequate workplace experience, and the ability to comment on contemporary issues in healthcare, we demonstrate our aptitude for retaining knowledge, solving problems, and operating efficiently to produce standardised outcomes to a relatively high level. Creativity, entrepreneurship and innovative thinking, however, do not seem as highly-valued by medical school admission boards. The medical professional workforce therefore shares features of intelligence, but wisdom is a separate entity which is not necessarily correlated. As a result, doctors are highly talented at ticking all the boxes, but may not be so proficient at knowing which boxes are worth ticking.
For example, while we are able to deploy a hypertension guideline with accuracy and skill, we may be less adept at deciding which guideline is most appropriate to follow, at knowing when to deviate from this pre-determined strategy, and at asking why the patient presents to us with hypertension in the first place. While we swiftly incorporate novel technologies, pharmaceutic products, surgical procedures and even methods of consulting into the normative landscape of our everyday practice, we may be less skilled in knowing when doing so may not be in the best interests of our patients, communities and society as a whole. We may even point to cost-effectiveness analyses to vouch for the utility of our new interventions, but are less able to understand the limitations of these studies and the assumptions and trade-offs inherent to their designs. The Tavistock Clinic and gender affirmation in children offer a concrete and timely example: just because we can block puberty, administer cross-sex hormones, and surgical modify bodies with a variety of techniques, does this mean we should do so in children with gender dysphoria without carefully considering other diagnoses beforehand? The Cass Review interim report suggests the Clinic was not wise in doing so.13
Just as it is difficult to get a man to understand something when his salary depends upon his not understanding it, we are rewarded for our intelligence, while wisdom is less evidently in the ‘commercial’ interest of our profession.
While doctors are able to prescribe pre-determined healthcare in a highly efficient manner, we might be less able to question whether this is the type of healthcare that we ought to be providing, whether healthcare – especially more healthcare – even constitutes the best solution to the problem at hand, and whether we may, albeit unintentionally, be doing patients a disservice by delivering care in this way. This may, at least in part, reflect the central conflict of interest at the heart of the medical profession – that sickness must continue for our skillsets to be needed. Just as it is difficult to get a man to understand something when his salary depends upon his not understanding it, we are rewarded for our intelligence, while wisdom is less evidently in the ‘commercial’ interest of our profession.
What to do?
If our genuine intention is to improve the health of patients, we must be wary of the gap between our intelligence and wisdom. While progress is desirable when improvements are truly possible, we must learn to accurately distinguish between reality and wishful thinking. A definite way to do this is to become skilled in critical appraisal – of both empirical research that is presented as ‘evidence,’ and policy propositions that impact populations. Another strengthening principle is to observe for Chesterton’s fences and to resist their dismantling before their utility is understood. Similarly, the Precautionary Principle should always be invoked until sufficient evidence has been accumulated to render it no longer necessary. Finally, we should become more epistemically humble in the confidence of our predictions – such as the ability of an intervention to improve quality of lives – by stating the likelihood of the outcome to a particular percentage, which will improve our ability to forecast to a useful degree of accuracy (for example, outcomes that we consider to be 70% probable should, if we are well calibrated and reliable forecasters, happen 70% of the time).
Due to the accelerating power of our technological arsenal, and the contrasting stasis of our professional wisdom, the intelligence-wisdom gap is expanding at a blistering pace. With formidable technologies on the scientific horizon – nanotechnology, CRISPR, and general-purpose AI – the necessity to close this gap is becoming increasingly urgent. Beyond the income gap, wealth gap, and even the growing health gap, this is arguably the key challenge to determine the success of our profession.
Deputy Editor’s note: If you enjoyed this article, consider reviewing the A-Z of medical philosophy series by David Misselbrook in the BJGP. Of relevance here is the article on Phronesis (practical wisdom).
- S Legg and M Hutter, ‘A Collection of Definitions of Intelligence’ in Advances in Artificial General Intelligence: Concepts, Architectures and Algorithms (eds. B Goertzel and P Wang), IOS Press 2007
- RJ Sternberg, SB Kaufman, eds. Cambridge Handbook of Intelligence. New York, NY: Cambridge University Press; 2011
- J Piaget. The Psychology of Intelligence. London: Routledge; 1st ed; 1950
- Aristotle. Nicomachean Ethics. C Rowe (trans.), Oxford: Oxford University Press; 2002.
- Plato. The Republic. HDP Lee (trans.), Penguin Classics; 3rd ed; 2007
- 6 R Descarte. Principles of Philosophy. RP Miller (trans.), Springer; 1982.
- S Ryan. ‘Wisdom’ in Stanford Encyclopedia of Philosophy. 04 February 2013. https://plato.stanford.edu/entries/wisdom/[accessed 24 October 2022]
- R Hursthouse and G Pettigrove. ‘Virtue ethics’ in Stanford Encyclopedia of Philosophy. 11 October 2022. https://plato.stanford.edu/entries/ethics-virtue/ [accessed 24 October 2022]
- D Baltzly. ‘Stoicism’ in Stanford Encyclopedia of Philosophy. 10 April 2018. https://plato.stanford.edu/entries/stoicism/[accessed 24 October 2022]
- R Cohon. ‘Hume’s Moral Philosophy’ in Stanford Encyclopedia of Philosophy. 20 August 2018. https://plato.stanford.edu/entries/hume-moral/ [accessed 24 October 2022]
- G Kendall. Your Mobile Phone vs. Apollo 11’s Guidance Computer. Real Clear Science 02 July 2019. https://www.realclearscience.com/articles/2019/07/02/your_mobile_phone_vs_apollo_11s_guidance_computer_111026.html[accessed 24 October 2022]
- K Setiya. Midlife: A Philosophical Guide. Princeton University Press, 2017.
- The Cass Review. Interim Report. February 2022. https://cass.independent-review.uk/publications/interim-report/ [accessed 24 October 2022]