The Smartest Guy in the Room is First to the Grave

Why geniuses die like idiots

Scott Adams, beloved Dilbert cartoonist has joined Steve Jobs, beloved founder of Apple in slipping from this mortal coil… into genius-bar purgatory: an afterlife reserved for guys who bet their lives (and lost) on the belief that they knew more about medicine than actual experts.

Their journey was neither uplifting nor gentle. It was a meat grinder of suffering that could have been avoided as easily as not stepping in dogshit on the sidewalk while every credible expert on canine excrement and walking on sidewalks was simultaneously screaming:

“HEY! WATCH OUT! THERE’S DOGSHIT ON THE SIDEWALK IN FRONT OF YOU! GO AROUND, OR STEP OVER IT… OR MAYBE JUST STOP WALKING FOR A SECOND!”

It’s a uniquely American brand of ignorance to eschew the advice of experts. Many imagine that the strength of their intuitive convictions outweighs the weight of expert consensus and the massive body of evidence that makes expertise possible.

So they unflinchingly step in that steaming, corn-speckled pile of shit with pride and unshaken confidence, only occasionally coming to their senses when they realize that pile of shit was a treatable disease like cancer or HIV. Such was the case for Mr. Adams, as it has been for so many stars before him.

Why do people with gifts of intelligence, privileged education, and comfortable finances choose to die a preventable death filled with pain and a side of last minute regret -memorable to the survivors only for its exceptional stupidity?

Disinformation, tribalism, and vanity.

Wasn’t Dilbert all about calling this out? Unquestionably.

Dilbert specifically elevated the fact that technical expertise is routinely ignored in favor of intuition, charisma, or hierarchy within a broken system of management. And while I won’t say that healthcare isn’t one of those broken systems, medical expertise is routinely ignored in favor of the intuition and vanity of non-experts: from soccer moms and gym bros all the way up through heads of state.

I loved Dilbert. I never worked in a cubicle, but I worked at several monolithic corporate health centers, and his scathingly accurate satire of being imprisoned within a perpetually broken bureaucracy was never lost on me. Mr. Adam’s comic strip was pure genius -the only one to briefly dethrone my Far Side calendar.

I wasn’t alone in my admiration. Dilbert was syndicated in over 2,000 newspapers across 70 countries, translated into 25 languages to be enjoyed by 30-40 million readers at its peak in the 90’s. Adams wasn’t just a cartoonist, he had deep understanding of corporate life, and leveraged it to make millions of folks chuckle knowingly. That takes real intelligence.

The smartest guy in the room isn’t the smartest guy in the world, and the smartest guy in the world still doesn’t know it all.

The world is bigger than any of us, no matter how exceptional.

• Albert Einstein couldn’t box or perform surgery.

• Jonas Salk couldn’t dunk or design a city electrical grid.

• Elon Musk isn’t fluent in any language other than English, and doesn’t understand basic pulmonary physiology or the laws of cause and effect (kind of terrifying for a guy who helps run a medical device company).

This relationship is endlessly true: find me a brilliant individual, and I will find an area in which they are ignorant. This human condition isn’t contested by most of us, but those who are exceptional in a very narrow area of knowledge can often convince themselves that the intellectual success they have found in one domain can be extrapolated to all others -especially medicine.

Scott Adams was seduced by his own intellect into believing that he knew more about his own cancer than oncologists. His story of being too smart for medicine didn’t begin with the prostate cancer that killed him, it began during the pandemic, where he fiercely latched on to covid contrarianism.

Adams loudly promoted disinformation about covid, its treatment, and its prevention. In 2023 Adams shared on his podcast:

“The anti-vaxxers clearly are the winners at this point, and… they came out the best.” (After recovering from covid) “now you’ve got natural immunity and you’ve got no vaccination in you. Can we all agree that that was the winning path?”

We cannot really agree on that, given that over 1.2 million Americans have died of covid, ~90% of whom were unvaccinated. Excluding the opinions of depressed goth teens, more death is not the winning path.

While several thousand vaccine-related deaths were submitted for review, none were found to be causally related. A few thousand deaths out of over 700 million doses wouldn’t even be that bad -but it’s even better that none of those deaths resulted from being vaccinated. So it is impossible to agree with Adams on his whimsically upbeat, yet absolutely bonkers assessment, given that vaccination objectively reduced disease severity and death.

When the oncologist knocks, you should answer… and listen.

It isn’t clear when Adams first received his cancer diagnosis, but he did admit that ivermectin and fenbendazole did not work in treating it. This is no surprise because both medications are for parasites, not cancer.

One could expect the same poor results from treating cancer with Ozempic or fluoride mouthwash. Drugs only treat things that they have a mechanistic relationship with -and nothing else. Mr. Adams believed that these drugs would help, given that American conservatives have elevated medications that treat neither covid nor cancer, to magical elixirs that treat both covid and cancer. Spoiler alert: they don’t. If you don’t believe me, brush your teeth with Vitamin C (which is good for you) instead of toothpaste and let me know how that goes.

That was satire. Please do NOT substitute vitamin C for toothpaste. It is impressively acidic and will dissolve your teeth, making all who see your smile think you had a meth problem without any of the euphoria that drives meth abuse. I’m just making the point that one can’t simply manifest the dream that a drug that works really well for one thing, will work on any other condition your imagination offers. This is a delusional journey into danger, injury, and death.

Speaking of danger, one of the biggest harms of alternative medicine comes from well-meaning believers when they say:

“what’s the harm to trying this random, unvetted drug/supplement/procedure?”

The answer is plenty. Even if your naturalist/homeopath/health-vibologist has given you something that is totally benign and thus unable to harm you directly, you lose unrecoverable time treating your real disease with something that is useless. Remember, the disease is still killing you even if you have strong intentions to treat it. You have to actually direct those intentions in a way that works.

Don’t believe a doctor who often treats patients with cancer? Ask doctor who treats patients specifically for cancer:

Did Adams die of anti-parasitic poisoning? No, but he died much earlier by putting off real cancer treatments to take ideologically-aligned ant-parasitic drugs. Mel Gibson’s ferociously confident beliefs in the cancer-curing properties of ivermectin did fuck-all for Scott Adams.

I will always wonder if Mr. Adams was one of Gibson’s three unnamed friends who he claimed were cured, because in this instance, Mad Max was the real villain of the story.

When you wake up late for work, no matter what you do -you are still late for work

Scott Adams had an epiphany about his rapidly spreading cancer near the end. He wasn’t getting better from taking modern-day snake oil, so he abruptly pivoted to frantically embrace evidence-based medicine. He knew he was running out of time when a metastasis to his spine robbed him of the use of his legs, so he did what any other normal American would do: he tweeted to the sitting president of the United States that he needed to jump ahead of everyone else in line for cancer treatment to get a last-ditch treatment option at his local hospital.

And because Mr. Adams was just like every other American citizen, he swiftly received direct responses from both Secretary Kennedy and President Trump. This is very relatable, because when I had some testicular swelling after a vasectomy, I tweeted about it to then-president Obama and he told me (and half the world) to just slap a bag of frozen corn on my crotch. Based. Thanks, Obama!

Adams insisted on receiving Pluvicto, which isn’t an experimental drug -it’s been FDA approved since 2022, but it’s reserved for patients who tried and failed androgen-blocking drugs for prostate cancer. Adams initially refused those drugs, and as such, would be ineligible to receive Pluvicto short of a full course of them. This is not gatekeeping, but because it isn’t really known if Pluvicto works well in the absence of preliminary treatment failure. FDA indications explicitly require this level of compliance for the rest of us mortals with prostate cancer.

Thus, Adams used his unearthly influence over two of the most powerful men in America to push himself to the front of the line for therapy that was unlikely to work because of his refusal to accept proven treatment at the start of his cancer journey. And predictably -it didn’t work.

But this is rare, right? People (especially smart, successful people) aren’t usually this dumb, right?

Wrong. This happens all the time. Let’s sort these bananas into a list that is anything but exhaustive:

Notable cancer deaths:

Ananda Lewis, model and MTV VJ, died of breast cancer shortly after publicly describing avoidance of screening and conventional treatment in favor of natural and holistic approaches.

Bob Marley famously declined a curative toe amputation for melanoma, in order to try alternative medicine. He died of metastatic disease four years after treatable diagnosis and likely would still be alive today even 40 years later.

Steve Jobs delayed surgery for one of the most curable forms of pancreatic cancer to pursue alternative therapies like drinking juice and talking to psychics.

Jessica and Sharyn Ainscough, were daughter and mother -diagnosed with two different unrelated cancers: sarcoma, and breast respectively. While Jessica was open to conventional treatment at first, she had a change of heart when her tumor recurred later. Both mother and daughter opted for pseudoscientific Gerson Therapy managed by a quack in Mexico, and both died in line with expectations for untreated cancer. Jessica was only 29 when she passed, and was known by her fans as “the Wellness Warrior.” To be fair, her recurrence only gave her about a coin toss for survival, but Gerson promised much and delivered nothing.

Notable HIV / AIDS denialism deaths:

Former heavyweight boxing champion and costar of Rocky V, Tommy “the Tommy Gunn” Morrison, publicly denied that HIV caused AIDS, rejected antiretroviral therapy for years, and… died from AIDS-related complications. HIV had already become routinely survivable with scientifically sound treatment while Morrison was infected.

Christine Maggiore was a prominent HIV/AIDS denialist with a marketing degree (this tracks if you ever argue about science with people on LinkedIn). She rejected antiretroviral therapy, claimed HIV was harmless, and died of AIDS-related pneumonia. Her story is extra tragic, because her 3 year old daughter who was infected in utero, was neither tested nor treated for HIV at her mother’s behest, and also died of AIDS-related pneumonia. Both died needlessly for the ideology of proud ignorance.

Notable COVID denial deaths

Obviously, Herman Cain, computer scientist, businessman and Tea Party activist extraordinaire needs to be at the top of this list. He has an award in his name for his posthumous contributions to public health awareness. Cain dismissed COVID severity and opposed mitigation measures. He died of severe COVID pneumonia after putting his money where his mouth was, attending a large indoor gathering without observing any mitigation measures.

Marc Bernier was a conservative radio host who also denied COVID severity and opposed vaccination. He -and many others, died of COVID complications that could have been avoided through apolitical vaccination and threat recognition.

Other notable infectious deaths: blessed are the children, for they suffer the price of their parent’s egomania.

Madeline Kara Neumann died at 11 years of age because her parents refused to seek treatment for her evolving type 1 diabetes. Diabetic ketoacidosis is easily treated with insulin, and lethal without it. Her parents relied exclusively on prayer, convinced that “putting the doctor before God” was sinful idolatry.

Elizabeth Rose Struhs later suffered the same fate as Madeline several years later, for having the misfortune of being born to parents who believed that faith healing was a substitute for insulin. Dead at 8 years old.

Herbert and Catherine Schaible had not one, but two of their young children die of pneumonia after treating them exclusively with prayer instead of antibiotics. Bacterial pneumonia in otherwise healthy children is usually quite curable when presenting a reasonable amount of time after illness begins.

Ezekiel Stephan died at only 19 months of age from severe, untreated bacterial meningitis. Ezekiel’s parents rejected standard therapy in favor nutritional supplements, which is interesting given that they ran a supplement company. The causative agent was HiB, which is a routine childhood vaccine that Ezekiel’s parents also denied him. That said, survival rates from infection are high with prompt antibiotics, and fatality rates are high without.

But sometimes, that crazy woo-woo works, right? A broken clock is right twice a day, after all.

Only under certain circumstances: namely… and this detail is absolutely crucial… when you fabricate your cancer diagnosis.

Belle Gibson, still-living, disgraced Australian wellness guru, had believers in magic lining up to admire her brave triumphs over brain, blood, spleen, uterine, liver, and kidney cancers -which she claimed were caused by vaccination against HPV (vaccination doesn’t cause any of that, in case you were wondering).

Gibson very successfully sold books and subscriptions to her app that outlined how you could eat natural, drink raw milk, while avoiding vaccinations and all conventional cancer treatments to cure cancer.

But it turns out that fake cancer is WAY easier to treat than real cancer. Little details like not having any scars from multiple cardiac surgeries she claimed to have had in her faux-battle with cancer, exposed Gibson as a giant festering abscess on the rectum of humanity who capitalized on the desperation of real cancer patients to become wealthy. Who knows how many fans died young by emulating her bold delusions.

The only thing Gibson got right was that there is a lot of money to be made on the sick and dying if you can only sink low enough to scoop it up.

But I digress… this is just grift disguised as belief in secret knowledge. More despicable to be sure, but less likely to be lethal in the absence of disease. Scott Adams was no grifter, he was a true believer. I just want everyone to better scrutinize those who would have us become true believers.

Alternative cures yield alternative results… and they are all worse.

Remember, for every one of these sensational cases of people boldly taking medicine into their own hands and losing their lives over it, there are thousands of lesser-known tragedies wrought by the same fallacious thinking. Usually, you only get to be famous for being dumb if you were already famous to begin with.

The most robust data comes from cancer patients like Scott Adams. Compared to those using conventional treatment, patients with curable cancers who chose alternative medicine as their sole treatment were 250% more likely to die overall, with particularly elevated risks for breast cancer (568%), colorectal cancer (457%), and lung cancer (217%).

Even when alternative medicine was used alongside conventional therapy, patients were more likely to refuse recommended conventional treatments, and suffered twice the risk of death compared to those didn’t use alternative medicine at all. Shocking, and yet alternative medicine is what people choose every time they think they know more about medicine than actual experts.

To be clear, none of these people were necessarily stupid, even though their actions were. In the examples I gave, they almost always lived a comfortable if not successful lifestyle in a developed nation and had evidence of a decent education. What they have in common is that they believed that their success in marketing, sports, engineering, or satire translated into exceptionalism in all areas they turned their attention to.

This ignores the fact that these same people likely spent long years mastering what they later became good at, while only spending a few hours doom-scrolling alternative health blogs on the toilet, to become good at medicine too. All things are equal only if you subtract the things that demonstrate they aren’t equal at all.

Like a boss

What did Dilbert teach us about systems and the people trapped within them?

Dilbert’s defining trait as the protagonist of his story is rationality:

• He understands cause-and-effect

• He recognizes how bad incentives drive bad outcomes

• He can often predict failure before it happens

The reader sees the system through his eyes because he reliably interprets it correctly before it cascades into disaster.

Antagonists on the other hand, are not merely wrong, they:

• Externalize the blame for their bad decisions

• Shield themselves behind power, and

• Push the costs and consequences of their abysmal plans downward onto people with less agency.

In the end, Scott Adams used his immense influence to exploit the system long after rejecting its legitimacy, using power that he accumulated from years of criticizing such systems.

Regular people waiting in line for treatment suffered delays as federal authority’s muscled Adams ahead of them. Other regular people will be inspired by his journey, and will also delay their own chances of successfully beating cancer to follow in his footsteps. Those of us with medical insight see this coming all the time. Bad decisions double the demand on our services, and frankly -we don’t need the extra business.

The irony is as tangible as it is heartbreaking. By Dilbert’s moral grammar, Scott Adams left us not as the lovable engineer trapped in a dysfunctional system, but as the pointy-haired manager who repetitively orchestrated his own undoing: the bumbling, unrepentant antagonist of Adams’ finest creation.

That is a second, distinct reason to be sad over his passing.