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The standardised admission ratio for measuring widening participation in medical schools: analysis of UK medical school admissions by ethnicity, socioeconomic status, and sex

BMJ 2004; 328 doi: (Published 24 June 2004) Cite this as: BMJ 2004;328:1545

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Britain is not a meritocracy…

I find much of what McManus says disappointing and questionable. One
labours in vain to find any truth in this entire paragraph: "Post-1945
Britain has been very much a meritocracy, with social class strongly
related to intelligence, extensive social mobility between classes depends
primarily upon intelligence…and intelligence showing moderately high
within-family correlations. Since intellectual ability is also a major
predictor of examination results and hence university entrance, it is
hardly surprising that individuals from social classes I & II are
accepted at higher proportions than their representation in the
population." [McManus]

In failing to define such blurred and woolly terms as post-1945
Britain, social class, social mobility, intelligence and meritocracy, he
then provides a thoroughly unconvincing case that the UK is "very much a
meritocracy," either now or back in the 1950s. He builds a fabric solely
composed of fatuous generalisations. Concerning meritocracy, more people
probably gain advancement in life from unquantifiable and unpredictable
random factors—relatives, friends, chance meetings, etc, that is from what
they are, or what they seem to be, not from what they know. Such is not
reducible to straight IQ or qualifications terms. I think this has always
been the case—rightly or wrongly—and though truer perhaps of pre-1960
Britain than post-1960, it is still in broad terms true today everywhere
on the planet.

While Britain has become a more meritocratic, and credentialised
society since the 1950s, that is a more modest and realistic claim than
using it as a sweeping and absolute tool of social analysis, or converting
it into a ham-fisted over-generalisation. Credentialism has been defined
as, “the use of credentials as a way of selecting people for employment;”
[Buon] “the use of educational credentials as a means of job selection… an
over-reliance on credentials in selecting staff;” [Buon] and often
“denotes the…use of credentials as a means for screening people into
jobs.” [Buon] Of course, there is much more credentialism today than in
the 50s, especially in the professions, entry to which requires, by
definition, certain mandatory qualifications. Such is broadly self-
evident, but outside the cosy world of professions, this so-called axiom
melts into a mere supposition, if not indeed a fiction.

In any case, his preference for data encourages McManus to ignore too
much of the real world. For example, in Britain, for very many decades, a
rich person could buy his son or daughter a place at private school and
Oxbridge and guarantee them a job in the City, in Law, medicine, the
Church, an officer’s post in the Army or Navy, in the Foreign Office, the
Diplomatic service or publishing, regardless of their innate
intelligence—in other words, elite professions of high status giving well-
paid careers for life. This ‘old boys network’ [OBN] is still in operation
today, so please don’t try to kid people that Britain is a meritocracy
when it so obviously isn’t and never has been. Who you know [accident of
birth] not what you know is, and always has been, a more reliable
indicator of career progression and social status than qualifications or
intelligence—as McManus claims. Such privileged groups exist in all
societies and though the power of the OBN has been significantly eroded in
the last forty years or so, only the socially blind could seriously claim
that Britain is a meritocracy.

Even in the USA, Canada and Australia, which might make better claims
of being meritocracies than Britain, there exist privileged groups and
social elites—mostly white, male, middle-class, heterosexuals—who fare
better and rise quicker in life than all the rest. To be so ignorant of
such potent social facts of life in a so-called intelligent discussion of
this topic, as McManus is, truly beggar’s belief. What planet is he living
on? As social research has repeatedly shown in the last ninety years or
so, the only way a person who is not from these social elites can gain
advancement, apart from education, is through crime, sport, films or pop
music. These may well seem illegitimate and demeaning means of social
advancement—being perhaps rewards disproportionate to ‘talent’ or ability
to succeed in the school system—yet they are obviously viable and
alternative routes to success and even to ‘celebrity status.’ For many,
they are the only hope and dream they have left.

McManus claims that "social class is strongly related to
intelligence." Do we simply have to accept this notion just because he
says so? What does he mean by ‘strongly related to?’ What does he mean by
‘social class’ or ‘intelligence?’ They are not simple clear-cut matters.
It may well be true nowadays that "extensive social mobility between
classes depends primarily upon…"well, upon something, possibly
qualifications, but not intelligence, as McManus claims. Intelligence and
qualifications are very different beasts. His claim that "intelligence
shows moderately high within-family correlations," crumbles under even the
briefest scrutiny, because just as many ‘bright people’ come from modest
circumstances as from well-endowed families. The data simply cannot be
contrived into the kind of crude social slide-rule that McManus seems
eager to wield; more truthfully, intelligence and families are only
loosely correlated if at all.

Are not so-called lower-class, unskilled people also intelligent in
their own ways? Do they not live satisfying and rewarding lives—often with
little complaint—just as well as ‘intelligent and well-qualified’ people
do? McManus blunders on, skating blithely over such complex issues with
more than a whiff of social elitism underpinning his disfigured landscape
of generalised and unreferenced opinions. When he claims that
"intellectual ability is also a major predictor of examination results and
hence university entrance," well, who says so and why? McManus just hands
down his scantily-defined words as if carved upon tablets of stone. On
what does he base his view that qualifications = intelligence?

Nor does he anywhere explore the real barriers against social
mobility that still exist, such as low self-esteem and lack of ambition
among lower-class people. What about such important and largely
unquantifiable confounding factors as class-based, culture-bound and money
-based inequalities in educational and employment opportunities? If you
live in a poor district, you cannot even get your kids into a ‘good
school,’ let alone a university—where is the meritocracy in that?

Arguably, none of these glaring social inequalities are explicitly
determined by IQ. McManus remains dumb on these pertinently large tears in
the otherwise neat fabric of his equations. Not even mentioning them shows
how much he really regards them. Yet, these are all critically important
factors to the so-called 'under-achievement' of unskilled and uneducated
people. There is also the matter of rich people being more able to pay for
their child through university today—a door that remains stubbornly shut
for the poor.

Wielding “a species of positivist reductionism,” [Coleman] McManus
has signally failed “to analyze the manifold relations between different
dimensions of social inequality, especially class, gender and ethnicity.”
[Kocka] He has failed to appreciate the value and significance of
“networks and relations [which] become objects of study, instead of social
entities like specific societies or groups within specific societies.”
[Kocka] He has failed to progress much “beyond uni-directional models of
causality in the quest for a means of grasping and making sense of the
complexity of the social world.” [Hunt]

Cognisant of “the dangers of reductionist views in the study of
social reality,” [Coleman] most sociologists oppose “positivism…in the
social sciences,” [Coleman] and would rightly condemn his approach as a
heavy-handed mis-use of top-down quantified data about populations rather
than people, spawning spurious conclusions, which fall a long way short of
obvious, unquestioned or universally accepted truths.

McManus ignores such potent social factors as the degrading effect of
low self-esteem, high crime, bullying and the grinding hopelessness of
poverty, not to say the demoralising impact of living in dangerous, run-
down districts and unpleasant visual environments on only a meagre and
uncertain income. Because many less skilled people "live in a depressing
situation with severe social and activity restrictions at work, play and
in relationships, it is not surprising that situational depression
occurs." [Fraser]

He could follow the examples of Michael Portillo recently [BBC], or
Matthew Parris 20 years ago [Mclean] “to live on supplementary benefit for
a week. Parris, then a new MP full of puppyish enthusiasm for Thatcherite
dogma, had been defending the low level of benefits for the unemployed.”
[Mclean] Social mobility, educational advancement and intellectual
achievements are pretty meaningless terms in such districts. Maybe he
should abandon his mathematical formulas and enter such districts himself,
to live as they live and acquire some first-hand research. Counterbalanced
with some real-world experience from ‘roughing it’ in bad streets, his
opinions and formulas might carry a little more credibility.

Laying out an ambitious feast of bold but essentially fatuous
opinions and blurred definitions—an unquantified muddle "of loosely
connected assumptions," [Gupta]—does NOT constitute a cogently reasoned
analysis of observable social entities. Crisply quantified mathematical
toys, neatly arrogated in a formulaic manner, a pretentious form of
intellectual juggling, and the misleading arithmetic window-dressing of
what are complex social phenomena—such approaches miserably fails to
generate authentic conclusions. The issue requires more varied and subtler
interpretations across a spectrum of opinion; there exists no consensus
about the view he peddles. I don’t buy his formulas, his categories or his

One should never "underestimate the psychosocial dimension,"
[Infanta]; factors such as "culture, material circumstances, health care
access and social expectations," [Bhopal] inevitably impact upon the
career aspirations and subsequent achievements of unskilled people. And
such features are endemic to the lives of unskilled and uneducated people
the world over, inspiring them to aim low in life, to be grateful for a
few crumbs rather than a banquet of rewards and opportunities, to drift
through life in a generally unambitious way and to mysteriously mis-value
education's golden potential to lift them out of perhaps drab, unrewarding
lives, and so into the comparative paradise of the educated professions.
These are the very social realities McManus ignores.

None of these pertinent factors figure significantly in McManus'
fancy but flawed equations, probably because they are inherently resistant
to quantification, being mere "labels...loose and inaccurate shorthand
developed for non-scientific purposes." [Casey] That should not exclude
them from the analysis—marginalised by an essentially positivist approach:
“connoting an embarrassing affiliation to vulgar positivism, scientism and
technocracy,” [Aldridge] and spouting the “positivist catechism, so
embarrassing that few of us can bear to read about.” [Aldridge]

McManus succeeds only in demonstrating how inappropriate such
mathematical approaches ultimately are in social analysis. Such pretty
formulas are "artificial constructions, logical figments with no necessary
relation to the outside world." [Berlin, 123] Mathematical models always
"leave out the richest and most important part of human experience...daily
life, history, human laws and institutions, the modes of human self-
expression." [Berlin, 110] Failing to appreciate the subtle complexity of
social worlds, they get excluded from the formulas, even though, “no easy
reductionism will do justice to the material.” [Coleman] He fails to
concentrate “on social structures, processes, and actions in a specific
sense (inequality, mobility, classes, strata, ethnicity, gender relations,
urbanization, work and life of different types of people, not just
elites).” [Kocka]

Algebra may seem like some "unshakeable deductive edifice, but it
cannot give us factual information, any more than a game or a piece of
fiction, which we have made up can, as such, describe the world to us.
Mathematics is not determined by reality outside itself, to which it has
to conform, but only by our own fancy or creative imagination, which
moulds the material as it pleases." [Berlin, 36] Mathematics and logic
"are not forms of discovery at all but of invention." [Berlin, 41] There
thus exists an irreconcilable "logical gulf between mathematical truths
and those of fact," [Berlin, 198] or, as Goethe said, mathematics "can
achieve nothing in the moral sphere." [Berlin, 287 footnote]

Finally, there is the sticky matter of cautious interpretation—well,
where is it? Statisticians are "very cautious when they examine causal
inferences from observational studies," [Wang] because "cautious
interpretation is required to avoid erroneous conclusions." [NCI]
Furthermore, "in order to compare categories, it becomes essential to
define those categories as well as you can. Defining categories with some
‘complete certainty’ is not possible, therefore you must cautiously do the
best you can; and then remain very aware of difficulties of
classification." [abelard] Likewise, "many of the things we might wish to
study are not subject to experimental manipulation (e.g. health
problems/risk factors). If we want to understand them in a causal
framework, we must be very cautious. It will require a multifaceted
approach to the research." [Helberg]

Far from adopting a cautious interpretation of the figures, McManus
excludes a subtle multi-faceted approach in favour of rampant positivism
and the desire to make inflated interpretations from globalised figures,
leading only to misleading conclusions. This is further compounded by his
unwillingness at the outset to more carefully define terms and categories.
He might profit from reading Wax and Roscoe as a starting point—or better
still, follow the example of Parris and Portillo to feel and then
understand poverty from first-hand contact.

Sources, ‘intelligence’: misuse and abuse of statistics

Alan Aldridge, Prediction in Sociology: Prospects for a Devalued
Activity, Sociological Research Online, vol. 4, no. 3, 1999

BBC, Your views: Portillo as a single mum, 16 Oct 2003

Sir Isaiah Berlin, Three Critics of the Enlightenment: Vico, Hamann,
Herder, Princeton: Princeton Univ Press, 2000

Raj S Bhopal, Persistence of bias against females can be tested in
migrants, BMJ e-letter, 15 July 2004, [reference url currently

Tony Buon, The Use Of Educational Credentials For Employee Selection,

William F Casey, Re: Comparison of reporting ethnicity in US and
European randomised controlled trials, BMJ e-letter, July 2004 [reference
url currently unavailable]

John A. Coleman, Sociology of Religion: The bible and sociology, the
1998 Paul Hanly Furfey Lecture, Sociology of Religion, Summer, 1999

Douglas T Fraser, Re: Re: Please don't let me be misunderstood, BMJ e
-letter, 11 July 2004

Vinod K Gupta, MD, Re: Re: Randomized controlled trials: the mythical
hypomagnesaemia -- intrinsic noradrenergic activation -- cortical
spreading depression nexus in migraine, BMJ rapid response, 8 July 2004
[reference url currently unavailable]

Chay Helberg, Pitfalls of Data Analysis, (or How to Avoid Lies and
Damned Lies)

Alan Hunt, Anxiety and social explanation: some anxieties about
anxiety, Journal of Social History, Spring, 1999

Claudia Infanta, ¿How do medical complaints regulate medical
practice? BMJ e-letter, 8 July 2004

Jurgen Kocka, Losses, Gains, and Opportunities: Social History Today
- introducing the issues, Journal of Social History, Fall, 2003

I C McManus, Social class data are problematic to interpret, BMJ e-
letter, 27 Jun 2004

Gareth Mclean, Poverty as Entertainment, 28 Jan 2004

NCI, Cancer in Alaska Native Women: Key Points, Vital Statistics and
Social Indicators

Paul Roscoe, The Perils of 'Positivism' in Cultural Anthropology,
American Anthropologist, 97 (3) 1995: 492-504

Chamont Wang, Statistics,

Murray Wax, On Negating Positivism: an Anthropological Dialectic,
American Anthropologist, 99 (1) 1997: 17-22

Competing interests:
None declared

Competing interests: No competing interests

22 July 2004
Peter Morrell
Hon Research Associate, History of Medicine
Staffordshire University, UK