Antifragile 21. Medicine, Convexity, and Opacity

Following the schedule of our reading calendar.

Medicine is one of the favorite themes of Mr Taleb. Not only because he extracts from medicine some of the concepts that helped him to give form to his idea of antifragility like “hormesis” and “Iatrogenics”. It is also because history and practice of the medicine are full of the incorrect approaches to science and life that the author so much criticizes.

And it is true that for everybody medical decisions can be among the most relevant decisions involving our philosophy of the world we may have to confront.

His two principles:

1. We do not need evidence of harm to claim that a drug is dangerous. It is the non-natural that has to present evidence. Human bodies swell after a hit. It is a body response evolved after millions of years of selection. Is the option selected by history and nature. It is the guy who argues that swelling has to be removed who has to present evidence showing why this is a good idea.

What Mother Nature does is rigorous until proven otherwise; what humans and science do is flawed until proven otherwise. (p. 349)

2. Iatrogenics (harm by medicine) is not linear. It is reasonable to try almost everything on the terminally ill, because the worst outcome is not much worse than the non-action. However, in the case of the almost-healthy, intervention, even when theoretically save can be loaded with hidden downsides.

Which reminds me of one of may favorite Yogi Berra’s sentences:

In theory there is no difference between theory and practice. In practice there is.

Surgery has been for centuries immune to Iatrogenics for a very simple reason: the lack of anesthesia made such a horrible experience an operation that none was performed unless in the most desperate situations. Medicine, however, lost in his high flying philosophical foundations, was prone to ridiculous bloodlettings at every possible occasion. With the advent of anesthesia surgery has become victim of the human hubris and unnecessary and risky operations are performed everywhere.

We act for the small gains that we see ignoring the huge side effects that are hidden by the complexity and opacity of the world. And in case of doubt, we intervene.

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