Notes on ''Naive' Intervention ( Chapter 7: Antifragile - Nassim Taleb )
INTERVENTION AND IATROGENICS
On Wednesday July 3rd in the year 1930; 389 children were presented to NYC doctors; 174 of them were recommended tonsillectomies. The remaining 215 children were again presented to doctors, and 99 were said to need the surgery.
When the remaining 116 children were shown to yet a third set of doctors, 52 were recommended the surgery.
(Note that there is morbidity in 2 - 4% of the cases today, not then, as the risks of surgery were very bad at the time)
Death occurs in about every 15,000 such operations and you get the idea about the break-even point between medical gains and detriment.
This story allows us to witness probabilistic homicide at work.
Every child who undergoes an unnecessary operation has a shortening of her life expectancy.
This example not only gives us an idea of harm done by those who intervene, but, worse, it illustrates the lack of awareness of the need to look for a break-even point between benefits and harm.
This urge as Nassim Taleb calls it in the book Antifragile - as ''naive interventionism''.
Let's examine its costs.
In the case of tonsillectomies, the harm to the children undergoing unnecessary treatment is coupled with the trumpeted gain for some others.
The name for such net loss (usually hidden or delayed) damage from treatment in excess of the benefits, is known as iatrogenics.
Literally, ''caused by the healer'', iatros being a healer in Greek.
Every time you visit a doctor and get a treatment, you incur risks of such medical harm, which should be analyzed the way we analyze other tradeoffs; probabilistic benefits minus probabilistic costs.
Consider the death of George Washington in December 1799.
There is enough evidence to suggest that his doctors greatly helped, or at least hastened, his death, thanks to the then standard treatment that included blood-letting (between five and nine pounds of blood).
Now the risks of harm by the healer can be so overlooked that, depending on how you account for it, until penicillin, medicine had a largely negative balance sheet - going to the doctor increased your chance of death.
Its why my grandfather all those years ago, refused and flat out rejected the notion of even a minor surgery on his abdomen (he suffered, but lived to an old age). Most of his friends who were admitted to hospital, never made it out alive.
And with good reason. Back then, hospitals were seedbeds of death.
Thanks to modernity; clinics and hospitals substituted home remedies, that caused death rates to shoot up in these places.
So when politicians on TV says they are following the science to imply its safe. Nothing can be further from the truth.
Science, contrary to popular believe, isn't safe. No, history is safe, geometry is safe, science is nuclear and hydrogen bombs, science is injecting yourself with the plague and trying to find a cure in time.
Science can be reckless.
Science is mass experimentations.
So, thank you for your sacrifice in the name of ''Scientific progress''!
The famously mistreated Austro-Hungarian doctor Ignaz Semmelweis had observed that more women died giving birth in hospitals than giving birth on the street. He called the establishment of doctors a bunch of criminals - which they were. The doctors who kept killing patients could not accept his facts or act on them since he had no theory for his observations.
Semmelweis entered a state of depression, helpless to stop what he saw as murders, disgusted at the attitude of the establishment.
He ended up in an asylum, where he died, ironically, from the same hospital fever he had been warning against.
His story is sad, a man who was punished, humiliated, and even killed for shouting the truth in order to save others.
The worst punishment was his state of helplessness in the face of risks and unfairness. But the story is also a happy one - the truth prevailed eventually, and his mission paid-off, with some delay.
“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so. “ – Mark Twain
I love Mark Twain quotes. He cuts through seemingly complex and confusing matters with such precision and gets to the heart of the issue.
His quote is alluding to the tendency that many of us to believe what we think is fact when unfortunately it’s just opinion, and as an opinion it may not always be correct.
We may think that the experts or doctors with their fancy PHDs are always right in their assessment of the situation. It may well be for some, but not for each and everyone of us.
The average mind lack the capacity for nuance. It is either left or right, 1 or 0, not something in between.
We all suffer from the Dunning-Kruger effect.
The Cost of Doing Business
Medical errors today still kills between 3X (as accepted by doctors) and 10X as many people as car accidents in the US. Barring the mass vaccination for Covid since 2020, which would have incurred far more excess death than the establishment is willing to admit.
It is generally accepted that harm from doctors - not including risks from hospital germs - accounts for more deaths than any single cancer.
...although medicine is getting better over time.
Still we have to worry about the overtreatment on the part of pharmaceutical companies, lobbies, and special interest groups and the production of harm that is not immediately salient and not accounted for as an ''error''.
Pharma plays the game of concealed and distributed iatrogenics, and it has been growing.
It is easy to assess iatrogenics when the surgeon amputates the wrong leg or operates on the wrong kidney, or when the patient dies of a drug reaction. But when you medicate a child for an imagined or invented psychiatric disease, say, ADHD or depression, instead of letting him out of the cage, the long-term harm is largely unaccounted for.
Iatrogenics is compounded by the “agency problem” or “principal-agent problem,” which emerges when one party (the agent) has personal interests that are divorced from those of the one using his services (the principal). An agency problem, for instance, is present with the stockbroker and medical doctor, whose ultimate interest is their own checking account, not your financial and medical health, respectively, and who give you advice that is geared to benefit themselves. Or with politicians working on their career.
Unfortunately, the idea of iatrogenics is an incredibly difficult notion to teach, let alone explain. I myself did not know the exact word until I read Antifragile by Nassim Taleb.
But the word stems from a very ancient idea in the 4th century - primum non nocere ( first, do no harm ). A phrase integrated into the Hippocratic Oath taken by every medical doctor on their commencement day.
No ''expert'' or parent, doctor, leader likes to think they are the ones that could possibly be the source of any damage. In fact, when you approach such players with such skepticism, they tend to say that ''you're against scientific progress.''
The Koran mentions, ''those who are wrongful while thinking of themselves that they are righteous.''
Or my favorite: most of the evil in the world is done by people with good intentions.
So what's the opposite of iatrogenics? Something that's known as Antifragile.
Something which ends up helping while trying to cause it harm.
When you attack something that's antifragile, it becomes stronger instead.
For example, hackers/nations/politicians/economists/bankers attacking the Bitcoin network ended up making it stronger over time (Bitcoin has been attacked for the past 12 years) and it didn't die as predicted each time or end the way of the tulip bubble. In fact, more and more people, even some nations have adopted it.
An idea, language, code, internet, protocols down to banned books tend to be antifragile. A common trait of antifragility is volatility and tends to grow based on Network Effects.
The idea of capitalism according to Taleb could very well be an inverse-iatrogenic effect in plain sight; capitalism may sound selfish or greedy for an individual need, but it facilitates the conversion of selfish aims individually into something beneficial for the collective society.
Bitcoin exhibits this property too. I secure my savings in the Bitcoin network, and the more people who selfishly adopt it to protect their money from debasement, the more value accrues to the entire network.
Game theory is the study of how such a relationship occurs. And it is observed that Bitcoin is a kind of global competition for decentralized, open money that anyone can plug into the system (permission-less) not forced/by decree like fiat.
The game theory is that no one wants to start the cascade of adoption, but once your adversary does it, you are forced to adopt the technology or risk being left behind. (Observe electrification, automobile, flight, internet.)
These kinds of ideas or technology that starts out at the fringes tends to be a long term asymmetric bet.
Stasis and calm are expensive, but volatility is inherently free.
Because Man instinctively fear uncertainty, we confer immense power upon individuals and institutions that offer us a sense of tranquility. Our politicians tell us they have a plan, our corporate chieftains chart the path forward to future profitability, and we follow in hopes that yesterday, today, and tomorrow will exhibit the same qualities. But the universe throws an unexpected wrench time and time again (Black Swan), and the best laid plans always tend to fall woefully short.
And just as our civic society projects calm, the money that powers civilization must appear stable as well.
Fiat currencies are designed for slow depreciation over time.
Man cannot fathom the loss of purchasing power over decades or centuries when juxtaposed with stable purchasing power measured over the course of days, weeks, and months. We are attuned to believe that a dollar, euro, yen, etc. today will buy the same amount of energy tomorrow. But they can't as long as there is someone in charge of the money supply.
Stability therefore comes at a huge cost to us over the long run!
If time is money and life is short, then shouldn’t money be scarce?
A main source of the economic crisis that started in 2007 lies in the iatrogenics of the attempt by Alan Greenspan — to iron out the “boom-bust cycle” which caused risks to go hide under the carpet and accumulate there until they blew up the economy.
These attempts to eliminate the business cycle lead to the mother of all fragilities. Just as a little bit of fire here and there gets rid of the flammable material in a forest, a little bit of harm here and there in an economy weeds out the vulnerable firms early enough to allow them to “fail early” (so they can start again) and minimize the long-term damage to the system.
An ethical problem arises when someone is put in charge. Greenspan’s actions were harmful, but even if he knew that, it would have taken a bit of heroic courage to justify inaction in a democracy where the incentive is to always promise a better outcome than the other guy, regardless of the actual, delayed cost.
Fighting inflation... with price controls. It’s genius!
Ingenuous interventionism is incredibly pervasive within our society.
One of the most repeated lessons we see over and over again throughout human history is that bumbling politicians almost invariably try to ‘fix’ inflation with price controls.
Emperor Diocletian famously imposed strict price controls across the Roman Empire in 301 AD to fight off inflation that had resulted from a massive debasement of the Roman currency.
Naturally, Diocletian’s price controls weren’t successful. They’re never successful. But that dismal record of failure hasn’t stopped politicians from thinking that they can do it better.
From Hammurabi to modern day Argentina, from ancient Egypt to Richard Nixon (who “ordered a freeze on all wages and prices in the United States” in 1971), price controls have literally never worked, ever.
But I’m suuuuuuure The Next ''Hero'' would think that his/her price controls would succeed.
There’s an old saying that, in a truly free market, “the cure for high prices is high prices.”
In other words, when, say, oil prices spike, the free market compels companies to explore for more oil, drill more, and produce more. The high prices create a profit incentive for more production.
Eventually those high prices encourage so much production that the market becomes oversupplied... and prices fall.
So high prices cure high prices.
The argument in this chapter isn't to go completely against the notion of intervention. Just as there is a tendency for us to over-intervene, so is under-intervening when it is truly necessary.
As with all things in life, understanding the nuances gives you a more complete picture.
Over-intervention comes with under-intervention. Indeed, as in medicine, we tend to over-intervene in areas with minimal benefits (and large risks) while under-intervening in areas in which intervention is necessary, like emergencies.
So what should we control?
As a rule, intervening to limit size (of companies, airports, or sources of pollution), concentration, and speed are beneficial in reducing Black Swan risks.
The only problem is, it is hard to get governments to limit the size of governments.
Governments tend to grow in size over time which lead to an over-reaching nanny state.
Relinquishing too much power & control to the system ends up reducing our alertness.
For example, motorists need stressors and tension coming from the feeling of danger to feed their attention and risk controls, rather than some external regulator.
Thought experiment: Would you feel safer with a commercial pilot compared to a fighter pilot? (A commercial pilot spend years relinquishing his craft to an autopilot which makes them more placid.)
Well it depends on the mission right? I mean, if the mission is risky, I wouldn't bet my life with a commercial pilot. On the other hand, I'm more comfortable trusting my life to a fighter pilot regardless of whether it is a dangerous mission or just flying me to my holiday destination.
Of course, the fighter pilot might make me puke (volatility) but it is better risk-management.
More examples revealed in Chapter 7: Antifragile...
In praise of Procrastination
It’s much easier to sell “Look what I did for you” than “Look what I avoided for you.” Of course a bonus system based on “performance” exacerbates the problem on interventionism.
Throughout history, you will not find a hero for his inaction. Heroes become heroes precisely for what they did, not what they did not do.
I guess we live in a society obsessed with becoming the Hero/Savior. Perhaps we are dealing with the human condition of ego.
The doctor who refrains from operating on a back (a very expensive surgery), instead giving it a chance to heal itself, will not be rewarded and judged as favorably as the doctor who makes the surgery look indispensable, then brings relief to the patient while exposing him to operating risks, while accruing great financial rewards to himself.
Why do you think surgeons tend to drive pink Rolls-Royces'.
I also think that part of the problem with people today is they tend to be instantly-gratified (high time-preference) and people pay a ton of money for problems that could be solved ''Right Now!''
Few understand that procrastination is our natural defense, letting things take care of themselves and exercise their antifragility; it results from some ecological or naturalistic wisdom, and is not always bad—at an existential level, it is my body rebelling against its entrapment. It is my soul fighting the Procrustean bed of modernity.
Granted, in the modern world, my tax return is not going to take care of itself—but by delaying a non-vital visit to a doctor, or deferring the writing of a passage until my body tells me that I am ready for it, I may be using a very potent naturalistic filter. I write only if I feel like it and only on a subject I feel like writing about—and the reader is no fool.
So I use procrastination as a message from my inner self and my deep evolutionary past to resist interventionism in my writing. Yet some psychologists and behavioral economists seem to think that procrastination is a disease to be remedied and cured.
The benefits of procrastination apply similarly to medical procedures: we saw that procrastination protects you from error as it gives nature a chance to do its job, given the inconvenient fact that nature is less error-prone than scientists.
Psychologists and economists who study ''irrationality'' do not realize that humans may have an instinct to procrastinate only when no life is in danger. I do not procrastinate when I see a lion entering my bedroom or fire in my neighbor’s library. I do not procrastinate after a severe injury. I do so with unnatural duties and procedures.
Using my ecological reasoning, someone who procrastinates is not irrational; it is his environment that is irrational. And the doctor, psychologist scientist or economist calling him irrational is the one who is beyond irrational.
In fact we humans are very bad at filtering information, particularly short-term information, and procrastination can be a way for us to filter better, to resist the consequences of jumping on information, as we discuss next.
A Legal Way to Kill People
If you want to accelerate someone’s death, give him a personal doctor. I don’t mean provide him with a bad doctor: just pay for him to choose his own. Any doctor will do.
This may be the only possible way to murder someone while staying squarely within the law. We can see from the tonsillectomy story that access to data increases intervention, causing us to behave like the neurotic fellow.
Someone with a personal doctor on staff should be particularly vulnerable to naive interventionism, hence iatrogenics; doctors need to justify their salaries and prove to themselves that they have a modicum of work ethic, something that “doing nothing” doesn’t satisfy. Indeed, Michael Jackson’s personal doctor has been sued for something equivalent to overintervention-to-stifle-antifragility (but it will take the law courts a while to become directly familiar with the concept).
Did you ever wonder why heads of state and very rich people with access to all this medical care die just as easily as regular persons? Well, it looks like this is because of overmedication and excessive medical care.
Media Driven Neuroticism
Well, thanks to modernity, the internet and apps; we rely on a variety of copious data to make everyday decisions ranging from calorie intake, to ''whether I should take my umbrella with me to work''. Every business and economic decision must come from the data (Science™).
A very rarely discussed property of data is that it is toxic in large quantities.
Consuming data 24/7 is unnatural to us humans.
We did not live like this 50 years ago.
The more frequently you look at data, the more noise you are disproportionally likely to get (rather than the valuable part, called the signal); hence the higher the noise-to-signal ratio.
This is not psychological, but inherent in the data itself.
Say you look at information on a yearly basis, for stock prices, or the fertilizer sales of your father-in-law’s factory, or inflation numbers in Vladivostok. Assume further that for what you are observing, at a yearly frequency, the ratio of signal to noise is about one to one (half noise, half signal)—this means that about half the changes are real improvements or degradations, the other half come from randomness.
This ratio is what you get from yearly observations.
But if you look at the very same data on a daily basis, the composition would change to 95 percent noise, 5 percent signal. And if you observe data on an hourly basis, as people immersed in the news and market price variations do, the split becomes 99.5 percent noise to 0.5 percent signal.
That is two hundred times more noise than signal—which is why anyone who reads the news or Twitter (except when very, very significant events take place) is one step below sucker.
The Iatrogenics of Newspapers
As with blogs & websites today, newspapers used to need to fill their pages every day with a set of news items—particularly those news items also dealt with by other newspapers.
But to do things right, they ought to learn to keep silent in the absence of news of significance. Newspapers should be of two-line length on some days, two hundred pages on others—in proportion with the intensity of the signal. But of course they want to make money and need to sell us junk food.
There is a biological dimension to this story. I have been repeating that in a natural environment, a stressor is information. Too much information would thus be too much stress, exceeding the threshold of antifragility.
In medicine, we are discovering the healing powers of fasting, as the avoidance of the hormonal rushes that come with the ingestion of food.
Hormones convey information to the different parts of our system, and too much of them confuses our biology.
Here again, as with news received at too high a frequency, too much information becomes harmful—daily news and sugar confuse our system in the same manner.
Too much data causes statistics to become completely meaningless.
Now let’s add the psychological to this: we are not made to understand the point, so we overreact emotionally to noise.
The best solution is to only look at very large changes in data or conditions, never at small ones. Just as we are not likely to mistake a bear for a stone (but likely to mistake a stone for a bear), it is almost impossible for someone rational, with a clear, uninfected mind, someone who is not drowning in data, to mistake a vital signal, one that matters for his survival, for noise—unless he is overanxious, oversensitive, and neurotic, hence distracted and confused by other messages.
Significant signals have a way to reach you. In the tonsillectomies story, the best filter would have been to only consider the children who were very ill, those with periodically recurring throat inflammation.
Consider that every day, 6,200 persons die in the United States, many of preventable causes. But the media only report the most anecdotal and sensational cases (hurricanes, freak accidents, small plane crashes), giving us a more and more distorted map of real risks.
The media with all its interesting explanations and theories induces a blanket of illusion of understanding the world.
So we are living in a more and more fragile world, while thinking it is more and more understandable.
To conclude, the best way to mitigate interventionism is to ration the supply of information, as naturalistically as possible.
This is hard to accept in the age of the Internet.
It has been very hard for me to explain that the more data you get, the less you know what’s going on, and the more iatrogenics you will cause.
People are still under the illusion that “science” means more data.
THE STATE CAN HELP—WHEN INCOMPETENT
The famine in China that killed 30 million people between 1959 and 1961 can enlighten us about the effect of the state “trying hard.”
It was discovered that famine was more severe in areas with higher food production in the period before the famine began, meaning that it was government policy of food distribution that was behind much of the problem, owing to the inflexibility in the procurement system. And indeed, a larger than expected share of famine over the past century has occurred in economies with central planning.
But often it is the state’s incompetence that can help save us from the grip of statism and modernity—inverse iatrogenics.
The insightful author Dmitri Orlov showed how calamities were avoided after the breakdown of the Soviet state because food production was inefficient and full of unintentional redundancies, which ended up working in favor of stability.
Stalin played with agriculture, causing his share of famine. But he and his successors never managed to get agriculture to become “efficient,” that is, centralized and optimized as it is today in America, so every town had the staples growing around it.
This was costlier, as they did not get the benefits of specialization, but this local lack of specialization allowed people to have access to all varieties of food in spite of the severe breakdown of the institutions.
In the United States, we burn twelve calories in transportation for every calorie of nutrition; in Soviet Russia, it was one to one. One can imagine what could happen to the United States (or Europe) in the event of food disruptions.
...which is happening around the world today (this book was written in 2012)
When constrained systems collapse, they are never seen as the result of fragility, rather, as the product of poor forecasting.
So every year, politicians, economists, scientists and of course 'experts' foolishly try to predict in advance what they can intervene (w/ regulation) to stifle such a calamity from ever happening. Yet they happen all too often.
You'd think that by electing a new guy in the next election, all problems can be solved in the future.
Alas, political and economic “tail events” are unpredictable, and their probabilities are not scientifically measurable. No matter how many dollars are spent on research, predicting a Black Swan is not the same as counting cards; humans will never be able to turn politics and economics into the tractable randomness of blackjack.