EDGE questions attract such interesting responses every year. This year the question is “What will Change Everything?“
Nassim Nicholas Taleb, the author of The Black Swan, poses the response that “the idea of negative and iatrogenic science” will change everything. Here’s his main point…
I will conclude with the following statement: you cannot do anything with knowledge unless you know where it stops, and the costs of using it. Post enlightenment science, and its daughter superstar science, were lucky to have done well in (linear) physics, chemistry and engineering. But, at some point we need give up on elegance to focus on something that was given the short shrift for a very long time: the maps showing what current knowledge and current methods do not do for us; and a rigorous study of generalized scientific iatrogenics, what harm can be caused by science (or, better, an exposition of what harm has been done by science). I find it the most respectable of pursuits
What he’s highlighting is the tendency for some science advocates to suggest that science is not just the only way to know the truth, but to assume that the scientific approach is in all circumstances the one likely to produce the most positive outcome. This relates to his other work where he highlights “illusions of control” – this insight has been dramatically shown to be correct in the global collapse of the financial and banking system. I always find it disturbing when an “expert” claims absolute certainty about something….yes, pretty much always! The humility which comes with awareness of our limits of our knowledge or skill is a great quality in my opinion.
He highlights not only the limits of knowledge though, but the concept from medicine of iatrogenesis – the harm done from the attempts to help…
Let’s consider Medicine –which only started saving lives less than a century ago (I am generous), and to a lesser extent than initially advertised in the popular literature, as the drops in mortality seem to arise much more from awareness of sanitation and the (random) discovery of antibiotics rather than therapeutic contributions. Doctors, driven by the beastly illusion of control, spent a long time killing patients, not considering that “doing nothing” could be a valid option –and research compiled by my colleague Spyros Makridakis shows that they still do to some extent. Indeed practitioners who were conservative and considered the possibility of letting nature do its job, or stated the limit of our medical understanding were until the 1960s accused of “therapeutic nihilism”. It was deemed so “unscientific” to decide on a course of action based on an incomplete understanding to the human body –to say this is the limit of where my body of knowledge stops. The very term iatrogenic, i.e., harm caused by the healer, is not well spread — I have never seen it used outside medicine. In spite of my lifelong obsession with what is called “type 2 error”, or false positive, I was only introduced to the concept very recently thanks to a conversation with the essayist Bryan Appleyard. How can such a major idea remained hidden from our consciousness? Even in medicine, that is, modern medicine, the ancient concept “do no harm” sneaked-in very late. The philosopher of Science Georges Canguilhem wondered why it was not until the 1950s that the idea came to us. This, to me, is a mystery: how professionals can cause harm for such a long time in the name of knowledge and get away with it.
Ouch! That’s a pretty negative view of doctoring! It’s not often that you hear people say so clearly that the main improvements in health come from social, economic and political change rather from “therapies”, but it’s true, and it’s not only what I was taught at university, but it’s still a clear message conveyed by people like Prof Richard Wilkinson. It’s certainly worth re-iterating when we’re in the middle of a medical culture which assumes so often that the best thing to do is prescribe a drug or operate on a patient. It’s good to hear a challenge to that mind-set and for the question of “watchful waiting”, or certainly of caring but not intervening with a potentially harmful procedure or drug, to be raised for discussion.
I’m a bit amazed that Nassim Nicholas Taleb had never come across the concept of “iatrogenesis” before. It’s a well known phenomenon in the medical world. Would it be a useful concept in other sciences? I expect it would. Again, too often, there is far greater emphasis given to the potential benefit of a technology, than the potential harm. Yet to make informed choices, we need to know both these aspects well.
If these points made by Taleb aren’t thought provoking or controversial enough for you, I’ll leave you with this one…..
I have also in the past speculated that religion saved lives by taking the patient away from the doctor
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