First Principle of Iatrogenics (Empiricism)

First Principle of Iatrogenics (Empiricism)

The first principle of iatrogenics is as follows: we do not need evidence of harm to claim that a drug or an unnatural via positiva procedure is dangerous. Recall my comment earlier with the turkey problem that harm is in the future, not in the narrowly defined past. In other words, empiricism is not naive empiricism.

We saw the smoking argument. Now consider the adventure of a human-invented fat, trans fat. Somehow, humans discovered how to make fat products and, as it was the great era of scientism, they were convinced they could make it better than nature. Not just equal; better. Chemists assumed that they could produce a fat replacement that was superior to lard or butter from so many standpoints. First, it was more convenient: synthetic products such as margarine stay soft in the refrigerator, so you can immediately spread them on a piece of bread without the usual wait while listening to the radio. Second, it was economical, as the synthetic fats were derived from vegetables. Finally, what is worst, trans fat was assumed to be healthier. Its use propagated very widely and after a few hundred million years of consumption of animal fat, people suddenly started getting scared of it (particularly something called "saturated" fat), mainly from shoddy statistical interpretations. Today trans fat is widely banned as it turned out that it kills people, as it is behind heart disease and cardiovascular problems.

For another murderous example of such sucker (and fragilizing) rationalism, consider the story of Thalidomide. It was a drug meant to reduce the nausea episodes of pregnant women. It led to birth defects. Another drug, Diethylstilbestrol, silently harmed the fetus and led to delayed gynecological cancer among daughters.

These two mistakes are quite telling because, in both cases, the benefits appeared to be obvious and immediate, though small, and the harm remained delayed for years, at least three-quarters of a generation. The next discussion will be about the burden of evidence, as you can easily imagine that someone defending these treatments would have immediately raised the objection, "Monsieur Taleb, do you have evidence for your statement?"

Now we can see the pattern: iatrogenics, being a cost-benefit situation, usually results from the treacherous condition in which the benefits are small, and visible—and the costs very large, delayed, and hidden. And of course, the potential costs are much worse than the cumulative gains.

For those into graphs, the appendix shows the potential risks from different angles and expresses iatrogenics as a probability distribution.