Iatrogenics and the Nihilism Label

Iatrogenics and the Nihilism Label

Let’s consider medicine (that sister of philosophy), 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 from 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 (it was “nihilistic”)—and research compiled by Spyros Makridakis shows that they still do to some extent, particularly in the overdiagnoses of some diseases.

The nihilism label has always been used to harm. Practitioners who were conservative and considered the possibility of letting nature do its job, or who stated the limits of our medical understanding, were until the 1960s accused of “therapeutic nihilism.” It was deemed “unscientific” to avoid embarking on a course of action based on an incomplete understanding of the human body—to say, “This is the limit; this is where my body of knowledge stops.” It has been used against this author by intellectual fraudsters trying to sell products.

The very term iatrogenics, i.e., the study of the harm caused by the healer, is not widespread—I have never seen it used outside medicine. In spite of my lifelong obsession with what is called type 1 error, or the false positive, I was only introduced to the concept of iatrogenic harm very recently, thanks to a conversation with the essayist Bryan Appleyard. How can such a major idea remain 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.

Sadly, further investigation shows that these iatrogenics were mere rediscoveries after science grew too arrogant by the Enlightenment. Alas, once again, the elders knew better—Greeks, Romans, Byzantines, and Arabs had a built-in respect for the limits of knowledge. There is a treatise by the medieval Arab philosopher and doctor Al-Ruhawi which betrays the familiarity of these Mediterranean cultures with iatrogenics. I have also in the past speculated that religion saved lives by taking the patient away from the doctor. You could satisfy your illusion of control by going to the Temple of Apollo rather than seeing the doctor. What is interesting is that the ancient Mediterraneans may have understood the trade-off very well and may have accepted religion partly as a tool to tame the illusion of control.

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 to give up on elegance to focus on something that was given 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.

Iatrogenics of Regulators. Alas, the call for more (unconditional) regulation of economic activity appears to be a normal response. My worst nightmares have been the results of regulators. It was they who promoted the reliance on ratings by credit agencies and the “risk measurement” that fragilized the system as bankers used them to build positions that turned sour. Yet every time there is a problem, we do the Soviet-Harvard thing of more regulation, which makes investment bankers, lawyers, and former-regulators-turned-Wall-Street-advisers rich. They also serve the interest of other groups.