2009 : WHAT WILL CHANGE EVERYTHING?

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Distinguished Professor of Risk Engineering, New York University School of Engineering ; Author, Incerto (Antifragile, The Black Swan...)
THE IDEA OF NEGATIVE AND IATROGENIC SCIENCE

People want advice on how to get rich –and pay for it. Now how not to go bust does not appear to be valid advice –yet given that over time only a minority of companies do not go bust, avoiding death is the best possible –and most robust --advice. It is particularly good advice after your competitors get in trouble and you can go on legal pillages of their businesses. But few value such advice: this is the reason Wall Street quants, consultants, and investment managers are in business in spite of their charlatanic record. I was recently on TV and some "empty suit" kept bugging me for precise advice on how to pull out of the crisis. It was impossible to communicate my "what not to do" advice –or that my field is error avoidance not emergency room surgery, and that it could be a standalone discipline. Indeed I spent 12 years trying to explain that in many instances no models were better –and wiser –than the mathematical acrobatics we had in finance and it took a monumental crisis to convince people of the point.

Unfortunately such lack of rigor pervades the place where we expect it the least: institutional science. Science, particularly its academic version, never liked negative results, let alone the statement and advertizing of its own limits — the reward system is not set up for it. You get respect for doing funambulism or spectator sports –following the right steps to become the "Einstein of Economics" or the "next Darwin" rather than give society something real by debunking myths or by cataloguing where our knowledge stops.

[In some instances we accept limit of knowledge trumpeting, say, Gödel's "breakthrough" mathematical limits –because it shows elegance in formulation and mathematical prowess – though the importance of such limit is dwarfed by our practical limits in forecasting climate changes, crises, social turmoil, or the fate of the endowment funds that will finance research of such future "elegant" limits].

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. 

Sadly, further investigation shows that these iatrogenics were mere rediscoveries after science got too arrogant by the enlightenment. Alas, once again, the elders knew better –Greeks, Romans, Byzantines, and Arabs had a built-in respect for 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 have accepted religion partly as a tool to tame such illusion of control.

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.