Thursday, June 28, 2012

Taleb Comment on Iatrogenics

I do not believe that we should take risks with near-healthy people; I also believe that we should take a lot, a lot more risks with those deemed in danger.

[...]In the very ill condition, the benefits are large relative to iatrogenics, in the borderline one, they are small. This means that we need to focus on high symptom conditions and ignore, I mean really ignore, other situations in which the patient is not very ill.

Another way to view it is by considering that mother nature had to have tinkered through selection in inverse proportion to the rarity of the condition. Of the hundred of thousands of drugs today, I can hardly find a via positiva one that makes a healthy person unconditionally “better”. And the reason we have not been able to find drugs that make us feel unconditionally better when we are well (or unconditionally stronger, etc.) is for the same statistical reason: nature would have found this magic pill. But consider that illness is rare, and the more ill the person the less likely nature would have found the solution, in an accelerating way. A condition that is three deviations away from the norm is more than three hundred times rarer than normal; an illness that is five deviations from the norm is more than a million times rarer!

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