First, Do No Harm (Iatrogenics)
The principle of 'first do no harm' (primum non nocere) from medicine is applied to other domains, highlighting that interventions can cause unintended harmful side effects (iatrogenics), often due to denial of antifragility and overconfidence in human intervention.
THE IDEA
First, Do No Harm
Medicine has known about iatrogenics since at least the fourth century before our era—primum non nocere (“first do no harm”) is a first principle attributed to Hippocrates and integrated in the so-called Hippocratic Oath taken by every medical doctor on his commencement day. It just took medicine about twenty-four centuries to properly execute the brilliant idea. In spite of the recitations of non nocere through the ages, the term “iatrogenics” only appeared in frequent use very, very late, a few decades ago—after so much damage had been done. I for myself did not know the exact word until the writer Bryan Appleyard introduced me to it (I had used “harmful unintended side effects”). Let us apply this idea born in medicine to other domains of life. Since no intervention implies no iatrogenics, the source of harm lies in the denial of antifragility, and to the impression that we humans are so necessary to making things function.
Enforcing consciousness of generalized iatrogenics is a tall order. The very notion of iatrogenics is quite absent from the discourse outside medicine (which, to repeat, has been a rather slow learner). But just as with the color blue, having a word for something helps spread awareness of it. We will push the idea of iatrogenics into political science, economics, urban planning, education, and more domains. Not one of the consultants and academics in these fields with whom I tried discussing it knew what I was talking about—or thought that they could possibly be the source of any damage. In fact, when you approach the players with such skepticism, they tend to say that you are “against scientific progress.”
But the concept can be found in some religious texts. The Koran mentions “those who are wrongful while thinking of themselves that they are righteous.”
To sum up, anything in which there is naive interventionism, nay, even just intervention, will have iatrogenics.
When to use it
Before implementing a new educational curriculum, assess potential negative impacts on student well-being and learning outcomes.
When proposing a new business strategy, evaluate possible harm to employees, customers, or company culture from overly aggressive changes.
In urban planning, consider the iatrogenic effects of large infrastructure projects on community cohesion and local economies.
Before starting a medical treatment, discuss with patients the risks of overtreatment and the possibility of doing more harm than good.
FROM THEORY TO EVERYDAY LIFE
In practice
Overprescription of Antibiotics
An antibiotic prescribed for a viral infection does not treat the virus, while exposing the patient to adverse effects and contributing to antibiotic resistance. The example illustrates how an intervention can add harm without the intended benefit.
Mandatory Minimum Sentences in Criminal Justice
A mandatory-minimum sentencing proposal aims to reduce crime. Evaluating it also requires examining possible increases in incarceration, costs, and community harm. Those outcomes cannot be settled by the policy’s stated intention alone.
A MOMENT TO REFLECT
Put it to work.
Think of a recent decision you made (e.g., in work, health, or relationships) where you intervened. What unintended negative side effects could have occurred, and did you consider them in advance?
How can you incorporate a 'first do no harm' principle into your daily decision-making, especially when you feel pressure to act?
Identify a policy or practice in your field that has been criticized for iatrogenic effects. What alternative approach might reduce harm?
Often confused with
CONTINUE THE CONVERSATION
Source texts
- Antifragile (Nassim Nicholas Taleb)