Mind the Gaps

Mind the Gaps

As we saw with the stories of Thales and the wheel, antifragility (thanks to the asymmetry effects of trial and error) supersedes intelligence. But some intelligence is needed. From our discussion on rationality, we see that all we need is the ability to accept that what we have on our hands is better than what we had before—in other words, to recognize the existence of the option (or “exercise the option” as people say in the business, that is, take advantage of a valuable alternative that is superior to what precedes it, with a certain gain from switching from one into the other, the only part of the process where rationality is required). And from the history of technology, this ability to use the option given to us by antifragility is not guaranteed: things can be looking at us for a long time. We saw the gap between the wheel and its use. Medical researchers call such lag the “translational gap,” the time difference between formal discovery and first implementation, which, if anything, owing to excessive noise and academic interests, has been shown by Contopoulos-Ioannidis and her peers to be lengthening in modern times.

The historian David Wooton relates a gap of two centuries between the discovery of germs and the acceptance of germs as a cause of disease, a delay of thirty years between the germ theory of putrefaction and the development of antisepsis, and a delay of sixty years between antisepsis and drug therapy.

But things can get bad. In the dark ages of medicine, doctors used to rely on the naive rationalistic idea of a balance of humors in the body, and disease was assumed to originate with some imbalance, leading to a series of treatments that were perceived as needed to restore such balance. In her book on humors, Noga Arikha shows that after William Harvey demonstrated the mechanism of blood circulation in the 1620s, one would have expected that such theories and related practices should have disappeared. Yet people continued to refer to spirit and humors, and doctors continued to prescribe, for centuries more, phlebotomies (bloodletting), enemas (I prefer to not explain), and cataplasms (application of a moist piece of bread or cereal on inflamed tissue). This continued even after Pasteur’s evidence that germs were the cause of these infectious diseases.

Now, as a skeptical empiricist, I do not consider that resisting new technology is necessarily irrational: waiting for time to operate its testing might be a valid approach if one holds that we have an incomplete picture of things. This is what naturalistic risk management is about. However, it is downright irrational if one holds on to an old technology that is not naturalistic at all yet visibly harmful, or when the switch to a new technology (like the wheel on the suitcase) is obviously free of possible side effects that did not exist with the previous one. Taleb also favors removing harmful interventions. Removal, however, still requires comparing what happens with and without the intervention; calling it non-natural does not establish that withdrawal is harmless.

In other words, I do not give the resistance to the implementation of such discoveries any intellectual credit, or explain it by some hidden wisdom and risk management attitude: this is plainly mistaken. It partakes of the chronic lack of heroism and cowardice on the part of professionals: few want to jeopardize their jobs and reputation for the sake of change.