Subtraction Adds to Your Life

Subtraction Adds to Your Life

Now I speculate the following, having looked closely at data with my friend Spyros Makridakis, a statistician and decision scientist whom we introduced a few chapters ago as the first to find flaws in statistical forecasting methods. We estimated that cutting medical expenditures by a certain amount (while limiting the cuts to elective surgeries and treatments) would extend people’s lives in most rich countries, especially the United States. Why? Simple basic convexity analysis; a simple examination of conditional iatrogenics: the error of treating the mildly ill puts them in a concave position. And it looks as if we know very well how to do this. Just raise the hurdle of medical intervention in favor of cases that are most severe, for which the iatrogenics effect is very small. It may even be better to increase expenditures on these and reduce expenditures on elective treatments.

In other words, reason backward, starting from the iatrogenics to the cure, rather than the other way around. Whenever possible, replace the doctor with human antifragility. But otherwise don’t be shy with aggressive treatments.

Another application of via negativa: spend less, live longer is a subtractive strategy. We saw that iatrogenics comes from the intervention bias, via positiva, the propensity to want to do something, causing all the problems we’ve discussed. But let’s do some via negativa here: removing things can be quite a potent (and, empirically, a more rigorous) action.

Why? Subtraction of a substance not seasoned by our evolutionary history reduces the possibility of Black Swans while leaving one open to improvements. Should the improvements occur, we can be pretty comfortable that they are as free of unseen side effects as one can get.

So there are many hidden jewels in via negativa applied to medicine. For instance, telling people not to smoke seems to be the greatest medical contribution of the last sixty years. Druin Burch, in Taking the Medicine, writes: “The harmful effects of smoking are roughly equivalent to the combined good ones of every medical intervention developed since the war.… Getting rid of smoking provides more benefit than being able to cure people of every possible type of cancer.”

As usual, the ancients. As Ennius wrote, “The good is mostly in the absence of bad”; Nimium boni est, cui nihil est mali.

Likewise, happiness is best dealt with as a negative concept; the same nonlinearity applies. Modern happiness researchers (who usually look quite unhappy), often psychologists turned economists (or vice versa), do not use nonlinearities and convexity effects when they lecture us about happiness as if we knew what it was and whether that’s what we should be after. Instead, they should be lecturing us about unhappiness (I speculate that just as those who lecture on happiness look unhappy, those who lecture on unhappiness would look happy); the “pursuit of happiness” is not equivalent to the “avoidance of unhappiness.” Each of us certainly knows not only what makes us unhappy (for instance, copy editors, commuting, bad odors, pain, the sight of a certain magazine in a waiting room, etc.), but what to do about it.

Let us probe the wisdom of the ages. “Sometimes scantiness of nourishment restores the system,” wrote Plotinus—and the ancients believed in purges (one manifestation of which was the oft-harmful, though often beneficial, routine of bloodletting). The regimen of the Salerno School of Medicine: joyful mood, rest, and scant nourishment. Si tibi deficiant medici, medici tibi fiant haec tria: mens laeta, requies, moderata diaeta.

There is a seemingly apocryphal (but nevertheless interesting) story about Pomponius Atticus, famous for being Cicero’s relative and epistolary recipient. Being ill, incurably ill, he tried to put an end to both his life and his suffering by abstinence, and only succeeded in ending the latter, as, according to Montaigne, his health was restored. But I am citing the story in spite of its apocryphal nature simply because, from a scientific perspective, it seems that the only way we may manage to extend people’s lives is through caloric restriction—which seems to cure many ailments in humans and extend lives in laboratory animals. But, as we will see in the next section, such restriction does not need to be permanent—just an occasional (but painful) fast might do.

We know we can cure many cases of diabetes by putting people on a very strict starvation-style diet, shocking their system—in fact the mechanism had to have been known heuristically for a long time since there are institutes and sanatoria for curative starvation in Siberia.

It has been shown that many people benefit from the removal of products that did not exist in their ancestral habitat: sugars and other carbohydrates in unnatural format, wheat products (those with celiac disease, but almost all of us are somewhat ill-adapted to this new addition to the human diet), milk and other cow products (for those of non–Northern European origin who did not develop lactose tolerance), sodas (both diet and regular), wine (for those of Asian origin who do not have the history of exposure), vitamin pills, food supplements, the family doctor, headache medicine and other painkillers. Reliance on painkillers encourages people to avoid addressing the cause of the headache with trial and error, which can be sleep deprivation, tension in the neck, or bad stressors—it allows them to keep destroying themselves in a Procrustean-bed-style life. But one does not have to go far, just start removing the medications that your doctor gave you, or, preferably, remove your doctor—as Oliver Wendell Holmes Sr. put it, “if all the medications were dumped in the sea, it would be better for mankind but worse for the fishes.” My father, an oncologist (who also did research in anthropology) raised me under that maxim (alas, while not completely following it in practice; he cited it enough, though).

I, for my part, resist eating fruits not found in the ancient Eastern Mediterranean (I use “I” here in order to show that I am not narrowly generalizing to the rest of humanity). I avoid any fruit that does not have an ancient Greek or Hebrew name, such as mangoes, papayas, even oranges. Oranges seem to be the postmedieval equivalent of candy; they did not exist in the ancient Mediterranean. Apparently, the Portuguese found a sweet citrus tree in Goa or elsewhere and started breeding it for sweeter and sweeter fruits, like a modern confectionary company. Even the apples we see in the stores are to be regarded with some suspicion: original apples were devoid of sweet taste and fruit corporations bred them for maximal sweetness—the mountain apples of my childhood were acid, bitter, crunchy, and much smaller than the shiny variety in U.S. stores said to keep the doctor away.

As to liquid, my rule is drink no liquid that is not at least a thousand years old—so its fitness has been tested. I drink just wine, water, and coffee. No soft drinks. Perhaps the most possibly deceitfully noxious drink is the orange juice we make poor innocent people imbibe at the breakfast table while, thanks to marketing, we convince them it is “healthy.” (Aside from the point that the citrus our ancestors ingested was not sweet, they never ingested carbohydrates without large, very large quantities of fiber. Eating an orange or an apple is not biologically equivalent to drinking orange or apple juice.) From such examples, I derived the rule that what is called “healthy” is generally unhealthy, just as “social” networks are antisocial, and the “knowledge”-based economy is typically ignorant.

I would add that, in my own experience, a considerable jump in my personal health has been achieved by removing offensive irritants: the morning newspapers (the mere mention of the names of the fragilista journalists Thomas Friedman or Paul Krugman can lead to explosive bouts of unrequited anger on my part), the boss, the daily commute, air-conditioning (though not heating), television, emails from documentary filmmakers, economic forecasts, news about the stock market, gym “strength training” machines, and many more.3