- Author:: [[Nassim Nicholas Taleb]] -  - [[∙Melvil Decimal System (DDC)]] - [[1 - Philosophy and Psychology]] - [[15 - Psychology]] - [[155 - Developmental And Differential Psychology]] - [[155.2 - Individual Psychology]] ### Highlights Modernity has replaced ethics with legalese, and the law can be gamed with a good lawyer. So I will expose the transfer of fragility, or rather the theft of antifragility, by people "arbitraging" the system. These people will be named by name. Poets and painters are free, liberi poetae et pictores, and there are severe moral imperatives that come with such freedom. First ethical rule: If you see fraud and do not say fraud, you are a fraud. Just as being nice to the arrogant is no better than being arrogant toward the nice, being accommodating toward anyone committing a nefarious action condones it. Further, many writers and scholars speak in private, say, after half a bottle of wine, differently from the way they do in print. Their writing is certifiably fake, fake. And many of the problems of society come from the argument "other people are doing it." So if I call someone a ous ethically challenged fragilista in private after the third glass of Lebanese wine (white), I will be obligated to do so here. Calling people and institutions fraudulent in print when they are not (yet) called so by others carries a cost, but is too small to be a deterrent. After the mathematical scientist Benoît Mandelbrot read the galleys of The Black Swan, a book dedicated to him, he called me and quietly said: "In what language should I say 'good luck' to you?" I did not need any luck, it turned out; I was antifragile to all manner of attacks: the more attacks I got from the Central Fragilista Delegation, the more my mesdangersage spread as it drove people to examine my arguments. I am now ashamed of not having gone further in calling a spade a spade. Compromising is condoning. The only modern dictum I follow is one by George Santayana: A man is morally free when world, and judges other men, with uncompromising sincerity. This is . he judges the not just an aim but an obligation. (Page 15) - Further, this randomness is necessary for true life. Consider that all the wealth of the world can't buy a liquid more pleasurable than water after intense thirst. Few objects bring more thrill than a recovered wallet (or laptop) lost on a train. Further, in an ancestral habitat we humans were prompted by natural stimuli-fear, hunger, desire-that made us work out and become fit for our environment. Consider how easy it is to td the energy to lift a car if a crying child is under it, or to run for your ie if you see a wild animal crossing the street. Compare this to the heaviness of the obligation to visit the gym at the planned 6 P.M. and 1 bullied there by some personal trainer-unless of course you are und the imperative to look like a bodyguard. Also consider how easy it is skip a meal when the randomness in the environment causes us to do c because of lack of food-as compared to the "discipline" of sticking to some eighteen-day diet plan. There exist the kind of people for whom life is some kind of project. After talking to them, you stop feeling good for a few hours; life starts tasting like food cooked without salt. I, a thrill-seeking human, have a b***t detector that seems to match my boredom detector, as if we were equipped with a naturalistic filter, dullness-aversion. Ancestral life had no homework, no boss, no civil servants, no academic grades, no conversation with the dean, no consultant with an MBA, no table of procedure, no application form, no trip to New Jersey, no grammatical stickler, no conversation with someone boring you: all life was random stimuli and nothing, good or bad, ever felt like work.* Dangerous, yes, but boring, never. Finally, an environment with variability (hence randomness) does not expose us to chronic stress injury, unlike human-designed systems. If you walk on uneven, not man-made terrain, no two steps will ever be identical-compare that to the randomness-free gym machine offering the exact opposite: forcing you into endless repetitions of the very same movement. Much of modern life is preventable chronic stress injury. (Page 63) - The point of the previous chapter was that the risk properties of the first brother (the fragile bank employee) are vastly different from those of the second one (the comparatively antifragile artisan taxi driver). Likewise, the risk characteristic of a centralized system is different from that of a messy municipally-led confederation. The second type is stable in the long run because of some dose of volatility. A scientific argument showing how tight controls backfire and cause blowups was made by James Clerk Maxwell of electromagnetic theory fame. "Governors" are contraptions meant to control the speed of steam engines by compensating for abrupt variations. They aimed at stabilizing the engines, and they apparently did, but they paradoxically sometimes brought about capricious behavior and crashes. Light control works; close control leads to overreaction, sometimes causing NA the machinery to break into pieces. In a famous paper "On Governors," published in 1867, Maxwell modeled the behavior and showed mathematically that tightly controlling the speed of engines leads to instability. It is remarkable how Maxwell's neat mathematical derivations and the dangers of tight control can be generalized across domains and help debunk pseudo-stabilization and hidden long-term fragility.* In the markets, fixing prices, or, equivalently, eliminating speculators, the so-called "noise traders" and the moderate volatility that they bring-provide an illusion of stability, with periods of calm punctuated with large jumps. Because players are unused to volatility, the slightest price variation will then be attributed to insider information, or to changes in the state of the system, and will cause panics. When a currency never varies, a slight, very slight move makes people believe that the world is ending. Injecting some confusion stabilizes the system. Indeed, confusing people a little bit is beneficial-it is good for you and good for them. For an application of the point in daily life, imagine someone extremely punctual and predictable who comes home at exactly six o'clock every day for fifteen years. You can use his arrival to set your watch. The fellow will cause his family anxiety if he is barely a few minutes late. Someone with a slightly more volatile-hence unpredictableschedule, with, say, a half-hour variation, won't do so. Variations also act as purges. Small forest fires periodically cleanse the system of the most flammable material, so this does not have the opportunity to accumulate. Systematically preventing forest fires from taking place "to be safe" makes the big one much worse. For similar reasons, stability is not good for the economy: firms become very weak during long periods of steady prosperity devoid of setbacks, and hidden vulnerabilities accumulate silently under the surface-so delaying crises is not a very good idea. Likewise, absence of fluctuations in the market causes hidden risks to accumulate with impunity. The longer one goes without a market trauma, the worse the damage when commotion occurs. (Page 100) - One of the methods, called ‘sortes virgilianae’ (fate as decided by the epic poet Virgil), involved opening Virgil's Aeneid at random and interpreting the line that presented itself as direction for the course of action. You should use such method for every sticky business decision. I will repeat until I get hoarse: the ancients evolved hidden and sophisticated ways and tricks to exploit randomness. For instance, I actually practice such randomizing heuristic in restaurants. Given the lengthening and complication of menus, subjecting me to what psychologists call the tyranny of choice, with the stinging feeling after my decision that I should have ordered something else, I blindly and systematically duplicate the selection by the most overweight male at the table; and when no such person is present, I randomly pick from the menu without reading the name of the item, under the peace of mind that Baal made the choice for me. (Page 105) - There is an element of deceit associated with interventionism, accelerating in a a professionalized society. It's much easier to sell "Look what I did for you" than "Look what I avoided for you." Of course a bonus system based on “performance” exacerbates the problem. I've looked in history for heroes who became heroes for what they did not do, but it is hard to observe nonaction; I could not easily find any. The doctor who refrains from operating on a back (a very expensive surgery), instead giving it a chance to heal itself, will not be rewarded and judged as favorably as the doctor who makes the surgery look indispensable, then brings relief to the patient while exposing him to operating risks, while accruing great financial rewards to himself. The latter will be driving the pink Rolls-Royce. The corporate manager who avoids a loss will not often be rewarded. The true hero in the Black Swan world is someone who prevents a calamity and, naturally, because the calamity did not take place, does not get recognition or a bonus-for it. I will be taking the concept deeper in Book VII, on ethics, about the unfairness of a bonus system and how such unfairness is magnified by complexity (Page 121) - We will see many barbells in the rest of this book that share exactly the same asymmetry and somehow, when it comes to risk, produce the same type of protection and help in the harnessing of antifragility. They all look remarkably similar. Let us take a peek at a few domains. With personal risks, you can easily barbell yourself by removing the chances of ruin in any area. I am personally completely paranoid about certain risks, then very aggressive with others. The rules are: no smoking, no sugar (particularly fructose), no motorcycles, no bicycles in town or more generally outside a traffic-free area such as the Sahara desert, no mixing with the Eastern European máfias, and no getting on a plane not flown by a professional pilot (unless there is a co-pilot). Outside of these I can take all manner of professional and personal risks, particularly those in which there is no risk of terminal injury. In social policy, it consists in protecting the very weak and letting the strong do their job, rather than helping the middle class to consolidate its privileges, thus blocking evolution and bringing all manner of economic problems that tend to hurt the poor the most. Before the United Kingdom became a bureaucratic state, it was barbelled into adventurers (both economically and physically) and an aristocracy. The aristocracy didn't really have a major role except to help keep some sense of caution while the adventurers roamed the planet in search of trading opportunities, or stayed home and tinkered with machinery. Now the City of London is composed of bourgeois bohemian bonus earners. My writing approach is as follows: on one hand a literary essay that can be grasped by anyone and on the other technical papers, nothing in between-such as interviews with journalists or newspaper articles or oped pieces, outside of the requirements of publishers. The reader may remember the exercise regimen of Chapter 2, which consists in going for the maximum weight one can lift, then nothing, compared to other alternatives that entail less intense but very long hours in the gym. This, supplemented with effortless long walks, constitutes an exercise barbell. More barbells. Do crazy things (break furniture once in a while), like the Greeks during the later stages of a drinking symposium, and stay "rational" in larger decisions. Trashy gossip magazines and classics or sophisticated works; never middlebrow stuff. Talk to either undergraduate students, cab drivers, and gardeners or the highest caliber scholars; never to middling-but-career-conscious academics. If you dislike someone, leave him alone or eliminate him; don't attack him verbally. So take for now that a barbell strategy with respect to randomness results in achieving antifragility thanks to the mitigation of fragility, the clipping of downside risks of harm-reduced pain from adverse events, while keeping the benefits of potential gains. To return to finance, the barbell does not need to be in the form of investment in inflation-protected cash and the rest in speculative securities. Anything that removes the risk of ruin will get us to such a barbell. The legendary investor Ray Dalio has a rule for someone making speculative bets: “Make sure that the probability of the unacceptable (i.e., the risk of ruin) is nil." Such a rule gets one straight to the barbell.t (Page 165) - Observing my father close up made me realize what being a valedictorian meant, what being an Intelligent Student meant, mostly in the negative: they were things that intelligent students were unable to under stand. Some blindness came with the package. This idea followed me for a long time, as when I worked in trading rooms, where you sit most of the time waiting for things to happen, a situation similar to that of people sitting in bars or mafia men “hanging around." I figured out how to select people on their ability to integrate socially with others while sitting around doing nothing and enjoying fuzziness. You select people on their ability to hang around, as a filter, and studious people were not good at hanging around: they needed to have a clear task. When I was about ten I realized that good grades weren't as good outside school as they were in it, as they carried some side effects. They had to correspond to a sacrifice, an intellectual sacrifice of sorts. Actually my father kept hinting to me the problem of getting good grades himself: the person who was at the exact bottom of his class (and ironically, the father of a classmate at Wharton) turned out to be a self-made merchant, by far the most successful person in his class (he had a huge yacht with his initials prominently displayed on it); another one made a killing buying wood in Africa, retired before forty, then became an amateur historian (mostly in ancient Mediterranean history) and entered politics. In a way my father did not seem to value education, rather culture or money and he prompted me to go for these two (I initially went for culture). He had a total fascination with erudites and businessmen, people whose position did not depend on credentials. My idea was to be rigorous in the open market. This made me focus on what an intelligent antistudent needed to be: an autodidact-or a person of knowledge compared to the students called "swallowers" in Lebanese dialect, those who "swallow school material" and whose knowledge is only derived from the curriculum. The edge, I realized, isn't in the package of what was on the official program of the baccalaureate, which everyone knew with small variations multiplying into large discrepancies in grades, but exactly what lay outside it. Some can be more intelligent than others in a structured environment-in fact school has a selection bias as it favors those quicker in such an environment, and like anything competitive, at the performance outside it. Although I was not yet familiar with expense of gyms, my idea of knowledge was as follows. People who build their strength using these modern expensive gym machines can lift extremely large weights, show great numbers and develop impressive-looking muscles, but fail to lift a stone; they get completely hammered in a street fight by someone trained in more disorderly settings. Their strength is extremely domain-specific and their domain doesn't exist outside of ludicextremely organized-constructs. In fact their strength, as with overspecialized athletes, is the result of a deformity. I thought it was the same with people who were selected for trying to get high grades in a small number of subjects rather than follow their curiosity: try taking them slightly away from what they studied and watch their decomposition, loss of confidence, and denial. (Just like corporate executives are selected for their ability to put up with the boredom of meetings, many of these people were selected for their ability to concentrate on boring material.) I've debated many economists who claim to specialize in risk and probability: when one takes them slightly outside their narrow focus, but within the discipline of probability, they fall apart, with the disconsolate face of a gym rat in front of a gangster hit man (Page 224) - When I was in business school I rarely attended lectures in something called strategic planning, a required course, and when I showed my face in class, I did not listen for a nanosecond to what was said there; did not even buy the books. There is something about the common sense of student culture; we knew that it was all babble. I passed the required classes in management by confusing the professors, playing with complicated logics, and I felt it intellectually dishonest to enroll in more classes than the strictly necessary. Corporations are in love with the idea of the strategic plan. They need to pay to figure out where they are going. Yet there is no evidence that strategic planning works-we even seem to have evidence against it. A management scholar, William Starbuck, has published a few papers debunking the effectiveness of planning-it makes the corporation option-blind, as it gets locked into a non-opportunistic course of action. Almost everything theoretical in management, from Taylorism to all productivity stories, upon empirical testing, has been exposed as pseudoscience—and like most economic theories, lives in a world parallel to the evidence. Matthew Stewart, who, trained as a philosopher, found himself in a management consultant job, gives a pretty revolting, if funny, inside story in The Management Myth. It is similar to the self-serving approach of bankers. Abrahamson and Friedman, in their beautiful book A Perfect Mess, also debunk many of these neat, crisp, teleological approaches. It turns out, strategic planning is just superstiFor an illustration of business drift, rational and opportunistic business drift, take the following. Coca-Cola began as a pharmaceutical product. Tiffany & Co., the fancy jewelry store company, started life as a stationery store. The last two examples are close, perhaps, but consider next: Raytheon, which made the first missile guidance system, was a refrigerator maker (one of the founders was no other than Vannevar Bush, who conceived the teleological linear model of science we saw earlier; go figure). Now, worse: Nokia, who used to be the top mobile phone maker, began as a paper mill (at some stage they were into rubber shoes). DuPont, now famous for Teflon nonstick cooking pans, Corian countertops, and the durable fabric Kevlar, actually started out as an explosives company. Avon, the cosmetics company, started out in door-to-door book sales. And, the strangest of all, Oneida Silversmiths was a community religious cult but for regulatory reasons they needed to use as cover a joint stock company. (Page 234) - The biologist and intellectual E. O. Wilson was once asked what represented the most hindrance to the development of children; his answer was the soccer mom. He did not use the notion of the Procrustean bed, but he outlined it perfectly. His argument is that they repress children's natural biophilia, their love of living things. But the problem is more general; soccer moms try to eliminate the trial and error, the antifragility, from children's lives, move them away from the ecological and transform them into nerds working on preexisting (soccer-mom-compatible) maps of reality. Good students, but nerds-that is, they are like computers except slower. Further, they are now totally untrained to handle ambiguity. As a child of civil war, I disbelieve in structured learningactually I believe that one can be an intellectual without being a nerd, provided one has a private library instead of a classroom, and spends time as an aimless (but rational) flâneur benefiting from what randomness can give us inside and outside the library. Provided we have the right type of rigor, we need randomness, mess, adventures, uncertainty, self-discovery, near-traumatic episodes, all these things that make life worth living, compared to the structured, fake, and ineffective life of an empty-suit CEO with a preset schedule and an alarm clock. Even their leisure is subjected to a clock, squash between four and five, as their life is sandwiched between appointments. It is as if the mission of modernity was to squeeze every drop of variability and randomness out of life-with (as we saw in Chapter 5) the ironic result of making the world a lot more unpredictable, as if the goddesses of chance wanted to have the last word. Only the autodidacts are free. And not just in school mattersthose who decommoditize, detouristify their lives. Sports try to put random ness in a box like the ones sold in aisle six next to canned tuna—a form of alienation. If you want to understand how vapid are the current modernistic arguments (and understand your existential priorities), consider the difference between lions in the wild and those in captivity. Lions in captivity live longer; they are technically richer, and they are guaranteed job security for life, if these are the criteria you are focusing on ... As usual, an ancient, here Seneca, detected the problem (and the difference) with his saying "We do not study for life, but only for the lecture room," non vitae, sed scolae discimus, which to my great horror has been corrupted and self-servingly changed to fit the motto of many colleges in the United States, with non scolae, sed vitae discimus as their motto, meaning that "We study [here] for life, not for the lecture hall." →Most of the tension in life will take place when the one who reduces and fragilizes (say the policy maker) invokes rationality. (Page 242) - A squeeze occurs when people have no choice but to do something, and do it right away, regardless of the costs. Your other half is to defend a doctoral thesis in the history of German dance and you need to fly to Marburg to be present at such an important moment, meet the parents, and get formally engaged. You live in New York and manage to buy an economy ticket to Frankfurt for $400 and you are excited about how cheap it is. But you need to go through London. Upon getting to New York's Kennedy airport, you are apprised by the airline agent that the flights to London are canceled, sorry, delays due to backlog due to weather problems, that type of thing. Something about Heathrow's fragility. You can get a last-minute flight to Frankfurt, as there are very few seats left. You fume, shout, curse, but now you need to pay $4,000, close to ten times the price, and hurry, your upbringing and parents who taught you to save, then shell out the blame yourself, $4,000. That's a squeeze. Squeezes are exacerbated by size. When one is large, one becomes squeezes become nonlinearly costlier as size increases. vulnerable to some errors, particularly horrendous squeezes. The To see how size becomes a handicap, consider the reasons one should not own an elephant as a pet, regardless of what emotional attachment you may have to the animal. Say you can afford an elephant as part of your postpromotion household budget and have one delivered to your backyard. Should there be a water shortage-hence a squeeze, since you have no choice but to shell out the money for water-you would have to pay a higher and higher price for each additional gallon of water. That's fragility, right there, a negative convexity effect coming from getting too big. The unexpected cost, as a percentage of the total, would be monstrous. Owning, say, a cat or a dog would not bring about such high unexpected additional costs at times of squeeze-the overruns taken as a percentage of the total costs would be very low. 279 In spite of what is studied in business schools concerning "economies of scale," size hurts you at times of stress; it is not a good idea to be large during difficult times. Some economists have been wondering why mergers of corporations do not appear to play out. The combined unit is now much larger, hence more powerful, and according to the theories of economies of scale, it should be more "efficient." But the numbers show, at best, no gain from such increase in size-that was already true in 1978, when Richard Roll voiced the "hubris hypothesis," finding it irrational for companies to engage in mergers given their poor historical record. Recent data, more than three decades later, still confirm both the poor record of mergers and the same hubris as managers seem to ignore the bad economic aspect of the transaction. There appears to be something about size that is harmful to corporations. As with the idea of having elephants as pets, squeezes are much, much more expensive (relative to size) for large corporations. The gains from size are visible but the risks are hidden, and some concealed risks seem to bring frailties into the companies. Large animals, such as elephants, boa constrictors, mammoths, and other animals of size tend to become rapidly extinct. Aside from the squeeze when resources are tight, there are mechanical considerations. Large animals are more fragile to shocks than small ones-again, stone and pebbles. Jared Diamond, always ahead of others, figured out such vulnerability in a paper called "Why Cats Have Nine Lives." If you throw a cat or a mouse from an elevation of several times their height, they will typically manage to survive. Elephants, by comparison, break limbs very easily. (Page 278) - Consider the futuristic projections made throughout the past century and a half, as expressed in literary novels such as those by Jules Verne, H. G. Wells, or George Orwell, or in now forgotten narratives of the future produced by scientists or futurists. It is remarkable that the tools that seem to currently dominate the world, such as the Internet, or more mundane matters such as the wheel on the suitcase of Book IV, were completely missing from these forecasts. But it is not here that the error lies. The problem is that almost everything that was imagined never took place, except for a few overexploited anecdotes (such as the steam engine by Hero the Alexandrian or the assault vehicle by Leonardo da Vinci). Our world looks too close to theirs, much closer to theirs than they ever imagined or wanted to imagine. And we tend to be blind to that fact-there seems to be no correcting mechanism that can make us aware of the point as we go along forecasting a highly technocratic future. There may be a selection bias: those people who engage in producing these accounts of the future will tend to have (incurable and untreatable) neomania, the love of the modern for its own sake. Tonight I will be meeting friends in a restaurant (tavernas have existed for at least twenty-five centuries). I will be walking there wearing shoes hardly different from those worn fifty-three hundred years ago by the mummified man discovered in a glacier in the Austrian Alps. At the restaurant, I will be using silverware, a Mesopotamian technology, which qualifies as a "killer application" given what it allows me to do to the leg of lamb, such as tear it apart while sparing my fingers from burns. I will be drinking wine, a liquid that has been in use for at least six millennia. The wine will be poured into glasses, an innovation claimed by my Lebanese compatriots to come from their Phoenician ancestors, and if you disagree about the source, we can say that glass objects have been sold by them as trinkets for at least twenty-nine hundred years. After the main course, I will have a somewhat younger technology, artisanal preparation for several centuries. cheese, paying higher prices for those that have not changed in their Had someone in 1950 predicted such a minor gathering, he would have imagined something quite different. So, thank God, I will not be dressed in a shiny synthetic space-style suit, consuming nutritionally optimized pills while communicating with my dinner peers by means of screens. The dinner partners, in turn, will be expelling airborne germs on my face, as they will not be located in remote human colonies across the with the aid of kitchen tools and implements that have not galaxy. The food will be prepared using a very archaic technology (fire), changed since the Romans (except in the quality of some of the metals used). I will be sitting on an (at least) three-thousand-year-old device commonly known as the chair (which will be, if anything, less ornate that its majestic Egyptian ancestor). And I will be not be repairing to the restaurant with the aid of a flying motorcycle. I will be walking or, if late, using a cab from a century-old technology, driven by an immigrant-immigrants were driving cabs in Paris a century ago (Russian aristocrats), same as in Berlin and Stockholm (Iraqis and Kurdish refugees), Washington, D.C. (Ethiopian postdoc students), Los Angeles (musically oriented Armenians), and New York (multinationals) today. David Edgerton showed that in the early 2000s we produce two and a half times as many bicycles as we do cars and invest most of our technological resources in maintaining existing equipment or refining old technologies (note that this is not just a Chinese phenomenon: Western cities are aggressively trying to become bicycle-friendly). Also consider that one of the most consequential technologies seems to be the one people talk about the least: the condom. Ironically, it wants to look like less of a technology; it has been undergoing meaningful improvements, with the precise aim of being less and less noticeable. (Page 311) - I complete this section with the following anecdote. One of my students (who was majoring in, of all subjects, economics) asked me for a rule on what to read. "As little as feasible from the last twenty years, except history books that are not about the last fifty years," I blurted out, with irritation as I hate such questions as "what's the best book you've ever read," or "what are the ten best books,"-my "ten best books ever" change at the end of every summer. Also, I have been hyping Daniel Kahneman's recent book, because it is largely an exposition of his research of thirty-five and forty years ago, with filtering and modernization. My recommendation seemed impractical, but, after a while, the student developed a culture in original texts such as Adam Smith, Karl Marx, and Hayek, texts he believes he will cite at the age of eighty. He told me that after his detoxification, he realized that all his peers do is read timely material that becomes instantly obsolete. (Page 331) - In Aristotle's Magna Moralia, there is a possibly apocryphal story about Empedocles, the pre-Socratic philosopher, who was asked why a dog prefers to always sleep on the same tile. His answer was that there had to be some likeness between the dog and that tile. (Actually the story might be even twice as apocryphal since we don't know if Magna Moralia was actually written by Aristotle himself.) Consider the match between the dog and the tile. A natural, biological, explainable or nonexplainable match, confirmed by long series of recurrent frequentation-in place of rationalism, just consider the history of it. F Which brings me to the conclusion of our exercise in prophecy. I surmise that those human technologies such as writing and reading that have survived are like the tile to the dog, a match between natural friends, because they correspond to something deep in our nature Every time I hear someone trying to make a comparison between a book and an e-reader, or something ancient and a new technology, "opinions" pop up, as if reality cared about opinions and narratives. There are secrets to our world that only practice can reveal, and no opinion or analysis will ever capture in full. This secret property is, of course, revealed through time, and, thankfully, only through time. Let's take this idea of Empedocles' dog a bit further: If something that makes no sense to you (say, religion-if you are an atheist-or some age-old habit or practice called irrational); if that something has been around for a very, very long time, then, irrational or not, you can expect it to stick around much longer, and outlive those who call for its demise. (Page 334) - Second principle of iatrogenics: it is not linear. We should not take risks with near-healthy people; but we should take a lot, a lot more risks with those deemed in danger. Why do we need to focus treatment on more serious cases, not mar ginal ones? Take this example showing nonlinearity (convexity). When hypertension is mild, say marginally higher than the zone accepted as 5.6 percent (only one person in eighteen benefit from the treatment). But "normotensive," the chance of benefiting from a certain drug is close to when blood pressure is considered to be in the "high" or "severe" range, the chances of benefiting are now 26 and 72 percent, respectively (that is, one person in four and two persons out of three will benefit from the treatment). So the treatment benefits are convex to condition (the benee disproportionally, in an accelerated manner). But consider that the iatrogenics should be constant for all categories! 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. fits rise The argument here is based on the structure of conditional survival probabilities, similar to the one that we used to prove that harm needs to be nonlinear for porcelain cups. Consider that Mother Nature had to have tinkered through selection in inverse proportion to the rarity of the condition. Of the hundred and twenty thousand drugs available today, I can hardly find a via positiva one that makes a healthy person unconditionally "better" (and if someone shows me one, I will be skeptical of yet-unseen side effects). Once in a while we come up with drugs that enhance performance, such as, say, steroids, only to discover what people in finance have known for a while: in a "mature" market there is no free lunch anymore, and what appears as a free lunch has a hidden risk. have found a free lunch, say, steroids or trans fat, something that helps the healthy without visible downside, it is most you think you likely that there is a concealed trap somewhere. Actually, my days in trading, it was called a "sucker's trade. When And there is a simple statistical reason that explains why we have not been able to find drugs that make us feel unconditionally better when we are well (or unconditionally stronger, etc.): nature would have been likely to find this magic pill by itself. But consider that illness is rare, and the more ill the person the less likely nature would have found the solution by itself, in an accelerating way. A condition that is, say, three units of deviation away from the norm is more than three hundred times rarer an illness that is five units of deviation from the norm is than normal; more than a million times rarer! The medical community has not modeled such nonlinearity of bene fits to iatrogenics, and if they do so in words, I have not seen it in formalized in papers, hence into a decision-making methodology that takes probability into account (as we will see in the next section, there is little explicit use of convexity biases). Even risks seem to be linearly extrapolated, causing both underestimation and overestimation, most certainly miscalculation of degrees of harm-for instance, a paper on the effect of radiation states the following: "The standard model currently in use applies a linear scale, extrapolating cancer risk from high doses to low doses of ionizing radiation." Further, pharmaceutical companies are under financial pressures to find diseases and satisfy the security analysts. They have been scraping the bottom of the barrel, looking for disease among healthier and healthier people, lobbying for reclassifications of conditions, and fine-tuning sales tricks to get doctors to overprescribe. Now, if your blood pressure is in the upper part of the range that used to be called "normal," you are no longer "normotensive" but "pre-hypertensive," even if there are no symptoms in view. There is nothing wrong with the classification if it leads to healthier lifestyle and robust via negativa measures-but what is behind such classification, often, is a drive for more medication. I am not against the function and mission of pharma, rather, its business practice: they should focus for their own benefit on extreme diseases, not on reclassifications or pressuring doctors to prescribe medicines. Indeed, pharma plays on the interventionism of doctors. Another way to view it: the iatrogenics is in the patient, not in the treatment. If the patient is close to death, all speculative treatments should be encouraged-no holds barred. Conversely, if the patient i near healthy, then Mother Nature should be the doctor. (Page 340) - The list of such attempts to outsmart nature driven by naive rationalism is long-always meant to "improve" things-with continuous first-order learning, that is, banning the offending drug or medical procedure but not figuring out that we could be making the mistake again, elsewhere. Statins. Statin drugs are meant to lower cholesterol in your blood. But there is an asymmetry, and a severe one. One needs to treat fifty high risk persons for five years to avoid a single cardiovascular event. Statins can potentially harm people who are not very sick, for whom the benefits are either minimal or totally nonexistent. We will not be able to get an evidence-based picture of the hidden harm in the short term (we need years for that-remember smoking) and, further, the arguments cutrently made in favor of the routine administration of these drugs often lie in a few statistical illusions or even manipulation (the experiments used by drug companies seem to play on nonlinearities and bundle the very ill and the less ill, in addition to assuming that the metric "cholesterol" equates 100 percent with health). Statins fail in their application the first principle of iatrogenics (unseen harm); further, they certainly do lower cholesterol, but as a human your objective function is not to lower a certain metric to get a grade to pass a school-like test, but get in better health. Further, it is not certain whether these indicators people try to lower are causes or manifestations that correlate to a condition-just as muzzling a baby would certainly prevent him from crying but would not remove the cause of his emotions. Metric-lowering drugs are particularly vicious because of a legal complexity. The doctor has the incentive to prescribe it because should the patient have a heart attack, he would be sued for negligence; but the error in the opposite direction is not penalized at all, as side effects do not appear at all as being caused by the medicine. The same problem of naive interpretation mixed with intervention bias applies to cancer detection: there is a marked bias in favor of treatment, even when it brings more harm, because the legal system favors intervention. Surgery. Historians show that surgery had, for a long time, a much better track record than medicine; it was checked by the necessary rigor of visible results. Consider that, when operating on victims of very severe trauma, say, to extract a bullet or to push bowels back in their place, the iatrogenics is reduced; the downside of the operation is small compared to the benefits-hence positive convexity effects. Unlike with the usual pharmaceutical interventions, it is hard to say that Mother Nature would have done a better job. The surgeons used to be blue-collar workers, or closer to artisans than high science, so they did not feel too obligated to theorize. The two professions of medical doctor and surgeon were kept professionally and socially separate, one was an ars, the other scientia, hence one was a craft built around experience-driven heuristics and the other reposed on theories, nay, a general theory of humans. Surgeons were there for emergencies. In England, France, and some Italian cities, surgeons' guilds were merged with those of barbers. So the SovietHarvardification of surgery was for a long time constrained by the visibility of the results-you can't fool the eye. Given that for a long time people operated without anesthetics, one did not have to overly justify doing nothing and waiting for Nature to play her role. But today's surgery, thanks to anesthesia, is done with a much smaller hurdle-and surgeons now need to attend medical school, albeit a less theoretical one than the Sorbonne or Bologna of the Middle Ages. By contrast, in the past, letting blood (phlebotomy) was one of the few operations performed by surgeons without any disincentive. For instance, back surgery done in modern times to correct sciatica is often useless, minus the possible harm from the operation. Evidence shows that six years later, such an operation is, on average, equivalent to doing nothing, so we have a certain potential deficit from the back operation as every operation brings risks such as brain damage from anesthesia, medical error (the doctor harming the spinal cord), or exposure to hospital germs. Yet spinal cord surgery such as lumbar disc fusion is still ticed liberally, particularly as it is very lucrative for the doctor.* pracAntibiotics. Every time you take an antibiotic, you help, to some degree, the mutation of germs into antibiotic-resistant strains. Add to that the toying with your immune system. You transfer the antifragility from your body to the germ. The solution, of course, is to do it only when the benefits are large. Hygiene, or excessive hygiene, has the same effect, particularly when people clean their hands with chemicals after every social exposure. Here are some verified and potential examples of iatrogenics (in terms of larger downside outside of very ill patients, whether such downside has been verified or not)t: Vioxx, the anti-inflammatory medicine with delayed heart problems as side effects. Antidepressants (used beyond the necessary cases). Bariatric surgery (in place of starvation of overweight diabetic patients). Cortisone. Disinfectants, cleaning products potentially giving rise to autoimmune diseases. Hormone replacement therapy. Hysterectomies. Cesarean births beyond the strictly necessary. Ear tubes in babies as an immediate response to ear infection. Lobotomies. Iron supplementation. Whitening of rice and wheat-it was considered progress. The sunscreen creams suspected to cause harm. Hygiene (beyond a certain point, hygiene may make you fragile by denying hormesis-our own antifragility). We ingest probiotics because we don't eat enough "dirt" anymore. Lysol and other disinfectants killing so many "germs" that kids' developing immune systems are robbed of necessary workout (or robbed of the "good" friendly germs and parasites). Dental hygiene: I wonder if brushing our teeth with toothpaste full of chemical substances is not mostly to generate profits for the toothpaste industry-the brush is natural, the toothpaste might just be to counter the abnormal products we consume, such as starches, sugars and high fructose corn syrup. Speaking of which, high fructose corn syrup was the result of neomania, financed by a Nixon administration in love with technology and victim of some urge to subsidize corn farmers. Insulin injections for Type II diabetics, based on the assumption that the harm from diabetes comes from blood sugar, not insulin resistance (or something else associated with it). Soy milk. Cow milk for people of Mediterranean and Asian descent. Heroin, the most dangerously addictive substance one can imagine, was developed as a morphine substitute for cough suppressants that did not have morphine's addictive side effects. Psychiatry, particularly child psychiatry-but I guess I don't need to convince anyone about its dangers. I stop here. Again, my statements here are risk-management-based: if the person is very ill, there are no iatrogenics to worry about. So it is the marginal case that brings dangers. The cases I have been discussing so far are easy to understand, but some applications are far more subtle. For instance, counter to "what makes sense" at a primitive level, there is no clear evidence that sugar-free sweetened drinks make you lose weight in accordance with the calories saved. But it took thirty years of confusing the biology of millions of people for us to start asking such questions. Somehow those recommending these drinks are under the impression, driven by the laws of physics (naive translation from thermodynamics), that the concept that we gain weight from calories is sufficient for further analysis. This would be certainly true in thermodynamics, as in a simple machine responding to energy without feedback, say, a car that burns fuel. But the reasoning does not hold in an informational dimension in which food is not just a source of energy; it conveys information about the environment (like stressors). The ingestion of fo (Page 344) - 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, Imove 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). reI, 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 documen tary filmmakers, economic forecasts, news about the stock market, gym "strength training" machines, and many more. (Page 361) - Religion has invisible purposes beyond what the literal-minded scientistic-scientifiers identify-one of which is to protect us from scientism, that is, them. We can see in the corpus of inscriptions (on graves) accounts of people erecting fountains or even temples to their favorite gods after these succeeded where doctors failed. Indeed we rarely look at religion's benefits in limiting the intervention bias and its iatrogenics: in a large set of circumstances (marginal disease), anything that takes you away from the doctor and allows you to do nothing (hence gives nature a chance to do its work) will be beneficial. So going to church (or the temple of Apollo) for mild cases-say, those devoid of trauma, like a mild discomfort, not injuries from a car accident, those situations in which the risk of iatrogenics exceeds the benefit of cure, to repeat again, the cases with negative convexity-will certainly help. We have so it many inscriptions on temples of the type Apollo saved me, my doctors tried to kill me typically the patient has bequeathed his fortune to the temple. And it seems to me that human nature does, deep down, know when to resort to the solace of religion, and when to switch to science. IF IT'S WEDNESDAY, I MUST BE VEGAN Sometimes, for a conference dinner, the organizers send me a form asking me if I have dietary requirements. Some do so close to six months in advance. In the past, my usual answer had been that I avoid eating cats, dogs, rats, and humans (especially economists). Today, after my personal evolution, I truly need to figure out the day of the week to know if I will be vegan then or capable of eating those thick monstrous steaks. How? Just by looking at the Greek Orthodox calendar and its required fasts. This confuses the usual categorizing business-readerTED-conference modern version of the naive fellow who cannot place me in the "Paleo camp" or the "vegan camp." (The "Paleo" people are carnivores who try to replicate the supposed ancestral high-meat, high-animal-fat diet of hunter-gatherers; vegans are people who eat no animal product, not even butter). We will see further down why it is a naive rationalistic mistake to be in either category (except for religious or spiritual reasons) except episodically. I believe in the heuristics of religion and blindly accommodate its rules (as an Orthodox Christian, I can cheat once in a while, as it is part of the game). Among other things the role of religion is to tame the iatrogenics of abundance-fasting makes you lose your sense of entitlement. But there are more subtle aspects. Convexity Effects and Random Nutrition Recall from the lung ventilator discussion this practical consequence of Jensen's inequality: irregularity has its benefits in some areas; regularity has its detriments. Where Jensen's inequality applies, irregularity might be medicine. Perhaps what we mostly need to remove is a few meals at random, or at least avoid steadiness in food consumption. The error of missing nonlinearities is found in two places, in the mixture and in the frequency of food intake. The problem with the mixture is as follows. We humans are said to be omnivorous, compared to more specialized mammals, such as cows and elephants (who eat salads) and lions (who eat prey, generally salad-eating prey). But such ability to be omnivorous had to come in response to more variegated environments with unplanned, haphazard, and, what is key, serial availability of sources-specialization is the re sponse to a very stable habitat free of abrupt changes, redundancy of pathways the response to a more variegated one. Diversification of fit of tion had to come in response to variety. And a variety of a certain structure. Note a subtlety in the way we are built: the cow and other herbivores are subjected to much less randomness than the lion in their food intake; they eat steadily but need to work extremely hard in order to metabolize all these nutrients, spending several hours a day just eating. Not to count the boredom of standing there eating salads. The lion, on the other hand, needs to rely on more luck; it succeeds in a small percentage of the kills, less than 20 percent, but when it eats, it gets in a quick and easy way all these nutrients produced thanks to very hard and boring work by the prey. So take the following principles derived from the random structure of the environment: when we are herbivores, we eat steadily; but when we are predators we eat more randomly. Hence our proteins need to be consumed randomly for statistical reasons. So if you agree that we need "balanced" nutrition of a certain combination, it is wrong to immediately assume that we need such balance at every meal rather than serially so. Assuming that we need on average certain quantities of the various nutrients that have been identified, say a certain quantity of carbohydrates, proteins, and fats.* There is a big difference between getting them together, at every meal, with the classical steak, salad, followed by fresh fruits, or having them separately, serially. Why? Because deprivation is a stressor-and we know what stressors do when allowed adequate recovery. Convexity effects at work here again: getting three times the daily dose of protein in one day and nothing the next two is certainly not biologically equivalent to "steady" moderate consumption if our metabolic reactions are nonlinear. It should have some benefits at least this is how we are designed to be. I speculate; in fact I more than speculate: I am convinced (an inevitable result of nonlinearity) that we are antifragile to randomness in food delivery and composition-at least over a certain range, or number of days. And one blatant denial of convexity bias is the theory about the benefits of the so-called Cretan (or Mediterranean) diet that triggered a change in the eating habits of the U.S. enlightened class, away from steak and potatoes in favor of grilled fish with salad and feta cheese. It happened as follows. Someone looked at the longevity of Cretans, cataloged what they ate, then inferred-naively-that they lived longer because of the types of food they consumed. It could be true, but the second-order effect (the variations in intake) could be dominant, something that went unnoticed by mechanistic researchers. Indeed, it took a while to notice the following: the Greek Orthodox church has, depending on the severity of the local culture, almost two hundred days of fasting per year; and these are harrowing fasts. Yes, harrowing fasts, as I am feeling it right now. For I am writing these lines during Orthodox Lent, a forty-day period in which almost no animal product can be consumed, no sweets, and, for some sticklers, no olive oil. As there are several gradations, I try to stick to a semistrict level, and life is not very easy, as is meant to be. I just spent a long weekend in Amioun, my ancestral village in Northern Lebanon, in the Greek Orthodox area called the Koura valley. There traditional "ruse" foods are perfected, with great imagination: Levantine kibbeh made with herbs and beans in place of meat, meatballs made of matzoh-style small brown balls in a lentil soup. Remarkably, while fish is banned, most days, shellfish is allowed, probably as it was not considered a luxury item. The compensation for the absence of some nutrients from my daily diet will take place in lumps. I will make up my deprivation of what researchers (for now) call protein with fish on days when it is allowed, and of course I will ravenously eat lamb on Easter Day, then consume disproportionally high quantities of fatty red meat for a while thereafter. I dream of the red steak served in Fat Tony-patronized restaurants in unapologetically monstrous portions. And there is this antifragility to the stressor of the fast, as it makes the wanted food taste better and can produce euphoria in one's system. Breaking a fast feels like the exact opposite of a hangover. for you, I wonder how people can accept that the stressors of exercise are good , but do not transfer to the point that food deprivation c the same effect. But scientists are in the process of di (Page 364) - We saw how the ancients understood the Stiglitz syndrome-and associated ones—rather well. In fact they had quite sophisticated mechanisms to counter most aspects of agency problems, whether individual or collective (the circular effect of hiding behind the collective). Earlier, I mentioned the Romans forcing engineers to spend time under the bridge they built. They would have had Stiglitz and Orszag sleep under the bridge of Fannie Mae and exit the gene pool (so they wouldn't harm us again). The Romans had even more powerful heuristics for situations few today have thought about, solving potent game-theoretic problems. Roman soldiers were forced to sign a sacramentum accepting punishment in the event of failure-a kind of pact between the soldier and the army spelling out commitment for upside and downside. Assume that you and I are facing a small leopard or a wild animal in the jungle. The two of us can possibly overcome it by joining forces-but each one of us is individually weak. Now, if you run away, all you need to be is just faster than me, not faster than the animal. So it would be optimal for the one who can run away the fastest, that is, the most cowardly, to just be a coward and let the other one perish. The Romans removed the soldiers' incentive to be a coward and hurt others thanks to a process called decimation. If a legion loses a battle and there is suspicion of cowardice, 10 percent of the soldiers and commanders are put to death, usually by random lottery. Decimationmeaning eliminating one in ten-has been corrupted by modern language. The magic number is one in ten (or something equivalent): putting more than 10 per cent to death would lead to weakening of the army; too little, and cowardice would be a dominant strategy. And the mechanism must have worked well as a deterrent against cowardice, since it was not commonly applied. The English applied a version of it. Admiral John Byng was court-martialed and sentenced to death as he was found guilty of failing to "do his utmost" to prevent Minorca from falling to the French following the Battle of Minorca (Page 392) - I believe that forcing researchers to eat their own cooking whenever possible solves a serious problem in science. Take this simple heuristicdoes the scientific researcher whose ideas are applicable to the real world apply his ideas to his daily life? If so, take him seriously. Otherwise, ignore him. (If the fellow is doing pure mathematics or theology, or teaching poetry, then there is no problem. But if he is doing something applicable, then: red flag.) This brings us to Triffattype fakeness compared to Seneca, the talker versus the doer. I applied this method of ignoring what an academic writes and focusing on what he does when I met a researcher on happiness who held that anything one makes beyond $50,000 does not bring any additional happiness-he was then earning more than twice that at a university, so according to his metric he was safe. The argument seen through his "experiments" published in "highly cited papers" (that is, by other academics) seemed convincing on paper-although I am not particularly crazy about the notion of "happiness" or the vulgarity of the modern interpretation of "seeking happiness." So, like an idiot, I believed him. But a year or so later, I heard that he was particularly avid for dollars and spent his time on the road speaking for fees. That, to me, was more sufficient evidence than thousands of citations. (Page 395)