Everything nonstable or breakable has had ample chance to break over time. Further, the interactions between components of Mother Nature had to modulate in such a way as to keep the overall system alive. What emerges over millions of years is a wonderful combination of solidity, antifragility, and local fragility, sacrifices in one area made in order for nature to function better. We sacrifice ourselves in favor of our genes, trading our fragility for their survival. We age, but they stay young and get fitter and fitter outside us. Things break on a small scale all the time, in order to avoid large-scale generalized catastrophes.
theories come and go; experience stays.
The doctor and medical essayist James Le Fanu showed how our understanding of the biological processes was coupled with a decline of pharmaceutical discoveries, as if rationalistic theories were blinding and somehow a handicap.
A Lacedaemonian was asked what had made him live so long; he answered, “Ignoring medicine.” Montaigne also detected the agency problem, or why the last thing a doctor needs is for you to be healthy: “No doctor derives pleasure from the health of his friends, wrote the ancient Greek satirist, no soldier from the peace of his city, etc.”
the great statistician and debunker of statistical misinterpretation David Freedman showed (very convincingly) with a coauthor that the link everyone is obsessing about between salt and blood pressure has no statistical basis.
There is a break-even point that is easily crossed by panicked doctors and patients: treating the tumor that will not kill you shortens your life—chemotherapy is toxic.
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.
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 Ennius wrote, “The good is mostly in the absence of bad”;
The regimen of the Salerno School of Medicine: joyful mood, rest, and scant nourishment.
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.
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.
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.”
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.
When I see pictures of my friend the godfather of the Paleo ancestral lifestyle, Art De Vany, who is extremely fit in his seventies (much more than most people thirty years younger than him), and those of the pear-shaped billionaires Rupert Murdoch or Warren Buffett or others in the same age group, I am invariably hit with the following idea.