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Iatrogenics: Why Intervention Often Leads to Worse Outcomes

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Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#71

Post by karrot-kake »

kryogen1c wrote: post #11
HPsquared wrote: post #5

Earlier quoted context omitted.

See also, Le Chatelier's principle. It kind of makes sense, if a complex system has found some kind of steady state there must be some "restoring forces" at work to hold it there.

> if a complex system has found some kind of steady state there must be some "restoring forces" I think this is one of those things that is True with a capital T. If you start with the premise that life is valuable, it is eventually derivable. Life tries to exist, and since existence is path-dependent making a change is likelier to be wrong than right.

> making a change is likelier to be wrong than right.

This agrees with the slightly-neutral theory of evolution. A given mutation is more likely to break something a little bit than improve that something a little bit.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#72

Post by Kamq »

m0llusk wrote: post #19

This misses the problem of scale. Often the only way to patch an existing system is to try small and localized changes and then propagate them slowly. Even correct changes may require unexpected related details to be in order for a successful result. Going slowly allows for analysis of related factors and anticipating range of variation.

This reminds me of Eisenhower's old quote to his advisors: “Let's make our mistakes slowly"

Which, ironically enough, if you make changes slowly, and have a good way to back them out when they go wrong, you can change much faster. Mostly because you don't have people screaming about a change being the end of the world so hard that you need to go to war in order to change the smallest thing.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#73

Post by thfuran »

jtc331 wrote: post #67
vosper wrote: post #46

Earlier quoted context omitted.

Or their cost-benefit analysis said that the cost of removing kids from schools was worth it. Do you have any evidence of ignored cost-benefit studies that were available at lockdown decision time (there wasn’t much time for studies when these decisions needed to be made)?

Not having any studies to ignore is by definition not doing cost benefit analysis.

Or perhaps they considered the cost of studies and deemed it too high.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#74

Post by strken »

dial9-1 wrote: post #58
vosper wrote: post #46

Earlier quoted context omitted.

Or their cost-benefit analysis said that the cost of removing kids from schools was worth it. Do you have any evidence of ignored cost-benefit studies that were available at lockdown decision time (there wasn’t much time for studies when these decisions needed to be made)?

your second paragraph kinda answers itself

I don't think it does. If you have a ? in your cost-benefit spreadsheet for "cost in DALYs of locking down schools", the obvious solution (that one assumes governments actually used) is to ask your education expert for a guess and a confidence interval.

Getting that estimate wrong is not the same as failing to consider it.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#76

Post by projektfu »

Doctors are always thinking about the potential for harm in their therapies but you don't always have a lot of options. For example, amoxicillin is the standard of care for strep but some people are allergic. Azithromycin is also standard but overuse of macrolides is driving resistance in organisms that are already resistant to other antibiotics.

I understand the article is really trying to reach into medicine to find the reason to push back on other actions. If doctors recognize they can cause harm when they try to heal, so must other practitioners, presumably politicians, bureaucrats, engineers, marketers, activists, parents, etc.

It's not enough to identify the problem. We can bias for or against intervention. But neither bias is scientific or necessarily likely to produce a good outcome without externalities or adverse effects. Ideally we would try more things with small samples and also try to understand externalities, comparing that to other possible interventions or nonintervention. However, the status quo bias also has an implicit blind spot, which is assuming that things will remain the same. Unfortunately, conditions do change.

We also have a problem with the moral aspect of the question. Who has the right to intervene? Who has an obligation? Is it moral to decline to intervene? If you intervene for good reasons, but cause bad outcomes, is that a moral failing? Is one person's assessment of the outcome more morally correct than another's?

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#77

Post by littlestymaar »

throw_pm23 wrote: post #62
littlestymaar wrote: post #61

Earlier quoted context omitted.

There's several billion medical intervention of all kinds every year, harmful interventions do exist but they are only a very tiny fraction of the total.

Yes, but there are _kinds of_ interventions which turned out to be systematically harmful. For instance, in most developed countries it was a policy to thoroughly wash newborns, until they realized it was harmful.

True, but if you look at the entire collection of kinds of intervention you'll find that the harmful kinds are also a small fraction of them.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#78

Post by littlestymaar »

jtc331 wrote: post #69
littlestymaar wrote: post #26

While conservatives love the stories of interventions failing with second order effects being worse than the initial situation, in practice these are only rare instances among plenty of successful intervention we don't even think about. The main factor leading to a disaster is usually the desire to make grandiose interventions (instead of steadily increasing ones that have proven successful at small scale) and refusa…

Given virtually all interventions have no control how do you know they’re successful? Now it may well be that many interventions are successful. But your assumption of your conclusion is actually the bias the article describes.

> Given virtually all interventions have no control how do you know they’re successful?

Nobody ever ran a controlled trial on parachutes, how can we do know that they work?

Controlled trial aren't the alpha and omega of knowledge. They are powerful tools, but they also have a fairly narrow scope of applicability (and they are also a quite recent addition to the collection of scientific tools).

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#79

Post by ashwagary »

DVassallo wrote: post #45
CipherThrowaway wrote: post #37

Although it is certainly written by a human being, this article gives me a similar feeling to ChatGPT essays. The tone is compelling and plausible. But when I thought about it, I realized it didn't make much sense. > Rarely do we even consider that the cost of doing something might outweigh the benefits. Cost vs benefit is the main thing that people consider when making decisions. It's a core decision making framewor…

Iatrogenics happens when the benefits are clear and the harms are hidden. So “rational” people tend to intervene because it would seem the benefits outweigh the costs.

Correct. To parse that further, the costs may be hidden, involve unknowns and/or unknown unknowns.

This is the explanation many of the unvaxed smart people I know used to justify relying on their immune systems which were developed and tested for a million+ years over recently developed covid vaccines.

Re: Iatrogenics: Why Intervention Often Leads to Worse Outcomes

#80

Post by loa_in_ »

DoreenMichele wrote: post #7

I learned this big time as a parent: If the only solution you have is guaranteed to make it worse, it's better to stand there and watch it burn than to put out the fire with gasoline. The piece I wrote about it (titled The Hand Licking Incident ) did well on HN if you want to read a variation on this theme.

I actually remember reading your story!

It's a good read, because these things happen every day around the world but the world usually finds people too dumbfounded in this to learn from it, much less write a cautionary tale!

https://news.ycombinator.com/item?id=18842009

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