Antifragile: Things That Gain from Disorder (68 page)

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

To understand the outright denial of antifragility in the way we seek wealth, consider that construction laborers seem happier with a ham and cheese baguette than businessmen with a Michelin three-star meal. Food tastes so much better after exertion. The Romans had a strange relation to wealth: anything that “softens” or “mollifies” was seen negatively. Their reputation for decadence is a bit overdone—history likes the lurid; they disliked comfort and understood its side effects. The same with the Semites, split between desert tribes and city dwellers, with city dwellers harboring a certain cross-generational nostalgia for their roots and their original culture; so there is the culture of the desert, full of poetry, chivalry, contemplation, rough episodes, and frugality, plotted against the cities’ comfort, which is associated with physical and moral decay, gossip, and decadence. The city dweller repairs to the desert for purification, as Christ did for forty days in the Judean desert, or Saint Mark in the Egyptian desert, starting a tradition of such asceticism. There was at some point an epidemic of monasticism in the Levant, perhaps the most impressive being Saint Simeon, who spent forty years on top of a column in Northern Syria. The Arabs kept the tradition, shedding possessions to go to silent, barren, empty spaces. And of course, with mandatory fasting, on which a bit later.

Note that medical iatrogenics is the result of wealth and sophistication rather than poverty and artlessness, and of course the product of partial knowledge rather than ignorance. So this idea of shedding possessions to go to the desert can be quite potent as a
via negativa
–style subtractive strategy. Few have considered that money has its own iatrogenics, and that separating some people from their fortune would simplify their lives and bring great benefits in the form of healthy stressors. So being poorer might not be completely devoid of benefits if one does it right. We need modern civilization for many things, such as the legal
system and emergency room surgery. But just imagine how by the subtractive perspective,
via negativa,
we can be better off by getting tougher: no sunscreen, no sunglasses if you have brown eyes, no air-conditioning, no orange juice (just water), no smooth surfaces, no soft drinks, no complicated pills, no loud music, no elevator, no juicer, no … I stop.

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. If true wealth consists in worriless sleeping, clear conscience, reciprocal gratitude, absence of envy, good appetite, muscle strength, physical energy, frequent laughs, no meals alone, no gym class, some physical labor (or hobby), good bowel movements, no meeting rooms, and periodic surprises, then it is largely subtractive (elimination of iatrogenics).

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 it again, the cases with negative convexity—will certainly help. We have so 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.
⁴

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-reader-TED-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.

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 response
to a very stable habitat free of abrupt changes, redundancy of pathways the response to a more variegated one. Diversification of function 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.
⁵
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.