>I once broke my nose…walking. For the sake of antifragility, of course. I was trying to walk on uneven surfaces, as part of my antifragility program, under the influence of Erwan Le Corre, who believes in naturalistic exercise. It was exhilarating; I felt the world was richer, more fractal, and when I contrasted this terrain with the smooth surfaces of sidewalks and corporate offices, those felt like prisons. Unfortunately, I was carrying something much less ancestral, a cellular phone, which had the insolence to ring in the middle of my walk.
>In the emergency room, the doctor and staff insisted that I should “ice” my nose, meaning apply an ice-cold patch to it. In the middle of the pain, it hit me that the swelling that Mother Nature gave me was most certainly not directly caused by the trauma. It was my own body’s response to the injury. It seemed to me that it was an insult to Mother Nature to override her programmed reactions unless we had a good reason to do so, backed by proper empirical testing to show that we humans can do better; the burden of evidence falls on us humans. So I mumbled to the emergency room doctor whether he had any statistical evidence of benefits from applying ice to my nose or if it resulted from a naive version of an interventionism. His response was: “You have a nose the size of Cleveland and you are now interested in…numbers?” I recall developing from his blurry remarks the thought that he had no answer.
>Effectively, he had no answer, because as soon as I got to a computer, I was able to confirm that there is no compelling empirical evidence in favor of the reduction of swelling. At least, not outside of the very rare cases in which the swelling would threaten the patient, which was clearly not the case. It was pure sucker-rationalism in the mind of doctors, following what made sense to boundedly intelligent humans, coupled with interventionism, this need to do something, this defect of thinking that we knew better, and denigration of the unobserved ... The researchers Paul Meehl and Robin Dawes pioneered a tradition to catalog the tension between “clinical” and actuarial (that is, statistical) knowledge, and examine how many things believed to be true by professionals and clinicians aren’t so and don’t match empirical evidence. The problem is of course that these researchers did not have a clear idea of where the burden of empirical evidence lies (the difference between naive or pseudo empiricism and rigorous empiricism)—the onus is on the doctors to show us why reducing fever is good, why eating breakfast before engaging in activity is healthy (there is no evidence), or why bleeding patients is the best alternative (they’ve stopped doing so). Sometimes I get the answer that they have no clue when they have to utter defensively “I am a doctor” or “are you a doctor?”