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John Mafi @jnmafi
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Welcome all to our #SITG Book Review! I will kick this off with a tweetorial attempting to summarize Nassim Taleb’s major books and ideas (and this will be missing lots) and how they might relate to medicine #PennRadBook @RogueRad @anish_koka 1/?
Fooled by Randomness: using Markov models, Taleb elegantly illustrates the unexpectedly large and underappreciated role of chance in finance and in everyday life…
Application to medicine: most medical research is wrong largely due to chance (e.g., multiple testing) underscored by failure of reproducibility of research (e.g., low reproducibility/concordance of observational nutrition studies with randomized trials) - see Ioannidis
The Black Swan: how the modern world is increasingly dominated by highly improbable extreme events, and which importantly our classical “Gaussian” predictive models are totally blind to these “fat tail” events
For example the financial collapse of 2008 which Taleb famously predicted is one Black Swan… and importantly it’s the consequences that matter more than the probability (and the latter estimate is often wrong)
Also “via negativa”: it is much easier to disprove than to prove (a single black swan can tell you that not all swans are white, whereas even 1 trillion white swans can never fully convince you that all swans are white)…
via negativa introduces the critical role of well-designed observational studies, which can tell you with far more confidence that something doesn’t work (or even harms) than if something does work
Antifragile: Introduces a new concept coined by Taleb: fragile things are harmed from disorder (tea cup), robust things are unchanged by disorder (rock, but to a point). Antifragile things GAIN from disorder (e.g., bones gain strength from high intensity resistance training)
Application to medicine: biology often displays a non-linear S-curve of dose response. When you have severe disease (e.g., blood pressure of >180) you tend to gain NON-LINEARLY from variability (or reductions) in blood pressure – this is called convexity.
When you are relatively healthy (e.g., you have a viral upper respiratory infection) you gain little to no benefit from antibiotics and expose yourself to harm via “black swan” adverse events (rare, extremely harmful adverse reaction such as Stevens Johnsons syndrome)
Also the green lumbar fallacy: The most famous and successful lumber trader had no idea that “green lumber” meant young trees. Yet despite missing this “essential” detail, he was able to achieve success, underscoring that the "rational" details often irrelevant to success.
Also the green lumbar fallacy: The most famous and successful lumber trader had no idea that “green lumber” meant young trees. Yet despite missing this “essential” detail, he was able to achieve success, underscoring that the "rational" details are often be irrelevant to success
Skin in the Game: This book, the subject of our discussion highlights the role of hidden asymmetries in daily life… He cites lack of exposure to negative consequences as a major flaw of modernity
In other words “you cannot make profits and transfer the risks to others, as bankers and large corporations do… Forcing skin in the game corrects this asymmetry better than thousands of laws and regulations”
Example: War hawks who push for invasions and wards in the middle east bear no negative consequence for their decision… Example in medicine: Coming soon from @anish_koka
Other hidden asymmetries: The minority rule: Real change in the world is not built from consensus but from an intransigent minority who forces it.
Science is dominated by the minority rule where a small number of scientists attack the mainstream thought, if not for this rule, we’d still be stuck in the middle ages
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