It’s Complex!

Lisa Rosenbaum wrote in the New Yorker about the unintended (and obviously unexpected) consequence of putting limits on the length of shifts for resident doctors at hospitals. The intent was obvious: fewer hours would mean fewer sleep deprived residents, which would then translate into better decisions, fewer errors and better quality of care. But what really happened?

“The number of times a patient was passed from one doctor to another increased; residents started to focus on the clock; learning opportunities decreased; and quality of care, despite intentions, decreased.”

In Antifragile, Nassim Taleb described the term, “iatrogenics”:

“In the case of tonsillectomies, the harm to the children undergoing unnecessary treatment is coupled with the trumpeted gain for some others. The name for such net loss, the (usually bitten or delayed) damage from treatment in excess of the benefits, is iatrogenics, literally, “caused by the healer,” intros being a healer in Greek.”

Of course, not all side-effects are bad. Many are just impossible to predict or anticipate. Like take the next two examples.

Did the iPad kill the reading habit? David Hansson argues that the iPad did something far more subtle:

“What really happened, of course, was much more subtle. Instead of killing the Kindle, the iPad just killed my desire to read books...I still don’t understand why I can read blogs, news, and code on a screen all day with nary a complaint, but I can’t finish a book on the iPad.”

With the awful sex ratio in so many parts of India, you’d assume that brides, being in short supply, would start commanding a premium. If you think a bit more, you’ll realize that things aren’t that simple: a bride, once “acquired”, can be ill treated, so she has to think long term and can’t risk pissing off the groom by charging a premium. So that’s that then? Nope, there’s more to the story. In North India, more inter-caste marriages have begun to happen due to this shortage of brides. But only with “imported” brides from elsewhere: inter-caste marriage from within the same region is still a no-no. Go figure!

All of the above would be examples of the butterfly effect (named after the famous idea from chaos theory that a butterfly flapping its wings in one end of the world can trigger a sequence of events that that causes a cyclone at the other end). HR McMaster must have had that in mind when he said:

“It’s so damned complex. If you ever think you have the solution to this, you’re wrong and you’re dangerous.”