The Black Swan Flies: Call the Black Swan, Be Ready

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Psychiatric Unpredictability

When you finish the Black Swan, be ready to read it again.

I knew I would like it as I reported the buzz on it back in June. I liked it more than I thought I would. It's an easy leap to suggest that if you are reading this blog you will very much enjoy the Black Swan. Why? -Simple:

Taleb connects interesting observations from statistical analysis in economics to epidemiology and medical evolution… on the subject of acceptance – acceptance of real evidence, beyond statistical analysis. He documents the limitations of tunnel vision – thinking that the world is only occupied by White Swans [agreed upon conclusions].

Check out this interesting interview by Stephen Dubner with Taleb in the NYTimes.

Over time, over the years of practice, the Black Swans events in our offices can either teach new perspectives – or we can simply ignore their impact and hang tight with the popular belief system of the day – founded on stats: The Standard of Care. The Standard is not a bad thing, but may be a limiting perspective for any single patient that calls the Black Swan for us.

So many of our medical ideas must fall within a Gaussian curve of predictable probability, while what we see in the office often presents as quite unpredictable and out of the ordinary. Take a look at this view of the Gaussian curve:

See this Link
Taleb encourages the realization of the fact that the unpredictable lies outside of the color [the top of this curve], and can surprise us from the blue periphery.

If we think out of the box we are more likely to be helpful for ourselves and the people we treat, advise.

A brief note follows from notes at an interview with Taleb at EconTalk – Taleb responds to a question:

“[We are often] fooled by small sampling. They'd [banks] had many good years in a row, and had forgotten about the small probability of a very bad thing happening. This kind of error is pervasive, way beyond financial markets. Skeptical empiricist: don't just tell me the narrative, the ex-post story, but give me the data so I can figure out the general distribution (which will include estimating the probability of extreme events). This is in contrast to misuse, deceptive use of data to give data an air of scientism which is not scientific. In The Black Swan, I discuss Narrative Fallacy. Hindsight bias, retrospective view, after the fact. We are suckers for stories, and ex post we have stories. 80% of epidemiological studies fail to represent real life–that is, they cannot be replicated. What people with statistical data do is process it and find accidental associations. We can even find a study where smoking lowers the risk of breast cancer – Non-representative statistical knowledge.”

Remember my previous enthusiasm for Korzybski in several previous posts – quantum theory coalesces more information within the observable field, and includes the variable of time and change. With time, perspectives change.

Sputum assessment for hormones appears as an unpredictable and odd Black Swan if we are only thinking with White Swan glasses. And SPECT imaging for brain function? -Abundant in the literature, but still perceived by many as unbelievable. If you understand these new intervention tools, and actually use them in the office, the mystery dissolves.

If we think Black Swan, – if we call on Black Swan thinking, we evolve our appreciation of our real experience rather than ignore it and remain asleep.

Special bonus: Listen to Taleb himself: Podcast interview with Taleb here at EconTalk.


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