When the Cure is Worse than the Disease

Life is one trade-off after another. There are no “solutions,” even though intellectuals and politicians are constantly talking as if there were.¹

– Thomas Sowell

There has been much debate about the measures taken to bring the COVID-19 pandemic under control. Putting aside the ethics of enforced quarantines, have the lockdowns been effective in curtailing the spread of the virus? Have populations wearing masks (either surgical or N95) fared better? What about the effects of travel bans?

Such questions deserve answers but are only part of a larger puzzle. Also worth considering, are the potentially harmful side effects of a given ‘solution’; what economists call ‘the unseen’. Those who fail to account for the unseen consequences of a proposed ‘cure’ risk creating entirely new problems.

There are numerous historical examples of attempted solutions to perceived problems that have gone awry. The efficacy of these ‘cures’ run the gamut from highly contentious to patently counter-productive. An example of the former, is the debate surrounding how best to reduce gun violence in the United States.

Supporters of bans and stricter gun controls argue that guns are simply too easy to obtain. Therefore, stricter gun laws are necessary to keep firearms out of the hands of those who wish to do harm. Opponents of such interventions claim that regardless of the laws in place, criminals will find ways to acquire guns. Furthermore, making gun-ownership more difficult punishes law-abiding citizens, inhibiting their ability to defend themselves.

Another long-standing controversy pertains to poverty. Critics of the welfare state argue that programs designed to support the poor create perverse incentives that actually perpetuate poverty. Whereas welfare advocates argue that a ‘social safety net’ is a prerequisite for any civil society.

Perhaps the quintessential example of the cure being worse than the disease was the US government’s attempt to prohibit alcohol in the early twentieth century.

When the National Prohibition Act was passed in 1919, demand for alcohol didn’t suddenly dry up. What did change, however, was that supplying alcohol to the masses now represented a hugely lucrative opportunity (for those willing to break the law).

Risking imprisonment in order to enjoy the hefty financial rewards for selling alcohol was deemed a worthy trade-off by many Americans; Americans like Al Capone, the mob boss reportedly earning ‘as much as $100 million a year in the mid-1920s ($1.4 billion in 2018) and spending a half million dollars a month in bribes to police, politicians and federal investigators.’

With so much money at stake, violent rival gangs began vying for territory. In 1929, for example, on what is now known as the St. Valentine’s Day Massacre, Al Capone’s henchmen impersonated police officers and shot seven members of a rival gang. Thousands more lives were lost due to the consumption of illicit liquor. A government order designed to deter would-be drinkers compelled companies to add toxic chemicals to the industrial alcohol used to produce these black market beverages, making them even more dangerous.

Just as passing a law prohibiting alcohol did not eliminate Americans’ desire to drink, the repeal of Prohibition in 1933 did not vanquish the organised crime syndicates that it had inspired. These criminal gangs simply found new markets via which to exercise their power and control:

The biggest gangs shifted their operations away from alcohol and into secondary businesses like drugs, gambling and prostitution. They also profited greatly from the Great Depression. . . In hindsight, it’s clear that Prohibition. . . gave birth to one of the nation’s worst criminal traditions.

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In the West, the idea of child labour has become a reviled concept. Dickensian images of coal mining kids clad in soot paint a dismal picture of what it used to mean for a child to earn a living. Nowadays, children typically forgo employment in order to attend school. However, in developing nations, children without such opportunities still work to help support their families.

In response to emotionally-charged reports of children working long hours in factories, attempts have been made to prohibit child labour (either through overt bans or indirectly via bans on imports). Although seemingly well-intentioned, such bans have been largely unsuccessful according to the World Bank:

To date, rigorous evidence of the impact of child labor bans is still scant and limited to the US and the findings point to the limited effect of these policies in reducing child labor (Moehling 1999; Margo and Finegan 1996; and Lleras-Muney 2002).

But that’s not the end of the story. What happened to the children prevented from working, such as the Bangladeshi kids fired from their textile jobs due to pressure from the US? They didn’t just sit at home twiddling their thumbs or enrol in school. No, instead, they became street beggars, embarked on a life of crime, or engaged in child prostitution.

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Thus far, we’ve focused on broad, societal attempts at solving problems. The “cure is worse than the disease” phenomenon also shows up in people’s personal lives. As before, let’s begin with some contentious examples before moving on to some more obviously counter-productive ‘cures’.

Corporal Punishment

Overlooking the ethics of hitting a minor, on its surface, corporal punishment appears somewhat logical: “In order to discourage a child from touching the stove, apply a negative stimulus in the form of a slap; the child will remember this unpleasant stimulus and refrain from repeating the unwanted behaviour in the future.” Like the previous ‘cures’, this neat equation fails to account for several unseen effects.

Beyond the immediate cessation of an unwanted behaviour, corporal punishment is not only ineffective, it is correlated with numerous negative outcomes including more aggression, more antisocial behaviour, more negative relationships with parents, and lower cognitive ability.² Decades of research have failed to support the efficacy of spanking, leading authors of a 2012 literature review to conclude: ‘no study has found physical punishment to have a long-term positive effect, and most studies have found negative effects.’³

In recognition of these findings, support for this age-old ‘cure’, both by parents and nation states, is on the decline.

Medical Interventions

Medical errors are the third leading cause of death in the US. Many of these deaths are the result of adverse drug reactions (ADR). Dr Donald Light and colleagues⁴ estimated that ADRs result in 2.7 million hospitalisations and 128,000 deaths, each year. This is without including deaths and ADRs occurring outside of hospitals. And to be clear, these ADRs and deaths follow the use of prescription drugs that are ‘appropriately prescribed and used.’⁵

Psychiatric drugs, a class of drugs ostensibly designed to combat psychological issues, are consumed by 1 in 6 Americans.⁶ Putting aside there questionable efficacy,⁷ these drugs have been shown to cause sexual dysfunction,^{8 9} brain abnormalities,¹⁰ suicide,¹¹ violence,¹² and risks to newborns.¹³ They also kill a lot of people.

In his 2015 book, Deadly Psychiatry and Organised Denial, Dr Peter Gøtzsche estimated that psychiatric drugs kill 500,000 Americans and Europeans over the age of 65, every year.¹⁴

Cosmetic Surgery

Americans spent over $16.5 billion on cosmetic surgery in 2018. In the same year, 20 million Chinese citizens underwent a procedure. Women underwent 90 percent of the 28,000 procedures that took place in the UK; the three most popular being breast augmentation, breast reduction, and eyelid surgery.

After spending thousands of dollars to realign their nose, enhance their breasts, or augment their eyelids, how do people typically feel about their new look?

A survey involving 2638 respondents, found that 65 percent of those who volunteered to go under the knife ended up regretting it. Frequently cited complaints included medical complications and side effects that patients felt were not clearly explained. Some respondents (13 percent) also reported feeling less confident following their procedures.

Several high-profile celebrities have also expressed regret following their decision to surgically alter their appearance.

Divorce

Although divorce rates appear to be declining in the US and UK, the fact remains that millions of people around the world choose to end their marriages, every year. China has experienced a substantial increase in divorce over the last couple of decades, with 3.8 million couples divorcing in 2015.

Divorce proceedings can be incredibly stressful,¹⁵ time-consuming and costly. The average American divorce costs $15,000 per person and can take a year to finalise (assuming you don’t go to trial). After all is said and done, how do people who’ve gone through a divorce typically feel about it?

A US survey conducted by Avvo, an online attorney directory, found that about two-thirds of respondents did not regret their decision to divorce. However, in the UK, a survey of 2000 men and women found that over half of those who separated did regret it. Popular reasons for regretting a divorce included missing an ex-partner, feeling like a failure, and still being in love with an ex-partner. Other surveys have reported lower levels of regret.

Whichever numbers you consider most accurate, taken together, the data suggest that divorce regret is a very real phenomenon affecting significant numbers of divorcees.

Another concerning consequence of divorce is suicide. Without controlling for divorce, men are almost four times more likely to commit suicide than women.¹⁶ After divorcing, a man’s suicide risk roughly doubles. Interestingly, no difference is observed when comparing married versus divorced women. The most concerning finding, comes from comparing the suicide rates of divorced men relative to divorced women. Using data from the US National Longitudinal Mortality Study, an analysis found that divorced men were almost 10 times more likely to kill themselves than comparable divorced women.

Divorce is well-known to negatively impact children. For the children of divorced men, their fathers’ heightened risk of suicide is especially concerning given that fatherlessness has been shown to have highly deleterious effects on kids, especially boys.¹⁷

Paranoid Parents

In their 2018 book, The Coddling of the American Mind, Greg Lukianoff and Jonathan Haidt explore the culture of ‘safetyism’ that has taken root in the United States. They argue that despite declines in crime and the invention of life-saving technologies (e.g. seatbelts), parents perceive the world to be a highly dangerous place for kids. Coupled with an increased emphasis on academic achievement (relative to physical and social skills), these safety concerns have prevented children from engaging in the kinds of unsupervised free play that previous generations took for granted.

Undirected play is not only fun but fosters risk-taking and experimentation. It also ‘allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts, and to learn self-advocacy skills.’¹⁸ Children deprived of free play risk becoming less physically and socially competent, and more anxious and risk-averse, adults. Speaking of which…

Anxious Avoiders

Many people consider public speaking more terrifying than death. If you’re one of them, you probably work fairly hard to avoid finding yourself in front of an audience. Other situations in which the spotlight effect can rear its ugly head (e.g. approaching a stranger at a party or asking someone out on a date) are also common sources of anxiety.

If you tend to avoid anxiety-provoking situations, perhaps you remain hopeful that one day you will overcome your fears. For now, though, you continue to tell yourself that you just aren’t ‘ready’ and will try ‘next time’. This implies that through some miracle destined to occur in the not too distant future, you will have mastered the thing you are avoiding doing right now… without ever having tried. That’s preposterous.

The fatal flaw in this strategy becomes patently obvious when applied to any other practical endeavour. How much progress are you likely to make on your golf swing if you never pick up a club? Expect to ace your physics exam without any test prep? Not likely. Want to perform a guitar solo before learning some basic chords? Forget it. Social skills are no different. Only through trial and error are you likely to make progress.

By failing to try you’re not only failing to improve, you’re becoming more fragile. Every time you eschew an uncomfortable situation, you make the next encounter that much more difficult to handle: your capacity to evade stressful situations is growing in inverse proportion to your capacity to face them. Put another way, the better you get at avoiding, the worse you get at confronting. This is one way mild anxieties grow and evolve into crippling phobias.

Afterword

Through the above examples, we have seen how attempting to ‘solve’ problems (real or imagined) can reap unforeseen negative consequences. This habit of adding (pills, policies, punishments) relates to a concept popularised by author, Nassim Nicholas Taleb, called via negativa.¹⁹

Briefly, via negativa is the process of learning through removing what is false or inefficacious, rather than adding what we believe is true or will work. In Taleb’s view, ‘negative knowledge (what is wrong, what does not work) is more robust to error than positive knowledge (what is right, what works).’²⁰ Additive solutions (e.g. taking a pill) create circumstances in which unintended consequences (e.g. sudden death) can arise. Preferring to subtract can allow us to avoid implementing ‘cures’ which may bring about problems that outstrip the original problem in their severity.

Since attempts to restrain the pandemic (and prevent subsequent waves) are still ongoing, it is likely too early to appreciate the extent of the damage caused by both the virus, itself, and the ‘cures’ designed to halt its spread. Many of these ‘cures’ lie outside the purview of the average citizen, having been implemented by a central authority. Thus, I end with a question for you, the reader: What ‘cure’ or attempted solution have you recently implemented in your personal life that, upon reflection, may be doing more harm than good?

1. Sowell, T. (1999). Barbarians inside the gates—and other controversial essays. Stanford, California: Hoover Institution.
2. Gershoff, E. T., & Grogan-Kaylor, A. (2016). Spanking and child outcomes: old controversies and new meta-analyses. Journal of Family Psychology, 1-17.
3. Durrant, J., & Ensom, R. (2012). Physical punishment of children: lessons from 20 years of research. CMAJ, 184(12), 1373-1377, p. 1375.
4. Light, D. W., Lexchin, J., & Darrow, J. J. (2013). Institutional corruption of pharmaceuticals and the myth of safe and effective drugs. Journal of Law, Medicine, and Ethics, 590-600.
5. Light et al., 2013, p. 593.
6. Moore, T. J., & Mattison, D. R. (2017). Adult utilization of psychiatric drugs and differences by sex, age, and race. JAMA Internal Medicine, 177(2), 274-275. doi:10.1001/jamainternmed.2016.7507
7. Kirsch, I. (2014). Antidepressants and the placebo effect. Zeitschrift für Psychologie, 222(3), 128–134.
8. Montejo, A. L., Llorca, G., Izquierdo, J. A., & Rico-Villademoros, F. (2001). Incidence or sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. The Journal of clinical psychiatry.
9. Simonsen, A. L., Danborg, P. B., & Gøtzsche, P. C. (2016). Persistent sexual dysfunction after early exposure to SSRIs: systematic review of animal studies. International Journal of Risk & Safety in Medicine, 28(1), 1-12.
10. Breggin, P. R. (2012). Psychiatric drug withdrawal: A guide for prescribers, therapists, patients and their families. Springer Publishing Company.
11. Sharma, T., Guski, L. S., Freund, N., & Gøtzsche, P. C. (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. bmj, 352.
12. Moore, T. J., Glenmullen, J., & Furberg, C. D. (2010). Prescription drugs associated with reports of violence towards others. PloS one, 5(12), e15337.
13. Eke, A. C., Saccone, G., & Berghella, V. (2016). Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and risk of preterm birth: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 123(12), 1900-1907.
14. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.
15. The film Marriage Story is a great dramatization of a modern American divorce.
16. Farrell, W., & Gray, J. (2018). The boy crisis: Why our boys are struggling and what we can do about it. Dallas: BenBella.
17. Farrell & Gray, 2018.
18. Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182-191, p. 183.
19. Taleb, N. N. (2012). Antifragile: Things that gain from disorder. New York: Random House.
20. Taleb, N. N., 2012.