When Interventions Do More Harm Than Good
Updated: Dec 18, 2021
“Naïve interventionism” is a term introduced by Nassim Nicholas Taleb in his book, Antifragile: Things That Gain From Disorder. It describes intervening, based on an urge to help, without weighing up the potential harm of such an intervention. Taleb provides examples from medicine to illustrate the concept; from the historic use of bloodletting, to the modern-day doctors visit that rarely results in 'doing nothing' even when warranted.
Taleb also considers the peer-review process, during which perhaps reviewers feel the need to suggest edits, but are they always truly necessary? Or are they changes (interventions) for the sake of ‘doing something’? Similarly, naïve interventionism has been considered elsewhere in the sphere of education.
Such interventionism is however, driven by good intentions. It is our desire to help, to fix, to improve. Yet, doing so from a position of naivety can result in a potentially harmful outcome. When a treatment does indeed cause more harm than benefit, this is called iatrogenics, meaning; “caused by the healer” in Greek.
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In reading over these concepts, I could not help but consider the influence of naïve interventionism on the role of sports practitioners. We are expected to make suggestions, to influence decision making. Indeed, we are paid for our input. Subsequently, there is pressure to ‘do something’ given the resources and attention invested in sports science and medicine nowadays. Do we, at times, recommend interventions for the sake of intervention?
Given the complex nature of both performance and injury, we often cannot be certain of the outcomes of an intervention. Indeed, if there is a harmful outcome, such as injury, illness, or poor performance, it is difficult to trace the cause back to a single intervention.
While this provides us some protection for our decisions, it highlights the necessity to consider the potential outcomes of an intervention, both positive and negative. Let's consider a couple of common situations...
When recommending a particular supplement, have we considered the potential side effects, as well as the possibility of contamination and a positive drug test?
When recommending some form of training load reduction, have we considered the potential effects on physical preparation and long-term fitness, as well as possible harmful outcomes relating to missing the technical, tactical, psychological, and social benefits of training?
When recommending a training programme focussed on "correcting" muscle or movement imbalances, have we considered the possible negative effects on an individual's technique or on injury risk as the individual's body attempts to adapt to changes in the system?
As a coach, every cue can be an intervention. In this post, @ImSporticus describes how the discovery of Taleb's concept of naïve interventionism led them down the path of a 'Silent Coach'. One who ensures they add value if and when they step in.
If we step in, we better know how to add value. If we step away, we better know how to add value. Either way we need to do no harm. - @ImSporticus, Drowning in the Shallow
Striving for innovation can also increase the possibility of naïve interventionism. I recently came across this example in Shoe Dog, the excellent memoir of Nike creator Phil Knight, regarding their creation, the LD 1000:
"... a running shoe that featured a dramatically flared heel. The heel flared so much, in fact, that from certain angles it looked like a water ski. The theory was that a flared hell would lesson torque on the leg and reduce pressure on the knee, thus lowering the risk of tendinitis and other running-related maladies... Customers loved it. At first. Then came the issues. If a runner didn't land just right, the flared heel could cause pronation, knee problems, or worse."
Of course, it is not necessarily a case of avoiding harm altogether, especially when it comes to performance. We need muscle damage to adapt. We need to balance injury risk with striving for optimal performance, a tug of war I've previously explored. We may also need to make mistakes, in order to learn and improve. Yet, it is the naivety to potential harms that Taleb warns against.
According to Taleb, we should strive for “non-naïve interventionism”. Not avoiding intervention altogether - Taleb states he is as concerned with under-intervention as over-intervention - but making ourselves aware of our natural tendency to intervene, as well as the potential harm from an intervention. Given the complex constructs we are dealing with, I believe it is our ethical responsibility to try to overcome naivety and consider both the potential upsides and downsides of interventions we recommend.
Need for Shared Visions
According to Taleb, iatrogenics is compounded by the “agency problem”. This is where the interests of one party are not aligned with those using their services. For instance, providing a costly medical treatment may be in the personal interests of the provider who is set to benefit financially from it, even though it is not in the best interests of the individual’s health.
In our realm, we could face an agency problem if the objectives within the organisation are not aligned. Support staff may be motivated or assessed by injury statistics. While player availability and saving time and financial resources on injury costs may be important to management, presumably, winning ultimately supersedes that. As such, interventions should be made with both performance and injury risk in mind. Otherwise if training management or return to play decisions are driven by the motivation to reduce injury risk, athletes may not be best prepared for performance.
Naïve interventionism describes ignorance to the potential outcomes from an intervention, with iatrogenics describing the situation when damage from a treatment is in excess of the benefits.
Sports practitioners are susceptible to iatrogenics due to the complexity of performance and injury, but the link between an intervention and an outcome (positive or negative) may not be clear.
We should strive for “non-naïve interventionism” by considering both the potential benefits and harm from every intervention.
Overcome the “agency problem” by agreeing and communicating the objectives of an organisation and department to ensure decision making is aligned with those goals, rather than competing personal interests
Want to learn more about how you can reduce naïve interventionism? Global Performance Insights supports individuals and organisations by auditing processes to understand the impact their interventions are having, developing practitioners that thrive in the complexity of performance and injury, and delivering solutions and systems optimised to your specific environment. Get in touch to discuss further.