Abstract
How would you rate this book? (5 star means excellent book useful for all GPs in training – a must have item; 1 star means poor book that you would not buy yourself)
What is good about this book?
The central theme of this book is the striking concept of antifragility. The author, Nassim Taleb, suggests that we should make ourselves not just less vulnerable to setbacks, but actually aim to take advantage of setbacks, so stressors, errors and changes lead to improvement. He describes a spectrum ranging from ‘fragile’ (affected negatively by stressors) to ‘robust’ (resist stressors) or ‘resilient’ (bounce back from stressors) and beyond these to ‘antifragile’ (benefit from stressors).
Taleb uses mythology to explain this triad. Damocles, who dines with a sword dangling over his head, is fragile as a small stress to the string holding the sword will kill him. The Phoenix, which dies and is reborn from its ashes, is robust. It always returns to the same state following a stressor. The Hydra demonstrates antifragility. When one head is cut off, two grow back. Taleb explores this idea using a myriad of examples and argues, by building antifragility into our lives, we can respond far more positively to changes in our environment. With questions about how we manage the increasing burden of frailty in society, could antifragility provide solutions?
Taleb covers other interesting ideas. He uses the ‘Procrustean Bed’ story to demonstrate harm created by reducing variation. Procrustes would capture travellers and put them in his bed, stretching them on a rack if they were too short for it, or chopping off their extremities if they were too tall. He argues, when we destroy variations to fit a model, we do similar harm. Does this argue against the increasing standardisation we are driving towards in primary care?
The author believes in the value of randomness to a system. He illustrates this with a donkey, equally hungry and thirsty, stuck between a bale of hay and water. The donkey will die of starvation and thirst as it cannot decide between the two. A random nudge in one direction will solve the problem. Randomness helps to direct us and without it, we lose a beneficial stressor to decision making. Strangely enough, while fearlessly shaping what he means by antifragility, Taleb might just be inadvertently challenging some established thinking behind healthcare policy.
What is bad about this book?
Although enthusiastically grandiose and multidisciplinary, addressing issues ranging from the domains of politics and economics to social policy, philosophy and medicine, the writing suffers as it jumps from subject to subject. This book could have benefited enormously from some judicious editing.
The author undermines his more persuasive ideas by scattering them among rash assertions presented without persuasive evidence and, all indiscriminately flung at the reader. Some of his assertions are rather odd and as a result, he loses credibility. For instance, he incredulously suggests that administering mammograms to ‘women over 40 on an annual basis does not lead to an increase in life expectancy’, because a doctor, seeing a tumour, ‘cannot avoid doing something harmful, like surgery followed by radiation, chemotherapy, or both — that is more harmful than the tumour’. Hmmm …
Aside from these shortcomings, the author is far better at identifying examples of fragility than laying out specific strategies to actually become more antifragile. Suggestions, when made, for developing antifragility are not well thought through. The book would be better for more such suggestions.
The most frustrating thing about ‘Antifragile’ is that it is riddled with contradictions. The author offers predictions about the future, yet repeats that predictions are unreliable. He repeatedly attacks academics and theorists as people who would ‘lecture birds on how to fly’. Yet he is an academic himself and the book is one big, hyperextended, all-encompassing theory about how to live better in a random and uncertain world.
