In medicine there is a principle of “first, do no harm”. The phrase is included in some versions of the Hippocratic Oath for example, and it follows the more general philosophy of “via negativa”, a form of addition through subtraction. With this philosophy, one wins by staying away from losing, gets rich by avoiding going bankrupt, lives healthier by eliminating all the bad habits. It is not to say that we should not attempt anything positive, only that we should start with removing the bad first, because that will result in a bigger benefit while being much safer. And when we do need to do something pro-active, such an explicit medical treatment, it usually carries with it some risk, so the relative benefit should be evaluated before blindly jumping in.

This sounds great in theory, but is difficult to follow in practice. First there is the lack of knowledge on harm. When we are uncertain of the risk vs. reward, as we often are with more complex issues, do we err on the side of caution and do nothing, or abandon the via negativa philosophy and take our chances? There is usually no simple answer. Then there is the natural tendency for people to want to do something pro-active, or at least show/signal to others that they are doing something pro-active. This results in actions, often at the group level, being done for reasons other than the pure information on risk vs. benefit.

I see the lack of consideration of this principle often in media-hype-driven public group actions. Perhaps this is because mob-think amplifies our already high desire to turn emotions into actions. An example that comes to mind is the recent public frenzy to replace all plastic straws with paper ones. We know that plastic straws are harmful to the environment, so the proper via negativa thing to do would be to simply stop using them, and sip our drinks from the cups directly. But that’s too much convenience to give up, so we needed a better substitute: paper straws. This transformed what would have been a purely “eliminating the harmful” action into a pro-active intervention, where now we have to source and produce paper straws to replace the plastic ones. I don’t think we know much about the impact of this switch, because it is difficult to find any reputable research on the topic. From what little info I could find, it seems that paper straws cost significantly more greenhouse gas to produce (4x by some estimates), so this swap is definitely not straightforwardly beneficial. It seems to come down to trading more greenhouse gas emissions for a slight reduction in plastic waste, which is not immediately evident to me as a worthwhile trade. But we have gone ahead with the change anyway, driven in no small part by our urge to do something pro-active.

We need to recognize that a world of do-no-harmers will always result in fewer pro-active things being done., which includes both the harmful and beneficial kinds. But despite the reduced number of potentially good things that will be done, we will probably still be better off overall, simply from the reduction in harm. This, in my opinion, is what the principle of “first, do no harm” is really trying to say.