Iatrogenics and Courage: Education Needs to Think about Side Effects

In his skeptical tome “Antifragile,” Nassim Taleb discusses the term “iatrogenics.”  It is a well-known term in the health care industry used to describe unintended effects that are caused by “the healer.” He wants policymakers, particularly economists, to adopt the wisdom of iatrogenic analysis. 

Many of the statistical tools used in education policy evaluations seem lifted from medical research (“treatment effect”) so why not import iatrogenics?

While it is true that evaluations of education policies include cost-benefit and cost-effectiveness analyses, there are differences.  Iatrogenics focuses on the output side of the equation, finding outcomes that would (or more importantly, could) blunt benefits.  Also, much of it is focused on implementation. 

To be clear: iatrogenics, in medicine, discusses drug interactions, misdiagnoses, medical error, adverse side effects, and nosocomial (hospital-induced) infections. 

Policy literature includes countless discussions of the “law of unintended consequences.” Iatrogenics will improve that conversation.  Here are two suggestions:
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1. Side effects: If a treatment is set up with perverse incentives built in, it is naïve to assume that rational people will not respond rationally.  There has been a flurry of interest recently in programs that offer money to students for good grades.  Almost none of the evaluations of these programs take a deep look at the possible effects of the obvious perverse incentives, particularly for cheating.  Unfortunately, the absence of evidence for adverse effects is treated as evidence of their absence. 
2. Drug Interactions:  some policies, just like some medicines, will not interact well with others.  Some colleges, for example, have honor systems in which students can take exams home.  Implementing an honor system while implementing a system of financial incentives for grades would be a recipe for disaster.  

More and more policy descriptions include “theories of action” which are relentlessly upbeat, describing (in detail) how a series of outcomes cause each other. I would like evaluators to add potential “policy interactions” and “side effects.”

For example:

Warning: providing financial incentives to students increases the motivation to cheat and game the system.  Do not combine this program with programs that have less vigilance on student assessments or with assessments that are overly subjective.

Reporting these on the front page of an evaluation will allow the people on the ground to better implement these policies, just as side effect warnings help people take drugs at the right time. 

Imagine if drug makers lobbied to stop reporting side effects?  
 
Also, reporting side effects and possible policy interactions will help us promote “non-cognitive” traits.  Recent research on these "softer" qualities have focused on traits such as “conscientiousness,” which are easy to measure. However, there are many extremely important non-cognitive traits that are difficult to measure.  Here is how iatrogenics could help:

Think about honesty.  It would be impossible to test people for honesty, but identifying incentives for dishonest behavior would be simple.

Consider risk-taking.  Would offering financial incentives encourage students to take very hard classes?  Obviously not.

Or enthusiasm.  Would offering money to students make them passionate about the subject itself?  Perhaps, but it seems like it would change the style of motivation to something less internal.

Psychologist Martin Seligman, the founder of “positive psychology,” considers honesty, risk-taking, and enthusiasm to be the fundamental elements of courage. Courage is a worthy goal for education; indeed, in the words of the immortal stoic philosopher Seneca, “If you are not teaching courage, you are not teaching.”  

The difficulty in measuring courage should not divert our attention from it.  Iatrogenics could help remove that impediment.  

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