Anticipating the unanticipated

Today's Washington Post "word of the day" is "un-an-tici-pat-ed" which staff writer Paul Farhi defines as "lacking foresight in hindsight."

Examples abound. He notes the U.S. military's missteps in Iraq, the D.C. treasurer's problem with escalating bond interest rates, UCLA's point guard's observations about the shooting accuracy of the Mephis Tigers' basketball team in the Final Four semis, Barack Obama's 20 year association with his fiery minister and Hillary Clinton's faulty sniper fire memory. Best, it seems:

While he was press secretary for President Bush, Tony Snow was constantly fending off media questions that implied that officials should have anticipated the unforeseen, he says. "Everyone plays that game," Snow says. "It's always taken as a sign of your incompetence, cupidity or callousness if you didn't anticipate a million different reactions."

Snow says he tried to avoid we-didn't-anticipate responses to questions about the administration's policies because "it probably sounds defensive." Instead, he says, he tried to explain the context in which decisions were made -- what the facts, goals and priorities were at the time -- and let others engage in "retroactive perfectionism."

As toxic as is "retroactive perfectionism," so is our inability to recognize that our understanding DID err and our perspective should become more "perfected." So we don't exactly agree with Farhi who rejects the Tony Frost worldview. He quotes Grant Barrett, the editor of the Oxford Dictionary of American Political Slang.

It's a buck-passing maneuver and a tacit admission of failure"...

"It really means that you didn't have foresight, that you didn't plan well, that you were ignorant before and that you're confessing that you're not ignorant now," Barrett says. "You're basically providing your opponents with the wedge in which they'll place their hammer and chisel to chip away at your credibility. You might as well draw up your letter of resignation."

Often, Barrett says, we-didn't-anticipate can give the perception that you just ignored someone else's anticipation.

We're big into transparency and accountability, but we cannot agree with Farhi. Sure, in many decisions we make, the easy-out of "unanticipated consequences" must be rejected. After all, how "unanticipated" is it that our social values have demographic consequences? That economic mobility in America re-shuffles the poverty "quintiles" every decade? That earmarks "buy" Congressional votes? That disparaging certain foods results in diminished intakes of not only the complained-of nutrients, but all those in that food? The list is endless and reinforces George Santayana's observation that "Those who cannot learn from history are doomed to repeat it."

Unanticipated consequences, however, are also how we learn. Particularly in science, the discovery that the hypotheses is NOT confirmed shouldn't be an occasion for mourning; celebrate the advance -- one less dead end to pursue. Truth is like an onion being stripped away layer by layer, so disposing of the discarded layer of only partially-understood truth is an advance.

So is it, for example, with our understanding of the role of dietary salt and health. We know all healthy bodies require salt. We know that salt is related to blood pressure. We know that populations with lower blood pressures have less risk of cardiovascular events and mortality. Our investment in studies to examine the question of whether lowering intakes of salt will lower the rates of heart attacks and strokes have been worthwhile -- even if they've produced the contrary, "unanticipated consequence" that the evidence does not support a link of lower sodium diets to improved health. Rather, the resesearch has unmasked other "unanticipated consequences" that we now know well occur when dietary salt is reduced: insulin resistance rises, the kidney produces the hormones renin and aldosterone. "Unanticipated" at one point, they have been predictable for a couple decades now. So, let's face facts and get on with our pursuit of truth. It doesn't look like reducing dietary salt is going to reduce cardiovascular risk. Don't believe it? Fine. Let's test the proposition -- a solution we suggested to HHS nearly two years ago, "up close and personal" after having voiced the recommendation publicly even earlier.

Even worse that the mea culpa that US preventive medicine couldn't have foreseen the "unintended consequences" of low salt diets that has neutered the expected benefits (and perhaps even reversed them such that a number of studies have found greater risk for those who cut back salt ), is the unexcusable insistence on pursuing this discredited strategy and pretending that the "unanticipated consequences" aren't actually happening.

That's what prevented the Bush Administration from recognizing the need for its new strategy in Iraq and what sent UCLA's basketball team home last Saturday. Things may not turn out the way we believe going in. Get over it. Move on.

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