The meaning of “harm” in personalized medicine—an alternative perspective

This commentary examines an article by Sarvet and Stensrud in which they discuss the concept of "harm" and its application in medical practice. They advocate for an intervention-based interpretation of harm, downplaying its counterfactual interpretation. We take issue with this stance. We show that the counterfactual approach is vital for effective decision-making policies and that neglecting it might lead to flawed decisions. In response to the contention of Sarvet and Stensrud that "when the outcome is death and a counterfactual approach is used…more people will die," we demonstrate how counterfactual reasoning can actually prevent deaths. Additionally, we highlight the advantages of counterfactual thinking in the fields of medical malpractice, legal reasoning, and general diagnoses. Relying solely on intervention-based analyses limits our ability to accurately represent reality and hinders productive discussions about evidence, assumptions, and consensus building.