An article in the Wall Street Journal offers an instructive example of the failure of primary prevention. Primary prevention in medicine is the attempt to avoid a disease event that has yet to happen. An example is the use of lipid-lowering drugs to prevent cardiovascular disease in a subject who has never suffered from CV disease. Secondary prevention is designed to avoid a disease recurrence in a patient who has already suffered from the disease in question. In medicine primary prevention while attractive often doesn’t work. The use of lipid-lowering drugs in subjects without detectable CV disease doesn’t seem to be effective. Similarly, aspirin administration to prevent heart attacks is without a positive effect.

Away from medicine primary prevention is often inconvenient in situations where it may be beneficial. The article linked above details all the problems with Reagan Airport that were detailed well in advance of the recent catastrophe at the airport. A few quotations from the article detail the problems that led to the crash that were recognized years ago, but allowed to persist.

We’re dealing with an extraordinarily complex airspace system that has been complicated even worse by the addition of flights to National Airport,” said Keith Meurlin, a retired Air Force major general and head of the Washington Airports Task Force. “At what point is enough enough?

Pilots have been complaining for decades about the presence of military and other aircraft around Reagan. “I cannot imagine what business is so pressing that these helicopters are allowed to cross the path of airliners carrying hundreds of people!” one pilot wrote in a 2013 report filed to the Aviation Safety Reporting System, or ASRS, after a near-collision with a helicopter. “What would normally be alarming at any other airport in the country has become commonplace at DCA (Reagan National Aiport).”

“Why does the tower allow such nonsense by the military in such a critical area?” wrote another pilot in 2006, according to a record reviewed by the Journal. “This is a safety issue, and needs to be fixed.” 

But Washington power brokers clamored to add routes. Some cities far from Washington were largely shut out, following a 1960s-era rule that limited how far planes could travel from then-National Airport. In turn, long-haul flights were shifted to newly built Dulles International Airport farther from the city, although exceptions have been made over the years. The late Sen. John McCain (R., Ariz.), for instance, pushed for a nonstop flight from Reagan to Phoenix.

Sen. Tim Kaine (D., Va.) beseeched his colleagues last April to stop adding more flights to the area.

It’s obvious that there are many problems with Reagan Airport that have not been addressed. The opportunity for primary prevention has passed. The likelihood that secondary prevention will be used is very high. But it took the deaths 67 people to bring the issues of congestion, understaffing, and the presence of military flights near a busy airport to such prominence that these problems can no longer be ignored.

In medicine, politics, transportation, and virtually any human endeavor knowledge is a prerequisite for intelligent management. But knowledge is not enough. It is the combination of knowledge with wisdom that leads to a desirable outcome. We are deluged with knowledge in today’s world, but wisdom seems as rare as it was three or more millennia ago. In a Socratic twist the more we know the less we understand.