[extropy-chat] Effectiveness of Medicine (was: Robin Hanson onCynicism)

[Robin Hanson]

At 09:48 PM 9/24/2005, Brett Paatsch wrote:
>>>>>In your essay [http://hanson.gmu.edu/feardie.pdf] you say
>>>>>"fear of death makes us spend  15% of our income on medicine from
>>>>>which we get little or no health benefit, ...
>>>>>You seem to assume that *everyone* just knows what medicine is. ...
>>>>... intuitive definition of medicine is "the stuff that doctors do". ...
>>>To me, intuitively, medicine is about treating ailments. ...
>>How would *you* study the aggregate effectiveness of "treating ailments"?
>
>By first making explicit what the class of ailments under consideration
>would be. I would NOT try to cluster all the treatments of real and
>imaginary ailments together into a superclass and call it medicine. (That's
>potentially dangerous some dill might read my confusion and formulate
>more bad policy based on it.)  I'd personally only study the stuff that
>had a physiological basis not stuff that doctors treat with no clue as to
>its basis. In computer parlance that approach to medicine seems like
>garbage in garbage out. I'd argue doctors that treat without knowing
>what it is that they are treating aren't practicing medicine at all.

The personal policy decision people face is whether or not to go to the
doctor and do what he says.  People do not face the decision of whether
or not to treat a real ailment or to treat an imaginary ailment, because
they do not know at the moment of decision whether the aliment is real
or imaginary.  Similarly a commonly discussed government policy decision
is whether or not to subsidize or support medical spending.  For example
with Medicare or Medicaid, or tax free employer provided health care.
You don't get to say "we should only subsidize real ailments" because
that's not one of the options on the table.  Doctors say all the things
they treat are real, after all.

>>And if you think that people given money to
>>spend on medicine wouldn't spend it wisely to gain health, then why
>>would you think people spend their own money on medicine any more
>>wisely?
>
>Because those with money to spend, rather than those holding vouchers
>that are only good for going to the doctor type services, retain the
>discretion to spent that money on other things. I think people will only
>spend money on reducing dis-ease that they actually experience or take
>action for problems they actually know they have (you might be
>forewarned in your youth about a higher risk of heart disease because
>your father had it) if there is an opportunity cost to them of pleasures
>foregone by money wasted. When they have no dis-ease they will
>spend the money on things they actually want. They'll act to increase
>their pleasure rather than act to reduce the pain they aren't
>experiencing.

That really doesn't make much sense to me.  Of course if there is no
opportunity cost they might spend too much.  But among the things they
choose they should choose the best things as they see them.  If they
can't make good choices among the options in one case, they can't in
the other case either.

>>I'd love to see a new experiment done like the RAND experiment, but
>>until that happens this is the only aggregate experiment data we have.
>
>Okay. And at present that data isn't enough for me to move to agree
>with your assertion that the US spends 15% of its income on medicine
>for which there is little or no health benefit.
>
>I'm not saying your conclusion is wrong. I'm just saying I am not
>persuaded yet on the basis of the data your essay provides me.  I'm a
>bit concerned that some dill politician might read only the abstract of an
>essay you write and conclude that economists think all contempory
>medicine is largely useless.

Do you have an opinion on the subject?  If not, why object that I have one?
If you do have an opinion, what is the basis for it, if you reject the
best evidence we have as not good enough?



Robin Hanson  rhanson at gmu.edu  http://hanson.gmu.edu
Associate Professor of Economics, George Mason University
MSN 1D3, Carow Hall, Fairfax VA 22030-4444
703-993-2326  FAX: 703-993-2323