> I think if Robin wants to do something with these insurance study results, he should follow other economists, including the study authors, and argue about whether the marginal unit of insurance is cost-effective - not about whether medication works at all.
As far as I can recall, Robin Hanson generally talks about the marginal unit of h…
> I think if Robin wants to do something with these insurance study results, he should follow other economists, including the study authors, and argue about whether the marginal unit of insurance is cost-effective - not about whether medication works at all.
As far as I can recall, Robin Hanson generally talks about the marginal unit of healthcare, rather than whether medication works "at all". For example, in his long paper on medical behavior, he talked about "A near-zero marginal health-value of medical care" rather than whether medical care had any value "at all" (see https://mason.gmu.edu/~rhanson/showcare.pdf). I also recall him being clear to say that he's only talking about marginal effectiveness of medicine in his book The Elephant in the Brain.
I agree that the way he talks about this topic can be confusing. But ultimately I suspect that, if Hanson ends up replying to this post, he will say that you misunderstood his views on medicine.
I recall that, many years ago, Hanson published a piece in a libertarian website arguing that the US government should cut its medical spending to half its current levels. This supports the interpretation that he is talking about the marginal value of medicine, since otherwise why not cut the budget to zero? On the other hand, some of the quotes Scott provides support the opposite interpretation. My sense is that Hanson has not stated his views about the value of medicine sufficiently clearly.
I agree, I've been following Hanson for close to 15 years, read both Age of EMs and Elephant in the Brain, tend to agree he is misread very often and think basically all of his "I said this and people misread me"s are correct and I *still* thought his view was closer to "most medicine save antibiotics, bone setting and diabetes" does close to zero, rather than "the marginal rate is negative".
Why did I think this? He opens his chapter on Medicine in Elephant in the Brain with a detailed story about obviously fake treatments on a long where age is essentially tortured as a cure, and asks how this could all happen if the treatments didn't work and Medicine was about medicine. He repeatedly emphasizes the status of doctors, and how the status distorts treatment incentives. He probably said somewhere that he mostly thinks about the margin, I don't deny that! But when lots of points are stated like "here's why we wouldn't expect this to work all" instead of "here's why this works less better than it could", forgive a brother for misremembering.
Saying treatments have no effect and saying that they don't have any net effect are two different positions.
If you take antibiotics as an example, it's possible that a society uses antibiotics in a way where they are on net harmful because they destroy benefitial bacteria as well as harmful bacteria.
For ear infections, bronchitis, sinusitis, and sore throats Hanson even makes that point explictely "Patients with ear infections are more likely to be harmed by antibiotics than helped. [...] The same is true for bronchitis, sinusitis, and sore throats." (https://www.overcomingbias.com/p/medical-ideologyhtml)
Antibiotics are not special in Hanson's view. In general, just because a drug was benefitial in an RCT in a population that was carefully selected to benefit from the drug does not mean that the average way doctors use the drug is net benefitial to patients.
Hanson has now replied to Scott, and makes exactly the same point I did above:
> There’s also my 2007 article Cut Medicine in Half where I say:
>> In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. … the tiny effect of medicine found in large studies is in striking contrast to the large apparent effects we find even in small studies of other influences.
> Obviously, if I thought medicine was useless at all margins, I’d have said to cut it all, not just cut it in half.
> I think if Robin wants to do something with these insurance study results, he should follow other economists, including the study authors, and argue about whether the marginal unit of insurance is cost-effective - not about whether medication works at all.
As far as I can recall, Robin Hanson generally talks about the marginal unit of healthcare, rather than whether medication works "at all". For example, in his long paper on medical behavior, he talked about "A near-zero marginal health-value of medical care" rather than whether medical care had any value "at all" (see https://mason.gmu.edu/~rhanson/showcare.pdf). I also recall him being clear to say that he's only talking about marginal effectiveness of medicine in his book The Elephant in the Brain.
I agree that the way he talks about this topic can be confusing. But ultimately I suspect that, if Hanson ends up replying to this post, he will say that you misunderstood his views on medicine.
I recall that, many years ago, Hanson published a piece in a libertarian website arguing that the US government should cut its medical spending to half its current levels. This supports the interpretation that he is talking about the marginal value of medicine, since otherwise why not cut the budget to zero? On the other hand, some of the quotes Scott provides support the opposite interpretation. My sense is that Hanson has not stated his views about the value of medicine sufficiently clearly.
I agree, I've been following Hanson for close to 15 years, read both Age of EMs and Elephant in the Brain, tend to agree he is misread very often and think basically all of his "I said this and people misread me"s are correct and I *still* thought his view was closer to "most medicine save antibiotics, bone setting and diabetes" does close to zero, rather than "the marginal rate is negative".
Why did I think this? He opens his chapter on Medicine in Elephant in the Brain with a detailed story about obviously fake treatments on a long where age is essentially tortured as a cure, and asks how this could all happen if the treatments didn't work and Medicine was about medicine. He repeatedly emphasizes the status of doctors, and how the status distorts treatment incentives. He probably said somewhere that he mostly thinks about the margin, I don't deny that! But when lots of points are stated like "here's why we wouldn't expect this to work all" instead of "here's why this works less better than it could", forgive a brother for misremembering.
Saying treatments have no effect and saying that they don't have any net effect are two different positions.
If you take antibiotics as an example, it's possible that a society uses antibiotics in a way where they are on net harmful because they destroy benefitial bacteria as well as harmful bacteria.
For ear infections, bronchitis, sinusitis, and sore throats Hanson even makes that point explictely "Patients with ear infections are more likely to be harmed by antibiotics than helped. [...] The same is true for bronchitis, sinusitis, and sore throats." (https://www.overcomingbias.com/p/medical-ideologyhtml)
Antibiotics are not special in Hanson's view. In general, just because a drug was benefitial in an RCT in a population that was carefully selected to benefit from the drug does not mean that the average way doctors use the drug is net benefitial to patients.
Hanson has now replied to Scott, and makes exactly the same point I did above:
> There’s also my 2007 article Cut Medicine in Half where I say:
>> In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. … the tiny effect of medicine found in large studies is in striking contrast to the large apparent effects we find even in small studies of other influences.
> Obviously, if I thought medicine was useless at all margins, I’d have said to cut it all, not just cut it in half.
https://www.overcomingbias.com/p/response-to-scott-alexander-on-medical