Thanks for the detailed reply.

Regarding arguments that the allocation of medical resources, particularly in the U.S. are wasteful and harmful in many cases - I agree in general, though the specifics are messy, and I don't find Robin's posts on the matter very well argued*. I'm most interested in this bit:

This is statisticians and efficiency experts and so on trying to apply standard industrial techniques to medicine and getting pushback that looks ludicrous to me. For example, human diagnosticians perform at the level or worse than simple algorithms (I'm talking linear regressions, here, not even neural networks or decision trees or so on), and this has been known in the efficiency literature for well over fifty years

Particularly since your initial claim that had me raising eyebrows was that MetaMed failed because they have great diagnostics, but medicine doesn't want good diagnostics.

Edit: *In the RAND post he argues that lower co-pays in a well insured population resulted in no marginal benefit of health (I'm unconvinced by this but I'd rather not go there), therefore the fact that most studies show a positive effect of medicine is a sham. I'm not sure if he thinks that statins and insulin are a scam but this is a bold and unjustified conclusion. The RAND experiment is not equipped to evaluate the overall healthcare effects of medicine, and that was not its main purpose - it was for examining healthcare utilization. The specific health effects of common interventions are known by studying them directly, and getting patients to follow the treatment protocols that get those results is, as far as I know, an unsolved problem.

0Vaniver4yA good place to get started there is Epistemology and the Psychology of Human Judgment [], summarized on LW [] by badger. Ah, that's a slightly broader claim than the one I wanted to make. MetaMed, especially early on, optimized for diagnostics and very little else, and so ran into problems like "why is the report I paid $5,000 for so poorly typeset?". So it's not that medicine / patients wants bad diagnostics ceteris paribus, but that the tradeoffs they make between the various features of medical care make it clear that healing isn't the primary goal. As I understand it, the study measured health outcomes at the beginning and end of the study, as well as utilization during the study. The group with lower copays consumed much more medicine than the group with higher copays, but was no healthier. This suggests that the marginal bit of medicine--i.e. the piece that people don't consume, but would if it were cheaper or do consume but wouldn't if it were more expensive--doesn't have a net impact. (Anything that it would do to help is countered by the risks of interacting with the medical system, say.) I think I should also make it clear that there's a difference between medicine, the attempt to heal people, and Medicine, the part of our economy devoted to such, just like there's a distinction between science and Science. One could make a similar claim that Science Isn't About Discovery, for example, which would seem strange if one is only thinking about "the attempt to gain knowledge" instead of the actual academia-government-industry-journal-conference system. Most of Robin's work is on medical spending specifically, i.e. medicine as actually practiced instead of how it could be practiced.

Open Thread, Dec. 28 - Jan. 3, 2016

by [anonymous] 1 min read27th Dec 2015145 comments


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