I'm most interested in this bit:

A good place to get started there is Epistemology and the Psychology of Human Judgment, summarized on LW by badger.

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.

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.

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.

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.

"People evaluated this report solely using non-medical considerations" is not the same as "medical considerations aren't the primary goal" in the way that is normally understood. The non-medical consdierations serve as a filter.

I want to read a book with a good story (let's call that a good book). However, I don't want to read a good book that will cost me $5000 to read. By your definition, that means that my primary goal is not to read a good book, my primary goal is to read a cheap enough book.

That is not how most people use the phrase "primary goal".

1pianoforte6114yThanks, I'll try to find the relevant parts. I didn't want to get in too in depth into this discussion, because I don't actually disagree with the weak conclusion that a lot of people receive too much healthcare and that completely free healthcare is probably a bad idea. But Robin Hanson doesn't stop there, he concludes that the rest of medicine is a sham and the fact that other studies show otherwise is a scandal. As to why I don't buy this, the RAND experiment does not show that health outcomes do not improve. It shows that certain measured metrics do not show a statistically significant improvement on the whole population. In fact in the original paper, the risk of dying was decreased for the poor high risk group but not the entire population. Which brings up a more general problem - such a study is obviously going to be underpowered for any particular clinical question, and it isn't capable of detecting benefits that lie outside of those metrics.

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

by [anonymous] 1 min read27th Dec 2015145 comments

10


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