Testing Hanson's hypothesis about the uselessness of health care.

by JoshuaFox1 min read13th Jun 20201 comment

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Robin Hanson has hypothesized that much health care is useless, and that if we radically cut health care (just the part that looks most useless, or even at random), there would be no effect on health outcomes.

People have been staying away from clinics and hospitals in droves. So, are general outcomes generally worse, excluding Covid-19 itself?

Like all such natural experiments, there are confounders, like reduction in other infections diseases improving outcomes; and it is hard to isolate the effects of Covid-19. But overall, this seems like an excellent opportunity to test his hypothesis.

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N=1 story time

A few weeks after the Covid-19 madness started, I woke up feeling incredible pain in my lower back and right leg. The next one hour I spent literally crawling on the floor and silently crying, trying to stand up but failing. After one hour I was finally able to walk like a zombie. I went to the kitchen where my wife was, and described what happened to me.

She told me that it seems like I have a herniated disc, that she had the same problem years ago, spent a few months in a hospital, and had lots of physiotherapy afterwards. In her experience, the most useful thing were some exercises she was taught, so she taught them to me. But I was warned that the exercises only provide partial relief, and that I should expect to spend the next year or two in almost constant pain, although smaller than at the beginning.

That didn't sound encouraging. Also, with lockdown and no one knowing how the pandemics will proceed, this didn't seem like a good time to visit doctors. It was Saturday, so I spent the weekend doing the exercises and waiting what happens. Because of constant pain, I was unable to sleep most of the night, and it was obvious I couldn't focus on doing my job on Monday, so I called my general practictioner, because I needed the paperwork for sick leave.

The doctor gave me an injection against pain, prescribed some pills against pain, and gave some advice how to take care of myself. We agreed that if the situation remains manageable, it is probably safer not to see a specialist. The pills allowed me to sleep for a large part of the night. I exercised like crazy, and after a week I was able to focus on work again. (Productivity maybe 30% of usual at first, but better than nothing.)

I realized that the problem was a result of my sedentary lifestyle, which only got worse with Covid-19, because not only I spent most of the day sitting by the computer, but when working from home, I no longer got the daily walk to work, walk to lunch, walk from lunch, walk from work, walking across the office to get coffee or go to a meeting; in other words, my cca 3 hours typically spent walking were overnight reduced to almost zero, which was probably the last straw that, ahem, broke my back.

So I reorganized my home so that I use computers while standing, which means that during the day I only sit down to eat. The first day this made me feel tired, then my body adapted. I took regular long breaks to walk outside, and I kept doing the exercises my wife recommended me. And... after a month and half, I stopped taking the pills when I ran out of them, and the pain was mostly gone. Today, I feel almost normal.

Of course, maybe my injury was simply much smaller than my wife's, and that is why it healed more quickly. I still haven't seen the specialist, so I have no expert data. But it kinda feels, with low confidence, when I compare my wife's experience to mine, that a problem that took two years when using the health care, took only two months when trying hard to avoid the health care. (Ok, to be fair, the pain pills were also part of the health care, and they helped a lot.) Instead of laying on a bed in a hospital, which would probably only make the pain worse, I changed my lifestyle, suffered a bit, then got better. My wife told me that she researched the scientific status of the help she had received, and that most of it is not scientifically supported (which is actually not a rare thing in medicine).

I imagine that in a situation without Covid-19 I would have visited the specialist, and probably got prescribed some of that useless cure. Actually, I would have to do it to signal the seriousness of the problem to my employer, because in normal circumstances, either you are sick (and then you take some treatment), or you are not (and then you are productive at 100%), nothing in between. Spending the day in low-level pain, working in short intervals, taking long breaks, getting about 5 hours of sleep at night after taking the pain pills, but avoiding the doctors... is simply not an option, if people can see you in the office all day long.