I’ve swapped out Buchanan’s C,H&tUW for Ian Ayres’ Supercrunchers* in my car’s CD player. Ayres’ inner-Dubner isn’t that great, but there’s plenty of interesting material and I’m a lay-partisan of the gospel he’s preaching to boot. The section I’ve been listening to recently is on medicine. The impression you’re supposed to get is shock at how many people needlessly died due to medical mistake and relief that supercrunching methods will soon rectify things. I had second thoughts though. Most of what I’ve heard about the downside of medicine has come by way of Robin Hanson. He doesn’t merely stop at showing that the marginal value of healthcare appears to be zero, but asks why that is. Why do we have a preference for ignorance? His conclusion is that healthcare spending is not about health, and so the neat innovations created over time (mostly medical procedures, admittedly, which are on a level below procedures to decide procedures) cannot be assumed to result in incremental improvements in health outcomes (in contrast to, say, computers). Better health is not being selected for, and a few idealistic iconoclasts in the profession are unlikely to change things. I also have to add that I liked how he introduced the idea of experts & algorithms living together in harmony, only to shoot down the experts’ tactical retreat by explaining how experts advised by algorithms do worse than algorithms on their own and instead flips it around by suggesting algorithms with final authority advised by experts.
*Not the original title. In a randomized trial its Google AdClicks beat “The End of Intuition”. I much prefer the neglected title. Stupid test audiences. I also preferred the alternate subtitle, but can’t remember what it was now.
On an unrelated note, did Robert K. Merton introduce the idea of “unintended consequences“?