Robin Hanson on Doctors

I am visiting George Mason University. Yesterday, as I was answering email, I heard a class in progress on the other side of the partition by my desk. It was Robin Hanson lecturing about the economics of health care to 20 undergraduates. It was so interesting I ended up listening to about 90 minutes of it. “Do your students know what a great class they’re getting?” I asked Robin during a break. “I don’t know myself,” Robin replied.

I have heard hundreds of professors lecture. I had never heard anything like this. It wasn’t the usual stuff. It wasn’t the usual stuff made entertaining with cartoons or demonstrations or jokes or war stories. Instead, it was a straightforward look at how the medical profession operates, and a lot of it was about how it operates to empower doctors, reduce the power of patients, and reduce health care innovation. Robin traced the history of the profession from the 1800s until today. “What separates a trade from a profession?” he asked his class. Professionals have ethics, he said. Doctors devised a code of ethics. At the top was “first, do no harm.” What does this mean in practice, he asked his class. If a patient dies, does the doctor feel shame? No. If a patient wants a medical procedure that isn’t recommended, does this mean the doctor doesn’t do it? Apparently not. In contrast to the remarkable vagueness of “first do no harm” the rest of the doctors’ ethics code was quite clear: no practice without a license, no advertising, and so on — each item with clear economic implications.

Robin also discussed how little doctors are supervised. A British doctor managed to kill over 200 people before anyone noticed; he was finally caught only because he forged a will. A nurse at a local hospital was assigned to measure how often doctors wash their hands. They’re supposed to always wash their hands but many do not. The nurse did the survey, and, as requested, correlated hand-washing compliance with death rates. It turned out that the doctor who washed his hands the least had the highest death rate. The nurse reported this. The exceptional doctor had her fired.

On and on like this. Several books cover bits of this territory. A Sacred Trust by Richard Harris, very well written, is about how the AMA fought public health legislation. Overtreated by Shannon Brownlee, which Robin assigned, is a recent overview. The nice thing about Robin’s critique is that it was very accessible and at the right level of detail — I didn’t have to spend 10 hours reading a book to learn what Robin said in 20 minutes — and it was very wide-ranging. During my last visit to GMU, Robin had told me about the RAND study that found groups with different access to health care had the same health. Uh-oh. This was a much broader, more narrative look at same thing — how well is our health care system working? — and was a kind of explanation of the results of the RAND study.

10 Replies to “Robin Hanson on Doctors”

  1. When I first started in the California Workers’ Compensation industry in 1993, I thought the shady people were the attorneys. I now know it is the doctors. In my opinion, somewhere over the last 30 years or so making a really good living as a doctor no longer was enough. Now, many doctors attempt to maximize their earning potential. As soon as that bridge was crossed, healthcare costs exploded and patient care suffered.

  2. It is interesting how the AMA is winning the public relations battle.

    The public is quick to blame everyone in the health care industry, with the exception of the doctors.

  3. I am in the middle of reading Shannon Brownlee’s book “Overtreated” and I highly recommend it. More people need to be made aware of how the medical profession operates. And thus be allowed more conscious choice and freedom in their healthcare decision making process. Perhaps Robin could be persuaded to put a lecture or transcript online.

  4. I know Seth Roberts disagrees with this, but I strongly believe the health care industry needs to be run more like a business.

    There needs to be more transparency with costs and doctor performance. And there desperately needs to be more competition. Screw the AMA and their lawyers, Walmart should be able to open clinics.

  5. “I know Seth Roberts disagrees with this.” ??? I agree with your suggestions. More transparency with costs and doctor performance and more competition are excellent ideas, well worth testing. I’m for more empowerment of everyone else involved, including nurses, hospital administrators, and especially the rest of us, before and after we get sick. My self-experimentation was a way of taking my health care into my own hands.

  6. I ended up at a Wal-Mart clinic this last vacation, due to an emergency and it was a seamless experience. I was impressed.

    BTW, Taubes ought to just write a fiction novel. White Death and interleave factoids about medicine with a codebreaker on the run from unknown enemies who turn out to be cardiologists in league with flour and sugar manufacturers … treat the misfeasance in diet as intentional malfeasance.

    Makes a much easier way to get across the real problem.

  7. I think Taubes is moving the culture — not as dramatically as with “Big Fat Lie”, but perhaps more lastingly.

    “Good Calories, Bad Calories” is beginning to get into the groundwater.

  8. I apologize for misrepresenting Seth Roberts. Looking back it, I think Roberts argued in a previous post that the profit motive should be more limited in health care (wall street shouldn’t make all of the decisions on health care).

    That is much different than what I claimed above.

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