I agree 100%. We devote so much money towards developing new cures, but so little money towards determining whether existing treatments are effective. This should be the #1 priority of medical research.
I would caution us to make the distinctions that are absolutely necessary here. Some interventions dont work and we should know that (and one would think medical experience, expertise, and solid observational studies could help here). Some interventions may or may not work and we dont know because we dont have the evidence either way because we keep funding these underpowered or mis- designed studies. And some interventions might work if delivered at the right time and with the right intensity. We have built this huge behemoth system with all the wrong incentives and rewards. I dont know how it all unravels with even the best of intentions. And a clearer road map of where it exactly we think we are going.. .
"... we keep funding these underpowered or mis- designed studies. "
Exactly! This is more clearly seen in comparing studies of the "hard sciences" vs. the soft sciences of psychology, sociology, anthropology, etc. It is actually easier to isolate the variables in physics and chemistry (and sometimes but not always in biology) to help ensure rational and decent interpretations of the results observed. In contrast, the studies trying to learn something about humans in general involve so many competing influences and factors that are never fully planned for and separated out in the investigation, often because the test population is too small or too distinct (i.e., college students, young adults, etc.) to show the full uncertainty with a too-small statistical population base.
This is compounded in medical studies since both human and natural variations come into play, with a lot of "subjective reporting" [how do you feel today?"]. In the soft science studies I would advocate having fewer but larger and well planned investigations, but when it comes to medical advances, I am less certain that interim results are not also valuable - just that they need to be accepted and promoted as "good as far as we know now, but more detailed investigations are still needed for a fuller understanding of the relevant issues", etc.
What an eye opener on the extent of how much doctors just screw around. A court should JUST ONCE rule that those practices are not deemed lege artis (no matter how much patients consent to risk) and then doctors will risk complete responsibility if anything happens. This way the field might just switch to the strong evidence practices.
90% screwing around.. how are these things even called recommendations? There should be a way to remove the recommendation of low evidende practices "by using proper language alone" in the supply chain of recommendations.
Your framing of incentives as both drivers and distorters of science resonates strongly. I’m exploring a similar theme in governance—how coherence rather than control might shape our collective intelligence. Thank you for sparking the reflection.
Great topic to explore as an extension of progress studies. My only concern is that we don't find ourselves throwing the valuable medical knowledge baby out with the bathwater of failed or under supported medical results. The concern in this article (of course) is to know if/when that knowledge is real vs. flawed (or maybe even only limited) in some important way.
Clearly medical advances and innovation are part of advancing progress, but I gather a major aspect of your proposals is that progress really involves extending those benefits to a wide/large group of the population. It strikes me that improving that component of medical care needs to return to a more market based, first party paying, approach with less governmental involvement in the distribution of medical services, vs. perhaps their continued contribution to funding new knowledge.
2. The first RobinHanson argument is that "+/- 2x in medical expenditure, either via free insurance or other methods seems to have no impact on medical outcomes." This is a big part of it.
3. The second, deeper, RobinHanson argument is that "medicine is not about health" but about showing care. I'm fairly convinced, and thus I think a bigger problem is that most of medical spending has effectiveness as a secondary concern...which will make your effort harder to undertake.
I agree 100%. We devote so much money towards developing new cures, but so little money towards determining whether existing treatments are effective. This should be the #1 priority of medical research.
I would caution us to make the distinctions that are absolutely necessary here. Some interventions dont work and we should know that (and one would think medical experience, expertise, and solid observational studies could help here). Some interventions may or may not work and we dont know because we dont have the evidence either way because we keep funding these underpowered or mis- designed studies. And some interventions might work if delivered at the right time and with the right intensity. We have built this huge behemoth system with all the wrong incentives and rewards. I dont know how it all unravels with even the best of intentions. And a clearer road map of where it exactly we think we are going.. .
"... we keep funding these underpowered or mis- designed studies. "
Exactly! This is more clearly seen in comparing studies of the "hard sciences" vs. the soft sciences of psychology, sociology, anthropology, etc. It is actually easier to isolate the variables in physics and chemistry (and sometimes but not always in biology) to help ensure rational and decent interpretations of the results observed. In contrast, the studies trying to learn something about humans in general involve so many competing influences and factors that are never fully planned for and separated out in the investigation, often because the test population is too small or too distinct (i.e., college students, young adults, etc.) to show the full uncertainty with a too-small statistical population base.
This is compounded in medical studies since both human and natural variations come into play, with a lot of "subjective reporting" [how do you feel today?"]. In the soft science studies I would advocate having fewer but larger and well planned investigations, but when it comes to medical advances, I am less certain that interim results are not also valuable - just that they need to be accepted and promoted as "good as far as we know now, but more detailed investigations are still needed for a fuller understanding of the relevant issues", etc.
What an eye opener on the extent of how much doctors just screw around. A court should JUST ONCE rule that those practices are not deemed lege artis (no matter how much patients consent to risk) and then doctors will risk complete responsibility if anything happens. This way the field might just switch to the strong evidence practices.
90% screwing around.. how are these things even called recommendations? There should be a way to remove the recommendation of low evidende practices "by using proper language alone" in the supply chain of recommendations.
Does anybody here work in this supply chain?
Your framing of incentives as both drivers and distorters of science resonates strongly. I’m exploring a similar theme in governance—how coherence rather than control might shape our collective intelligence. Thank you for sparking the reflection.
Great topic to explore as an extension of progress studies. My only concern is that we don't find ourselves throwing the valuable medical knowledge baby out with the bathwater of failed or under supported medical results. The concern in this article (of course) is to know if/when that knowledge is real vs. flawed (or maybe even only limited) in some important way.
Clearly medical advances and innovation are part of advancing progress, but I gather a major aspect of your proposals is that progress really involves extending those benefits to a wide/large group of the population. It strikes me that improving that component of medical care needs to return to a more market based, first party paying, approach with less governmental involvement in the distribution of medical services, vs. perhaps their continued contribution to funding new knowledge.
1. Well said, well argued
2. The first RobinHanson argument is that "+/- 2x in medical expenditure, either via free insurance or other methods seems to have no impact on medical outcomes." This is a big part of it.
3. The second, deeper, RobinHanson argument is that "medicine is not about health" but about showing care. I'm fairly convinced, and thus I think a bigger problem is that most of medical spending has effectiveness as a secondary concern...which will make your effort harder to undertake.
Sad that Biden can’t access state of the art cancer treatment. Self-centered JHH doctors have failed him. See Syncromune.com