Thursday, March 15, 2012

Stop revering doctors

Warning: Non-sports post. And, this is only tangentially related to the recent "should employers' insurance companies have to pay for employees' birth control" controversy, or Rush Limbaugh's response. My arguments do not depend on which side of that debate is correct. They apply to only one small aspect. (If you're not familiar with the debate, Google "Sandra Fluke".)


A little while ago, Steven E. Landsburg decided to post about some of economic issues surrounding the question of employer coverage of contraceptives. He was critical of Fluke for demanding free birth control without providing a good economic reason why. He then got in trouble from the president of the University of Rochester, where he teaches.

Afterward, reporters started calling him for comment. One reporter asked him,

"Do you think that “reasons” accepted by an economist deserve more weight and respect than “reasons” a medical doctor might have for recommending that birth control be universally covered by medical insurance?"

Landsburg replied,

Yes, absolutely. Here’s why: Economists are trained to look at all the consequences of a decision before passing judgment; doctors tend to focus only on some kinds of consequences (those directly related to health) while ignoring others (for example, the many other effects that flow from raising people’s taxes or insurance premiums). ...

Economists have thought long and hard about how to make sure we do that. We don’t always get it right, but at least we’ve got a framework for it. Doctors don’t.

Landsburg is, of course, absolutely correct.

Why would this reporter, or, anyone, think that a doctor was as qualified to talk about an economic question as an economist is?

Because we respect doctors too much. We respect them well beyond the scope of their expertise. We somehow think that they're better and smarter than the rest of us, and we have this unspoken feeling that their opinions have extra weight, because of their higher class and status.

It's certainly not that we need their subject matter expertise to argue the question. Because, suppose Sandra Fluke had stepped up before Congress to demand that the car companies include oil changes in their warranty coverage. And economists disagreed that that was a good idea. And suppose the reporter had asked,

"Do you think that “reasons” accepted by an economist deserve more weight and respect than “reasons” an auto mechanic might have for recommending that oil changes be universally covered by warranty?"

That would be laughable. It's equally laughable when it's a doctor.

I think it's all a matter of pecking order. Doctors have high status, and auto mechanics have low status.

Economists have high status too, but significantly lower status than doctors. To see that, imagine the situation reversed, where Landsburg said something about medicine -- say, about why birth control works, biochemically -- and a doctor corrected him. And the reporter asked the doctor,

"Do you think that “reasons” accepted by a doctor deserve more weight and respect than “reasons” an economist might have for understanding how birth control works, biochemically?"

That question answers itself. The other one should have, too.


P.S. A previous post about doctors overstepping their expertise is here.



At Thursday, March 15, 2012 11:44:00 AM, Anonymous kendynamo said...

you know who doesn't over estimate the business and economic acumen of doctors? salesmen. i interned one summer many years ago at a retail brokerage house and cold callers loved the doctor leads, because they had a lot of money and often thought that knew more than they did, so they were easier sells.

At Thursday, March 15, 2012 1:07:00 PM, Anonymous David said...

As an economist, I totally agree!

Seriously though, I think it's important to consider the limits of economists' knowledge, too. Landsburg is right to the extent that we have the ability to predict likely outcomes of mandating birth control coverage (i.e. likely increase in birth control usage but also potential increases in premiums). But the actual decision about which policy is best gets beyond economics. It involves making a moral judgment (in this case about how we should value increasing birth control coverage, increasing insurance premiums, and religious freedom). We have no special expertise in that.

At Thursday, March 15, 2012 4:26:00 PM, Blogger Phil Birnbaum said...


Yes, of course ... the bottom line is that it's a moral judgment. But as Landsburg says, you economists have more experience in weighing competing costs and benefits, which is exactly what you need in order to have an informed moral judgment -- or at least one that's not based on faulty assumptions.

At Thursday, March 15, 2012 7:46:00 PM, Anonymous Anonymous said...

Thanks for your flattering words. I will show the post to some of my peers who increasingly doubt the usefulness of their studies and regret that they did not choose physics, engineering, or math.

I am, however, not fully convinced by your post. Sure, we as economists are better trained to weigh the costs and benefits, but how do we know about them?
Sometimes it's obvious, but I'd argue that in the case of birth control it is not (at least partially). The benefit analysis crucially depends on some doctoral expertise, thus it is the interplay of both sciences that will yield the basis for an informed moral judgement.
As you pointed out in your post, an economist is by no means qualified to evaluate the biochemical usefulness of birth control and same holds for potential psychological side-effects IMO. I'd even doubt, that the economist is more qualified in terms of social side effects. Takin' this into account, I'd say that the usefulness of the doctor's and the economist's judgement depends on who is better trained/has more knowledge in the field of the other.

At Thursday, March 22, 2012 2:03:00 PM, Blogger Zach said...

Could you compare the last posts you put up to this one? Berri is a respected economist. Does that mean I should trust his opinion on drafting QBs, since he can 'weigh the competing costs and benefits' drafting QBs entails?


At Thursday, March 22, 2012 7:45:00 PM, Blogger Phil Birnbaum said...

As I have argued, for this particular QB instance, I believe Berri is incorrect.

That doesn't change the fact that if you want an opinion on QB draft values, you should generally look to a sabermetrician rather than a doctor.

At Monday, March 26, 2012 3:42:00 PM, Blogger Zach said...

I completely agree that you should talk to a sabermetrician over a Dr. when drafting QBs.

I don't think that Economist:Health Care policy::NFL Sabermetrician:QB drafting policy.

There are plenty of policy wonks out there that aren't economists. I'd even guess that there are more health care policy wonks that are Drs. than are economists. Not everything in health care policy should boil down to naked economics. Even the parts that do are more normative than positive (to the extent a distinction exists in the real world). Sabermetrics is all positive, but health care policy is just about as normative as it comes.

The thing that should cause people pause when deferring to practicing Drs. in health care policy is their level of self-interest. Any change to the current system will affect Drs. Drs. made career, and financial, decisions based on historical norms. They are vested in the current system in ways that don't necessarily align with the interests of the general public.

At Tuesday, May 08, 2012 8:53:00 PM, Blogger DavidN1818 said...

As a doctor and lover of sabermetrics, I totally see your point. The difference is emotion. Looking at commodities or shortstops is emotion free. Life and death is not. doctors, hospitals and pharmacies are totally focused on their own self-interests. Until we can find a way to bring analytics and compassion together on this issue, we will either get a government controlled nightmare or even more of the same cesspool we already have


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