Links to Consider, 5/2

Scott Alexander vs. Robin Hanson on medical efficacy; Dan Williams on rational persuasion; Glenn Reynolds on the higher education industry; Joel Kotkin on the rise of the Mean Girls

Scott Alexander writes,

Robin Hanson of Overcoming Bias more or less believes medicine doesn’t work.

This is a strong claim. It would be easy to round Hanson’s position off to something weaker, like “extra health care isn’t valuable on the margin”. This is how most people interpret the studies he cites.

Most economists who have looked at comparisons between health care spending and health outcomes take the weaker position. They think that up to a point, more spending improves outcomes, but beyond that point “flat of the curve” medicine kicks in, and outcomes do not improve. I tend toward this view myself. I express it by saying that we undertake too many medical procedures with high costs and low benefits.

Robin’s view, which Scott does not seem to have absorbed, is not that medicine doesn’t work. There is plenty of medicine that is proven to work, and he readily accepts that. [update: Robin rightly criticizes Scott for falsely characterizing Robin’s views.] What Robin argues is that treatments that work are, in the aggregate, offset by other treatments that cause harm. I call these harmful interventions “Hansonian medicine.” I have observed it close up. I can tell you stories about close relatives who were clearly the victims of Hansonian medicine. They would be better off without the medical interventions that they underwent.

Take something like colonoscopy. There is no doubt that some people benefit from early detection of colon cancer. But the procedure can sometimes cause harm, by perforating the colon, for example. On net, do the benefits outweigh the harms? I am skeptical, because I doubt that the benefits are as large as people have been led to believe.

This really shows up in the treatment of terminally ill patients. They are often made to suffer from “heroic” interventions, usually at the insistence of relatives. Surveys consistently show that trained physicians would choose not to have as much medical intervention if they themselves were terminally ill.

Dan Williams writes,

I suspect that the primary reason why people think rational arguments do not work is because they simply do not have good arguments for their views, and the reason they do not have good arguments for their views is because their views are bad and uninformed. “Why don’t people see the self-evident truth of my political worldview?! They must be in denial, or irrational, or brainwashed, or subject to false consciousness, or … etc.” There are entire schools of intellectual inquiry founded on this kind of attitude. In fact, the main reason why people are not persuaded to accept the worldviews of passionate ideologues and activists is because those worldviews are typically simplistic, biased, ignorant, and dogmatic.

If rational persuasion works, but it only works when views are supported by evidence and good arguments, there is something troubling about people and groups that opt for the pressure strategy instead of the persuasion strategy. Even though their beliefs are sincere, they should ask themselves: If I lack confidence in my ability to persuade others of these beliefs, should I be persuaded myself?

If your views do not persuade someone on the other side, you can choose to believe that the other side is irrational or that your side has a weak case. Obviously, we prefer not to believe the latter.

Glenn Reynolds writes,

I thought that the existing system of higher education in America was doomed.  Not that higher education itself would cease to exist, but that the standard model of college, graduate, and professional education that had obtained since the passage of the G.I. Bill, and in many ways since the late 19^th Century, would largely cease to exist.  This was due to a combination of out-of-control costs and loss of prestige.

It takes a long time for people to accept that an industry is dying. Twenty years ago, people who worked as reporters or editors at local newspapers still thought they had a future. More recently, I have a relative who worked in the Hollywood ecosystem who ignored my warnings that his occupation was threatened. And there are plenty of young people who want to try becoming college professors.

All of these are instances where the consumer demand still exists. People consume plenty of news. They consume more entertainment than ever. And people want to learn.

The problem is with the business models of the legacy providers. The demand is there, but they are not meeting it efficiently.

As the market evolves, someone who wants employment in a declining segment ought to adapt. Instead of adapting, too often people go into denial and end up yelling at consumers to stop choosing their preferred options.

Joel Kotkin writes,

Women now collect nearly 60 percent of bachelor’s degrees. And they generally outnumber men in academia: 75 percent of Ivy League presidents, 66 percent of college administrators, and 58 percent of recent graduates are now female.

and

politically engaged women, particularly those at elite colleges, increasingly stand at the tip of the progressive spear.

He argues that what he calls the Mean Girls push an agenda that is unpopular with other constituents.

substacks referenced above: @

Response to Scott Alexander on Medical Effectiveness

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Education Apocalypse Now?

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Contra Hanson On Medical Effectiveness

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Rational Persuasion vs Cancel Culture