Comment by Tyler Cole (tyler-cole) on Moloch's Toolbox (1/2) · 2022-03-31T16:13:03.665Z · LW · GW

I am a surgical subspecialist, and I think there are good points here, but you fundamentally err when trying to equate the work of a doctor or surgeon to someone making a chair. All people are different and there often is not evidence to guide treatment for many patients, since it is impossible to study all of the variations in human anatomy and pathology. This is unlike chairs, which you can make uniformly. This means the work of a doctor is 1) understanding the evidence that is out there and 2) synthesizing how this could be applicable to a patient that may (in the case of some common medical problem) or may not (in the case of many different surgical pathologies) have a situation that represented by a study. Personally, as a surgical subspecialist, a large minority of patients that I see will never fit into "the evidence" because there has literally not been a case like that before. The surgeon has to use their accumulated knowledge of anatomy, patient risk, and the pathology at hand to make a decision, and also assess the preference and risk tolerance of the patient.

The next error that you make is assuming that people without medical training can properly regulate doctors. Given the above (that patients often do not fit into clean boxes), it requires people with training to understand where a doctor is safe and not safe, and prevent credentialing of unsafe doctors. This isn't perfect, but there is not a more optimal solution when it comes to the infinite array of problems that is human pathology. Again, you cannot reduce human anatomy, physiology, and pathology to that of a chair. That should be fairly obvious.

You also set up a straw man where you seem to assume that all doctors and surgeons are generalists, which is false. In general the section of "Total market failures" has assumptions about medical training and practice that are wildly off base and do not reflect reality. You seem to think that all the different steps in medical decision making and treatment can be separated, which is also not reflective of reality. There are many critiques to be made about the medical training process, but this isn't one of them.

Problems related to insurance companies, hospital obfuscation, pharmaceutical pricing, etc are far more problematic.

Your critiques around scientific investigation are, I believe, valid, however.