Doctors vs economists

The BBC are offering two series glorifying the medical profession: Superdoctors, which presents the “cutting edge” of medicine, and Blood and Guts, Michael Mosley’s whiggish view of the history of surgery “from butchery to brilliance.”
Which raises a question. Why do doctors  get such great publicity and acclaim when economists don’t?
For all its excellence, the medical profession still leaves a lot to be desired. Medical errors kill tens of thousands a year; doctors still have little idea how to treat many complaints such as gout, the common cold, backache or many degenerative diseases; and their treatment of the mentally ill is still often atrocious.
And yet, for all this, doctors get much less obloquy than we economists get for our frequent failures to forecast recession - even though our errors are less costly than doctors’.  Why is this? Here are some possibilities:
1. Survivorship bias. A man who’s been cured by a doctor lives to tell everyone. A man who’s been killed by one stays quiet. Economists’ “victims” - those stupid enough to believe forecasts - don’t keep schtum.
2. Publication bias. New medical research is often presented as an exciting breakthrough. Economic research rarely lends itself to such glowing headlines.
3. The fight against nature. If doctors are unable to cure disease, this is seen not as a failure of their intellect, but rather as testament to the force of hostility of nature, against which they are heroically battling.
What people fail to see is that economic forecasting is also a fight against a powerful force - the existence of free will. The reason for this is simple; economic activity next year is a function of the choices people will make then. But because they have free will, we cannot predict these choices. In this light, what’s astonishing is not that forecasts are wrong, but that they are ever right at all.
4. Selective judgment. Economists get judged, wholly wrongly, on their weakest activity - economic forecasting - whereas doctors get judged on their strongest.
5. Our greater antecedents. Economics has progressed in all sorts of ways. We know now, for example, that protectionism is generally a bad idea; that inflation targeting is a better monetary framework than fixed exchange rates; that countries can’t get rich merely by heavy capital investment, and so on. And yet it’s harder to present the history of economics as pure progress, as Michael Mosley does for surgery. One reason for this, perhaps, is that the great economists of the past were genuinely brilliant whereas their medical contemporaries were quacks, charlatans and butchers.  At the same time as Paul Samuelson was  creating foundations of the economics we learn today, Walter Freeman was hammering ice-picks into people - and he was regarded as a pioneer at the time. And let’s not even consider Adam Smith’s medical contemporaries.
Now, I say all this not to demean doctors, but to elevate economists. Our profession - at its best - should not be regarded as in anyway inferior to the natural sciences.

Comments

[TheophileEscargot]

Well, medicine in the sense they mean isn't a theoretical disciple, it's the act of curing sick people.

Economics in the sense you mean is a theoretical discipline. The people who actually practice it tend to be called businessmen, ministers, chancellors and civil servants.

So, for one thing you're demanding that developing theory be loved as much as engaging in action.

For another, the businessmen and ministers who actually practice economics, don't seem to regard theoretical economics as very helpful.

I recently read a collection of lectures called "The Chancellors Tales: Managing the British Economy". For instance, Denis Healey says:

"The real problem, I discovered, was economics. I didn't study economics at Oxford, but I discovered very soon that economics is not a science, it is a branch of social psychology. People try to make generalizations from situations described by their teachers when they were students which had actually occurred twenty years earlier. So economic theory tended to be based far too much on what had happened two generations earlier."

Nigel Lawson:

"Economists, at least since Marshall, have mistakenly sought to dignify their calling by describing it as a science, and have increasingly chosen to add verisimilitude to this pretence by clothing their propositions in the language of science, that is to say, mathematics. Despite being a one-time mathematician myself, I doubt if any chancellor of the Exchequer has ever been assisted in the slightest by a mathematical equation. For economics is not a science."

So as a closer analogy, suppose the medicine was sharply divided between at theoretical side and a practical side, and further suppose that the actual GP, doctors and surgeons doing the practical side continually said that the theoretical side was more or less useless.

Would the theoreticians really be loved by the public?

[William McIlhagga]

Actually, why do doctors get so much credit instead of statisticians? The randomized controlled trial must be the single most important advance in medical history.

[Neil]

"Medical errors kill tens of thousands a year"

Weren't you saying, just last week I seem to remember, that recessions kill *entire generations*?

[chris]

@Theophile. You make some very good points. But surely, it's quite possible for theory to be more respected than practice. Compare, for example, theoretical physicists with engineers.
@Neil. Recessions might kill people in one respect - though bear in mind the contrasting work of Christopher Ruhm:
http://www.uncg.edu/bae/people/ruhm/
But economists don't cause recessions - usually!

[Neil]

Sorry to be facetious, but that last sentence is begging for the word 'discuss' in place of 'usually'...

[reason]

Chris.
I still the killer question for economists is
"All well and good - but if the main conclusions of decades of economic research can be expressed in one sentence, why do we need more than one?"

[reason]

I still think ...

[Ideas of Civilisation]

I'm inclined to back Theophile on this.

I think this links in with the jobs that people want for themselves or their children. Namely jobs with decent pay where it's obvious exactly what is achieved each day.

Doctors do things which people can directly see the benefit of (and earn good money); economists don't.

I think that the bulk of professions which are 'liked' in the UK reflect this; so people think that engineering, teaching, medicine, scientists, joinery and so on are seen as real jobs because people can practically see what each of these jobs achieve.

However jobs such economists are obviously theoretical and so cannot show an obvious 'achievement' in the way that the professions above can.

I also mention earning good money because I think this is a factor too. McDonald's staff do an obvious job and you can see what they 'achieve' but their earnings will be much less than other professions listed, hence they will not be as 'popular'.

I think the only way around this may be to change your profession to 'home economist' because then people could at least see the cakes you bake...

[Dave]

"economic forecasting is also a fight against a powerful force - the existence of free will."

You didn't need to introduce dodgy metaphysics to make this point... :-)

The complexity of the human brain ensures that behaviour ("choices") is fundamentally unpredictable.

[dearieme]

Doctors have penicillin.

[Bob B]

Until doctors got penicillin, they had digitalis (a heart stimulant), a vaccine against smallpox and aspirin and not much else by way of effective medicine to administer apart from leaches and laudenam. In China, they had acupuncture.

By the time the doctors got to penicillin, economists had Adam Smith, Ricardo, Dupuit, Cournot, JS Mill, Bertrand, Walter Bagehot, Walras, Wicksell, Bachelier, Marshall and some Keynes. And, of course, we had had a pioneering industrial revolution without state direction.

[Both]

Expecting an armchair vocation like economics to receive the same degree of glorification as people who get their hands dirty and try to save individual lives is just silly.

On the flipside, how often do economists get sued for bad advice?

The history of medicine contains some truly atrocious stuff, but lets not forget that Marxism was spin-off of classical economics.

It's true that effective treatments did not really surface until the 20th century, but they were only made possible by centuries of work in anatomy, pathology, microbiology etc. By the time doctors got to penicillin, they'd already had Vesalius, Harvey, Morgagni, Rokitansky, Lister, Virchow, Osler, Koch and countless others.

[Bob B]

It has to be admitted that by the test of the market, economics grads don't make as much as medical school graduates:
http://www.timesonline.co.uk/tol/life_and_style/education/good_university_guide/article2253011.ece

[Bob B]

FWIW some further thoughts.

In personal experience, debates over the generality of the "scientific" standing of economics tends to be generated as a tactic to divert attention from specific policy issues.

IMO economic analysis of policy has to stand or fall on its own merits regardless of whether economics is "scientific" or not. Fortunately, economists as a species are hardly reticient about disputing issues. In fact, their propensity to dispute is often adduced to discredit economics, which is a little surprising since politicians, lawyers and, for that matter, medics are also notoriously prone to be disputatious.

It's not as though reflection on economic policy issues can be avoided, whether undertaken by the layity or professionals. Taxes have to be set and changed, presumably on the basis of some estimate of the likely consequences. What to do about curbing inflation? Is trade protection beneficial or not? Should monopoly suppliers of public services be regulated and, if so, how?

As for history, Nigel Lawson (NL) as Chancellor did well to lead us away from the morass of monetarism of the early 1980s - which had failed to achieve its own monetary targets - but then plunged us into another mess by using the policy instrument of interest rates both to curb inflation and to ensure a more competitive exchange rate for Sterling on route to the misguided goal of joining the European Exchange Rate Mechanism (ERM).

The eventual outcome from keeping interest rates low to maintain a "competitive" exchange rate for too long in the mid 1980s was an unsustainable growth rate by the end of the 1980s along with an upsurge in inflation - and then being ejected from the ERM in September 1992 as a result.

If only NL had read up on Tinbergen's contribution on the policy assignment issue in the fiscal policy texts instead of taking refuge in a pointless and boring debate on whether economics is a science.

[bill greene]

I believe most of these comments, and the posting itself, make the point that medicine is a hard-science and economics is a soft-science. Medical practice observes the scientific method with tests, observation, and measurement of results, so it progresses. Economics has been primarily the subject of a theoretical, ideological, and philosophical debate, so the arguments continue, and progress gets reversed or stagnates.
The horrible world-wide conflicts and disasters of the last century were the result of following soft-science policies that had proven to be failures in the past. The theoreticians failed to learn the lessons of history. Such "brilliant" thinkers, if ever allowed into practical medical areas, might well forget to pasteurize milk, or they could easily neglect to use sterile procedures in operations, or, in a number of such ways, they would be apt to replace established principles that worked with new fanciful abstract concepts that don't work.
The un-scientific mentality of such theorists is evidenced by the fact that those who hoped Russian communism might somehow work, maintained that optimistic outlook over three generations of demonstrated failure. Anyone with common sense or a scientific bent would have abandoned the "experiment" after the first few decades as Orwell and Koestler did. But many economists still advocate big government and communal economics!
The legal and business professions--and their academics--use the case method to study what--in their soft-science fields-- actually worked and what failed. They thus avoid the abstract theories that so often fail the other humanity subjects. That same case method approach can be used to interpret the lessons of economic and political history, as I have done in my book "Common Genius" -- but such a pragmatic technique is not popular among the soft-science academics who prefer theory over practice.
The posting itself concludes (incorrectly) that "our (economic) profession (is not) in any way inferior to the natural sciences." The writer thus concedes that economics is not a natural science. Now, in fact, all humanities, including economics, are inferior to physical sciences, in that they do not utilize proofs. Many soft-science intellectuals including economists supported both Hitler and Stalin's economic and political theories. Many still support the need for government to dictate too many aspects of both private lives and private enterprise. Many administrators of foreign aid still waste trillions in grants to corrupt leaders of third world countries. Many still support welfare payments so large that they reduce individual initiative and self-reliance; many still support government programs that reward bad behavior. No wonder the medical field is held in high regard and theoreticians in the soft-sciences are not!

[Laurent GUERBY]

All honesty has long left the economics field...

Comparing medecine results and economics results, wow. Something with likely 99%+ efficiency against crooks whose ideology makes them worse than throwing dices at predicting anything and who use measurements without any credibility (like unemployment) when there are much better available for the same object.

[Bob B]

Bill - I have to say that your post is a travesty of the facts. The professional economics periodical literature is virtually awash with a wide variety of empirical studies and econometric tests of theories. S&M here regularly quotes more than a few empirical papers and provides links.

"The horrible world-wide conflicts and disasters of the last century were the result of following soft-science policies that had proven to be failures in the past."

Keynes famously resigned from the UK delegation at the Versailles Conference after WW1 and wrote a book attacking Lloyd George's proposals for German reparations:
http://www.fordham.edu/halsall/mod/1920keynes.html

Arguably, the reparations imposed on Germany in the Versailles Treaty of 1919 were a significant contributing factor to the causes of WW2.

"Many soft-science intellectuals including economists supported both Hitler and Stalin's economic and political theories."

That's rubbish. Try Alan Bullock on: Hitler and Stalin - Parallel Lives. The leading British "intellectuals" who notoriously cheered Stalin on were George Bernard Shaw, HG Wells and Beatrice and Sydney Webb. Bertrand Russell famously and explicitly disavowed the Soviet model after a visit there.

No leading British academic economist of the time cheered on either Stalin or Hitler - certainly not Keynes, who was an economic adviser to the wartime government, nor economists such as Meade in the Cabinet Office or the three economists in Beverbrook's ministry of aircraft production: Alec Cairncross, Ely Devons and Brian Tew, nor Beveridge, author of the wartime report on social security and later director of the London School of Economics. The one possibly pro-Soviet intellectual who could be cited was Stafford Crips, a hugely successful lawyer.

Btw George Orwell was never a member of the Communist Party - unlike Arthur Koestler - and after fighting in the Spanish civil war on the Republican side and being wounded, he escaped with his wife across the frontier into France just ahead of an arrest warrant issued by the Republican government. Try: Peter Davison: George Orwell - a literary life (1996).

Oswald Mosley, a cabinet minister in Ramsay MacDonald's Labour government of 1929-31, famously went on to found the British Union of Fascists in 1932 but there never was wide support for the BUF in Britain and certainly not from among "intellectuals". The BUF stayed part of the lunatic fringe of British politics notwithstanding possible support from Edward VIII, who abdicated in 1936. Any suggestion that Edward was an intellectual would be novel and laughable.

[tmog]

Why do you think that Dr.s can not treat gout? Have you not heard of allopurinol(not a new drug)which prevents gout?

[Dr. Glenn]

Hey - I am a Dr. and an economist. The title Dr. was orignally given to those undertaking a Doctorate in Philosophy (Ph.D.) and not medicine. Those medical types nicked the title Dr, the b*st*rds.

I do use my title - in the past it has allowed me to get my dry cleaning done quicker, and quicker medical appointments!

[improbable (a Dr next year, but not and MD)]

Sanitary engineers don't get much respect either, but they (along with the statisticians someone mentioned) are the hidden guys actually saving lives.

Like economists, they have leverage, in the sense that their work can help many people at once, not one. But in gaining this they lose face-to-face contact, which seems to be what gets doctors respect.

Other things people love (like the internet) have nobody at the front line like that, so perhaps we look up to the hidden people there a bit more.

But why do we hate lawyers so much, even though we do get to interact with them? And like doctors, we're only likely to be doing so because things aren't working out right...