I mostly agree with Jake. It seems reasonable to follow ‘conventional wisdom’. So even though conventional wisdom on charity is mistaken, I don’t think the average person going off to work for a charity because conventional wisdom says that’s really ethical is at much epistemic fault. And if they aren’t at epistemic fault, I don’t think they’re guilty of being uncaring or reckless: they’re trying to do the good based on their reasonable beliefs, and that seems praiseworthy even if they’re beliefs happen to be mistaken.
(That said, there might be a case certain things are just irrational even if they are conventional wisdom: maybe for example one just should do a lot of research about how one should spent one’s career, and - even though it is conventional - those who do not do so are just irrational. But I find it hard to see how particular views on the empirical questions re. charity effectiveness would be unreasonable to hold even if it is conventional wisdom: that seems a bit too epistemically demanding; we don’t have time to scour all empirical questions ourselves.)
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Hello Ryan! In approximate order:
1) I haven’t factored in financial costs, in part because I am not sure how. 2) Future posts will take a better look at the fact that doctors don’t singlehandedly do all medical care which you mention, which will drive down the upper bound significantly. 3) Replaceability corrections will depend at what stage you are at, and short-run supply medical labour is pretty inelastic, but it is not clear how it is over the longer term. But this is Ben Todd’s forte, not mine!
Hello everyone, these thoughts are slightly dashed off - my apologies for the errors in advance :)
Neil: I’d say something like “The lions share of the battle in health is in the living conditions of people - so much of disease is caused or exacerbated by these things. Having a population that is well fed, access to clean water, sanitation, shelter, education and financial security will fare far better than populations without these things, even if they have similar access to medical care.”
Good things to look at are intra-country social gradients of health (wealthier people live longer in the UK than poorer people, people who are homeless in the UK have a life expectancy of around 50, despite - at least in principle - having access to the NHS, etc.) Also there are neat data (which I’ll talk about next!) about how heath corresponds to health spending and number of doctors. Not sure if that helps…
A Medical Student (and Another Medical student)
1) The estimate above does try to look at wellbeing improvements instead of ‘just’ life expectancy. Bunker estimates medicine gives 5 years free of disability, which you can attempt to translate into QALYs (cf. footnote 2)
2) There are ‘second order’ effects of being a doctor in terms of being a community role model, helping out with health policy, and things like that. I’m unsure how to factor these things in: I guess the first thing that springs to mind is that the behaviour of most doctors (barring public health physicians, medical directors, etc) is directed towards clinical activities rather than health policy work, making their good reputation clear, and so on. I could be wrong about this, but I guess if it transpires the main impact (or a big chunk of the impact) of being a doctor is these things rather than their ‘direct’ work, that is pretty interesting.
3) If I may, I’m going to bracket the issue about the replaceability argument, as it will be the subject of an entire post which will (hopefully!) answer your concerns about replaceability.
4) I’m also a bit biased: I’m a member of Giving What We Can, so I’m pretty keen on people giving lots of money, and so I find it interesting to compare how much good earning to give can do compared to one’s entire medical career.
But I certainly don’t think they’re mutually exclusive (I want to do both myself!) And medicine is a pretty good way of both earning lots of money as well as the satisfaction you get from directly helping others. I would say, though, that we should try to give priority to stuff that does lots of good over what makes us feel satisfied we are doing good, and because there are lots of people willing to help directly, there’s still plenty of room for people earning to give.
Hello everyone - I have not mastered the formatting of comments, so apologies for style as well as substance:
The issue you raise is something I completely missed when thinking about this, so thanks for pointing me in the right direction. :)
I think you are right that life expectancy should continue increasing - and further, it is likely that increasing proportions of that increase will be thanks to medical care. So there might be some reason to think that future impact of a doctor might be higher in the future.
That said, I’m not sure how to factor these things in the face of empirical and normative uncertainity. On the empirical side, although life expectancy is projected to increase, there’s also a retangularization thesis - our ‘natural maximum’ lifespan appears fairly unchanged, so improvements to health push us closer and closer to this limit. Further afield (which I guess is your forte), there are all sorts of future technologies (not to mention any black swans) that could completely change the life expectancy of a child born in the next 50 years or so. So I’m unsure how to better forecast the impact of a doctor starting now: I guess extrapolating the current linear trend is the best bet as you suggest.
Normatively, there’s a big debate about how long should we ‘ideally’ live, and so the underlying assumption used that all QALYs are broadly equal (or even a good thing) might be violated - perhaps three-score and ten is ideal, but getting ourselves to all live to 150 (or 15000) is net negative. (Hedonic Treader makes a related point in how QALYs may diverge from common morality - fertility services might be QALY negative). Population ethics starts to loom large here.
I might try (when I get time!) to write some more on likely future importance of medical care.
FOR MEDICAL STUDENT THE THIRD
One of pleasant problems of trying to investigate something like this is you end up finding lots of avenues to investigate further. I agree we should look at medical sub specialities, as they end up doing very different things: the ID doc in africa probably does more good than the archetypal cosmetic surgeon, but the latter will earn a lot more money, and giving it wisely could fund quite a few more ID docs, etc. etc. Rohling exemplifies yet another way doctors can do good through public advocacy and education.
For now I am focusing on the ‘direct’ good doctors do - via bandages, drugs, and all the stereotypes of clinical practice. I hope to address the wider question of what doctors should try to do to maximize the good they accomplish later. If you want to help me out, please do get in touch!
I’ve looked at the RAND experiments, (and Hanson’s work), I’m unsure how well it extrapolates out of the US system. The main thing I will be looking at in the next posts is intra-country comparisons, particularly between developed countries: does lifespan or DALYs/100000 change when you spend a bit more on health (or hire a few more doctors) when you are already a developed country?
Setting the cost at 10 mil per ‘life saved’ looks to be much more than the NHS is willing to pay, as (upperbounds) 70 years x 30k per QALY ~ 3 million dollars. I had a quick look at how much a doctor’s implied QALY yield is given the marginal 20-30k per QALY figure, which amounts to 120 QALYs, 5 fold smaller than the central measure. I’m unsure how significance this difference is, but there are plausible mechanisms for an undersupply of medics - not least the action of the medical profession itself.
Cool stuff, Jess!
I was wondering if there was any more fine-grained stuff on what careers interview performance served as a better predictor in? I would guess interview performance might serve as a (albeit not great) measure of inter-personal skills which might be the key skill for sales/fundraising/other stuff. Also, there’s been a move (at least in medicine) towards structured or semi-structured interviews, so I wonder if these might do better. All that said, I wouldn’t be too surprised if interviewing had no value ‘across the board’.
I’d imagine there are also careerist take-homes too. If climbing the job/scientific/whatever hierarchy is important to making a high impact, one can pick fields and companies accordingly: if you know you are the best, it is worth going for places that focus on objective measures when hiring (and vice-versa!) It would also suggest that focusing on ‘interview skills’ (whatever they are) may well have more instrumental value than actual achievements.
Third hand evidence (I spoke to a quant who knows people who do poker):
There are programs that beat the average human players. The websites that do online poker have counter-programs that detect if a computer is playing and ban accordingly. However, intelligent players (with appropriate computer decision support - e.g. analysis of the likely risk aversity/bluffing tendency of other players on the table) can turn online poker into a high-volume low-variance game as they play several games concurrently and can reliably win more than they lose in low stakes games. He didn’t mention how long you’d need to be good enough, or average earnings per hour, but implied that in most cases if you are good enough to clean up in online poker, the skills you had would be enough do something in finance which would earn a lot more.
I’m keen and grateful for this series, and think the issues are very important, but I’m a highly sceptical about productivity/task management systems, and I’m not persuaded by this post. I was hoping you can show me my mistakes.
If (say) there were 10% or so productivity gains to be made by using particular task management systems, we’d expect to see them dominate in situations where being highly productive is rewarded (which is most of them): the 110%ers have a huge competitive advantage in terms of working, getting good grades, doing lots of stuff, etc. Yet looking around my highly achieving peers, I don’t see any sort of trend where the most successful have particular methods of organising themselves - i.e. those who use GTD or similar don’t seem to manage better than those who don’t. Although I know much less about other high achieving groups (Execs, Nobellists, etc.), I’m unaware of any big trend between task management technique and success.
There is a (mild) trend where the most organized tend to do the best, but this isn’t method dependent (some have diaries, others fancy apps, some have flash cards, others seem to just keep it in memory, and actual process/prioritizing/workflow vary hugely), and might be better explained by virtue of high-conscientiousness predicting high achievement, rather than better task-management improving output controlling for selection-by-conscientiousness
All this isn’t very good anecdotal data, but the support you give for GTD as isn’t that compelling either: although common sense and popular opinion are correlated with the truth, I think there’s (justified) scepticism about commonsense, popular opinion, or anecdotal reports of success (we’d want better than that when deciding whether or not to spend our money - so why not on how to spend our time, too?). You mention that ‘But there is also scientific evidence that supports some components of task management’, but you don’t elaborate. Please do! I don’t know of any good data re. methods of task management and improved productivity, so I’d like to find out. (This would seem an area of high-impact research).
My underlying worry is this: if you look at great writers, the ‘methods’ they used to compose their great works varied enormously. Hemingway had to use a typewriter whilst standing, Nabokov used flashcards with paragraphs on, Pullman always went down to the shed in his garden, etc. etc. Now, there might be underlying similarities (cf. Newport’s idea of ‘deep work’), but recommending all aspiring writers use flashcards or get standing typewriters seems unlikely to help. Similarly, people who ‘get things done’ might share underlying features (IQ, conscientiousness, executive function), but it is not clear to me the particular methods they use to organise/task manage is one of them. If so, then recommending folks adopt a particular method (like GTD) will not make them more productive.
Enjoy life! Gregory
Hey Greg, Richard mentions a couple of other bits of support beyond the ones you mention. Also note that he’s arguing in favor of some kind of task management system, not necessarily GTD, although a simplified version of GTD seems like the best right now.
I think the main reason they’re not more widely used is that people don’t know about them, and it’s seen as a bit unusual. It’s also much less useful when you’re a student and mostly just have to manage your studies, which might explain why you don’t see it more among your peers. In other professions when high output is really important, people effectively have a task management system via their PA.
Unaware of anything ‘big picture’: re. changes in survival time from cancer. Moderately informed thoughts:
1) You would probably want to look at the top 20ish cancers in terms of population affected - there has been steady progress in the management of some (bowel, breast), ‘dramatic improvement in others (CML, Cervix) whilst others have shown little improvement (lung, melanoma). Be interesting to see how this correlates to research spending. Cancer has good mortality data, but I do not know how easy it would be to get spending data.
2) 10 years rather than 5-10, given time from basic research to licensing is around 10 ish or more years.
FWIW, I am pretty sure cancer research is going to be a long way short of most cost effective marginal spend. Most cancer strikes at 60+, so even curing it does not have a massive QALY yield due to competing causes of death. Cancer tends to be much better funded and staffed than ‘cinderella’ fields like NTDs, and we are a long way along the diminishing marginal returns (same applies to human capital - Oncology is fairly prestigious and competitive in medicine).
I agree that it would nice to fermi it, and it should be tractable. There’s some chance I might be doing cancer medicine next year after I qualify, and so I would be happy to spend some time on it then. Don’t have time to do it before, but happy to advise. Would another 80k medic be interested?
Aside: However, these things make cancer medicine a good E2G opportunity within medicine, as there’s more lucrative private work, and so higher median salaries compared to most other fields.