Faith in Docs

Today is my health econ final exam.  I also return their last paper, on faith healing.  After an entire semester hearing how we get little health value from a wide margin of medical spending, almost every student (21 undergrads & 9 grads) said that a big argument against legal faith healing is that it can discourage people from going to regular doctors.  Most also said it is hard to evaluate faith healer quality, and to know if they are just in it for the money.   

Sigh.  Regular docs are mostly in it for the money, and are also hard to evaluate.  If we on average get near zero health from our last units of medicine, we are better off replacing those units with anything cheaper, at least if it also gives near zero net health effect and similar non-health benefits.  Faith healing seems to fit this bill. 

Sure, we vary in how much medicine we get, and in how much we would substitute legal faith healing for medicine.  So yes a general trend toward more faith healing would no doubt produce a few people who sometimes get too little medicine.  But that harm should be far outweighed by a reduction in harmful overtreatment.  Alas, apparently even econ students after a semester of my indoctrination can’t see this (only two mentioned it) – we all just love docs too much. 

I’m struck by how emotional was the opposition to faith healing and how timid were its supporters.  Most people believe prayer can make you well, but few believe religious specialists can use such powers to similarly help others.  Yet our faith in docs is so strong that when considering medical quantity variation, a few getting too little dominates our attention – we just can’t see most getting too much.

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  • Yesterday was vaguely anti-science and pro-creationism, today you’re suggesting we might benefit from more faith healing.

    Are you sure you’re posting to the right blog?

  • Unknown

    Shane, Robin’s post yesterday was not “pro-creationism”. And the “benefit” that Robin says would result from more faith healing is “near zero net health effect”, which is said to be a benefit only because it’s cheaper than also useless, but expensive, medical treatments.

    Robin should give us more posts like this: they definitely reveal people’s biases, and might in the long run encourage people to start to overcome them… although it certainly hasn’t happened yet.

  • Valter

    You seem to suggest that more recourse to faith healing is good because it is a cheap placebo and a substitution of placebo “treatments” for medical treatments would improve on some notion of health care efficiency.

    Is this a correct interpretation?

    If so, I have a couple of questions (note: I am not an expert in the field):

    1) is it really cheaper? Placebo pills do not cost much. So maybe you are saying that they are an efficient way of doing placebo treatment: those with a religious bent will get their placebo from their preferred faith healer; those with a scientific bent should get it from doctors. Is that so?

    2) I understand you believe that the average medical intervention has a net welfare value lower than a placebo’s. But a promotion of “faith healing” would not mean that a random sample of potential medical treatments would be replaced by placebos.
    It is more likely that there will be a bunch of religious people who will substitute too much and fail to go see a doctor even when that would help on average (even given your estimates of the average worth of medical treatment) – which is what your students feared.
    Conversely, the scientific-minded people will be entirely unaffected by the change in policy.
    On balance, I don’t see why we should expect an improvement.

  • Robin, This post seems very broad and critical without many details. I know you just took a final, but could you provide more details for some of your arguments. I have read some of your other posts on health care as well, so feel free to reference those.

    Could you please expound more on the line:

    “Sigh. Regular docs are mostly in it for the money, and are also hard to evaluate.”

    I doubt you are ‘overcoming bias’ in that statement. If you said they (doctors) are hard to evaluate how can you make this claim? Who is the regular doctor? How have you determined the regular doctors motivation? And are we not all working in our jobs to some degree for money?

    Because overall health does not improve to the same degree of expenditures, this does not make all health care worthless. Part of the advancement of medicine is trying to figure out what parts work best, in essence ‘overcoming bias.’ In addition the results for the success of medicine for one patient and the failure for another patient may look like a net gain of zero on paper when looking at population statistics, but if we can learn from both the success and the failure we can improve health care. It has been yet to be shown that faith healing has the success that medicine has.

    Also, please provide some facts and detail for this statement so we may pursue more discussion of your assertions:

    “But that harm should be far outweighed by a reduction in harmful overtreatment.”

    Yes medicine has begun to acknowledge the harm of overtreatment, but to claim that avoiding traditional health care for faith healing would reduce harm in such a drastic measure needs some more evidence.

    Do you include public health (responsible for most of the life expectancy advancements in the 20th century) as part of medicine/health care?

    As a palliative care doctor, I agree that overtreatment needs to be examined more, as I see it often. But I also see the psychological harm from false hope in both traditional medicine and faith healing which can be hard to measure as a quantifiable harm. For some families and patients that false hope means “at least we tried EVERYTHING” and for others it means “we tried EVERYTHING, how come she didn’t get better?”

    And by the way as a long time reader, first time poster, I agree with most of the great posts and appreciate the insightful discussion here.

    (Sorry for all the questions, you don’t have to answer all of them.)

  • Sorry I meant to say ‘give’ rather than ‘take’ a final. But you may be tired still the same!

  • Jeff H.


    What exactly was the assignment for the paper?

  • If asked to evaluate whether candy should sold at schools, it would be reasonable to note that students already get too much sugar in their diet. It would not be reasonable to say some students would then eat only candy and die.

    Valter, I would also recommend that docs feel more free to recommend placebos. But that won’t avoid the big expense of the doc’s time to see patients.

    Christian, yes of course most people with jobs are mostly in it for the money. And yes innovation may be a benefit of apparently useless medicine. I don’t include public health in “medicine.”

    Jeff, follow the link to the class page.

  • @Shane Legg

    This post is another case of benefiting from Robin’s ability to “think different” and his subtle humor. I hope he won’t mind if I confess that he and I had a piece of this conversation ourselves, because it might clarify his line of thought.

    It might help to think of this from an SSRI context — these have now been proven to be nearly worthless for the moderately depressed.

    Yet this group formed the vast majority of users of Prozac et al, spent billions, suffered enormous important health-altering and quality-of-life-harming side effects — and still almost all would say they also got better and were happy with their treatment.

    This led me to argue to Robin that most healing was actually suggestion or auto-suggestion (this would account for prayer as well); thus going to the doctor, going to a therapist (who some scientific medicine types would argue are just faith healers with higher-pedigree degrees) or stepping into the revival tent are all equal.

    He noted that the student papers were quite against faith healing but accepting of prayer — both unscientific — why did students hold this belief? That was the interest in this question, I think. Robin is almost always interested in why people believe what they do, in my experience.

    I argued that it was due to the higher social status of therapists to faith healers, and the people believe in prayer because they overestimate their own power and control.

    Robin, in his wry way, dryly speculated that perhaps people just dislike spiritual middlemen! But the important point, I think, is that we as a society do spend billions on medical treatments and yet the outcomes of these treatments aren’t always as rigorously studied or useful as they should be.

    If we are wasting money on Prozac — and people are suffering bad side effects as a result — why isn’t it more rational to send people to a faith healer who will help them get the same benefits of suggestion without high cost and with no side effects?

    So yes, Robin is definitely posting to the right blog!

  • I think the point is that we all are not nearly sceptical enough: We all have irrational believes.

    We tend to assimilate believes trough osmosis which are culturally acceptable but remain unproven. eg. We have faith in doctors without having any real reason to have faith, we assume that we can trust them.

    I suggest also reading:

  • Rue Des Quatre Vents


    I fumbled a question for you at Caplan’s panel at Harvard, but what you write here comes closest to what I was trying to get at: is it possible that some irrationalities are ineradicable? (And the task of dealing with them is harder than Caplan suggests….)

    I have a sister who is afraid to fly. She readily accepts all arguments supporting the safety of flying. But anytime she’s on a flight, her heart races, she looses her ability to concentrate, and sometimes, she needs some kind of stress reducing medicine. (Could be placebo!).

    Maybe most people have transposed a similar fear to their views about healthcare? Do you think this is by nature or nurture?

  • @Frelkins

    If medicine is being over or inappropriately applied, how about addressing this problem for what it is rather than employing faith healers to fill the gap with their non-sense?

    I don’t deny that a person’s psychological state has a significant impact on their health: there are plenty of solid scientific studies to back this up. However, in my view the solution is to appropriately recognise the importance of things like friendship, understanding and compassion in health care, rather than hand things over to faith healers. In other words, there are perfectly rational ways to deal with people’s psychological well being that doesn’t require the sprint of Vido that lives in a magic blue crystal. Let’s use them.

  • Vladimir Nesov


    I’m afraid little benefit that one can get by using cheaper faith healing placebos doesn’t outweigh the risk of going to faith healer even in a much more serious condition. I heard of people (friends of my relatives) who would prefer homeopathy or faith healer (depending on person’s beliefs) to a surgery when diagnosed with cancer. Having faith in an “alternative healing” ritual is dangerous when normal treatment is scary.

  • Dan Burfoot

    This is a great post. You should receive some sort of prize for it.

  • Doug S.

    “Faith healing” should be illegal because it is fraud. Should I be allowed to sell “faith-based” investment advice – that you should invest in my mutual fund because God will make its value go up?* How about faith-based fire alarms, that sit on your ceiling and do nothing until God wills them to go off and alert you to a fire? Doctors may not be perfect, but conventional medicine represents humanity’s best knowledge of how to treat disease and maintain health. It’s wrong, but it’s a lot less wrong than it used to be. (And, yes, prayer is fundamentally useless.)

    *Then again, it’s well known that professional money managers tend to do worse than chance, so maybe reading tea leaves is a good investment strategy? 😉

  • Rue, I don’t know how far we can get eradicating irrationality, but sometimes we can at least substitute cheap for expensive ones.

    Shane, I tell my students that when asked to choose between X or Y, picking Z is no answer.

    Doug, should prayer also be illegal as fraud?

  • Caledonian

    Doug, should prayer also be illegal as fraud?

    Who is the fraudulent party that should be charged in that case?

  • Caledonian, you might charge a pastor/priest for suggesting prayers are answered, or charge someone who expressed sympathy for your troubles and said they would pray for you.

  • Caledonian

    I’m not a legal expert, but even I know those scenarios do not meet the legal requirements for fraud.

    The only people that DO meet those requirements are the ones Robin Hanson suggests we need more of: faith healers who claim they can cure and who charge for their ‘services’.

  • Doug S.

    Well, you could charge anyone who said that they’ll pray for you in exchange for money and suggested that you would benefit thereby… 😉 Faith healing is not a substitute for medicine, it’s a substitute for sanity.

    I have a strong dislike and contempt for religion, but as a practical matter, attempts to get rid of it by force tend to result in bigger problems than the religions themselves currently do.

    See also: Viruses of the Mind by Richard Dawkins.

  • Larry D’Anna

    Robin: would you argue for buying lottery tickets because they’re cheaper than betting on horseraces?

  • Larry, yes, if your choice is to blow $5 on some tickets or $50 at the track, by all means take the tickets.

    On prayer as fraud, I asked should it be illegal, not is it illegal.

  • Larry D’Anna

    Robin, but that’s not your choice. You could go buy a sandwich instead of either.

    Your saying that faith healing is less wasteful than the last margin of traditional health care we get. But that doesn’t mean faith healing is any better than we thought it was.

  • @Larry D’Anna

    Think about Robin’s idea from a policy perspective. If a Democrat wins the USA election, we will have some form of “universal” “mandatory” health care.

    A result of Robin’s interesting thinking is that the universal care should perhaps include provision for homeopathy, acupuncture, yoga therapy, even prayer groups — what have you — for some conditions, as these seem likely to have good outcomes equal to that of scientific medicine and *at much lower cost*. Plus, it will add more consumer choice to the system.

    Insurers and consumers could have saved tons by sending all the “worried well” to yoga class instead of paying out high $$$$ for Prozac and probably also made a dent in the obesity crisis too!

    I do believe, for example, that a certain amount of homeopathy is covered by the UK health system.

    Also, I suggest we as commenters pursue Robin’s interest: why do the otherwise intelligent students accept irrational, unscientific prayer, but not irrational, unscientific faith healing?

  • Kevin Dick

    I think it depends on your model of compliance and the relative benefits of preventive versus chronic versus acute care.

    My guess is that people would be fairly compliant in their adoption of faith healers when substituting for consumption of preventive and chronic treatment. The results here are likely to mixed. I think science-based preventive treatment is on average low cost and moderately effective. I think science-based chronic treatment is on average moderate cost and of questionable effectiveness.

    The problem comes with acute care. For a lot of acute conditions, I predict that compliance with faith healing will be low. People will turn to science-based acute treatment. On average, I think this treatment is high cost and ineffective. Moreover, the lack of science-based preventive treatment may lead to higher consumption of science-based acute treatment.

    So Robin, assuming I expanded this with references to appropriate research and build some supporting “toy” demand models, what grade would I get?

  • Mason

    “The only people that DO meet those requirements [for fraud] are the ones Robin Hanson suggests we need more of: faith healers who claim they can cure and who charge for their ‘services’.”

    Robin as good evidence that doctors;
    1) Claim to cure
    2) Charge for their services
    3) Have the same success rate as faith healers

    His question – why the preferential treatment for doctors?

    Here’s one student that got the message, – $300 for six months of catastrophic insurance, is that a good deal? We’ll see if I keep it after getting a job with benefits.

  • For those looking for data to back up Robin’s provocative claims, the first book listed in his class syllabus is Overtreated by Shannon Brownlee, available for $17.13 from Amazon. You can also listen to an interview with Brownlee at the Health Care Blog (click on the word “conversation”).

    As far as national policies, I understand that many countries orient their health care more towards having larger numbers of doctors who are perhaps not trained as intensively as in the U.S., and who certainly do not have access to all the expensive equipment that is routinely used here. But they are caring, knowledgeable, in some cases they will still make house calls, and they can screen patients to see whether more treatment is needed. Many studies have found that this kind of attentiveness can go a long way towards making patients feel better, at far lower costs. Faith based healing probably would offer most of these benefits, to people who believe.

  • Caledonian

    On prayer as fraud, I asked should it be illegal, not is it illegal.

    Actually, you asked whether it should be “illegal as fraud”. And the answer is no – it’s not fraudulent, and it shouldn’t be illegal on those grounds.

    The changes necessary to the standards of fraud so that prayer would be included would destroy the concept’s utility – practically everything would be fraudulent.

  • Huh. I had thought this was a good blog. Unsubscribing its RSS feed now.

  • Shane, *sigh* you fell into Robin’s trap today. The other day’s arguably crappy post isn’t related to today’s description of his “gotcha” final exam question. The response by some people in this comment section are so predictably irrational, and so ego-serving in their categorical dismissal of the blog (see for instance, Jamie McCarthy), that Robin couldn’t have done better if they were his sock-puppets.

    Still, sorry Robin, they don’t redeem the tenuous connections and sketchy arguments of your post on “Expelled”.

  • Doug S.

    I’d also like to round up the acupuncturists, chiropractors, herbalists, and other “alternative medicine” practitioners and charge them with fraud, too.

  • Psychohistorian

    “But that harm should be far outweighed by a reduction in harmful overtreatment.”

    We need actual evidence that people would tend to shift marginally useless spending rather than marginally useful spending. The children buying candy metaphor is completely absurd, as children do not control their diets outside of school. Adults have a great deal of control over where they go for medical treatment.

    Moreover, we do not know how a ban on faith healing would affect consumption of actual medical treatment. People who view faith healing as legitimate may be skeptical enough of real treatment that they will barely consume more. Alternatively, faith-healing dollars may be channeled into other alternative therapies that are slightly less fraudulent (or slightly more harmful; we don’t know).

    Ultimately, if we accept Hanson’s highly critical view of medicine, purchasing additional medical care at some point becomes a gamble: it might help you more than a placebo, but it probably won’t. Faith healing simply won’t help more than a placebo.

    So, which is a better deal? A $1 lottery ticket with an expected payoff of $.20 (total, not profit), or a $.10 piece of paper with some random numbers written on it?

  • Caledonian

    The random-number paper, of course. Know what’s an even better deal than that? Not buying anything.

    That’s the proper response to discovering that doctors aren’t better than faith healers – not replacing the doctors with the faith healers!

  • @Caledonian:

    “Not buying anything.

    That’s the proper response to discovering that doctors aren’t better than faith healers – not replacing the doctors with the faith healers!”

    But this is not true, Caledonian. To continue my example, the dysthymic – the worried well – do cost society in terms of absenteeism, etc. due to their anxiety, mild depression, whatever. It is in society’s interest to treat them; doing nothing has a defined cost here.

    They can return to full function with the expensive essentially placebo treatment of prescribing psychiatrist + Prozac with likewise expensive side effects or with the inexpensive essentially placebo treatment of Bach’s Flower Essences with no side effects.

    And, biases being what they are, people will probably prefer to take a “natural” treatment from a nice homeopath than a “chemical” from the forbidding shrink, so society will probably get better compliance and faster recovery.

  • I just recently learned via La Rana that the placebo effect may be largely a myth.

  • David

    Bertrand Russell once wrote the famous words “I wish to propose for the reader’s favorable consideration a doctrine which may, I fear, appear wildly paradoxical and subversive. The doctrine in question is this: that it is undesirable to believe a proposition when there is no ground whatever for supposing it true.”

    Believing things that are not true can be dangerous business. Even if the beliefs in themselves appear harmless, you are likely to base other beliefs on the faulty ones.

    Incidentally, I think a problem with making faith healing illegal is that people sometimes gets more interested in the forbidden and exciting. Spend the money on education instead and trust people to make good choices.

  • Doug S.

    Personally, I’ll take the chemical. 😉

    I’m wary of anything marketed as “natural”, as I tend to associate such marketing with “Our product doesn’t have any real benefits over the alternatives, we just want to manipulate gullible people who don’t know any better!” “Natural is good” is one of the most pernicious associations I know of, and one of the most blatantly false. There’s plenty of perfectly natural poisons around, for example. Smallpox virus is natural. Dying during a difficult childbirth is perfectly natural, while the potentially lifesaving Cesarean delivery is extraordinarily unnatural.

    I could go on, but I’ve already done enough thread-jacking as it is.

  • Robin should give us more posts like this: they definitely reveal people’s biases, and might in the long run encourage people to start to overcome them

    I find it hard to believe posts like this will encourage people to overcome biases. If his students, with a clear incentive (i.e. grades) to overcome their biased opinions of doctors, overwhelmingly resist, then why would blog posts (which provide virtually no incentive) do anything? It looks like the main effect of this post is to make readers more pessimistic, either about the effectiveness of pointing out biases, or the ability of this blog to identify biases. Maybe that pessimism is on average slightly more accurate, but it’s hard to see much value in that increased accuracy.

    So I’d like to see more posts about how to improve incentives or techniques, and only see posts documenting the existence of biases when there’s some reason to think readers want to overcome those biases but aren’t aware of them yet.

  • Peter, I respectfully disagree. I also would like to see more posts about how to improve incentives or techniques, but this blog post does something more useful than documenting the existence of biases. It also proposes that we could save money by siding with factions that want universal health insurance expanded to not just cover dubious medicine practiced by establishment doctors, but to dubious medicine practiced by the subset of “alternative healers” that are cheaper than establishment doctors. That’s an interesting, innovative idea, that might be a good idea, too. Because saving money in the realest sense can save lives, including, most importantly, my own. Although I agree that it only detracts from the good idea to express it to us in the form “Oh my god, my stupid, biased students”.

  • So Robin, who does your faith healing?

  • Paul Gowder

    Wait a second.

    Assume someone has a fixed health care budget. They can allocate this budget to medicine or faith healing. Each dollar allocated to either source, assume, has a positive probability of producing some health benefit. That need not be very much — there’s likely to be a lot of waste in medicine. Let the respective probabilities be P and Q for a dollar on medicine or a dollar on faith healing. Let the proportion of the budget allocated to medicine be X. Then the patient’s health utility (assuming constant units of health benefit) h(x)=PX+Q(1-X). Simple calculus will verify that so long as P>Q, the health benefit is strictly increasing in X.

    And whatever else it’s reasonable to think about the comparative benefits of medicine vs. faith healing, surely P>Q!

    So I suppose the assumption that makes this really easy is the fixed budget. So let’s drop it. We can assume that medicine is more expensive than faith healing for the same amount of “treatment” (measured somehow), perhaps because of moral hazards from insurance, etc. But then we have to ask why consumers can’t be encouraged to drop ineffective medicine without replacing it with (more ineffective) faith healing. If we don’t think consumers will reduce medicine use without a substitute in the form of faith healing, we must think consumers are hell-bent on consuming some fixed amount of “treatment” regardless of its efficacy. Why do we think that? Is it possible to correct for this tendency with some other social policy?

    (Incidentally, on prayer as fraud, *charging* for prayer perhaps should be criminalized as fraud. We criminalize fortune-telling on much the same grounds. Free prayer doesn’t defraud anyone. Perhaps only bad-faith prayer should be criminalized though — there are good reasons not to criminalize people for things they genuinely believe — although this would be hard to enforce by picking out the real from the false beliefs. The practical problems might be insurmountable. But in principle, sure, under some circumstances.)

  • Paul, I’m fairly certain that Robin would say, and it seems reasonable to agree, that consumers whose family and loved ones fall ill are, precisely as you say, hell-bent on consuming some fixed amount of “treatment” regardless of its efficacy because it serves as a signaling mechanism that they care deeply for the life and well-being of the one who is sick or injured.

  • it serves as a signaling mechanism that they care deeply

    Mike (and, to an extent, Paul), that’s a bit needlessly negative isn’t it? Are you saying there’s no chance that people actually want their loved ones to get better, and are prepared to expend whatever’s necessary, even to the point of irrationality?

    The desire to consume a certain amount of ‘treatment’ is not difficult to explain, and most likely has little to do with the efficacy of the treatment in question. To put it one way, people look for treatment to feel better, not to get better. Hence all those well-documented placebo studies.

    If my nearest and dearest fell seriously ill, I would probably not be at my most rational. I’d spend every penny I had on treatment in order of how likely it was to succeed. Throwing money away as a signal would not be a useful thought.

    Fraud addendum: if you’re banning people that sell ‘irrational utility’, after the faith healers, you should start on the palm readers, lottery organisers, churches, breweries….

  • Doug S.

    I agree with the palm readers bit. Gambling is a bit of a weird case, but the house advantage is well known, so there’s really no deception there. (I’d prefer that slot machine owners be required to disclose the odds of every prize-winning outcome, though.) Finally, alcohol also has well-known effects, some of which are desirable, so there’s no issue of fraud there either and it probably doesn’t count as “irrational” utility in the way that lottery tickets are. (There are other reasons why a ban on ethanol consumption may be desirable, but let’s not go there.)

    I wish I could ban churches, but the consequences of doing so tend to be worse than the churches. 😉

  • Peter, I’d suggest that it is actually more beneficial to learn that seeing the doctor is unlikely to do you much good, and that you can usually get just as much help from an alternative practitioner for much less money, than to learn that you should vote for certain universal health care policies. Learning the former can make a moderately significant difference in my life, in terms of changing my practices with regard to health care. But changing my political views isn’t likely to lead to an actual difference in my circumstances, because I am not in charge of national health care policies. So to me, this kind of posting is reasonably helpful.

    It’s true though that not many people are open to unbiased information about health care, as Robin has pointed out in his other papers. It is a remarkably resistant bias. I find that seeing that graphically illustrated in the comments here has been quite interesting and informative.

  • Caledonian

    The comments here have not been defending the doctors. They’ve been attacking the idea that faith healers would be better.

  • “”Faith healing” should be illegal because it is fraud.”

    So? People feel like it helps; it boosts their utility. Faith healing is proof that ignorance is bliss. And what’s wrong with having blissful idiots? That’s certainly better than depressed idiots. And who’s to say that they won’t blow their money some other way?

  • Thirty Three Things (v. 63)

    1. P.J. O’Rourke on “fairness, idealism and other atrocities”: All politics stink. Even democracy stinks. Imagine if our clothes were selected by the majority of shoppers, which would be teenage girls. I’d be standing here with my bellybutton exposed. …