Monthly Archives: June 2011

Subtext Beats Text

By Robin Hanson · June 2, 2011 11:25 pm · Comments (23)

We typically pay more attention to subtext than to text. For example, when we hear someone answer a question, we usually won’t notice if they actually answer a somewhat different question than the one that was asked. Oh we can tell the difference, if we pay attention, but we are usually too busy considering social subtext:

What happens when speakers try to “dodge” a question they would rather not answer by answering a different question? In 4 studies, we show that listeners can fail to detect dodges when speakers answer similar—but objectively incorrect—questions (the “artful dodge”), a detection failure that goes hand-in-hand with a failure to rate dodgers more negatively. We propose that dodges go undetected because listeners’ attention is not usually directed toward a goal of dodge detection (i.e., Is this person answering the question?) but rather toward a goal of social evaluation (i.e., Do I like this person?). Listeners were not blind to all dodge attempts, however. Dodge detection increased when listeners’ attention was diverted from social goals [or if listeners were given no goal] toward determining the relevance of the speaker’s answers, when speakers answered a question egregiously dissimilar to the one asked, and when listeners’ attention. … When listeners were guided to detect dodges, they rated speakers more negatively, and listeners rated speakers who answered a similar question in a fluent manner more positively than speakers who answered the actual question but disfluently. (more)

This raises the question: why is modest question-evasion so often tolerated in TV and radio interviews? Three possibilities:

  1. Interviewers are usually too stupid to notice modest evasions.
  2. Interviewees would refuse to appear on shows that highlighted evasions.
  3. Viewers would avoid shows where interviewee evasions were highlighted.

I lean toward #3 — viewers may watch such shows to affiliate with high status interviewees, but such affiliations seem weaker if interviewee evasions are challenged. Reporters seem plenty smart and attentive enough to notice the evasions, and interviewees seem eager enough to be interviewed. Viewers are the picky party.

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Let Brits Do US Med Eval

By Robin Hanson · June 1, 2011 9:00 pm · Comments (24)

Here is my entire 300 word NYT oped:

Medicare should stop paying for treatments that the British Medical Journal says probably don’t work.

Today, United States agencies that try to not pay for ineffective treatments face the wrath of Congress, egged on by the surgeons and drug companies whose revenue is threatened. So far, U.S. agencies have pretty much always backed down, and just paid for everything.

The United Kingdom, where, on average, people live longer than in the U.S., spends only about 9 percent of gross domestic product on medicine, compared with our 18 percent. The British control costs in part by having the will to empower a hard-nosed agency, the National Institute for Health and Clinical Experience (N.I.C.E.), to study treatments and declare some ineffective. Some hope the United States will create a similar agency, but I fear it would be hopelessly politicized and declawed.

My solution: admit we are cost-control wimps, and outsource our treatment evaluation to the U.K. Pass a simple law saying Medicare (and Medicaid) won’t cover treatments considered but not positively appraised by the Britain’s national health institute.

Even better, use clinical evidence evaluations of the British Medical Journal. They’ve classified more than 3,000 treatments as either unknown effectiveness (51 percent), beneficial (11 percent), likely to be beneficial (23 percent), trade-off between benefits and harms (7 percent), unlikely to be beneficial (5 percent) and likely to be ineffective or harmful (3 percent). Let’s at least stop paying for these last two categories of treatments! And to put pressure on doctors to collect evidence, let’s stop paying for “unknown effectiveness” treatments after 10 years of use.

Yes, eventually, this evaluation source would become corrupted, as were the asset risk rating agencies that contributed to the recent financial meltdown. But we’d at least have a few more years to come up with a better solution.

Interestingly, two of the nine other opeds on “What Medicare Services to Cut, Now“ wanted more hospice care.

Added 4June: Will Wilkinson:

This reminds me of another proposal, similar in spirit, to de-nationalise the drug-approval process … [by] Daniel Klein …:

One idea is to recognize the drug approvals of, say, 15 other governments. That is, we reform the U.S. system so that if the drug-approval agency of even one of those 15 countries approves a drug for that country, then the drug is automatically approved in the United States.

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Open Thread

By Robin Hanson · June 1, 2011 6:00 am · Comments (29)

This is our monthly place to discuss related topics that have not appeared in recent posts.

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