Robin links to an article about apparent manipulation of the medical process by drug manufacturers, dealing particularly with the drug Fosamax which is supposed to improve bone strength. The article raises the possibility that many modern diseases don’t exist at all but are the creation of the pharmaceutical industry to give them tools to sell more drugs.
I think this is an important general question - how do smart laypeople interpret controversial data in an unbiased fashion? I have this issue with medical/diet/exercise questions all the time. For those questions which will be resolved in the future, I think prediction markets is a good answer. But that doesn't really apply to people trying to solve the problem today.
'The panel's first step was to define "normal" bone density as that of the average 30-year-old woman. Next, the experts chose as their cutoff for osteoporosis a statistical point that was slightly below the bone density of their normal 30-year-old -- a definition they admitted was "somewhat arbitrary." Finally, they came up with a completely new disease -- osteopenia -- for bone density that fell somewhere between that normal 30-year-old and their arbitrary definition of osteoporosis.'
The Wikipedia article on osteopenia discusses the controversy about the definition of osteopenia:
'An osteoporosis epidemiologist at the Mayo Clinic who participated in setting the criteria in 1992 said "It was just meant to indicate the emergence of a problem," and noted that "It didn't have any particular diagnostic or therapeutic significance. It was just meant to show a huge group who looked like they might be at risk."'
'The definition has been controversial. Dr. Steven R. Cummings, of the University of California at San Francisco, said in 2003 that "There is no basis, no biological, social, economic or treatment basis, no basis whatsoever, for using minus one." Cummings also said that "As a consequence, though, more than half of the population is told arbitrarily that they have a condition they need to worry about."'
I think there are two distinct concepts being mixed here. Robin seems to be asserting that osteoporosis is an imaginary disease because the cutoff level for diagnosis seems arbitrary and because bone loss appears not to be a result of something like an infectious agent but is a natural result of the aging process. But so what? If loss of bone density leads to an increased chance of bone breakage and hence a decrease in the quality of life, why not try to reverse it? Aren't we pretty much all agreed here that medications that make people healthier than normal would be a good thing?
Now if the manufacturers of Fosomax have been engaging in shenanigans to overstate its benefits and understate its risks, that's clearly bad, but it's a separate question from the "fakeness" of the disease it purports to treat
Grant, another advantage of your system would be that computers could be programmed to look for specific combinations of symptoms and make diagnoses/place bets on specific diseases automatically. This would be cheap, near-instantaneous, the information the computers used to make their decisions could be updated as new studies came out and it would free up real doctors to deal with the more subtle and difficult cases.
One of my standard resources for questions of this type is Wikipedia. The "discussion" tab on Wikipedia is very useful for getting insight into the debate and controversy behind a Wikipedia entry. So I went to Wikipedia and typed in "fosamax". There is indeed a Wikipedia entry on fosamax, but it does not discuss the apparent manipulation of the medical process by drug manufacturers. Even the "discussion" tab does not mention any controversy. I'm tempted to add a section to the "fosamax" Wikipedia entry about this issue, to see what reaction it gets.
In my ideal libertopia fantasy land, doctors (and by doctors I mean highly-trained specialists) don't physically see the patient unless they need to. Technicians who specialize in bedside manner and diagnosis interact with the patient and post pertinent information on a sort of online market. Doctors (or really anyone the market allows; the term 'doctor' would have a looser meaning) can then question both the patient and technician, and place bets on both possible diagnosis and cures (which could include placebos). The technician would then present the patient with his options, their costs, and odds of success. Collusion between the technicians and doctors would be possible, but if the prediction market's contracts were decided by patient feedback, I think the incentives for significant corruption would be small.
Who do we have to lobby to make prediction markets completely legal? How else can groups of people estimate the truth? Unless you can use prices to aggregate medical knowledge, I think the information asymmetries are always going to be a big problem.
There are also interesting meta-questions: why don't more people perceive they have a big problem here, and why isn't there more interest in trying to solve it? If they think about the problem at all, most people seem to think it sufficient to just believe their doctor because he is licensed by the government.
I think this is an important general question - how do smart laypeople interpret controversial data in an unbiased fashion? I have this issue with medical/diet/exercise questions all the time. For those questions which will be resolved in the future, I think prediction markets is a good answer. But that doesn't really apply to people trying to solve the problem today.
The Washington Post link above says:
'The panel's first step was to define "normal" bone density as that of the average 30-year-old woman. Next, the experts chose as their cutoff for osteoporosis a statistical point that was slightly below the bone density of their normal 30-year-old -- a definition they admitted was "somewhat arbitrary." Finally, they came up with a completely new disease -- osteopenia -- for bone density that fell somewhere between that normal 30-year-old and their arbitrary definition of osteoporosis.'
The Wikipedia article on osteopenia discusses the controversy about the definition of osteopenia:
'An osteoporosis epidemiologist at the Mayo Clinic who participated in setting the criteria in 1992 said "It was just meant to indicate the emergence of a problem," and noted that "It didn't have any particular diagnostic or therapeutic significance. It was just meant to show a huge group who looked like they might be at risk."'
'The definition has been controversial. Dr. Steven R. Cummings, of the University of California at San Francisco, said in 2003 that "There is no basis, no biological, social, economic or treatment basis, no basis whatsoever, for using minus one." Cummings also said that "As a consequence, though, more than half of the population is told arbitrarily that they have a condition they need to worry about."'
I think there are two distinct concepts being mixed here. Robin seems to be asserting that osteoporosis is an imaginary disease because the cutoff level for diagnosis seems arbitrary and because bone loss appears not to be a result of something like an infectious agent but is a natural result of the aging process. But so what? If loss of bone density leads to an increased chance of bone breakage and hence a decrease in the quality of life, why not try to reverse it? Aren't we pretty much all agreed here that medications that make people healthier than normal would be a good thing?
Now if the manufacturers of Fosomax have been engaging in shenanigans to overstate its benefits and understate its risks, that's clearly bad, but it's a separate question from the "fakeness" of the disease it purports to treat
Grant, another advantage of your system would be that computers could be programmed to look for specific combinations of symptoms and make diagnoses/place bets on specific diseases automatically. This would be cheap, near-instantaneous, the information the computers used to make their decisions could be updated as new studies came out and it would free up real doctors to deal with the more subtle and difficult cases.
One of my standard resources for questions of this type is Wikipedia. The "discussion" tab on Wikipedia is very useful for getting insight into the debate and controversy behind a Wikipedia entry. So I went to Wikipedia and typed in "fosamax". There is indeed a Wikipedia entry on fosamax, but it does not discuss the apparent manipulation of the medical process by drug manufacturers. Even the "discussion" tab does not mention any controversy. I'm tempted to add a section to the "fosamax" Wikipedia entry about this issue, to see what reaction it gets.
In my ideal libertopia fantasy land, doctors (and by doctors I mean highly-trained specialists) don't physically see the patient unless they need to. Technicians who specialize in bedside manner and diagnosis interact with the patient and post pertinent information on a sort of online market. Doctors (or really anyone the market allows; the term 'doctor' would have a looser meaning) can then question both the patient and technician, and place bets on both possible diagnosis and cures (which could include placebos). The technician would then present the patient with his options, their costs, and odds of success. Collusion between the technicians and doctors would be possible, but if the prediction market's contracts were decided by patient feedback, I think the incentives for significant corruption would be small.
Who do we have to lobby to make prediction markets completely legal? How else can groups of people estimate the truth? Unless you can use prices to aggregate medical knowledge, I think the information asymmetries are always going to be a big problem.
IMO, YMMV.
There are also interesting meta-questions: why don't more people perceive they have a big problem here, and why isn't there more interest in trying to solve it? If they think about the problem at all, most people seem to think it sufficient to just believe their doctor because he is licensed by the government.