Bryan Caplan  

Deadly Medicine and Youthful Rebellion

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My colleague Robin Hanson introduced me to contrarian research on both health and the family. The orthodox views, of course, are that medicine is the primary cause for rising life expectancy, and good parenting is the primary cause of happy, successful kids. The contrarian views reply that medicine has little effect on health, and parenting has little long-term effect on kids' intelligence, income, personality, or happiness.

There is surprisingly good evidence in favor of the contrarian views of medicine and parenting, but I'm not quite convinced. Yes, the orthodox views are full of holes. And yes, the statistics for the contrarian views seem pretty solid, with lots of studies estimating effects around zero. But there are two interpretations of these zeros.

One is that there is no effect. The other is that there are both positive and negative effects - maybe large effects - that roughly cancel each other out. And for both medicine and parenting, the latter interpretation makes a lot more sense.

Start with medicine. Modern techniques have clearly saved a lot of lives. If memory serves me, survival rates for premature babies have skyrocketed from 10% to 90%. You probably know someone who is alive today as a result. I thin my twins qualify.

But you probably also know quite a few cases of people who died prematurely as a result of unnecessary medical treatment. Alex Tabarrok writes that:

More people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS and yet physicians still resist and the public does not demand even simple reforms.

My grandpa was probably one of the the mistakes. He got elective surgery on his knee, and never came out of anesthesia.

From this perspective, low estimates of the benefits of medicine cease to be counter-intuitive. You don't have to deny the medical miracles you've witnessed. You only need to remember to average them in with all the disasters.

The same goes for parenting. We all know kids who let their parents plan their lives for them. Maybe it's 100% genetic, but that's a stretch. It's more plausible to acknowledge that these pliable kids exist, but point out that they're only half the story. We also all know kids who heard their parents' plans for their future, and did exactly the opposite just to spite them.

Rebelling against pushy parents is fun! Would I cringe at the sound of televised sports and roll my eyes at antique cars if my dad hadn't been in love with both? I doubt it.

Bottom line: Contrarians often assert that medicine and parenting "don't matter." But that is only one interpretation of their empirical findings. My interpretation is more intuitively plausible, and the data is equally consistent with it.

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TRACKBACKS (9 to date)
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The author at Bayesian Investor Blog in a related article titled Contrary Views on Medicine and Parenting writes:
    Bryan Caplan writes about Robin Hanson's contrarian views on the effectiveness of medicine and parenting. Caplan's conclusion about medicine involving a mix of beneficial and harmful practices is probably correct (and probably consistent with Robin's ... [Tracked on June 2, 2005 6:16 PM]
The author at Exploit the Worker in a related article titled Econometrics Blogging writes:
    Bryan Caplan and Arnold Kling are going back and forth and back and forth on topics related to aggregation and rejecting null hypotheses. Sure, that sounds boring, but these issues have important implications for the conclusions we draw from empirical... [Tracked on June 3, 2005 4:10 AM]
The author at Catallarchy in a related article titled The Money Pit writes:
    There's been an intersting debate over at EconLog between Kling and Caplan over the general efficacy of medical care. An it goes as little something like this... [Tracked on June 20, 2005 8:09 PM]
COMMENTS (5 to date)
Jim Erlandson writes:

Some areas of modern medicine have been successful in saving (or more correctly prolonging) lives.

From 1992 to 2002 death rates from CVD [CardioVascular Disease] declined 18.0 percent.

From 1992 to 2002 the death rate from coronary heart disease declined 26.5 percent.

From The American Heart Association, Cardiovascular Disease Statistics.

The AHA's 2005 Statistical Fact Sheets (PDF) should be required reading for anyone trying to understand the economics of health care. Cardiovascular Disease is well studied, well understood and "accounted for 38.0 percent of all deaths or 1 of every 2.6 deaths in the United States in 2002."

Cardiovascular disease is also instructive because several of the risk factors (overweight and obesity, physical inactivity and smoking) can be controlled at no cost (or negative cost if you quit buying cigarettes).

Glen Raphael writes:

The question before us is: should we be spending more on medical care? If the documented net effect of spending on medical care at the current margin seems to be nil, then the answer to that question is "no". The hypothesis that there are some positives and some negatives that sum to zero rather than every individual treatment being zero isn't a useful contribution unless we have a good way to tell good parts from the bad parts. Which we apparently don't. So it's not clear that you're actually disagreeing with the contrarians in terms of the policy implications.

Second point: shouldn't we expect to see a declining marginal utility for medical spending? Suppose the first third of spending tends to do something very useful, the next third is marginal or zero effect, and the last third is of negative effect, somewhat masked by placebo effects. In that case, we could cut national health spending by 2/3rds and have a hugely healthier nation!

Robin's paper says that medical spending doesn't matter on the margin, and that seems to be true regardless of whether "all health spending doesn't matter", "health spending has various effects, some good and others bad", or "health spending has declining marginal utility."

Bob Knaus writes:

Related to your comment about pliable kids balancing out rebellious kids is the "good enough parenting" concept.

These days it's mostly used to ease parental guilt or to push for goverment policy changes.

But as I understand it, the concept is an example of an 80/20 rule, with the 20 split. That is, 10% are wonderful parents who make a positive difference in their children's lives. Another 10% are terrible parents, who really screw their kids up. Then there are the 80% who are "good enough" parents, who do some good and some bad and whose children turn out more or less according to their potential.

I do think that society's views on what constitutes "good enough" parenting change over time, and (being an optimist) I think overall for the better. For instance, pulling a kid's britches down and beating him with a willow switch would have been "good enough" 100 years ago in America, but not today.

Ian Lewis writes:

Bryan, I am curious: Were their any sports that your father wasnt that interested in (say Hockey, or Golf, or Jai-Lai) that you now may enjoy. I only ask because my older brother loved sports and beat me at all of them except hockey, he wasnt that interested in it, so it was the only non-monopoly that I could compete in.

Paul N writes:

Bryan, think of how devastated you'll be when your twins hate AD&D when they grow up...

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