Arnold Kling  

A Hansonist MD

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Reading List... Caplan, Bryan. 2007. The ...

Nortin Hadler is not your typical MD, as this interview indicates.


I think bypass surgery belongs in the medical archives. There are only two reasons you’d ever want to do it: one, to save lives, the other to improve symptoms. But there’s only one subset of the population that’s been proved to derive a meaningful benefit from the surgery, and that’s people with a critical defect of the left main coronary artery who also have angina. If you take 100 60-year-old men with angina, only 3 of them will have that defect, and there’s no way to know without a coronary arteriogram. So you give that test to 100 people to find 3 solid candidates—but that procedure is not without complications. Chances are you’re going to do harm to at least one in that sample of 100. So you have to say, “I’m going to do this procedure with a 1 percent risk of catastrophe to find the 3 percent I know I can help a little.” That’s a very interesting trade-off.

I read his book, The Last Well Person, and it is every bit as iconoclastic.

GMU's Robin Hanson is known for the belief that medical care is still roughly a 50-50 proposition (the harm balances the help), and Hadler is in his camp. Hadler argues that for many popular protocols (cancer screening, heart surgery, treatment of muscle pain), the most reliable studies show benefits that are either not significantly or not materially significant.


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Robert Speirs writes:

In my medical ignorance, I thought that most people who had bypass operations had had actual heart attacks, not just "angina". Or are the two the same thing? My mother has lived 12 years after a heart attack and bypass surgery. I don't remember her ever complaining of angina. Is she one of the 3 percent?

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