Not sure if there is a thread for this, does anyone have access to this article?

“Comparative Efficiency of Informal (Subjective, Impressionistic) and Formal (Mechanical, Algorithmic) Prediction Procedures: The Clinical Statistical Controvery”, Psychology, Public Policy, and Law 2: 293—323

I'm most interested in this bit:

A good place to get started there is Epistemology and the Psychology of Human Judgment, summarized on LW by badger.

Particularly since your initial claim that had me raising eyebrows was that MetaMed failed because they have great diagnostics, but medicine doesn't want good diagnostics.

Ah, that's a slightly broader claim than the one I wanted to make. MetaMed, especially early on, optimized for diagnostics and very little else, and so ran into problems like "why is the report I paid $5,000 for so poorly typeset?". So it's not that medicine / patients wants bad diagnostics ceteris paribus, but that the tradeoffs they make between the various features of medical care make it clear that healing isn't the primary goal.

The RAND experiment is not equipped to evaluate the overall healthcare effects of medicine, and that was not its main purpose - it was for examining healthcare utilization.

As I understand it, the study measured health outcomes at the beginning and end of the study, as well as utilization during the study. The group with lower copays consumed much more medicine than the group with higher copays, but was no healthier. This suggests that the marginal bit of medicine--i.e. the piece that people don't consume, but would if it were cheaper or do consume but wouldn't if it were more expensive--doesn't have a net impact. (Anything that it would do to help is countered by the risks of interacting with the medical system, say.)

I think I should also make it clear that there's a difference between medicine, the attempt to heal people, and Medicine, the part of our economy devoted to such, just like there's a distinction between science and Science. One could make a similar claim that Science Isn't About Discovery, for example, which would seem strange if one is only thinking about "the attempt to gain knowledge" instead of the actual academia-government-industry-journal-conference system. Most of Robin's work is on medical spending specifically, i.e. medicine as actually practiced instead of how it could be practiced.

Three main sources. (But first the disclaimer About Isn't About You seems relevant--that is, even if medicine is all a sham (which I don't believe), participating in the medical system isn't necessarily a black mark on you personally.)

First is Robin Hanson's summary on the literature on health economics. The medicine tag on Robin's blog has a lot, but a good place to start is probably Cut Medicine in Half and Medicine as Scandal followed by Farm and Pet Medicine and Dog vs. Cat Medicine. To summarize it shortly, it looks like medical spending is driven by demand effects (we care so we spend to show we care) rather than supply effects (medicine is better so we consume more) or efficacy (we don't keep good records of how effective various doctors are). His proposal for how to fund medicine shows what he thinks a more sane system would look like. (As 'cut medicine in half' suggests, he doesn't think the average medical spending has a non-positive effect, but that the marginal medical spending does, to a very deep degree.)

Second is the efficiency literature on medicine. This is statisticians and efficiency experts and so on trying to apply standard industrial techniques to medicine and getting pushback that looks ludicrous to me. For example, human diagnosticians perform at the level or worse than simple algorithms (I'm talking linear regressions, here, not even neural networks or decision trees or so on), and this has been known in the efficiency literature for well over fifty years. Only in rare cases does this actually get implemented in practice (for example, a flowchart for dealing with heart attacks in emergency rooms was popularized a few years back and seems to have had widespread acceptance). It's kind of horrifying to realize that our society is smarter about, say, streamlining the production of cars than we are streamlining the production of health, especially given the truly horrifying scale of medical errors. Stories like Semmelweis and the difficulty getting doctors to wash their hands between patients further expand this view.

Third is from 'the other side'; my father was a pastor and thus spent quite some time with dying people and their families. His experience, which is echoed by Yvain in Who By Very Slow Decay and seems to be the common opinion among end-of-life professionals in general, is that the person receiving end-of-life care generally doesn't want it and would rather die in peace, and the people around them insist that they get it (mostly so that they don't seem heartless). As Yvain puts it:

Robin Hanson sometimes writes about how health care is a form of signaling, trying to spend money to show you care about someone else. I think he’s wrong in the general case – most people pay their own health insurance – but I think he’s spot on in the case of families caring for their elderly relatives. The hospital lawyer mentioned during orientation that it never fails that the family members who live in the area and have spent lots of time with their mother/father/grandparent over the past few years are willing to let them go, but someone from 2000 miles away flies in at the last second and makes ostentatious demands that EVERYTHING POSSIBLE must be done for the patient.

Once you really grok that a huge amount of medical spending is useless torture, and if you are familiar with what it looks like to design a system to achieve an end, it becomes impossible to see the point of our medical system as healing people.

[edit]And look at today's Hanson post!

You seem to assume that the management consulting companies are paid for making the correct decision based on the data... as opposed to giving the answer someone important in the management (the person who made the decision to hire them) wanted to hear, while providing this person plausible deniability ("it wasn't my idea; it's what the world-renown experts told us to do; are you going to doubt them?").

Depending on which view is correct, there may or may not be a market demand for your solution.

I know about scoring rules and probability assessments. Email me and we'll set up a time to talk.

Similar to Viliam in a sibling comment, I think that this is the sort of idea that would work in the ideal world but not the real world. To channel Hanson, "Consulting is not about advice," and thus a product that seeks to disrupt consulting by providing superior advice will simply fail. (Compare to MetaMed, which tried to disrupt medicine by providing superior diagnostics. Medicine is not about healing!)

Did he ever retract his youthful indiscretions?

I'm 85% sure that you're VoiceOfRa.

LukeProg considers philosophy a diseased discipline

Four years ago! Probably a good idea mention that or check if he still thinks this.

Just say you are a dictator and ban at a whim

There is a slight problem in that LW is not Nancy's personal blog to be shaped by her whims.

Ask for help when you need it. If you're struggling with a class, ask the professor or your advisor where you can find help. If you're struggling with life, find a counsellor. If you're struggling with a paper, find a writing tutor.

Take introductory Calculus, Chemistry and Physics in your first year*. At least at my school it was somewhat difficult to complete a science major in three years, so best to start off as though you are going to do one (unless you really don't want to).

Find a way to contact and talk to people who are where you want to be in the future. That might mean law students, engineers, med students, people working in finance.

*Unless you are doing Engineering in which case your schedule is mostly decided for you.