Category Archives: 1

Wordpress now offers me free images of whatever I'm talking about. This is presumably an illustration of how the world doesn't necessarily become a better place if you tell everyone they urgently need to seek medical help for something you won't tell them anything more about. Image by uncultured via Flickr

I had a couple of bad looking medical test results in a row, so I was sent to a specialist, with advice along the lines of ‘well, we can’t say it’s not cancer… probably get checked out as soon as possible’. When I eventually got to the specialist he immediately told me a bunch of relevant conditional probabilities: of any problem at all given such test results, of it being a bad problem given it’s some kind of problem, the probability per year of cancer given each kind of problem. These were not scary numbers at all. Given that it can take months to extract your data from one doctor and get an appointment with a specialist, it would have been very nice to have been told these numbers by the original doctor, instead of just knowing for a few months that such results are some unknown degree of evidence in favor of cancer. Is this just an oversight by a particular useless doctor?

It seems not. I’ve noticed another two examples of the same problem in medicine recently. If you look up symptoms online, you will often be told to seek emergency medical assistance immediately. It often doesn’t even tell you what the potential problem is, and certainly not what the odds are of it occurring, so it’s pretty hard to evaluate the suggestion. If you actually go to a doctor about one of these symptoms, the doctor often tells you not to worry about it without more than knowledge of your age.  Often the website also knows your age, or at least asked it, and it would be simple for them to mention that said symptom is only a concern if you are over fifty, or even just the basic information about how common such a thing is given that symptom. Similarly my region has a free health phone line where you can ask a nurse whether symptoms are worth bothering to go to a doctor about. That seems like a decent idea, since apparently people overestimate when its worth going to the doctor. However in my small amount of experimentation it seems that anything I say prompts the suggestion that I see a doctor ‘within four hours’. I mean, I have tried telling them my bottom hurts at 2am and they tell me to get to a doctor within four hours.  I would be very surprised if an emergency room  was willing to treat sore bottoms in the middle of the night, so why not just tell the caller that at the start? Sending someone to a doctor can’t possibly help if the doctor is guaranteed to send them home.

In all these cases medical advice errs so much in the direction of caution that the doctor finally responsible for treating you will often hardly have to look at you before sending you home. The advice givers also refuse to offer relevant information such as conditional probabilities, so you can’t judge for yourself how far you want to cycle in freezing night to avoid a one in a million chance of arthritis or whatever. The costs of these behaviors in the short term are needless anxiety for patients, and doctors’ visits that informed patients would not want. In the long term patients will learn to distrust such advice givers and will miss out on useful advice when they really should go to an emergency room, while probably still harboring a slight fear that they have done wrong and will prematurely die for their sins. Is this medical advice format as common as it seems to me? Why is it done? I can understand an uninformed relative who is super-concerned about your wellbeing and believes you to be biased telling you you must seek medical advice for everything and refusing you any information. Or a doctor being in favor of it. But why do these presumably informed third parties and other doctors do it?

Added 1 Sept 10: I’m fine, sorry I wasn’t clear enough about that.

I wonder if part of the reason for persistent disagreement on political positions is that people mean quite different things by ‘We’ in sentences like ‘We should do x’. Here are three:

We = ‘the government’

As in, ‘we should control markets to avoid the dangers of their extremes’, ‘we should have discretion in the treatment of prisoners to allow for the complexities of the situation’,  ‘we should ban smoking even though people want to smoke, because they won’t when they stop being addicted’,  and ‘we should censor especially harmful writing’.

This is interesting because if ‘we’ should do these things, naturally ‘we’ should be given the power to do them. However in practice since you aren’t actually in the government, what you think ‘we’ should do is not very relevant once you have allowed such power. This is especially the case with issues where you can’t easily check that ‘we’ are doing what ‘we’ should, or do anything about it.  For instance issues which prohibit your knowing what’s going on (e.g. censorship), or where good and bad actions would be hard to tell apart from the outside (for instance well justified paternalism and interest-driven paternalism), issues which involve no simple standards to check behavior against (where much discretion is allowed it is hard to claim particular decisions were wrong, or to show this to others), and issues where you are expected to disagree (for instance paternalistic laws). By calling the government ‘we’ it’s easy to forget the difference in effort required to do something and to check a large powerful organization elsewhere is doing something.

We = ‘everyone’

As in, ‘if we just cut our meat consumption in half we would cut carbon emissions by –%’

This one is interesting for similar reasons to the above; it makes it extremely easy to overlook the fact that you don’t make decisions for everyone else, and don’t know what they are doing mostly. ‘Just cutting our meat consumption in half’ requires somehow persuading perhaps billions of others to reduce their meat consumption, despite their other priorities, disagreement with the claim, lack of sympathy to the cause, inability to hear you or know that you are suggesting such a thing even if you can afford a very expensive advertising campaign, lack of reason to trust you, lack of evidence that others will take part, and ability to just free ride if most people were to do what you say.  Despite these problems, when I was a teenager it took me a while to work out why ‘we’ don’t ‘just’ make electric cars powered by solar energy instead of petrol driven ones if we know carbon emissions are such a problem.

We = ‘you and I’

As in, ‘we shouldn’t have to pay for a corrupt bureaucracy to oppress us in the name of the majority’s interests’

This seems the least delusional meaning of ‘we’, but the others must exist for a reason. I suspect that if everyone thinks of themselves as part of ‘we’ and talks and acts as if their decisions are the ones everyone will make, they do avoid some of the coordination problems that their word usage overlooks. For instance if a bunch of people avoid polluting their local river because ‘if we just keep it clean will be much nicer’, they do actually get what they want, at least until someone has enough at stake to think about it more.

I think these meanings of ‘we’ are more popular amongst those with different political leanings.  In general, whoever ‘we’ are to you, you will tend to ignore the coordination problems within that group, or between that group and the real you. This helps policies that sound good to one group sound absurd to another.

Robin asks an interesting question:

Bryan Caplan recently pointed out to a few of us that while many dating web sites offer to help you find matching romantic mates, there are far fewer friend finding helpers.  We tend to collect friends informally, by liking the people we meet for other reasons, and especially friends of friends. But for mating purposes we are more willing to choose folks based on a list of their interests, an intro paragraph, a picture, etc.  Why the difference?

His theory:

We need mates more for their simple surface features, while we need friends more to serve as social allies in our existing social network.  Since we need friends in substantial part to serve as allies in our social world, supporting us against opposing coalitions, it makes sense to draw our friends from our existing social world.  And since we need mates more for their personal quality, e.g., good genes, youth, wealth, smarts, mood, etc., it makes sense to pick them more via such features.

I have a different theory, though I’m not especially confident in it. First notice that people are actually often eager to make friends with people outside their social circle. They don’t want to make friends on the subway, but they join groups, play sports, couchsurf, partake in a huge range of social online activities, and go to conferences often with the intention of making new friends, who would be outside their existing social circle. A difference between any of these activities and online dating is that with the latter you have to be explicit about the fact that you are trying each other out when you go on a date. It is obvious when one of you decides against the other, and the relationship is usually sharply ended. With meeting friends casually this is not so; you can talk to people and assess them a lot before anybody even knows you are considering being friends with them. Even once you have done some friendly thing with a person, if you don’t see them for months its not clear whether you hated them or have just been busy. Friend meeting activities are best then with a group of people and a supposed other purpose to the interaction.

I think this latter style is necessary for friends but not for romance because you can have many friends and only one partner, which makes turning someone down as a friend much ruder. Turning down someone as a partner says ‘I don’t think you are the best mate I can find given a few decades’ whereas turning down someone as a friend says ‘you are worse than zero’. It’s hard enough to explicitly tell someone the first thing, the second is near impossible. And if the recipient doesn’t listen to the first, you can get angry, have them arrested, get your new partner to threaten them, or whatever. Would be friends can safely hang around for years not getting hints.

So if you were to advertise for friends you would probably be stuck with most of those you tried out, at least for a little while until you managed to gradually happen to not see each other, and there is some risk of the relationship remaining for a long time. These risks make online-dating style friend seeking just too costly.