Monday, February 13, 2017

Complexity, risk and uncertainty

We unexpectedly lost a close family member over the weekend, who was in the ER and then had such a massive internal hemorrhage that they couldn’t save him. The ER doctor said it wouldn’t have been as severe — and implied that he might not have died — if he hadn't been on warfarin.

All weekend I have been thinking that while the risk of bleeding is a well known side effect — one he and his doctor willingly accepted — if only he hadn’t taken this medication we would still have him with us.

But then this morning I realized I had it all wrong. As an economist, I should know better — this is just another version of Bastiat’s broken window fallacy. We can see the death by internal bleeding at age 86; we can’t see the heart attack or (worse yet) disabling stroke that might have been prevented at 80 or 84.

This highlights the hubris of mankind’s attempts to understand the most complex organisms in creation – ourselves. Yes researchers try and should continue to try to do better, to extend life and continue to reduce the mortality and morbidity of major illnesses. But nonprofits using marketing slogans like “abolish cancer” are dishonest at best and fraudulent at worst, following in the footsteps of the politician who 45 years ago promised to win a “war on cancer” to distract from his losing a war overseas.

The reality is that we are generations if not centuries away from really understanding how it all works and how to prevent or repair many common fatal or disabling diseases. The doctors on the front lines— like 18-year veteran I met in the ER Saturday night — are painfully aware as to the limitations of what we know. In the meantime, there are trade-offs and risks in life — in clinical trials, with new drugs, with old drugs — and all we can do is improve the odds rather than hope to know what is “best” in any given situation.