Comment by acqq | Hacker News Reader

Comment by acqq | Hacker News Reader

My impression is that the article is based on the false premises: it starts with the number 5.25 years

"According to Bunker, the average person gains about 5.25 years due to medicine"

and then calculates "year of life the doctor saved" based on that. That's wrong.

The counterexample: the kid breaks the leg. The leg will "heal" even without the operation, but the form will be altered: the kid will never be able to walk normally, do the sport normally, anything you imagine (a). A few operations are performed on the kid's leg, afterwards he walks normally, lives the rest of his life normally (b). Now if the person having the problems in (a) lives the same number of years as the fully healthy (b) the statistics the whole article calculation is based don't show any contribution of the given operations, whereas these operations really did "save life" in the sense of giving somebody a healthy life that he otherwise wouldn't have.

There are immense number of equivalent examples and all are ignored in the article. Much more lives are effectively "saved" by the modern medicine than the author can see. We can also consider the lives of the family of the patient also effectively "destroyed" without the medicine.

(In short, the article appeared as (stereotypically said, more as the strong figure of speech not actually addressed at the specific author) written by 20-something male who hasn't first-hand experienced medical problems even in his family. I wasn't able to find more about "Gregory Lewis" who wrote it, but the whole "80,000 Hours" project site, on which this 2012 article was published was the result of the 2011 initiative of two Oxford students, and maybe that gives some idea about the setting.)

Doesn't the author also add in the average additional years lived without disability (5 years, according to his source, which is adjusted to 2.5 years in terms of lifespan)?

Sure, we all live a lot better lived with access to medicine, but the larger part of the improvement comes from improved access to nutrition and sanitation.

Besides, even if you disagree with the methodology (which they already admit is a back of the envelope calculation that is likely to be only accurate to an order of magnitude, I don't think the idea in itself, to identify the best way an individual can contribute to humanity as a whole is a bad idea.

Trying to estimate the impact one can make is OK thing to do, but I comment here just the article and how I see it. So I've now moved to the part 3 of the article, let's see the conclusion:

"I think my 17-year-old self would find that pretty galling. He’d signed up to medicine to save loads of lives, and he’d find it a bit of a downer to see this his entire medical career would likely do as much good as a £10 000 donation to the right charity. But that would be the wrong way of looking at things: instead, he should see that saving 17 lives is a vast amount of good, and being able to do 30 times more good on top of that is awesome."

Well... sounds a bit better. But the whole series still looks more like an excuse for somebody to forgo his medical career (also from the Part 3):

"If I become willing to work as a doctor, then I increase the supply of doctors. If more people are willing to be doctors, then the NHS can slightly decrease the wages for doctors (1). If the wages are slightly lower, the budget can be used to hire slightly more doctors.

How this all balances out is studied by economists. If the labour market for doctors is in equilibrium, then increasing the supply of doctors by one doctor, will probably increase the number of doctors by about 0.6 (2)."

I'd like to know if the article author really grew up to be a doctor or if he's now some activist in some charity instead.

Take a look at what the site suggests as the "right careers" for impact after I've filled the "career guide":

1) Management consulting (for skill-building & earning to give)

2) Foundation grantmaker

3) Think tank research

4) Economics PhD

Well if the guys who end up on this position only know to count megadeaths and QALYs before, I really doubt they will even understand what they decide about. But they'll surely have some impact, if it's a good impact it's fully another question.

> I'd like to know if the article author really grew up to be a doctor or if he's now some activist in some charity instead.

He's a practicing doctor at Churchill Hospital in Oxford.

http://www.thepolemicalmedic.com/

To the best of my knowledge, he continues to support 80,000 Hours.

It seems to me that he now more advocates

https://www.givingwhatwecan.org/

http://www.thepolemicalmedic.com/saving-the-world-and-healin...

and that he has spent short time with 80,000 Hours. It seems he was really still a student as he wrote there. I hope he'll blog more about his experiences as he grows up.

Giving What We Can and 80k Hours are very closely connected organizations with different missions. They shared office space at Oxford University.

Another article lists the author, Gregory Lewis, as a practicing MD in the UK. So he didn't forgo his medical career. Probably he was already well into it by the time he went through these numbers. https://80000hours.org/2015/07/if-you-want-to-save-lives-sho...

As for impact, the entire site is about advising people on how to have the greatest impact, which they calculate using economic arguments. That's how they come up with those careers which they think will contribute the most.

What are your concerns about they way they're doing it?

Article: "Medical care can be credited with 5 to 5.5 years of the increase in life expectancy since 1900"

You: "[The article] starts with the number 5.25 years...and then calculates "year of life the doctor saved" based on that. That's wrong....The counterexample: the kid breaks the leg....There are immense number of equivalent examples and all are ignored in the article.

Are you claiming that the article only accounts for deaths averted and fails to account for improved health and well being? Because the article addresses disability-adjusted life years literally 2 sentences later.

> Medicine also improves wellbeing: the average person has five more years free of disability.

(Incidentally, deaths averted are comparable in total value to injuries averted, so the article would still fulfill it's claim of getting an order-of-magnitude estimate even if it had ignored the later.)

I would focus less on ad hominems about the author's youth.

> Because the article addresses disability-adjusted life years literally 2 sentences later.

Yes, and I claim the article still misses the point. The doctor helping the patient really "saves" the patient life and the life of people in his family every time he/she helps. That's not measurable with QALYs the way it's done in the article, and to understand that, one has to live through the critical periods in his own life or the life of those closest to him, therefore the reference to the view by somebody young. Disclaimer: I've had exactly the same tunnel vision as I was younger, and I'm male, so I write based on my own experience.

The averages he calculates are for "what contributes the doctor on average." And the averages are even true: there are enough of doctors that work more for their own benefit that for the benefit of fellow humans. The best example is the UK doctor that started the anti-vaccine craze. He had a lot of impact, and even if he was eventually expelled for having interest in spreading the craze, a lot of people still follow what he started.

But if somebody really wants to make a huge positive difference by being a doctor, he really can. Who says that he must work at the hospital in Oxford? How about spending only a few months in some mission in Africa?

http://www.msf.org/about-msf

Also, what number of QALYs can be calculated for an average worker of other professions, including those recommended by the 80000 hours site?

All your points are low quality.

Instead of all, please concentrate on only two:

- What number of QALYs can be calculated for an average worker of other professions, especially those recommended by the 80000 hours site (e.g. QALYs saved by an average "Think tank researcher")?

- Is it even possible to calculate average QALYs in a way to really compare anything meaningful, across the different occupations? If not, why are they here calculated for "average" doctors?

> What number of QALYs can be calculated for an average worker of other professions, especially those recommended by the 80000 hours site (e.g. QALYs saved by an average "Think tank researcher")?

When you say "average", do you mean a marginal worker of average quality, or the literally the total impact of the profession divided over its total practitioners? The definition really isn't relevant for s careers because we expect diminishing returns, and individuals can only act on the margins. (On the other hand, the government might be interested in it if they had the ability to expand the size of the entire industry.)

I don't know what the estimates are, but I would wager heavily that there are identifiable think-tank research positions with much higher leverage, even on the margins, than the highest-impact medical professions. It's just a matter of multipliers: think tanks influenc large amounts of money while doctors generally can't help beyond their own patients.

> - Is it even possible to calculate average QALYs in a way to really compare anything meaningful, across the different occupations? If not, why are they here calculated for doctors?

Yes, I think an estimate is possible, although there may be large uncertainties. 80k Hours has previously estimated the value (and chance) of things like becoming a member of parliament, or working in finance and donating most of one's salary to health charities in the developing world. Even when these are off by an order of magnitude, they often are sufficiently informative to usefully change people's plans.

80k Hours claims that over 180 people have made serious career changes that those people explicitly attribute to the organization's research.

> The doctor helping the patient really "saves" the patient life and the life of people in his family every time he/she helps. That's not measurable with QALYs the way it's done in the article,

No, this is literally what QALY are for - measuring the impact of an improvement at someones life.

Right. For readers not familiar with this topic, QALYs are to be contrasted with disability-adjusted life-years (DALYs), which are less holistic (but also less subjective).

No, QALY was actually not designed to be used the way the article is using it

https://en.wikipedia.org/wiki/Quality-adjusted_life_year

"It is used in assessing the value for money of a medical intervention"

not to compare the doctors "impact" to other occupations "impact" which is the implicit goal of the article and the explicit of the site:

https://80000hours.org/2015/07/if-you-want-to-save-lives-sho...

"If you want to save lives, should you study medicine? Probably not."

And why would it be good for comparing money efficiency and not life choice efficiency?

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