Hacker News Reader

Comment by drcode | Hacker News Reader

A problem with bureaucracies is that they often care deeply if people die from an action they are responsible for, but are fine if there are massive deaths due to inaction.

View on HN

It's interesting because I feel the opposite as an acute care doctor in the US. If I give a medication, or get a scan, or whatever, and the patient has an adverse reaction, it's the medication/scan's fault. If I don't give the medication, don't get the scan, and something bad happens, it's my fault. At least that's how people see it for now. Leads to a lot of over-treatment and extra unnecessary testing in my opinion, especially around COVID (for example, I frequently see high-dose dexamethasone given for longer than 10 days or given to normoxic patients, despite the recommendation being for 6 mg daily for 10 days, and only for patients requiring oxygen).

Exactly. You care if people die on your lawn. So you give out medication, do scans, etc. so that if people die they do it on someone else's lawn. It's ass-covering all the way down.

> You care if people die on your lawn.

I don't know how you know that. Given the significant time and effort required to become a doctor, isn't it at least as likely that they are motivated about people not dying on any lawn?

A doctor is a job like any other job to be honest. Most people are in it to make a better life for themselves not to think about other people.

What you say makes complete sense, I'd argue the incentives are different for government agencies, however.

I thought that methylprednisolone was now preferred over dexamethasone for COVID-19 treatment.

https://covid19criticalcare.com/medical-evidence/methylpredn...

>If I give a medication, or get a scan, or whatever, and the patient has an adverse reaction, it's the medication/scan's fault.

What about the Hippocratic oath? First do no harm.

I mean, it doesn't actually say that, it says "I will do no harm" and "I will abstain from all intentional wrongdoing". That doesn't mean that doing nothing is fine, because you didn't do harm.

So a more accurate description is: politicians care deeply if people die from an action (or inaction) that went against the public opinion.

To take this further, public opinion cares much more about action than inaction.

A handful of unjust police killings cause widespread protest / riot / unrest, but 15,000 unprevented homicides are largely accepted as part of life.

You can argue that they are morally equivalent, but our brains get more angry at someone doing a bad thing than at someone not doing a good thing.

Or 42 000 people dead in traffic accidents (in the US year 2020), most of this preventable, eg by middle of the road separation barriers or separate bike lanes.

Most of the public doesn't care or understand, neither do the politicians. Not interesting to fix because no one intentionally did anything bad? And, spending time on this won't win any elections?

Feels similar to government IT risk aversion that I've seen. Folks are afraid to approve a new piece of software, or a new version, or a hotfix or whatever, because what if it goes awry and causes problems? But little weight seems to be put on "what if we keep running the same version we've been running for years and now that there's a known vulnerability, someone exploits it?".

"Better the devil you know" etc etc

It's not just bureaucracies. People in general prefer bad outcomes due to inaction to bad outcomes due to action. See: trolley problem.

Exhibit A, the FDA when it comes to new drug approvals.

Because you can very easily destroy public trust medicines if you approve something unsafe, even if in grand scheme of things, it was better for humans. Just look at antivaccination movement, and imagine how many more people would be there if their claims were actually supported by data.

Humans aren’t rational.

Practically the last half year of Germany's corona policy is influenced by the anti vaccination movement. It's really annoying, on the other hand I think the anti vaxxers seemed to have stopped all major public appearances. So at least one positive thing.

The solution is simple though: politicians simply ask experts how many people die if they do X versus Y, and make sure it is recorded (e.g. by journalists) so they can refer to it later.

Even assuming this utilitarian viewpoint is the correct one, you're putting a lot of faith in the general population to trust the experts / journalists and to be un-emotional when examining the facts.

Now as a politician, you just need to find the right expert that will recommend you whatever you want to do.

Of course you ask a reputable one, e.g. head of CDC etc. otherwise prepare to get in trouble with journalists.

> of course you ask a reputable one

What if that turns out to be more difficult than you originally realized.

You can just forget about it all and don't tell anyone you ever asked him/her.

Why would any politician/regulator/expert willingly opt-in to accountability?

The best strategy (however cynical) is to not be quantitatively explicit about expectations so that you can frame it as though you succeeded no matter what happens.

Almost as if people are doing their jobs then?

I don’t think that beurocrats are supposed to be leaders. The elected officials should be pushing for the change, not the people who run the operations.

The cliché of the EU is that it's bureaucrats all the way up, though.

Of course this is an exaggeration, but there is a somewhat disturbing neglect of EU elections, functions and political appointments in the public view (it's seen as less prestigious than national/federal elections in many EU member states).

As a result, it's a climate that doesn't always attract and get the leadership it really needs (given that the EU formally and practically overrules legislation and jurisdiction of member states).

I’m not sure if it’s bureaucracy or human nature, as government procedures had been responsive to the pandemic, and pressure to urge inactions have been overriding the pre-pandemic determined actions.

Pretty much all the responses of the government that were done quickly were to prevent action (i.e. no going to restaurants, no flights to certain areas, etc) so I'd argue that that also represents "inaction", just in a roundabout way.

Right. They were playing it safe, as opposed to having to defend themselves some day in the future for not playing it safe.

This would explain why the Swedish state were so heavily criticised for not locking down. Also would explain the UK government arresting people for being outdoors (there's not really any data supporting outdoor transmission, that I know of).

How do you explain the lockdowns then?

Lockdowns are enforced inaction, so the logic is counterintuitive in that case.

No, enforcing lockdowns is an action.

Oof. I think you strike upon a generally accurate point. Thinking about how this applies to all sorts of bureaucracies now (including corporate ones)

Well, yeah. First, do no harm. It's not ethically acceptable to kill or seriously hurt a bunch of otherwise healthy people in order to plow on through with vaccination that'll save a bunch of other people. Especially since there are many other vaccine types, the issue with AZ could be a tainted batch instead of a fundamental problem with AZ per se, etc.

Reply on news.ycombinator.com