Unhealthful News 103 – Do what is best, not what I do

There is an interesting report in the news right now from a survey of physicians that, roughly speaking, shows that many would to recommend a higher-survival but worse-side-effects treatment for patients though they would choose a greater risk of death for themselves to reduce other costs.  One commentator likened it to considering picking up someone in a bar, where you would definitely recommend your friend go for it, whereas you might hesitate yourself:  Your own fear of rejection, humiliation, or just awkwardness causes you to hesitate, but the prospect of your friend facing those seems completely inconsequential.  Or to add what I think is a more telling example, with positive rather than negative effects (but still a risk of death): lots of people strongly enjoy rock climbing, biking, and other dangerous activities, but almost no mother is all that happy about her child doing them.  The reason for the contrast is similar to the others:  The individual gets the upside of the activity to trade off agains the risk, but the worried parent (spouse, friend, etc.) sees only the risk of serious injury.

Though the survey itself was, like a lot of psych research, more a window into what we already knew than useful evidence in itself, this does bring up some interesting points.  These are not limited to the obvious point about whether physician recommendations are really honest if they are contrary to what the recommender would choose himself.  It also points out why physicians seem so blithely willing to tell people to give up important pleasures in their lives.  They are not all those condescending fascist nanny-state types who actively campaign to force people to adopt healthier behaviors.  Rather, they just forget that people care about things.  But this does mean they are not qualified to make policy (i.e., decision) recommendations most of the time

It is not certain whether physicians are particularly bad in terms of forgetting people have pleasures in life.  But it seems reasonable to conclude that they are worse than others who might be given similar influence.  While your mother may worry more about your risks than she appreciates your pleasures, she is probably not completely indifferent the joy you get from the latter, while your physician probably is.  Most people who try to benevolently make important life choices on behalf of others – social workers, parents, teachers, serious health policy analysts – pay attention to most (though likely not all) of the preferences of their charges.  It is the nature of their roles to do so.  But in their relationship to us, physicians fall somewhere in the middle of the spectrum from auto mechanics to parents.  Often policy and popular discourse is based on the assumption that medics are clear at the parental end, but they are not.  So we think of them as being perhaps too paternalistic when they back nanny-ish policies, but it is much worse than that:  They are just acting as engineers trying to fix a mechanical problem with the body, without regard to other things people care about; we can only wish they were feeling paternal. 

Unfortunately, thought this motive is far more forgivable than those that drive the nanny-state types, it tends to end us up at the same place.  And because it comes with the illusion of deeply thought-through benevolence, even thought it is actually much more like auto mechanics, it has the potential to cause more harm to people’s welfare.

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