How many lives does a doctor save?

https://80000hours.org/2012/08/how-many-lives-does-a-doctor-save/

by robertwiblin • 11 years ago

57 56 11 years ago

80000hours.org

acqq6• 11 years ago

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.)

mediumdeviation• 11 years ago

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.

acqq6• 11 years ago

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.

jessriedel7• 11 years ago

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.

acqq6• 11 years ago

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?

0x0• 11 years ago

The webpage pops up a modal overlay that completely hides the article and asks for email list subscription. Well, trying to subscribe bounces over to a different subscription page that asks to fill out a name and university, but to leave the university blank if it does not apply. But trying to submit that form fails with a validation error that university field cannot be blank. closes tab

Anderkent5• 11 years ago

Didn't happen to me. What browser?

peterhartree• 11 years ago

Well, trying to subscribe bounces over to a different subscription page that asks to fill out a name and university, but to leave the university blank if it does not apply. But trying to submit that form fails with a validation error that university field cannot be blank.

That's my bad - thanks for reporting this bug, and I'm sorry for the hassle. I've just pushed a fix.

upofadown• 11 years ago

A person with medical qualifications once chose to pick up garbage for a living instead of practising medicine. When interviewed they said that they saved more lives in a month by working as a sanitation engineer than they would during their entire career as a doctor.

Anderkent5• 11 years ago

That person doesn't understand marginal returns / replaceability. They could have been a doctor then paid some homeless person a small amount to pick up garbage for a living, easily combining both outcomes.

stingraycharles• 11 years ago

Medical bills is what made the person homeless. :)

hiou• 11 years ago

Considering that there are many more qualified willing and able candidates trying to become doctors and many less trying to become sanitation engineers, it actually may be a larger net benefit since the next medical student in line would likely be very close in ability.

Anderkent5• 11 years ago

One thing that confuses me in the conclusion of the article is the assumption that you can either be a doctor, or you can donate to charity and get much more impact. Porque no los dos?

(i have no idea how much doctors are paid; is it not a good career path from a financial perspective?)

reagency3• 11 years ago

The whole philosophy is silly. They advocate high paying careers (which tend to be exploitative ways to get money) and ignore the moral hazard of well intentioned people turning out to consume that income later. They inore that a smart person in a "mundane" public service / charity job might develop experience and connections that lead to a massive novel improvement to that sector.

griffinmahon• 11 years ago

One of their counter-arguments to your second sentence is that if you, the ethically-minded person who will donate a significant portion of your income, aren't in that position at the potentially exploitative job, odds are someone else will be who isn't ethically-minded. On the other hand, if you were to go work aid on the ground in Africa, it's likely that you, who maybe has a valuable skill-set capable of earning more, could be replaced by another person who wants to work in aid.

BenjaminTodd• 11 years ago

It's not evident from this particular post, but overall we put a lot of emphasis on the "career capital" you get out of different options (the extent to which they put you in a better position to have a positive impact in the future).

https://80000hours.org/career-guide/basics/

We also think "corruption risk" should be taken very carefully, which is why we advocate making a public pledge of your intention to donate, and being part of a community.

We also don't think you should take a high-earning career if it causes significant harm.

teh• 11 years ago

It's a super interesting topic to explore. Investigating how much bang we get for a buck in medicine is a touchy subject because when I'm ill I want the very best but while I'm fine I'm more willing to consider trade-offs.

Keeping that in mind I think that averaging numbers is not a great representation of doctors impact, the same way average latency isn't a great representation of what users see. What's the 95% percentile of QALYs? E.g. are doctors making one life (e.g. kid with a broken leg as mentioned in a comment here) better for 50 years when 9 people will just never break a leg?

If looking at shifts in distributions the story might (I could not find raw data) look very different.

jessriedel7• 11 years ago

The point of the article isn't to judge the value of the whole medical system, but rather to make a career choice. That means the relevant question is the value of the marginal doctor, not to try and get a representation of what patients see. We should expect that the marginal doctor is much less useful than the average doctor (i.e., the total benefit of the system divided by the number of doctors), and that furthermore ones expected impact of becoming a doctor is worth even less than the marginal doctor because if you don't go into medicine then someone else only slightly less skilled than you will take your place.

dghughes• 11 years ago

And when people are young and better able to recover from injury or disease the medical system I'm sure is not thought of.

When you hit 40 you get a glimpse how fragile we are and how valuable the consistency of health is.

Houshalter• 11 years ago

Past a certain point, medicine doesn't seem to improve health: http://www.overcomingbias.com/2007/05/rand_health_ins.html and http://www.overcomingbias.com/2007/05/rand_health_ins_1.html

PerfectElement2• 11 years ago

Related: how many lives does a doctor take? https://www.youtube.com/watch?v=X0xC7DCYHkM

noondip• 11 years ago

Came here to post this as well. Medical care itself is the third leading cause of death in the US.

reagency3• 11 years ago

That's only when you count every unsuccessful intervention as a "cause". The research paper that created this factoid counted every possible way medicine could have prevented the death, and did not weighting of other factors like me underlying illness or injury.

One of the paper's highlighted cases of " doctor-caused death" from its own summary , was a case where a kid had an unprovoked heart failure while running track, and the doctor forgot to tell him that doing that again might kill him, and then he kid ran again, and had another failure, and died. That's ridiculous to blame on faulty care.

If 10 people have heart attacks, and medicine saves 5, suboptimal care fails to save 3, and 2 cases were beyond the reach of even perfect care, that research paper would say medicine killed 3 and heart disease killed 2, ignoring the 5 saved. Medicine has room for improvement, but is an absolutely massive net win.

davycro• 11 years ago

A 51 year old man came into the hospital yesterday with chest pain. He was having a major heart attack. I watched the cardiologist catheterize and stent his coronaries. i saw the moment that the stent opened the coronary artery. I saw the blood flow restored to the left heart. The patient was 51, and that doctor, with the flick of his wrist, added decades to the mans life. That doctor does this everyday.

cbr3• 11 years ago

From the article:

    Diminishing marginal returns: some tasks performed by
    doctors have more impact than others. If there were one
    fewer doctor, the highest impact tasks they perform would
    be given to someone else, so the total impact wouldn’t
    reduce proportionally with the number of doctors.

In other words, that operation probably did add decades to this man's life, but this is the kind of critical care that we would find someone else to do if this doctor hadn't been there to do.

The question is, if you're considering becoming a doctor, what's the potential benefit that's due to your choices? How much good do you do that wouldn't have happened anyway?

reagency3• 11 years ago

But we have a shortage of doctors in this country (USA) at least, due to cartel controls on med school. More doctors, modestly paid, could serve more people currently underserved.

marincounty• 11 years ago

"I want to study medicine because of a desire I have to help others, and so the chance of spending a career doing something worthwhile I can’t resist."

Let's get real--this is said over, and over again, and I've never bought it. I won't go into the mind of the typical pre-med student, but being altruistic is not a trait I have seen in U.S. Medical students, and their sense of altruism doesn't improve with age.

It's a short article, and I honestly didn't read it closely, but I'd rather have it titled "How many lives does a doctor improve?"

There are a few questions I ask myself, whenever I meet a new doctor, and it's these; "What is this doctor's estimated kill card(the patients who died under their care), and does this doctor make conditions worse?"

I do take external factors into account when I make this unscientific judgement call; like the doctor's willingness to take on the sickest patients. The socio-economic status of the doctor's patients. The real reason this person became a doctor(it's usually not that hard to figure out on first impressions). I can usually spot the soley financial ones, and run!

(I have met a few altruistic doctors, and will bend over backwards to help them, or make their practice easier. They are appreciated, and respected! They are few and far between these days though? I don't know if the profession changed, or I changed?)

cbr3• 11 years ago

    > > I want to study medicine because of a desire I
    > > have to help others
    >
    > Let's get real--this is said over, and over again,
    > and I've never bought it.

The article is aimed at people who are trying to do as much good as possible with their careers. They're not asking "is the typical doctor altruistic?" but "if I'm altruistic should I become a doctor?".

kenesom1• 11 years ago

How many lives has the medical industry destroyed by artificially limiting the supply of physicians?

http://pulitzercenter.org/reporting/north-america-united-sta...

How many lives has the pharmaceutical industry destroyed by selling harmful substances?

http://www.amazon.com/Bad-Pharma-Companies-Mislead-Patients/...

slr5556• 11 years ago

Beating up pharma seems to be easy sport but consider this.

Have you ever had serious case of bronchitis, or a high fever, or needed any kind of surgery?

Guess what? No anesthesia (yes it's a drug not just a machine), no antibiotics, very likely no you.

Now take a look at the recent articles on the UK's much hyped NHS and how they are laggards in cancer survival because they do not take advantage of pharma innovations.

Know anyone anyone with hypertension or diabetes? Ask them whether they were well controlled and side effect free on the first drug they were prescribed . That's the big reason there are a lot of "me too" drugs that sell. (and while you're asking see if they fully compiled with their doctor's diet and exercise advice)

One size does not fit all.

DanBC4• 11 years ago

Now take a look at the recent articles on the UK's much hyped NHS and how they are laggards in cancer survival because they do not take advantage of pharma innovations.

That's definitely not the reason why the NHS has poor cancer outcomes.

Those very expensive new cancer meds add a month or so of low quality life (and are used within the NHS).

The problem is at the diagnosis end.

ams61102• 11 years ago

Is medicine a good career choice for someone wanting to ‘make a difference’?

I wish people would stop using that phrase. Stalin "made a difference."

slr5556• 11 years ago

Consider the following individual when you think about this question:

http://www.wwltv.com/videos/news/health/2015/07/28/trauma-su...

Norman McSwain was one man but through his work developing PHTLS (Pre-Hospital Trauma Life Support) and introducing modern EMS practices to numerous countries around the globe he truly did save countless lives. He has been credited for doing more to reduce the homicide in New Orleans than any mayor or police commissioner because he taught the trauma surgeons that increased survival from penetrating wounds and was an incredibly skilled surgeon himself. His work with the Tactical Combat Casualty Care Committee helped reduce battlefield fatality rates to historic lows.

The statistics don't take into account the kind of doctor you choose to be. If you choose to join a posh private practice and treat little old ladies who "just don't feel quite right" you may not save a lot of lives. But if you choose to be on the front lines, for instance one of the last doctors out of Charity hospital after Katrina, and spread knowledge far and wide you may just save more than "ninety lives".

We all get the same 24 hours in each day. Norman just used them better than most of us.

alpineidyll3• 11 years ago

I would be more interested to see a life saving face-off between going to medical school and basic science. Since the golden era of physician/scientists ended, the vast majority of life improving technologies have come from science specifically, while medicine enjoys massive amounts of credit for science's advancements.

U.S. graduate schools are filled with people from other countries, because students know that compensation for scientific careers is awful. We squander enormous amounts of intellectual capital making physicians, while people involved in nobel-prize winning advancements often have to leave their careers for lack of funding (c.f. http://discovermagazine.com/2011/apr/30-how-bad-luck-network...). It's a horrible failure of our medical system that the incentives are so misplaced.

How many lives does a doctor save?

Related Stories