Saturday, 5 February 2011

My first Goldacre post

Tim Worstall's blog alerts me to a Ben Goldacre article here.  Now I could easily get obsessed about Goldacre if I'm not too careful, seizing upon his every word until he becomes my nemesis (I'm thinking Baron Silas Greenback to my Penfold).  But his article is interesting as it gives an example of where we disagree.

Goldacre points out quite rightly that we have little scientific evidence as to which healthcare model works best but where we differ is he doesn't acknowledge the awful truth. It's that we should stop looking for "evidence" and admit that science isn't a suitable tool to address an issue so enormously complex as has how to deliver healthcare.  The input data are way to numerous, unobtainable and dirty.  Our modelling capabilities are not sufficient and the variables involved are so numerous I cannot see how you can ever corroborate your hypothesis with experimental results (see my earlier post on climage change on a similar theme).  There is a mechanism however which can do jobs too complex for science, such as working out the best way to allocate resources when providing healthcare.  It's called the free market.  Given enough freedom we would see a plethora of competing models of healthcare provision erupt, and we can choose which one we believe is best.  My choice by the way would be a combined insurance / cash pot type system which gives you the freedom to go to whoever will take your money. 

Now given what I've said before, I could never prove in a scientific sense which model is best, but I would still make a choice.  I would have a pretty good gut feeling when making my choice but that is not science.  However I am happy to admit that and in this way show where I believe the boundaries of science lay.  I would not be making my decision by science but by faith, faith that the free market will provide a good model, faith that if the model turns out to be crap it will soon disappear through no analysis other than the pressure of the free market that gave it birth.  I don't need to use science to prove it, I am happy simply to believe. 

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