How Little We Know
For the first time since my radiation treatment ended on Dec. 21, I saw two nurse-practitioners this week, one with the radiation oncologist and one with the urologist in charge of my treatment. Prior to these appointments I got a PSA test, which measures the amount of prostate-specific antigen (can’t really help you more there) in the blood. Alarmingly, it had gone up since the last measurement in July, 2021, from 4.05 to 8.1. Given that it had been stable in two readings over 11 months, between the second of those and this new one was was the radiation treatment, and given that this treatment is supposed to cause this measure of tumor presence to decrease a lot, this was quite alarming. The nurse told me that the prostate gland can be “irritated” for other reasons, and this might be what happened. They will do another test in six weeks, and we will see what happens.
But this entire journey has reminded me of a key tenet of economic thinking, that most of the time we know very little. When I teach I talk about products that succeed spectacularly, but not until someone thinks of them, and products that fail equally spectacularly, because people thought they knew things that turned out not to be true.
And what has struck me most is how little we know about the immensely complex thing that is the human body. When I was younger I used to enjoy Star Trek, but the show unavoidably did a lot of hand-waving about how their advanced technology worked. Doctors always had these little devices known as medical scanners, which would instantly tell the (trained) person waving them in front of a patient all the former needed to know about was was ailing the latter. The contempt of one of the doctors for late-20th-century medicine can be glimpsed here.
Alas, that is not the world we live in. Modern medicine can detect my tumor, and can assess it as expanding rapidly or slowly. As noted previously, I am fortunate that my tumor was caught early when it was developing slowly, so my prognosis is good. Am I guaranteed that it will never trouble me again? No. Could I have been told with precision how many years of life I would lose if I did nothing, opted for surgery or chose radiation? No. As is usually the case with cancer, doctors can only speak in probabilities, often crude ones. Some people have good prognoses, and then things turn bad, while others receive pessimistic diagnoses and then turn out to live long and healthy lives, or lives considerably longer than expected. (I knew one of the latter from work.) In this uncertainty lies some of the dread.
So too there are non-cancer conditions that admit of no cure at all through the treatments available to 2022 medicine. One thinks of multiple sclerosis (I had a graduate-school friend, already married, who was diagnosed with this), cystic fibrosis, and my own Type I diabetes, the latter definitely shortening one’s expected life, but not nearly as much as the first two. Has medicine advanced a lot since Hippocrates? Surely. We know that diseases classified as infectious spread through microbes. We know that a few conditions can be decisively treated with surgery, with appendicitis the classic example.
But there are often no simple treatments that decisively end, as opposed to merely controlling, conditions like the aforementioned ones, heart disease, hypertension, cancer and so on. And this is a knowledge problem. We simply know so little about the human body relative to all that could be known about it. Doctors far more often that not simply cannot prescribe a substance to be ingested, sitting under a particular machine, or changing the arrangement of one’s cells through surgery in a way that will “solve” the problem. They can only increase the chances of a better outcome. As the years roll by we know more and more, and this is all to the good. But the medical profession, through no fault of their own, is mostly flying blind, and long will be. People who treat cancer, if you pressed them, would surely acknowledge this. But in our COVID-19 times, the arrogance of people who consider themselves experts — Lock down! Don’t lock down! Ivermectin is a cure, and the establishment is depressing it! Ivermectin is junk as a COVID-19 treatment! Vaccines will end this! mRNA vaccines, despite their extensive testing, are worse than useless — is breathtaking. But they are responding to the incentives of the modern-media age, when certainty mixed with extremism is profitable , and epistemically humility is not.
I often tell my students that it is usually a mistake to think of problems to be solved. It is better to think about different possible outcomes, and rank them in comparison to each other. And all this must be done in the face of near-complete ignorance about all the ways resources can be combined, and about the outcomes of each combination. If you want to calculate how many options there are for the order of a deck of cards, it is “simply” 52 x 51 x 50 x…x 2 x 1 ≈ 8.06 x 1067. And so how to use the very much larger number of resources in an economy of any size, especially when the resources themselves can expand in number and purpose, is foolishly arrogant.
Is an economy even more complex than a human body, about which our vast ignorance is manifest? I think so, and this is why I am so skeptical of coercive government measures to make the economy “better.” But that is a topic for the classroom.