May 06, 2015

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Still, I have a certain amount of faith in intellectual elitism actually working, as long as the elitists go into the marketplace of ideas and take their lumps. It was pretty obvious in 1985, say, that Bill James was better at baseball statistics than anybody else before him. You could feel yourself getting better at thinking just by reading him.

One part of the problem in medicine is the assumption that medicine ought to be like physics, and therefore, like the Law of Gravity, what works for some should work for everybody. That’s how Science with a capital S works, right?

But in reality, Zoloft works for some people and Prozac works for some people, but not exactly all the same people. And the order in which your doctor prescribes Zoloft or Prozac to you can be a very big deal to you at the time when you are deeply depressed. Increasing the accuracy of doctors”€™ rank ordering of medicines to try out on individual patients would lead to a big absolute increase in human happiness, but drug companies don”€™t have much incentive to fund expensive research “€” such as how to figure out whether this individual patient should start with Zoloft or Prozac “€” that probably wouldn”€™t increase overall sales.

But if the research could be made cheaper by utilizing the propensity of people to sound off online for free, then perhaps the accuracy of prescriptions could be increased.

My impression is that the medical research profession is not very open to Yelp-style big data collection. They have pretty good reasons for being skeptical about the data. But, like the man said, quantity can have a quality all its own.

The reigning view is that all medical studies must have professional quality control. We are familiar with FDA studies to make sure that new drugs don”€™t cause Thalidomide-like horrors. But that’s an overly rigid viewpoint when it comes to helping doctors choose among medicines already approved by the FDA as safe.

We know that doctors are currently influenced by not-exactly scientific techniques such as hiring NFL cheerleaders as saleswomen. So why not consider online reviews? Obviously, they shouldn”€™t be trusted naively, but the occasional MD with a Bill James brain can provide critical consideration.

Perhaps the problem is that we don”€™t really like doctors laying all their cards on the table the way Bill James would do with his baseball theories. We prefer to imagine our doctors know more than we could ever imagine. If they told us their reasoning, it would take away their juju powers to heal us.

Finally, there’s the fear that big money has corrupted doctors into prescribing the wrong medicines, and we don”€™t really want to find that out.

Heck, even with Bill James, drugs seemed to corrupt him: the word “€œsteroids”€ barely crossed his lips until about a decade-and-a-half into the era of steroids distorting statistics, when in 2009 he published a risible piece in Slate claiming that Barry Bonds“€™ late-career surge might have had more to do with the type of wood in his bat than with PEDs.

But that’s a sin for which I”€™ll forgive him, especially if he becomes a role model for analysts outside of sports.


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