
How many lives does a doctor save? - robertwiblin
https://80000hours.org/2012/08/how-many-lives-does-a-doctor-save/
======
acqq
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
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.

~~~
acqq
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.

~~~
jessriedel
> 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.

He's a practicing doctor at Churchill Hospital in Oxford.

[http://www.thepolemicalmedic.com/](http://www.thepolemicalmedic.com/)

To the best of my knowledge, he continues to support 80,000 Hours.

~~~
acqq
It seems to me that he now more advocates

[https://www.givingwhatwecan.org/](https://www.givingwhatwecan.org/)

[http://www.thepolemicalmedic.com/saving-the-world-and-
healin...](http://www.thepolemicalmedic.com/saving-the-world-and-healing-the-
sick/)

and that he has spent short time with 80,000 Hours. It seems he was really
still a student as he wrote there. I hope he'll blog more about his
experiences as he grows up.

~~~
jessriedel
Giving What We Can and 80k Hours are very closely connected organizations with
different missions. They shared office space at Oxford University.

------
kenesom1
How many lives has the medical industry destroyed by artificially limiting the
supply of physicians?

[http://pulitzercenter.org/reporting/north-america-united-
sta...](http://pulitzercenter.org/reporting/north-america-united-states-
residency-doctor-shortage-congress)

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

[http://www.amazon.com/Bad-Pharma-Companies-Mislead-
Patients/...](http://www.amazon.com/Bad-Pharma-Companies-Mislead-
Patients/dp/0865478007)

~~~
slr555
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.

~~~
DanBC
> 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.

~~~
slr555
Sure about that?

Look at the five year survival rates for innovative treatments. Granted not
all of them and not every time, but to generalize to "months" is a gross mis-
characterization not borne out by a thorough review of the literature.

~~~
DanBC
Show me one of those treatments not offered on the NHS.

(Edit: yes, I am sure about this).

EDIT2: for one example where the UK NHS gets things wrong in diagnosis:
patient finds a lump, visits GP. That GP then gives a rapid referal to a
specialist, who then gives rapid screening requests.

What should happen is the GP asks for the rapid screening, and simultaneously
makes the rapid referal to specialists. This would reduce time to diagnosis,
and time to start treatment, and both of those are important in outcomes.

~~~
slr555
[http://www.bbc.com/news/health-33772892](http://www.bbc.com/news/health-33772892)

Note: They suggest some of the reasons behind this could include cancers being
diagnosed later, poorer access to treatment and less investment in health
systems.

PS Rapid referral to a specialist is an oxymoron in the NHS.

~~~
DanBC
You started by saying the NHS has poor outcomes for cancer (I agree) and that
the reason was because the NHS does not use modern meds.

I counter - pointing out that the problems are at the diagnosis end.

You respond with a comment about the five year survival rate of innovative
med.

I tell you that those meds are used within the NHS, and ask for an example med
that is not used within the NHS. I give an example of how there are
inefficiencies in the diagnosis end.

You post a link that doesn't mention meds; does mention delays in diagnosis
and treatment. You still haven't posted an example of a cancer medication that
provides good outcomes that is not used in the NHS.

Your little dig about referal times is weird. What do you think the referal
times are? There is a legally enforced maximum 2 week time from GP referral to
see a cancer specialist.

[http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtim...](http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide%20to%20waiting%20times.aspx)

> Patients with urgent conditions such as cancer and heart disease will be
> able to see a specialist more quickly. For example, you have the right to be
> seen by a specialist within a maximum of two weeks from GP referral for
> urgent referrals where cancer is suspected.

You appear to have a political ax to grind. That would be okay if you weren't
spreading lies and misinformation.

EDIT: you made an antiNUS documentary? You don't think that's the kind of
thing you should mention? I'd be interested in fact checking it because,
looking at this thread, you probably made a right fucking mess of it.

~~~
slr555
PS I don't know what documentary you are talking about? I have never created a
documentary on the NHS. Certainly not any documentary that was "Anti-NHS" That
is a patently falsehood.

I did work a documentary on Rheumatoid Arthritis patients across Europe, not
just the UK and not focused on health systems. The patients experiences with
their respective health service were out of scope and not on screen. I did
however speak with them at length on the subject. Before you go casting about
accusations please have some rudimentary idea of what you are talking about.

The NHS patients we met with each mentioned that in order to see a specialist
on a timely basis they had to get private insurance after which their months
longs waits dissolved to days. A close friend who was a staunch defender of
the NHS after being diagnosed with MS has soured on the program and has also
secured private insurance for specialist access. In another instance a young
woman with a bowel perforation secondary to Crohn Disease has been waiting for
at least two months to have surgery scheduled. Yes, yes I know anecdotal
experience and all that but I guess it's just a poisson distribution that
everyone I've ever known met or heard of that has needed specialty care from
the NHS has gone the route of private insurance for access to specialists.

Take a close look at the quote from the article I posted with the prefix
"Note:" and then sound it out. Use your vowels and note that it VERY CLEARLY
states that one of the problems is "poorer access to treatment".

If you want to go on a formulary hunt to see which drugs are not paid for by
the NHS that are recommended under NCCN guidelines or spend your night
frothing over pubmed searches be my guest.

PS I have no axe to grind. I'm not the one bringing profanity and personal
accusations into this. You don't know me. You clearly have no clue about my
politics but are clearly incensed that someone deigns to take issue with the
NHS. The bottom line is that patients are dying sooner in the UK than
elsewhere. If that is okay with you then great, I'm just saying as a personal
opinion informed by my reading and personal experiences that it is not a
system I would choose to live under or advocate the adoption of in my country.

If you are happy with the health care system in your country that's great.

~~~
DanBC
There is a legally enforced maximum wait time of 18 weeks for non urgent
referrals.

[http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtim...](http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide%20to%20waiting%20times.aspx)

> You have the legal right to start your non-emergency NHS consultant-led
> treatment within a maximum of 18 weeks from referral, unless you choose to
> wait longer or it is clinically appropriate that you wait longer.

> If you want to go on a formulary hunt to see which drugs are not paid for by
> the NHS that are recommended under NCCN guidelines or spend your night
> frothing over pubmed searches be my guest.

You made the claim, you should back it up. You said that poor cancer outcomes
on the NHS was caused by lack of access to new cancer meds. Your inability -
over four posts - to name any drugs that are not available on the NHS is
telling. Your choice to support your claim with an undetailed BBC report is
odd. It certainly doesn't say what you think it says: poorer access to
treatment is exactly what I describe in edit2 above.

> Yes, yes I know anecdotal experience and all that but I guess it's just a
> poisson distribution that everyone I've ever known met or heard of that has
> needed specialty care from the NHS has gone the route of private insurance
> for access to specialists.

What's your sample size? How do you counter the fact that there is legally
enforced maximum waiting times in the NHS?

> but are clearly incensed that someone deigns to take issue with the NHS.

I criticise the NHS, in this thread. I am angry that someone continues to lie
about the NHS, even after their lies have been debunked.

~~~
slr555
Check the Anger. This is an academic exchange of ideas. If you are angry go to
the gym it's better for you.

A. You have debunked nothing.

B. There are no lies here.

C. Just because some random guy on the internet tells me to do something, I am
no obligation to do that.

D. "Access to treatment", could mean the moon is made of green cheese but it
is unlikely.

E. Since you are angry about it, cite specifically the the formulary content
of the NHS and compare it to available treatments at Sloan Kettering. Since
your so convinced it's true, prove it. (two can play at that)

F. Support you assertion that novel treatments only extend life by "a few
months" with multiple citations from peer reviewed journals, oh and make sure
their recent.

G. As far as the legal mandates. I am sure that everything in the UK is done
exactly to the letter of the law in all cases and that deadlines are never
missed.

H. You're assertion that closing the two week gap between when the GP starts
testing and the specialist would start testing would close the mortality gap
between the UK and Europe strains credulity and common sense.

Oh and just because you are dead bone wrong,
[http://www.telegraph.co.uk/news/11788507/NHS-accused-of-
sham...](http://www.telegraph.co.uk/news/11788507/NHS-accused-of-shambles-as-
dying-cancer-sufferers-denied-drugs.html)

"A cancer drug hailed as one of the biggest breakthroughs since chemotherapy
will not be made available on the NHS, despite research showing it doubles
survival"

Can you here me now.

------
upofadown
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.

~~~
Anderkent
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
Medical bills is what made the person homeless. :)

------
PerfectElement
Related: how many lives does a doctor take?
[https://www.youtube.com/watch?v=X0xC7DCYHkM](https://www.youtube.com/watch?v=X0xC7DCYHkM)

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

~~~
reagency
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.

~~~
PerfectElement
I don't think every unsuccessful intervention is counted as an medical error;
but I might be wrong, since I didn't read Barbara Starfield's paper.

The majority of deaths are categorized as caused by hospital infections
(80,000) or adverse drug reaction (106,000).

------
marincounty
"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?)

~~~
cbr

        > > 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?".

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

------
slr555
Consider the following individual when you think about this question:

[http://www.wwltv.com/videos/news/health/2015/07/28/trauma-
su...](http://www.wwltv.com/videos/news/health/2015/07/28/trauma-surgeon-
saved-countless-lives-before-his-death/30816011/)

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.

------
0x0
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_

~~~
peterhartree
> 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.

------
alpineidyll3
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...](http://discovermagazine.com/2011/apr/30-how-bad-luck-
networking-cost-prasher-nobel)). It's a horrible failure of our medical system
that the incentives are so misplaced.

------
teh
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.

~~~
jessriedel
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.

------
davycro
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.

~~~
cbr
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?

~~~
reagency
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.

~~~
ams6110
Most people who go through the extensive training required to be a doctor want
more than "modest pay" as a result, and rightly so. And doctor pay is not the
cause of the high cost of health care. Doctors could all work for free and all
else remaining the same you'd hardly notice the difference.

------
Anderkent
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?)

~~~
reagency
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.

~~~
BenjaminTodd
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/](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.

------
ams6110
_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."

