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  • Martin Laurence

Framing

I read "Can You Outsmart an Economist?" by Steven Landsburg last week. It’s a very entertaining book, large portions of which are dedicated to explaining how irrelevant information can skew our choices. The Russian Roulette example in Chapter 6 is particularly convincing. This post was inspired by his book.


Question A:

An infectious disease has just emerged which has affected 2 million people worldwide. It’s a new disease, like the Zika virus, and has received much media attention. Affected people are very sick, and every day hundreds need to be operated on to remove affected parts of their digestive tract. This microbe is a never seen before bacterium of the genus Aizessalam, which might be killed by existing antibacterial drugs. In vitro (in the lab), this bacterium is susceptible to penicillin, a cheap and safe antibacterial drug. In vivo (in humans), it is unclear if penicillin will work. This means we should:

  1. Wait for double-blind placebo-controlled trials before giving patients penicillin? These trials will take ~3 years to run, so tens of thousands of patients will be operated on in the meantime, and millions will suffer for ~3 more years.

  2. Give patients penicillin immediately. While success is not guaranteed, penicillin is cheap and safe, so it is the only ethical choice in this situation.


Question B:

An autoimmune disease affects 2 million people worldwide. These people are very sick, and every day hundreds need to be operated on to remove affected parts of their digestive tract. An Australian researcher has just discovered that it is caused by an elusive bacterium of the genus Helicobacter, which might be killed by existing antibacterial drugs. In vitro (in the lab), this bacterium is susceptible to penicillin, a cheap and safe antibacterial drug. In vivo (in humans), it is unclear if penicillin will work. This means we should:

  1. Wait for double-blind placebo-controlled trials before giving patients penicillin? These trials will take ~3 years to run, so tens of thousands of patients will be operated on in the meantime, and millions will suffer for ~3 more years.

  2. Give patients penicillin immediately. While success is not guaranteed, penicillin is cheap and safe, so it is the only ethical choice in this situation.


If your answer is different for question A and question B, then you are not rational. In question B, it is immaterial that we did not have a solution beforehand; what matters is that we might have a solution now, and that by acting on it we have a good chance of alleviating future suffering. Past suffering is immaterial. Question A was theoretical. Question B was loosely based on Barry Marshall’s work with stomach ulcers: in this case, a combination of red tape and status quo bias meant that the first answer was chosen for about a decade. Thousands died and millions suffered needlessly.


Perhaps you would answer these questions differently:

  • if you or a loved one was affected?

  • if a study reported preliminary results showing that penicillin was effective in vivo?

  • if you needed to be operated on to remove an affected part of you gut tomorrow, and thereafter you would have to defecate in a bag for the rest of your life?



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