Comment by CipherThrowaway | Hacker News Reader

Comment by CipherThrowaway | Hacker News Reader

CipherThrowaway

Although it is certainly written by a human being, this article gives me a similar feeling to ChatGPT essays. The tone is compelling and plausible. But when I thought about it, I realized it didn't make much sense.

> Rarely do we even consider that the cost of doing something might outweigh the benefits.

Cost vs benefit is the main thing that people consider when making decisions. It's a core decision making framework taught as early as elementary school social studies. Institutional decision making is rife with processes for assessing risks and performing cost-benefit analysis.

> Intervention—by people or governments—should only be used when the benefits visibly outweigh the negatives.

This advice is the decision making equivalent of "just don't write code with bugs." Easily achievable but pretty useless and completely impractical. Real world decision making involves operating under uncertainty at almost all times. If it didn't, the topic wouldn't be worth writing articles about.

> Cost vs benefit is the main thing that people consider when making decisions.

I don't know what people you are talking about, but my experience is so different from this that I suspect your conclusion is purely platonic. You expect people to decide based on a cost/benefit analysis, or you hear people telling you they do.

People almost never do a cost/benefit analysis. On the best cases, they analyze one of that pair.

Iatrogenics happens when the benefits are clear and the harms are hidden. So “rational” people tend to intervene because it would seem the benefits outweigh the costs.

Correct. To parse that further, the costs may be hidden, involve unknowns and/or unknown unknowns.

This is the explanation many of the unvaxed smart people I know used to justify relying on their immune systems which were developed and tested for a million+ years over recently developed covid vaccines.

> Iatrogenics happens when the benefits are clear and the harms are hidden. So “rational” people tend to intervene because it would seem the benefits outweigh the costs.

Also as always you must remember that not every single person will be harmed equally. And in many cases solutions are chosen not because they are best(cheaper/least harmful), but because they harm specific portion of population. Think why swimming pools were filled with concrete and many more.

People use emotions and heuristics, not rational analysis when making most of their decisions. There is plenty plenty plenty of research on this.

> > Rarely do we even consider that the cost of doing something might outweigh the benefits.

> Cost vs benefit is the main thing that people consider when making decisions.

This article also makes the mistake of equation "we", the average reader of the blog, with the doctors who are making prescribing decisions.

Understanding the risks and side effects of prescribing a medication or procedure is core to the practice of medicine. It's integral to everything doctors do.

The field of medicine is often criticized for not being aggressive enough with treatments, though these criticisms often come from people who only see the potential upside but not the risks. We saw this most recently with complaints about how long the FDA took to get vaccines out (which was actually lightning fast) or in how the field of medicine didn't rush to recommend theoretical COVID treatments based on small-scale studies and petri dish studies (which turned out to be the right choice, given that none of them replicated at scale in controlled studies).

It's also the reason why the most effective medication may not be the first-line treatment, because the first-line treatment is chosen as a tradeoff of risks versus benefits.

Doctors know all of this. Unfortunately, doctors who decline to give patients the medications they think they need or recommend against surgical procedures patients think they want are subject to a lot of negative pressure in today's medical system. If someone goes into a doctor and demands antibiotics for their cold, the doctor must find a way to talk them down without risking another negative review which can impact their career and compensation in many systems. Some doctors just don't care enough, and will hand out prescriptions as asked. It's becoming a real problem now that medical systems have so many layers of middle management trying to put NPS scores and other feedback loops into the medical system, combined with social media pushing so many people to think they know they need antibiotics or thyroid medicine or other treatments that come with more downsides than benefits.

I think they are saying that there are known costs and benefits but unknown costs are hard to quantify and unknown benefits are probably rare. Therefore the benefits need to be very material (several orders of magnitude as they state). Don't trade noise for noise.

And yet governments worldwide ignored the cost-benefit of lockdowns and removing kids from schools. Perhaps it’s not such an obvious thing…

Or their cost-benefit analysis said that the cost of removing kids from schools was worth it.

Do you have any evidence of ignored cost-benefit studies that were available at lockdown decision time (there wasn’t much time for studies when these decisions needed to be made)?

your second paragraph kinda answers itself

My parent said cost-benefit was ignored, not that it wasn’t considered.

I don't think it does. If you have a ? in your cost-benefit spreadsheet for "cost in DALYs of locking down schools", the obvious solution (that one assumes governments actually used) is to ask your education expert for a guess and a confidence interval.

Getting that estimate wrong is not the same as failing to consider it.

Or their cost-benefit analysis said that the cost of removing kids from schools was worth it.

Cost is incurred by the children who have no voice, so zero cost to decision makers. Benefit is to one of the largest donor groups to politicians, so also large benefit to decision makers. Cost/benefit to society, population at large, the country? Seems to be willfully ignored.

Not having any studies to ignore is by definition not doing cost benefit analysis.

Or perhaps they considered the cost of studies and deemed it too high.

There was plenty of evidence that COVID was not as dangerous to children as it was to elderly and yet politicians kept schools locked down. This is why many parents took their kids out of public school and into private schools which re-opened, or at least families that could afford it did. There has been a massive impact to school-age children and the development loss is massive. See this article from 2021: https://www.medpagetoday.com/opinion/vinay-prasad/90658

Many of the studies referenced in that article are from 2020, yet schools had not re-opened.

In addition to that the teachers union in the US influenced guidance by the CDC on school openings: https://nypost.com/2021/05/01/teachers-union-collaborated-wi...

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