Home > ethics, The Economics Profession > Is medicine a model for ethics in economics?

Is medicine a model for ethics in economics?

from Peter Radford

A recent correspondent asks whether medicine could act as a template for the importation of ethical standards into economics. On balance I don’t think it can. Here’s why:

Medicine consists of a practical part that faces outward towards its customers. We call those customers patients. From the earliest times medicine has adopted the credo ‘first do no harm’ which forms the ethical bedrock for all subsequent standards. This is relatively easy to do since ‘doing harm’ is quite quickly identified. Even then such an ethical background failed to stop the development and implementation of some outrageous and harmful medical techniques. In the modern era the ‘doing no harm’ ethic has allowed the creation of a number of rules that govern doctor activity and provide a measure of protection to patients. Those rules are enforced by various governing bodies that not only establish and monitor the rules, but also govern the very process that allows someone to call themselves a doctor in the first place. This governance structure gives practical medicine a coherence and shape that are identifiable by the public, and ensures that the profession recognizes it relationship with society at large.

Medicine also has an academic part that focus not on patients but on research, the development of future cures, and on public policy issues. This part also adheres to the ‘do no harm’ ethic, but in a more loose and less immediate fashion. The background of ‘do no harm’ provides a setting for academic debates about the efficacy of various treatments, drugs, and policies, but does not diminish that debate. It channels it. All participants would agree that at the end, when new treatments, drugs, or policies move from the academic arm of medicine into the practical arm they must rise to meet the standards the profession sets for itself. Prior to that research is governed more by the ethics of scientific discovery which may have a less rigid set of standards, but which are recognizable to the research community and which, ultimately, help ensure the overall profession can maintain its ethical standing once the product or that research is made public.

Economics too has two parts, but they are often conflated into one. A professor may both research and teach. Often that same person may offer policy advice. This conflation leads to an easy muddle. Academic freedom to pursue debate over the efficacy of various theories leaks into a similar freedom to advocate policies based up in those various theories. Consequently there is little or no separation between the research and the practical arms of economics. Academics want to defend their right to argue and debate, but they also want to advocate policies without the profession first reaching closure on what is acceptable theory. This is a sharp distinction with medicine where what is acceptable treatment is quickly propagated throughout the practical side of the profession.

Medicine has a coherence that economics does not.

Worse still is the fact that some economists have assumed theoretic closure and have thus excluded from both their teaching and their policy advocacy theories that do not fit within their closed system of thought. They evade debate and thus represent themselves, falsely, as being complete.

Arguments over the efficacy of Keynesian style remedies to the recent crisis are a good example of the difference between medicine and economics. The lack of closure, inclusion, and agreement within economics leaves two or more sometimes contradictory ‘treatments’ available to the public. The so-called experts within the profession are exposed as having arrived at no conclusion and, instead, offer up a torrent of alternatives that leaves the onus of solution selection to the non-experts. Naturally, this leads to a selection process based not on efficacy but on some other criteria such as political preference. The upshot is that economics with a degraded as social value, but continues as a nice academic pursuit as debate rattles on.

The ultimate point being that you cannot enforce an ethical standard on the profession when there is no coherent set of ‘treatments’ both recognizable and doing no harm. The lack of settled theory prevents the emergence of governance within the profession and thus limits the social value of all the thinking going on within academia.

The only way out of this bind, as far as I can tell, is for the profession to acknowledge that economics does not exist as a coherent program or set of ‘treatments’. It is a melange of competing ideas each of which may contribute at different times and in different settings. It is also a deeply contingent set of ideas, with the context of time and place being of the utmost importance. An ethical stance based on this shifting foundation requires a humble and plural approach. Economists don’t know much of lasting substance. They have identified few, if any, fundamental laws. And they have failed, after two hundred years or more, even to agree on the diseases they should treat. This is a pedagogical nightmare that ought to enforce a plural syllabus, and is representative of a field so divided that it ought only issue a caution-laden set of policy advice.

For instance someone whose theory precludes involuntary unemployment is deeply ethically challenged when they offer advice on the issue of unemployment. How can they? They are, in effect, saying there is no disease to treat. Yet, manifestly, there is a symptom. So they identify something else to cure. The symptom persists. Their cure continues to fail. And no one pays a price for doing harm.

This, of course, assumes that we can agree on what ‘harm’ is in the context of the economy. Whereas in medicine we can.

So: is medicine a model for ethics in economics? No. At least not yet. Medicine exists as a coherent body of thought with agreed upon treatments and an agreed upon relationship with society. Economics does not exist in that way and refuses to acknowledge its social relationship. Medicine is a profession. Economics is not. So medicine can have standards and governance. Economics cannot.

Perhaps it is easier to see this if we accept that economics is simply a subtext to politics. Then we can accept the futility of an expectation of either standards or governance. Ideology and personal world views clutter up our thinking too much. The best we can do is to accept certain rules of civility, let economists go about their irascible arguments, and accept that economics can never achieve the social contribution that modern medicine has attained.

You cannot apply standards to something that doesn’t exist. Economists seem to like it that way. They call it academic freedom.

  1. SJB
    February 24, 2014 at 2:30 pm

    Thanks, this is very insightful.

  2. Marc Bebenroth
    February 24, 2014 at 11:04 pm

    Indeed, very insightful. This text answers some of my questions. The comparison of economics with medicine has boggled my mind for quite some time now. And I can follow the arguments made here.
    But don’t you, Peter Radford, between the lines suggest that it is possible to turn economics into a profession, or am I mistaken there?

  3. Reiner Buchegger
    February 25, 2014 at 7:11 am

    Don’t you idealize medicine too much? Diagnoses tend to differ as do treatments suggested – so what is left is just the ‘do-no-harm’ postulate. But does this imply that diagnoses and treatments are of the nature that no harm is done?
    This of course does not exonerate economics but just implies that we ought not to look at medicine as a model – but for other reasons than those suggested.

  4. davetaylor1
    February 25, 2014 at 10:40 am

    Unfortunately medicine has been contaminated by “economics” [i.e. Soddy’s chrematics] so its “do no harm” needs to be extended to not confusing itself and robbing the poor by charging premiums for unnecessary patented variations. Nevertheless medicine has advanced since Harvey established the circulation of energy-releasing blood; microscopy how the blood carries repair kits and antibodies as well as bacteria, viruses and cancers; x-rays the structure of the body and its parts; and chemistry how the antibodies work.

    In the reverse direction “economics” has not learnt from how medicine how real science looks at and analyses real flows and structure instead of denying their existence and measuring the unanalysed contents of mathematical spaces; i.e. not focussing on information carriers and channels in order to gradually discover their functions and how real function has to be complemented by the elimination of malignancies.

    • Marc Bebenroth
      February 25, 2014 at 11:01 am

      Even if Peter is right and the “body” of economics is too different from that of medicine, can’t we at least try to learn from medicine what “science” should be, e. g. founded on real evidence rather than pure theory? Medicine and Physics suffer both from unscientific schools of thought. But for economics the term “quack” does not in fact brand objectively wrong and possibly harmful “practitioners”.

      On the one hand, I think, economics stands nowadays where once astrophysics was: trying to add explanatory variables to an established model of the world until a point is reached where it is more reasonable to just abandon and replace it with a more fitting one. On the other hand, in economics a war is faught out between ideologies and belief systems which both base their thinking on diametrical different assumptions of the world, like it can be observed with “voodoo” medicine etc.

    • davetaylor1
      February 25, 2014 at 9:04 pm

      Marc, Peter’s issue was the lack of ethics in economics, but his proposal – that “we accept that economics is simply a subtext to politics” so “we can accept the futility of an expectation of either standards or governance” – is to my way of thinking a cop-out.

      What Peter says is true now, but was not always been that way. Before the Reformation, politics was about policy formation and not power arbitrage, while economics was about justice and not profit, with Church and State to some extent controlling each other. Following Henry VIII’s re-legalisation of usury and the UK’s constitutional scam of mortgaging the Kingdom’s Treasury to the money-printing Bank of England, the key texts are the three 1740 volumes of David Hume’s “A Treatise on Human Nature” which respectively reduced Newtonian science to measurement, ethics to mores and politics to agreement between the powerful. Building on this, Hume’s friend Adam Smith’s 1776 “Wealth of Nations” reduced the concept of wealth to measurable money and political agreement on mores to taking account of risks, and Social Science has followed Hume’s method of denial of evidence other than repeatable measurements rather than Bacon’s experimental method of taking things to bits to see how they work.

      So what should “science” be? At least it should be a dialectic between THEORY and PRACTICE, with theory founded on real (practical) evidence but corrected in light of unexpected results of acting on the theory. But there is more to it than this. First, the evidence for direction of motion is ambiguous. In astronomy the Ptolomaic system was based directly on such evidence as there was. Copernicus didn’t change the evidence but INTERPRETED it differently. Likewise, the Newtonian map of space assumed straight Cartesian mathematical coordinates, but Einstein reinterpreted these as curved and was supported by the evidence – which has taken us back to the pre-Humean theory of the creation of the universe in a Big Bang. The problem then is that there was nothing to observe at the Big Bang. We cannot see the motion of its energy, only chaotic variations in the light waves generated near its surface. We can EXPLAIN the formation of persistent matter, by analogy with spray formed by surface tension as waves break upon a beach, as the localisation (by circulation) of energetic motion. But this (what Copernicus, Newton and Einstein did) is not pure theory deduced from axioms, it is theory retroduced through time (like reverse engineering evolution or peeling off the skins of an onion) from what we know of reality and what we know of mathematical logic.

      On your one hand, then, I agree with you, Marc. Economics stands in need of a Copernican revolution, which means peeling off its Humean monetarist, neo-Classical and Classical layers so we can see its 4-dimensional structure unspecialised, living, and functional.

      On your other hand, ideologies and belief systems do not fight wars. These are stirred up by people with adolescent minds feeling their power to rebel, bully, pillage and destroy rather than their ability to appreciate, befriend, learn from and cooperate with those with more childlike, creative or thoughtful mindsets. Ideologies and beliefs may be learned from others and assumed true, but they usually originate and are sometimes held not as assumptions but as the conclusions of thoughtful minds with triangular fields of vision: each having its diametrical opposite but together forming a continuous spectrum.

  5. February 25, 2014 at 4:09 pm

    Medicine has an advantage of proximity to cause, if someone screws up it’s typically clear. Economics sadly less so, we can pontificate without personal injury, and this is dangerous.

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