Personal Science = Insourcing Your Health

I recently blogged about undisclosed risks of medical treatments. For example, sleeping pills are associated with a big increase in death rate. Patients are rarely (never?) told this. One reason risks are undisclosed is ignorance: Your doctor doesn’t know about them. Another likely reason is that you and your doctor have different goals. If a treatment harms you, your doctor is not harmed, in all but a few cases. If you refuse a treatment (such as a surgery), your doctor may make less money. This pushes doctors to overstate benefits and understate costs.

This is the simplest case for personal science: You care more about your health than any expert ever will. The experts have advantages, too (such as more experience with your problem) so it is not obvious that personal science will be better than expert advice — you have to try it and find out. When I started to study my acne, I was stunned how easy it was to improve on what my dermatologist had told me.

A recent article in The Atlantic (“The Insourcing Boom”) describes a similar revelation at General Electric. GE executives wondered if they could build a certain water heater (the Geospring) just as profitably in America as in China. They looked at it carefully:

The GeoSpring in particular, Nolan says, has “a lot of copper tubing in the top.” Assembly-line workers “have to route the tubes, and they have to braze them—weld them—to seal the joints. How that tubing is designed really affects how hard or easy it is to solder the joints. And how hard or easy it is to do the soldering affects the quality, of course. And the quality of those welds is literally the quality of the hot-water heater.” Although the GeoSpring had been conceived, designed, marketed, and managed from Louisville, it was made in China, and, Nolan says, “We really had zero communications into the assembly line there.”

To get ready to make the GeoSpring at Appliance Park, in January 2010 GE set up a space on the factory floor of Building 2 to design the new assembly line. No products had been manufactured in Building 2 since 1998. . . .

“We got the water heater into the room, and the first thing [the group] said to us was ‘This is just a mess,’ ” Nolan recalls. . . . “In terms of manufacturability, it was terrible.” . . . It was so hard to assemble that no one in the big room wanted to make it. Instead they redesigned it. The team eliminated 1 out of every 5 parts. It cut the cost of the materials by 25 percent. It eliminated the tangle of tubing that couldn’t be easily welded. By considering the workers who would have to put the water heater together—in fact, by having those workers right at the table, looking at the design as it was drawn—the team cut the work hours necessary to assemble the water heater from 10 hours in China to two hours in Louisville.

In the end, says Nolan, not one part was the same.

So a funny thing happened to the GeoSpring on the way from the cheap Chinese factory to the expensive Kentucky factory: The material cost went down. The labor required to make it went down. The quality went up. Even the energy efficiency went up. . . . The China-made GeoSpring retailed for $1,599. The Louisville-made GeoSpring retails for $1,299.

That’s what happened when designers and manufacturers were no longer so far apart. As far as I can tell, the designers at GE had no idea such big improvements were possible, just as I was shocked how easy it was to do  better than my dermatologist.

There are dozens of ways to bring the incentives of doctor and patient closer together but that would be like trying to bring the Chinese workers and GE designers closer together. Personal science is much easier. No one besides you needs to change. It corresponds to insourcing: insourcing responsibility for your health.

3 Responses to “Personal Science = Insourcing Your Health”

  1. dearieme Says:

    When I’ve designed instruments I’ve always gone through everything with my instrument maker so that the design can be practical for him to manufacture: it has always led to improvements. It’s amusing to learn that for GE the penny has only recently dropped. The next step should be to sack the dimwitted executives who were in charge before.

    Seth: Yes, I agree. It should not have been the great revelation it apparently was.

  2. derp Says:

    > If you refuse a treatment (such as a surgery), your doctor may make less money. This pushes doctors to overstate benefits and understate costs.

    I’m very much disappointed to hear such talk from a psychologist who should know better. It is a very simple case of extrinsic incentive bias. Doctors don’t do it because of the money — at least most of them, with your typical greedy bastard here and there.

    Why do we doctors overprescribe and overoperate? Most people expect us to, and we have grown to cater to the “do something” mentality. No patient wants to hear simple truths. Health improvement requires actual work on the patients side, such as smoking cessation, getting enough sleep, experiment with your diet etc. Often, the most important thing for your health is not “do something”, but “stop doing something”. (I hear ya, N. Nassim Taleb…)

    Most people *want* the easy fix, and we can give it to them. Our big-pharma-sponsored professional institutions and conferences play down any reference to possible harm, even censor or ignore it. Most of us choose to ignore it, too, because most of our colleagues ignore it. And given that the majority says there is no harm, there can’t be! Completely logical, isn’t it?

    As a medical professional, I highly recommend seeking medical treatment only if your condition is sufficiently severe. Everything else will quite probably harm you.

    Thank you.

    Seth: Learn more psychology and you will learn that people are often wrong about their motives. So, for example, a doctor is a bad person to ask what motivates doctors. People’s real motives often turn out to be different than what they say, to put it in plain English. The error is always in the direction of making themselves look better — as you do in your comment. Look at studies on extrinsic motivation bias and you will see that the bias is about stated motives, not actual ones. See Atul Gawande’s article about this (about why there are enormous cost variations in medical care from one place to the next) for evidence against your view that doctors overprescribe and overoperate because “most people expect [them] to”. The differences he found between where health care spending was high and where it was low seemed to be due to differences between the doctors in the two places, not between the patients in the two places. Can you point to any evidence supporting your view (blame the patient)?

    “Most of us choose to ignore [possible harm], too, because most of our colleagues ignore it.” Here I agree, psychology research supports this explanation. I also agree that drug company presentations are a plausible initial cause (that is reinforced by conformity).

  3. derp Says:

    Seth, thank you for your elaborate response.

    I have just finished reading Atul Gawandes “The Cost Conundrum”. As I can only talk for continental-European health care sytems that are still largely driven by non-profits and local and state agencies, I cannot completely follow the “it’s the money” theory; maybe the US is simply not comparable, because of the details of its healthcare “system”[1] or its entrepreneurship culture.
    Most colleagues I meet seem to be interested in “not working more than 9 hours a day” and “doing less night-shifts”. Either we have a severe case of all of us lying to each other (and ourselves) or the “it’s the money” theory is deeply insufficient.
    If I was lying to myself and went 6 years through med school because I’m a greedy bitch, I’d love to find out how I can stop lying to myself. (No sarcasm here, I’d really appreciate to know every self-deception of my brain.)

    For all the insufficiencies that exist in the system, a blog comment will not suffice, as we both know. I’d like to exclusively focus on the “doctors do it because of the money” thing, because from everything I observed, that is not how 99% of us operate. I’ve seen enough greedy folks in the economy department at the university, though. They even admitted to greed.

    OK. I will stop here because I don’t want to sound like that whiney blog commentator who loves to argue with the blog owner just to make a point.

    Thank you for your time reading and responding to my opinionated emissions.

    [1] I am deeply sorry for having to put that word in quotation marks, but you might have noticed that the USA is ridiculed for its healthcare system by virtually every other first world country.