The Lancet does not know the first thing about economics

by Carl V Phillips

The Lancet recently editorialized that medics should stick to what they are expert in, diagnosing and treating individual disease cases, because when they venture beyond their expertise they tend to say really stupid things.  Well, actually that is not quite true, as you might guess.  Instead they wrote an editorial that demonstrated that medics should stick to what they are expert in, diagnosing and treating individual disease cases, because when they venture beyond their expertise they tend to say really stupid things.

When physicians venture into epidemiology they are generally pretty bad at it, but at least they have the advantage of being consumers of the science and so are not completely illiterate.  When they venture into other fields, say economics, they are not only not nearly as expert as they think (medics are basically trained to pretend they know everything when dealing with patients, and many of them come to forget that they are pretending) but are completely oblivious to even the basics of the field.

Case in point is the editorial, which is entitled “Tobacco control: when economics trumps health”.  A little rearrangement of the words would actually make this an insightful observation:  Tobacco control: when health does not trump economics.  That rearrangement pretty much sums it up if (in contrast with the authors) you actually understand what the word “economics” means.

The thesis of the editorial seems to be that the reason tobacco control continues to fail is that  manufacturers make money selling the products.  I say “seems to be” because they kind of wave their hands in that direction but never actually argue it.  They seem most worried about the recent UK decision to not mandate plain packaging for tobacco products.  Never mind that there is no reason to believe such a rule would have any effect on health.  More important, never mind that the campaign against the proposal came more from the public than from business who stood to lose profit due to the resulting hassle and black market.

Why would the public object?  Economics.  Not business finance — that is not what the word means.  “Economics” is basically the science of limited resources and making tradeoffs among them to fulfill preferences, and so includes business finance, but also individual preferences and welfare, which I would argue is the far more interesting and important part of the field.  It seems that consumers do not like the government mandating what their cigarette packs look like.  Surprise!

More important, of course, is that people get benefits from using tobacco and nicotine.  That is the critical fact that the tobacco control industry pretends is not true, and that “public health”-type medics like those who wrote the editorial apparently do not even understand.  Preferences — not some contrived conspiracy — is why tobacco control continues to fail.  The most charitable interpretation of the dismissal of real preferences (and there are many others that are rather less flattering still) is that they think health concerns should trump all other human wants: anything that might benefit health, no matter how trivially, should be done, no matter how great the costs it imposes on people.

This is an utterly absurd position.  Those who exercise police powers to force such absurd priorities on others certainly do not behave that way in their own lives.  Do you think that they never eat anything unhealthy and avoid leisure travel, to name just a couple of activities that create risk?  You do not have to view yourself as a libertarian to believe that government should pay attention to economics (i.e., to what people want and to the actual costs and benefits of a policy) before acting.

But when this happens, and health concerns are not allowed to trump everything else, and the “public health” types whine that they are being trumped.  They are not, of course.  They are just being forced to put their personal preferences into the marketplace of ideas and political process, where it just might be that others’ personal preferences win the day.

They are right about one thing:  Economics is not on their side, they just do not know what that statement actually means.