What can economics learn from medicine?
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By Peter Swann
[Editor’s note: G.M. Peter Swann is Emeritus Professor of Industrial Economics at Nottingham University Business School]
Arnold Harberger once said that, when he thought about economics as a discipline that also has practitioners, “the analogy I like best is with medicine … a profession with one foot planted in medical science, the other in what we know as the practice of medicine.”1 And Keynes famously suggested that, “if economists could manage to get themselves thought of as humble, competent people, on a level with dentists, that would be splendid!”2 If the analogy with medicine and dentistry was good enough for Harberger and Keynes, then it is good enough for me.
Nevertheless, we should be clear that there are some fundamental differences between economics and medicine. This point has been well made in a thoughtful piece on the RWER Blog by Peter Radford.3 Therefore, I shall limit myself to listing five things that economics can usefully learn from medicine.4
First, it is widely recognised that medicine is not a single discipline, but a federation of semi-autonomous sub-disciplines.5 Indeed, this is true of many other disciplines too, including: physics, chemistry, neuroscience, materials science, cognitive science, computing, geography, history, and business studies. Medicine is one of the best examples of a federation, because the sub-disciplines enjoy (and need) some autonomy but adopt common standards to facilitate trade between them. In comparison, the economics discipline appears to be much closer to the unitary state model of an academic discipline. True, there are sub-disciplines, but they have little autonomy, and are expected to conform to the methodological standards of mainstream economics. Many of the problems recognised by critics of the mainstream, and by practitioners and those who use economics, would be easier to solve if economics were such a federation.
Second, many of the problems identified by critics stem from an inadequate empirical foundation to economics. Within the medical federation are three absolutely fundamental empirical sciences that are required knowledge for all who practice, study or research medicine: anatomy, physiology and pathology. They are sometimes called the ‘three eldest daughters of mother medicine’. They are heavily empirical, they involve detailed direct observation and description, and they underpin many of the other medical sub-disciplines. In comparison, the study of economic anatomy (structure) is sketchy, and the study of economic pathology (disease) is very underdeveloped. Indeed, one leading perspective asserts that pathological conditions are rare in free markets. Granted, the study of economic physiology (function) is very well developed (e.g. production functions, demand functions, and so on), but it is a ‘black box’ version of economic physiology, that rarely builds on economic anatomy. The dominant empirical technique in economics is econometrics, which uses indirect inference rather than direct description, and is therefore very different from anatomy.
Third, in addition to these three fundamental sciences, the federation contains a variety of sciences formed by the fusion of two disciplines (e.g. biochemistry), and a wider variety of complex hybrid sub-disciplines. I don’t suggest that there is, or should be, an economic equivalent to each and every one of these. But economics would benefit enormously and would be far better placed to answer some of the criticisms it faces, if hybrids like these were to emerge within the economics federation. Why is that? Other disciplines criticise economics because, despite the fact that trade plays an essential role in the economy, the economics discipline does not seem to recognise the importance of trade with other disciplines.
Fourth, as noted in the earlier quotation from Harberger, one thing that medicine and economics have in common is that they both have scientists and practitioners, though the nature and number of these practitioners is very different in the two cases. It is instructive to compare the extent of scientific interaction between practitioners and scientists in the two disciplines: this interaction appears to be markedly better developed in medicine that in economics. Within medicine, indeed, there are some sub-disciplines that build on collaboration between practitioners and medical academic, but that seems much less common in economics. I have been involved in several such collaborations and am clear that they offer exceptional opportunities to learn things that cannot be learned from conventional academic research. Collaborations of this sort could deal with many of the criticisms of economics emanating from business and government.
Fifth, and finally, to borrow the words of John Donne, no discipline “is an island”. What is expected of a discipline is not simply what the scholars of that discipline want to do in their discipline. There are wider social expectations which are discussed, informally at least, in a form of social contract. Medicine appears to have a good, though not perfect, understanding of the social contract governing their disciplines. But in economics, the picture is mixed: some economists appear to be sensitive to this social contract, while others appear to have little interest in what the wider world wants from economics.
I believe the idea of a federation can in principle offer the best of both worlds. It allows the core of the discipline to follow its traditional research approach, while creating new sub-disciplines to do the things that the core cannot do, and does not want to do. I understand that some researchers and practitioners from the core sub-disciplines may be sceptical about some of the new sub-disciplines. But there is a simple test of the usefulness of the latter: can they provide empirical methods or theoretical advances that work better than available methods in the core? If so, then they have earned their place.
- Harberger, A.C. (1993), ‘The Search for Relevance in Economics’, American Economic Review, Papers and Proceedings, 83 (2), 1–16
- Keynes, J.M. (1930/1963), ‘Economic Possibilities for our Grandchildren’, in J.M. Keynes (ed.), Essays in Persuasion, New York: W. W. Norton & Co., pp. 358–73
- Radford, P. (2014), “Is Medicine a Model for Ethics in Economics?”, Real World Economics Review Blog, rwer.wordpress.com/2014/02/24/is-medicine-a-model-for-ethics-in-economics/
- These are discussed in greater depth by Swann, G.M.P. (2019), Economics as Anatomy: Radical Innovation in Empirical Economics, Cheltenham: Edward Elgar Publishing
- Bucher, R. and A. Strauss (1961), ‘Professions in Process’, American Journal of Sociology, 66 (4), 325–34. Klein, J.T. (1993), ‘Blurring, Cracking and Crossing: Permeation and the Fracturing of Discipline’, in E. Messer-Davidow, D.R. Shumway and D. Sylvan (eds.), Knowledges: Historical and Critical Studies in Disciplinarity, Charlottesville: University Press of Virginia, pp. 185–211.
From: pp.4-5 of WEA Commentaries 9(1), April 2019
https://www.worldeconomicsassociation.org/files/Issue9-1.pdf
Dear Peter – Thanks for such a refreshingly useful little essay. It confirms my early insight & inspiration for my progressive R&D in economics, monetary theory and metatheory of ethical meta-economics. I started publishing drafts (online) entitled “Global Emergency Medicine.” In 2008 I had no idea that Harberger existed, nor that Keynes considered dentists superior to most economists. Nor did I know that Veblen saw an interdisciplinary whole-systems approach as the prerequisite for developing optimal theory and practice. Now, though I agree with most of your insights & sentiments, I think we need to look more deeply into what enables medicine’s domain of discourse, enabling the basic unity & effective interaction of its subdomains.
The foundation of the medical federation and its subfields of research & practice is its paradigm, the meta-logic, metatheory and bio-ethics informing & sustaining the whole universe of medical science & practice.
Now, though I will get into more detail in a forthcoming paper on your essay (and related issues), the problems you mentioned would all be impossible if economics had not forfeited ethics & realism for the sake of econometrics, plutonomy & kleptocracy. As mentioned elsewhere, there can be no cure of its ills nor a science of economics as long as it lacks a whole-systems approach to the study of civilization and reality. Unfortunately, as long as it ignores ethics, there can be no effective, whole-system R&D of meta-economics metatheory to support healthy evolution of the field. Lacking that, how then could there be any real fulfillment of a bio-ethical social contract?
As Illich implied, replacing the “good” with maths effectively rendered economics unethical and dysethical, amoral at best, and evil at worst. That seems to explain why John Law, Simmel & Schumacher are so often forgotten or ignored, unmentioned & unconsidered. It also seems to reveal the specious reasoning and pandemic denial that maintains the general lack of motivation for including bio-ethics as an essential element of the field, despite the mounting consequences of ecocide-for-profit.
I feel safe in saying that the general refusal to seriously consider the true nature and scope of the problem, for the sake of a systemic solution, ASAP, is a symptom of chronic economic autism, among other spiritual & socioeconomic illnesses. Dr. David Suzuki once said that he saw it all as symptoms of ethicide.
Hopefully, for the sake of all generations, somebody else will see the need for the cure, and help to co-create a viable, holistic, realistic science of economics or, perhaps, cultural holonomics or holonomic cultural ontology. In closing, if there are any such interested persons out there, I suggest starting with deep consideration & discussion of axiology and meta-axiology. After all, how can there be any valid science of economics without an adequate basis & understanding of value?
Michael: thank you for your comments which, for me, reinforce the attraction of economics as a federation of semi-autonomous sub-disciplines. Take your example of axiology (the philosophy of value): if the philosophy of health has a recognised place in the medical federation (see below), then surely the philosophy of value has a place within an economic federation. Indeed, John Ruskin’s famous maxim – “There is no wealth but life” (1862) – suggests that these two branches of philosophy are fundamentally inter-related.
The reaction to such philosophical enquiries, however, has been quite different in medicine and economics. In 2011, the British Medical Journal (one of the most mainstream medical journals) considered that the question, “what is health?”, was so important that they published a record of the online debate about that topic. In contrast, these remarks from Dasgupta (2002, p. 57), accurately summarise the typical mainstream view of such issues:
“Most economists I know have little time for the philosophy of economics as an intellectual discipline. They have even less patience with economic methodology.”
Your ambitions for a very fundamental re-design of economics are more ambitious than mine, but I am certainly not saying that you are wrong. I suppose that, after almost fifty years of studying economics, I have unhappily come to the conclusion that Medawar’s famous maxim (1982, pp. 253-4) is almost inescapable in the economics discipline of today:
“No scientist is admired for failing in the attempt to solve problems that lie beyond his competence. The most he can hope for is the kindly contempt earned by the Utopian politician. If politics is the art of the possible, research is surely the art of the soluble.”
But if economics were properly a federation of autonomous sub-disciplines, then things could be quite different.
BMJ (2011) ‘What is Health?’ https://www.bmj.com/content/343/bmj.d4817
Dasgupta, P. (2002), ‘Modern Economics and its Critics’, in U. Maki (ed.), Fact and Fiction in Economics: Models, Realism and Social Construction, Cambridge, UK: Cambridge University Press, pp. 57–89
Medawar, P.B. (1982), Pluto’s Republic, Oxford: Oxford University Press
Peter, thanks for such a helpful response. I wish it was more encouraging, but I appreciate your mention of Ruskin’s maxim: “There is no wealth but life” (1862)
It would probably be helpful if you specify the intended object of your quote from Medawar. Yet, I also wish you were optimistic about your profession’s potential for developing a capacity for understanding value and wealth. Contemplating economists’ lack of competence required for misunderstanding value and wealth is daunting indeed.
As issue 87 of RWER makes abundantly clear, the consequences of economics and commercially sponsored ecocidal mania are inseparably interdependent. Hence, without a self-consistent logical, ethical foundation of enabling metatheory, how could a federation of subdisciplines of an unethical pseudo-science do any good?
After all, what perpetuates ecocide-for-profit more effectively than making goodness, badness, greed and pandemic delusion externalities of kleptocratic economics?
Maybe I am not more ambitious than you, Peter, just too optimistic about the potential for a sane upgrade of economics.
BTW, the meta-logic of the medical federation’s unitive paradigm is bio-ethics. The enabling principles of bio-ethical metatheory are not matters of opinion, subject to a vote or majority rule. That holds true for any real science dealing with cultural economies.
Hence, without a foundation of valid enabling principles, generally accepted by practitioners, how can their be any valid, viable discipline or sub-disciplines of economics?
Clearly, if economists and economics theorists refuse to research and develop a foundation of meta-economics metatheory integrating axiology, their will be no systemic change for the better, with or without a unitive federation of pseudo-scientific sub-disciplines.
After all, thinking about what’s fair, good and bad for optimal quality of life is not like rocket science. We can all do it if. Additionally, we have a huge archive of expert knowledge of ethics and justice and history that should be sufficient. If economists lack sufficient education and familiarity with ethics, fairness and goodness, we could engage the help of an ethical AI expert system.
As you know, IBM’s Watson AI system can “read” & process 60 million pages of content per second. So, an ideally informed AI ethics advisor will be able to help us finish the job in a few seconds or less.
My short essay attempts to summarise a book-length argument, and the risk is that what the reader hears is somewhat different from what the writer is trying to say. I think that is happening here. If you are interested, you may need to read at least some of the book to make sense of the finer details of the argument.
There are two essential points. First, when I speak of a ‘federation’, I am using the term in the same way as those sociologists of science who observed that many sciences are in fact loose coalitions of quite different enterprises. In such a federation, no one constituent part is dominant. Your definition seems to me closer to the ‘unitary state’ model of a discipline, where one component is dominant, and the rest are subordinate to it.
Second, you wish that I were more optimistic, but my view is more nuanced than that. True, I am rather pessimistic that a ‘unitary state’ economics discipline will address some of the questions that interest us, but I am optimistic that a ‘federation’ could do so. With your definition of ‘federation’, this distinction probably does not make sense; with mine, it certainly does.
Finally, if the relevance of Medawar’s dictum is unclear in this context, then consider this. It is a common argument amongst critics of mainstream economics that it puts too much emphasis on reaching mathematically rigorous solutions on relatively small problems, and too little emphasis on grappling with big economic problems, which may not easily be amenable to such neat solutions.
I would like to bring to your attention the body of work by Prof John McMurty whose life-value onto-axiology which is sufficiently necessary to empirically and ethically life-ground economics in the structural integrity (anatomy) of the planetary and societal life support systems, the equitable provisioning and distribution and metabolism (physiology) of the universal human life necessiites, and identify the pathologies that arise when deprivation of these universal human life necessities occur or the planetary bounds or societal stresses are breached.
These two articles, the first from Prof McMurtry and the other from me that expands on his work by using a life-value onto-axiology approach to evolve economic thinking that is empirically grounded and ethically justified for one and all for once and all.
https://bsahely.com/2018/02/14/the-primary-axiom-of-value-universal-human-economy/
https://bsahely.com/2016/04/16/the-final-frontier-a-blueprint-for-building-a-life-value-rebased-global-economic-and-political-system-for-healing-and-solidarity/