Tyler Cowen: belief

Transcript context

…You probably know more about me than I do, so let’s see how it goes. [laughter] Maybe. But there are two phrases that strike me again and again. One is when you mention your wife, Sonia, and talk about differential diagnostics. The other is what you call the epoch of the Anthropocene, which you could think of as the time when human beings are in the world in an active way. When we start with primitive society, everything is determined by geography and resources. Economic development, in a sense, is an ongoing process where human beings impose their will and their reason on the world in a kind of planning or voluntaristic fashion. Then there’s a belief that first this needs to be done in a differential way. Not the same recipe everywhere. But a belief in the power of human reason to perform these differential diagnostics to turn this era when humans are on the earth into a time when we’re no longer ruled by resources and geography and the prevalence of malaria. But brought into an era where human reason is in some sense running the show. If I had to boil down my reread of you into a very short bulletin, that’s what I would say. Now do you agree with that, how would you change it, and what would you add to that? That’s pretty good, first of all. I would subscribe to that summary. I should explain this idea of clinical economics, as I’ve called it, or differential diagnosis. When you’re married to a pediatrician, as I have been for 35 wonderful years, you get up in the middle of the night a lot when patients call with a very sick child. I’ve listened to my wife take an oral history a thousand — thousands of times, perhaps. It’s a wonderful art, first of all, because a mother calls with a crisis of a baby or a young child — usually a high fever. The first thing that is important to know is that there are a thousand possible etiologies of that fever. My wife doesn’t say institutions. She says . . . [laughter] . . . “It depends. Let’s hear your problem. Oh, you’re in a desert, you’re here, you’re this . . .” No, when it comes to the child, it could be something as normal as a common cold or a something as devastating as meningitis. The purpose of a differential diagnosis is two things. First, it is of course to try to get to the core reasons so that you can make a proper prescription based on a proper diagnosis. Second, it’s done in a way that you’re minimizing serious risk. The first question always that my wife asks is, “Is the baby’s neck stiff, or do you notice that?” Because that’s one of the symptoms of meningitis. If the mother answers that way, the next point is “I’ll meet you at the emergency room. Don’t stop. Just go.” Because it could be something that is fulminant and life-threatening immediately. If it’s not that, then it can go on for an hour. But by the way, it’s not just an hour of questions. It’s an hour of sequenced questions down a decision tree, and it’s fascinating to watch. I wish as economists we had those basic skills inbred. I certainly didn’t learn them, and it took me a long time of seeing lots of “patients” to see that one needs that same kind of approach. That’s what I mean by differential diagnosis. Why it’s so annoying to me, the one explanation fits all viewpoints. Because now I’ve seen a lot of places, a lot of crises, a lot of challenges. One of the things that I discovered was how poor our profession is at times in having that sense that the problem that you saw over there is not the same as the problem that you’re seeing here.…

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