The medical field is so culturally ingrained with the belief that only randomized trials can prove causation that journals actively remove causal language (e.g., "X caused Y") from studies using observational data, even from rigorous natural experiments. This belief hinders the adoption of these valuable methods.
A natural experiment found that high-risk heart attack patients had higher survival rates when hospitalized during major cardiology conferences. This suggests that with senior specialists away, less intensive and potentially risky procedures were performed, benefiting patients on the margin for whom the risk-benefit profile of aggressive care was unfavorable.
The scientific process relies on replication to verify findings, yet academic journals create a "replication crisis" by prioritizing novelty over truth. They often reject crucial follow-up studies, telling researchers "you already published this finding, so there's nothing novel here," which obstructs the validation of important research.
To measure COVID transmission at small gatherings, researchers used insurance data to link birthdays—a proxy for parties—to subsequent diagnoses. They found households with a recent birthday had a 30% higher rate of COVID-19, empirically demonstrating that small, trusted social events were a significant vector for disease spread.
Medical ethicists reject "human challenge trials" (intentionally exposing paid volunteers to a virus) because it harms individuals, even if it could accelerate vaccine development and save countless more lives. This highlights a fundamental conflict with economic thinking, which prioritizes maximizing overall social welfare and would endorse such trade-offs.
Economists developed "natural experiments" to find real-world situations that mimic randomized trials. This approach, where otherwise identical groups receive different "treatments" by chance, can establish causality from observational data. It represents a powerful but underutilized tool for medical research beyond traditional, expensive trials.
The medical system can default to providing more intensive care, but this isn't always beneficial; sometimes 'less is more.' Patients should feel empowered to ask critical questions like, "How likely am I to benefit from this?" and "Could I be better off with less aggressive therapy?" to ensure the chosen path is truly right for them.