I stand accused. Not of a particularly heinous crime, but of something that has given me pause for thought recently. During a discussion about a piece of work involving patient outcomes, I was accused of ‘thinking like an economist’. Had this come from an economist, it would have been meant in a complementary sense – ‘now you’re thinking like an economist!’ Alas, it was not an economist but a clinician and medical researcher who said it and as such was meant more along the lines of ‘Unfortunately, you’re thinking like an economist’. In particular, the comment was meant to suggest that I was missing the importance of the patient, that I was focussed solely on the numbers, that I knew the price of everything and the value of nothing. Perhaps I am exaggerating the meaning but the sentiment still stands. I felt that this was unfair, both to me in that particular circumstance, but to economists and economics in general. However, I do see why people may come to this understanding of economics; economic discourse to the untrained ear is abstract and separate from the real world, economics is often very mathematical.
Typically, most economic fields do not work as closely alongside natural science as does health economics. Medical sciences and health economics often overlap greatly in their interests; many health economists publish in both medical and economics journals. However, their approach differs somewhat and the difference between them highlights an important difference between the natural and social sciences. Indeed, medical statistics and health econometrics are often considered different subjects, despite the similarities in the tools they use to approach the problems they face. Perhaps, then, it is important to analyse the distinction between the fields to find out the implications of ‘thinking like an economist’.
Economics is a social science. I am not going to provide a treatise on the philosophy of social science but will provide some thoughts on the distinction between the social sciences and the natural sciences. Arguably, the goal of science, social or natural, is to provide and validate statements which are epistemically objective. That is, we may say it produces falsifiable statements and facts. The difference between the natural and social sciences is that the former studies objects which are ontologically objective whereas the latter studies objects that are ontologically subjective. Or, to phrase it in another way, the objects of study of the natural sciences are observer independent and would exist and function whether or not there were humans or science; the social sciences studies observer dependent objects. The economy is a system of social relations in which economists participate and about which economists already have preconceived notions and have already made value judgements.
An education in the natural sciences involves teaching a student to ‘think scientifically’. To formulate and test falsifiable hypotheses about observer independent objects. An education in the social sciences involves teaching a student to re-observe the world in which they live, and to provide them with the tools to simplify it. This way we can think clearly about processes of causality in the social world. In economics, this often involves the use of mathematics and, importantly, a simplified vocabulary. This ‘econspeak’ does not identify new, economic objects – it is not more fundamental or philosophical than everyday language, it serves to simplify the social world. And, since economic words describe a social reality and since the social world is itself entirely linguistic, the meaning of economic words can always be restated in terms of everyday language and have the same meaning. For example, elasticity can be restated as ‘how much one variable changes in response to a change in another variable’, which can then be understood in terms of everyday social life – ‘how many more oranges would I buy if the price of oranges went up by 10p?’ But, in the natural sciences, the subject specific words cannot be restated in everyday language since they are not part of our world. The name of a specific protein cannot be restated in language any more simply, I could describe its function or its structure, but these explanations just skirt around the object, trying to identify it exactly. Our alternative ways of stating elasticity mean exactly the same thing.
Health economics is a social science. Medical science is perhaps more tricky to define. It has elements of both natural and social science since it studies how proteins and cells and ontologically objective objects function but also how behaviour affects health. Medicine is the application of science to improve health and is a social activity. But, many medical scientists come from a natural scientific background rather than a social scientific background. Thus, unless otherwise trained, economic representations of the social world will seem alien and abstract.
I certainly do not deny that economists lack the social interaction with many patients that health service staff have and that this may create a distance between the analyst and the people they study. This may even lead to a lack of understanding on the part of the economist about the nature of things and the state of the world that they examine. I would certainly advocate enhanced dialogue between practitioners of a variety of disciplines – this can only enhance the work being conducted – indeed, this goes both ways. Economists and clinicians alike may better learn about their subject matter. Social science has a lot to contribute to the understanding of medicine and its practice. Greater dialogue may mean greater understanding and fewer accusations such as this.