“Economists are the gods of global health.” Richard Horton at it again!

Richard Horton dislikes the economics discipline. That should not come as a shock to anyone. But worse still, this animus appears to arise from a misunderstanding of what economists actually do. Not so long ago, we discussed the fundamental errors in a piece in The Lancet Horton had published. Well, a new tweet from Horton leads us to yet another piece denigrating the economics profession:

The essence of Horton’s latest tirade is that (1) “economists silence the smaller voices of medicine”, (2) economists are responsible for austerity, (3) austerity has had a harmful effect both socially and economically, so that (4) “The task of health professionals is to resist and to oppose the egregious economics of our times.” The implication of the four points being that the influence of economists should be (at least partially) extricated from medicine and medical research. I would agree with point (3) here, as do a large consensus of academic economists (read this post and others from Simon Wren-Lewis for a good summary). But the other points don’t really stand up to close scrutiny.

One of the goals of academic economics is to provide evidence to support an optimal allocation of resources. From a macro perspective this may be the allocative efficiency of spending on different sectors like education and health care. Or, in a context used for much health economic analysis, how to allocate a health care budget fixed by the government through a political decision making process. What is considered ‘optimal’ in each of these circumstances is a normative decision and is, again, a political choice in practice. Perhaps this overlap with politics and economics has confused Horton, who mistakes one for the other with claims like

It is economists we must thank for the modern epidemic of austerity that has engulfed our world. Austerity is the calling card of neoliberalism.

But Horton also claims economics has displaced the “modest discipline of biology” in medicine. So, a reductio ad absurdum argument would have economists doing all the medical research and then implementing all medical and health care policy. Why do we need anyone else?

One can certainly claim this blog post is an apologia for economics. Of course would defend it. But it is true that there are good examples of poor economics and academic overreach. The work of the late Gary Becker was often criticized along these lines; his rational theory of addiction in particular. However, criticisms of the work of economists frequently come from economists themselves. I hope this blog serves as a case in point. More and more, health economists work as members of interdisciplinary teams, where a plurality of approaches, qualitative and quantitative, can aid in making sound inferences and supporting effective policy.

Horton’s views cannot unfortunately be dismissed as the ravings of the uninformed. He occupies an important position in medical research, serving as the editor-in-chief of one of the top medical journals, and his voice is influential. It serves no useful purpose to anyone and undermines the positions he advocates for, which many economists actually agree with, to publish false claims about economics.




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