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michaelsklar's avatar

Without endorsing a specific position, consider:

1. The scientific feedback loop in surgery is in some important ways better than drugs, in the sense that non-randomized evidence does a lot to improve the science. When surgery goes wrong, often-enough, it goes wrong in ways that can be reliably attributed to specific process sub-components, allowing iterative improvement. Causal mechanisms of drug side effects etc. are far harder to follow and mitigate at the level of a single case

2. If you bucket dental procedures as surgeries, I think you would clearly observe large amounts of fraud, unnecessary work, and wrong practices. Is medical surgery simply different from dental? Why? In part it may be due to medical surgery's extremely selective training and high stakes; even within medicine it is an outlier and consumes high-quality human capital in a way that may be unwise to scale

3. Most new surgeries are risky to patients and expensive, and so are restricted to cases where we expect large benefits on the core concerns. But the case for FDA-style regulation is, paradoxically, best for treatments which might have small margins of harm. If net effect is big and bad, we will figure it out before many people die (and can theoretically resolve costs via lawsuits and insurance). If net effect is small and bad, lacking a regulator with an RCT requirement, we will give it to everyone and fail to figure out the story.

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Nicholas Weininger's avatar

Trying to steelman a case against this: maybe non-FDA-regulated surgery only works because there is no such thing as Big Surgery, whereas there is Big Pharma. That is, maybe the incentives and capabilities of megacorporations make profiting from fraudulent drugs mechanically easier and more tempting than profiting from fraudulent surgical procedures. So the issue isn't just the information problem, it's the presence of a Molochian entity willing and able to hyperexploit that problem.

How might we check whether this is a plausibly salient difference? Note that even if it is, one can imagine different solutions to it than just FDA regulation. But whether it's worth fleshing out those solutions depends on whether this is actually what's going on.

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