Unbiased Analysis of Today's Healthcare Issues

The Boids and the Bees: A Book Review

Written By: Jason Shafrin - Feb• 19•10

The book The Boids and the Bees by A.H. Jones and Jerry Bozeman can be summarized in one acronym: CASY.  This stands for Complex Adaptive Systems.  The point of the book is that CASYs are more complex than we think and that most of life is make up of CASYs.

Let us take the example of your car (which is not a CASY).  If you have a problem with a cracked part in your engine, by replacing the part, the engine will be as good as new.

However, if you address the problem in such a direct manner for a CASY, the effect may not be what was intended.  For instance, antibiotics kill bacteria.  One would think that the use of antibiotics will make humans healthier.  However, bacteria adopt to the antibiotics through evolution.  The strong survive and then the most prevalent bacteria strains becomes the ones that are drug resistent.  Using antibiotics may, in the long-run, make humans more susceptible to disease.

The book The Boids and the Bees is basically a lists a series of CASYs. These include:

  • Health Insurance: Health insurance gives patients access to better medical care. But patients (moral hazard) and doctors (supplier-induced demand) adapt and unneccessary medical care is often provided when the patient has health insurance.
  • Biotechnology: Biotech companies are built on the premise that one gene coding produces one protein and fixing that gene can make an individual healthy. “But geneticists are now realizing that genes too are complex in the relationships and that focusing on one is just as risky as analyzing one part of the inflammatory chain.”
  • Education: The Bush administration wanted to improve learning. They decided to do this by measuring test scores. When this happened, teachers adapted and started teaching to the test. Tests scores improved but learning may or may not have.

Although the book makes a lot of valid points, I didn’t find much new in the text. Most social scientists know that systems are complex. Further, just admitting that they are complex does not help us understand how they operate. A bit of humility may help physicians, social scientists and researchers make less sweeping prognastications, but demonstrating that the mechanical view is incorrect does not show us what the correct model is.

The book does propose an interesting idea for reforming health care (although not an entirely novel one). The authors propose more spending on public health. Government run public health agencies would help disseminate information on the actions people could take to stay healthy. This includes eating better, exercising, and not smoking. They could also help improve the sanitation and clean water supplies in the country which, unfortunately, are often ignored as one of the main contributors to the health of a society. Public health would also monitor contaminants such as mercury, asbestos and lead.

While public health agency’s goal would be to maintain your health, health insurance is supposed to cover your medical costs when you are sick. Jones and Bozeman propose using an health savings account (HSA) model for health insurance. The HSA would put individuals more in control of their health care and insurance would be mainly for catastrophic illness. This would reduce the magnitude of moral hazard. Patients would be less likely to ask for unnecessary MRIs if they had to pay the full cost of the tests themselves.

Also, the authors are (correctly I believe) fairly skeptical of evidence based medicine.

  • “The effect of evidence based medicine is to promote the treatments that make enough money to pay for the expensive tests.”
  • “Evidence based medicine continues the error of our current medical model of treating the body mechanically; it attempts to analyze and reduce the problem to its one fundamental imbalance that can be treated with a drug.”

Overall, the concept of a CASY is important.  Jones and Bozeman make a number of wise suggestions for reforming social policy.  But the book rambles a bit and loses its focus.  The concepts of the book are worth understanding, but I would not put this work on any ‘must read’ list.

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  1. […] Healthcare Economist · The Boids as well as a Bees: A Book Review […]

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