Cruel Caring in Breaking Bad
Breaking Bad is a show about a terminally ill high school chemistry teacher who starts cooking meth to build up a bequest for his family. You see a lot about the economics of drug prohibition in the show, but you’re probably already familiar with it. What’s original about Breaking Bad is its highly Hansonian take on the economics of health care. [Warning: Mild spoilers follow.]
Robin Hanson doggedly argues that health care is more about “showing that you care” than about improving health. Breaking Bad shows us the dark side of caring. When Walt finally tells his family about his illness, he gets almost no genuine sympathy. Instead, his family bullies him into accepting painful, expensive treatments that are almost certain to fail. It’s all about them and their feelings; both objective statistics and the feelings of the man with two years to live count for nothing. Indeed, it’s precisely because his family insists on expensive treatments that Walt keeps making meth even though he’s in way over his head.
The main problem with Robins’ signaling model of medicine is that (unlike the signaling model of education) it’s counter-intuitive. Breaking Bad brings the Hansonian critique of medicine – and “admirable activities” generally – to life.
Jul 23 2009 at 11:23am
I don’t know how they did it, but they managed to get both the science and economics fairly correct in this show. I’ve really enjoyed it.
Jul 23 2009 at 11:44am
If you’re looking for more examples from literature supporting Hanson’s view, start with War and Peace. I apologize for the length of the quotation, but the whole chapter is worth reading, and it was hard enough to limit my selection to two paragraphs.
From: War and Peace, Book 9, Chapter 16, http://www.gutenberg.org/files/2600/2600-h/2600-h.htm#2HCH0183
“Natasha’s illness was so serious that, fortunately for her and for her parents, the consideration of all that had caused the illness, her conduct and the breaking off of her engagement, receded into the background. She was so ill that it was impossible for them to consider in how far she was to blame for what had happened. She could not eat or sleep, grew visibly thinner, coughed, and, as the doctors made them feel, was in danger. They could not think of anything but how to help her. Doctors came to see her singly and in consultation, talked much in French, German, and Latin, blamed one another, and prescribed a great variety of medicines for all the diseases known to them, but the simple idea never occurred to any of them that they could not know the disease Natasha was suffering from, as no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine—not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs. This simple thought could not occur to the doctors (as it cannot occur to a wizard that he is unable to work his charms) because the business of their lives was to cure, and they received money for it and had spent the best years of their lives on that business. But, above all, that thought was kept out of their minds by the fact that they saw they were really useful, as in fact they were to the whole Rostov family. Their usefulness did not depend on making the patient swallow substances for the most part harmful (the harm was scarcely perceptible, as they were given in small doses), but they were useful, necessary, and indispensable because they satisfied a mental need of the invalid and of those who loved her—and that is why there are, and always will be, pseudo-healers, wise women, homeopaths, and allopaths. They satisfied that eternal human need for hope of relief, for sympathy, and that something should be done, which is felt by those who are suffering. They satisfied the need seen in its most elementary form in a child, when it wants to have a place rubbed that has been hurt. A child knocks itself and runs at once to the arms of its mother or nurse to have the aching spot rubbed or kissed, and it feels better when this is done. The child cannot believe that the strongest and wisest of its people have no remedy for its pain, and the hope of relief and the expression of its mother’s sympathy while she rubs the bump comforts it. The doctors were of use to Natasha because they kissed and rubbed her bump, assuring her that it would soon pass if only the coachman went to the chemist’s in the Arbat and got a powder and some pills in a pretty box for a ruble and seventy kopeks, and if she took those powders in boiled water at intervals of precisely two hours, neither more nor less.
What would Sonya and the count and countess have done, how would they have looked, if nothing had been done, if there had not been those pills to give by the clock, the warm drinks, the chicken cutlets, and all the other details of life ordered by the doctors, the carrying out of which supplied an occupation and consolation to the family circle? How would the count have borne his dearly loved daughter’s illness had he not known that it was costing him a thousand rubles, and that he would not grudge thousands more to benefit her, or had he not known that if her illness continued he would not grudge yet other thousands and would take her abroad for consultations there, and had he not been able to explain the details of how Metivier and Feller had not understood the symptoms, but Frise had, and Mudrov had diagnosed them even better? What would the countess have done had she not been able sometimes to scold the invalid for not strictly obeying the doctor’s orders?”
Jul 23 2009 at 12:45pm
Thanks, Steven, for posting the brilliant extract from “War and Peace”.
Jul 23 2009 at 1:07pm
This comment contains spoilers from season two.
Unfortunately for Hansonianism, by season two we learn that the treatment is (surprisingly) successful, and that the prognosis (for Walt and for season three) is pretty good.
Jul 23 2009 at 2:42pm
Also, in a similar vein to your post, are the efforts of his son.
Jul 23 2009 at 3:56pm
Sorry I haven’t seen the show. But my initial reaction is that at what point does one say, “Yeah it’s not worth trying to convince a family member to try and save his or her life”? If the percentage is 50/50 do you say OK it’s not worth trying? How about a 10% success rate or a 1% success rate? At what point do you give up your admittedly selfish attempt to persuade a family member to live? I would think if really didn’t care about someone I wouldn’t need to “show that I care” and could give up trying to persuade someone rather quickly.
Jul 23 2009 at 5:21pm
…painful, expensive treatments that are almost certain to fail.
Would those be the same painful, expensive treatments that had the best chance for success?
(I’m on a “framing” kick after enjoying the paper demonstrating the huge cost of loss aversion in the PGA.)
Jul 23 2009 at 8:08pm
Steven, I use that War & Peace excerpt when I teach health econ.
Jul 24 2009 at 6:42pm
My Four Word Film Review: Teacher needed life insurance.
Of course, if he had sensibly purchased life insurance, there would be no dramatic story.
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