Conspicuous Caring
Medicine and charity are partly about health and helping — and partly about publicly demonstrating that you care. The demonstration has value independent of the outcome.
The core analogy: when a toddler scrapes a knee, a mother's kiss produces no medical benefit, and yet both parties value the ritual. The toddler is reassured; the mother demonstrates loyalty and commitment. A similar dynamic runs through adult medicine at scale, just obscured by all the genuine healing that also happens.
Evidence from medicine
- Randomized studies find that people given free healthcare consume significantly more medicine than control groups, yet don't end up noticeably healthier
- Non-medical interventions (stress reduction, diet, sleep, exercise) have larger effects on health outcomes but attract far less demand
- Patients show remarkably little interest in outcome data — only 8% of patients about to undergo dangerous heart surgery were willing to pay $50 to learn death rates at nearby hospitals
- Expensive end-of-life care is pursued even when cheap palliative care produces equivalent or better quality-of-life outcomes
If medicine were purely about health, these patterns wouldn't occur. They make sense if medicine is also about visibly demonstrating care — to the patient, to their family, and to the institution sponsoring their insurance.
The caring coalition
The "mother" in adult medicine isn't just the doctor — it's everyone who helps along the way: the spouse who drives to the hospital, the employer who provides health insurance, the government that subsidizes it. Each party is demonstrating commitment and buying loyalty, not only pursuing health.
Charity as conspicuous caring
The same dynamic applies to charitable giving. Singer's drowning child thought experiment reveals the gap: we'd immediately wade in to save a child drowning in front of us but don't donate equivalently to save statistically-equivalent distant children. The difference is the visibility of caring, not the child's need.
Warm-glow giving (James Andreoni): donors give partly for the internal reward of having given. The act of giving produces positive affect, independent of impact. This explains resistance to effective altruism — if you're giving for the warm glow, efficiency is orthogonal to your goal.
Related: costly-signaling competitive-altruism hidden-motives