The difference I'd point to is that surgery as a system generally works. Fresh med school graduates get hired, train for a few years, and mostly become competen

The difference I'd point to is that surgery as a system generally works. Fresh med school graduates get hired, train for a few years, and mostly become competent surgeons. Incompetent ones mostly get weeded out, or boxed into careers that minimize any harm they do. And they're (rightly) forced by lawsuits to compensate victims of genuine malpractice. Regulatory agencies, by contrast, are an extremely fragile system. That's in the sense that if the right people are in charge, it could go well, but if the wrong people are in charge, it's a disaster. And it's completely commonplace to find that the wrong people are in charge. A good system either makes it very hard for the wrong people to gain control, or, to use a Milton Friedman line, "makes it profitable for the wrong people to do the right thing". What I was trying to say with my comment is that neither of those conditions is true at most regulatory agencies.