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This will not be well-fleshed out. It's in my head, so I'm writing it down before I forget it.
Someone once said to me that the FDA should not be prohibiting companies from offering a variety of health options. They should, instead, focus on offering information so that customers can make informed decisions about their own health without being held back from tempting new therapies that might work but haven't been tested yet because when someone is about to die, they don't have the time to wait for FDA approval. His exact words were "because it's all about choice, right? I should have the freedom to make my own choices about my health".
No, sorry, it's not all about "choice". Also, the FDA doesn't do that, but that's besides my main point.
When I have a headache, I have the choice to take Aspirin, Acetaminophen (Tylenol), or Ibuprofin (Advil). I can go to the drug store and choose between 3 options that have been tested and shown to work on relieving headaches, and I can choose which one I want based on what I think is right for me using the information guidelines on the back of the box, including potential side effects and recommended doses.
But I do not think people should be presented with the "choice" between chemotherapy for their cancer, and homeopathic pills. That's not a choice between competing modalities that have more or less equal efficacy. That's fraud. One has been shown to work, and along with the offer of chemo comes the likelihood of its success, which is different for everyone. Homeopathy has no plausible mechanism and has been shown, definitively, not to work.
And I do not think the FDA, or any other governing body, should allow these two options to compete for a consumer's attention on an equal playing field.
Besides, the FDA serves a very important function, and that's to spank those companies that make false claims. The FDA, while not perfect, is there to *protect* us from harmful and fraudulent claims. It is not "restricting our personal freedom", it is restricting the freedom of charlatans to take advantage of an unsuspecting and vulnerable public, much like our justice system restricts the freedom of those who have been proven to be a danger to society (in theory).
Providing something like homeopathy with the same platform and legitimacy as chemotherapy, and simply giving the consumer "all the information" to allow him to make "his own choice for his own health" is counterproductive. This person is already sick, vulnerable, possibly desperate, and easy prey for fancy buzz words, pretty charts, and slick-talking, sciency-sounding "authorities". Any attempt to correct the misinformation can be easily spun as "trash talk" from their "competitor".
If there is no oversight by an independent agency to say "look, these guys over here with the chemotherapy are telling the truth. We checked it out, and their product does what they say it does. But those guys over there with the bottle of pills are lying - the pills are just sugar pills and don't do shit for your cancer." - if we don't have something like this in place, the average consumer is simply bombarded by companies vying for their attention and their dollar. There is *too much* information, and people cannot distinguish between the crap and the roses without the appropriate medical background.
The "free market" does not weed out those products that don't work, not in the health sector. It just doesn't. It's not like a TV that you can buy in the store where you know it doesn't work because you plugged it in and nothing happened. And even when a company is *known* to sell crap products, people still buy them. But an independent agency that reviews these things at least makes companies *recall* them when they're actively harmful, because you won't know that until after you've bought it - not unless there's someone out there specifically tracking this kind of thing, which, btw, is what these agencies do.
And with the health industry, it's a lot more complicated, and things that are known not to work, and things that are known to cause harm, are continually purchased and used by consumers, and many attempts to unmask these hucksters are quashed, often using our legal system for "free speech", which those who are touting the merits of "choice" in these matters are also fond of supporting.
The information *is* out there, for anyone to find if they're so inclined. But many are not, and many are not capable of understanding it even when they find it, and that's besides the point: we shouldn't *have* to dedicate our lives to biology and medicine in order to make decisions like which cold remedy to buy at Walgreens. We should have a method in place that prohibits and limits the exposure these quacks have, a method that does not allow them to compete with legitimate medicines as if they were actually comparable and a suitable alternative. SCAM artists (supplemental, complimentary, & alternative medicine) should not be allowed to play with the big boys because they are not playing the same game.
It's as if the medical community is the NFL, playing by an established set of rules that are complicated, but transparent, and anyone can watch a team to make sure it's playing fairly. But the SCAM industry is playing some bizarre version of Duck, Duck, Goose, only it randomly calls out "Antelope!" and that means something but since the rules aren't transparent, no one can tell. So SCAM comes to the doctors and says "we want to play on your football field with you. Yeah, we're totally playing football too! Pinky swear!", and then kicks out all the referees and enlists the audience in judging who the winner is by popular vote.
They don't explain what their Duck, Duck, Goose, Antelope, Pickup Truck game is or how to play it, but they like to spend a lot of time getting the audience up to participate in group cheers and booing the stuffy doctors with their rules for being all "restrictive" and "elitist" by denigrating their years of study and specialization as if that were a bad thing for medicine. The SCAM artists know what the crowd *really* wants! They want more kicklines and cheerleaders in short skirts! Not that boring old run from one side of the field to the other like every other game! And what about painting a hopscotch court onto the field? Those yardage lines are so *restrictive* and they stifle creativity!
Meanwhile, the legitimate doctors are standing on their field saying "what the fuck just happened? We have the rules right here. This is how you play the game. Hey, pipsqueak! Get off the field before you get hurt, or worse yet, drag some poor crowd member onto the field and *he* gets hurt! Go back to the playground and let the grown-ups get back to the real game here!"
OK, I think I've taken that analogy further than it should have gone. As I said, this isn't fleshed out yet, it's just my brain ramblings over being told "it's all about choice, right?" Anyway, back to the point. And that is that alt-med and legitimate medicine are not "all about choice" because they are not comparable options. One works, and the doctors will tell you how *well* it works, and the other either doesn't work, or hasn't been proven to work yet.
Sure, some alternative treatments turn out to be valid, after all, aspirin is the active ingredient in willow bark, which was often drunk as a tea for pain relief. When we discover that an alt-med practice works, it becomes ... medicine.
**UPDATE** Check out Common Questions about Science and "Alternative" Health Methods, which covers the "freedom of choice" issue, along with a few other common misunderstandings of science-based medicine vs. so-called alternative medicine.
Someone once said to me that the FDA should not be prohibiting companies from offering a variety of health options. They should, instead, focus on offering information so that customers can make informed decisions about their own health without being held back from tempting new therapies that might work but haven't been tested yet because when someone is about to die, they don't have the time to wait for FDA approval. His exact words were "because it's all about choice, right? I should have the freedom to make my own choices about my health".
No, sorry, it's not all about "choice". Also, the FDA doesn't do that, but that's besides my main point.
When I have a headache, I have the choice to take Aspirin, Acetaminophen (Tylenol), or Ibuprofin (Advil). I can go to the drug store and choose between 3 options that have been tested and shown to work on relieving headaches, and I can choose which one I want based on what I think is right for me using the information guidelines on the back of the box, including potential side effects and recommended doses.
But I do not think people should be presented with the "choice" between chemotherapy for their cancer, and homeopathic pills. That's not a choice between competing modalities that have more or less equal efficacy. That's fraud. One has been shown to work, and along with the offer of chemo comes the likelihood of its success, which is different for everyone. Homeopathy has no plausible mechanism and has been shown, definitively, not to work.
And I do not think the FDA, or any other governing body, should allow these two options to compete for a consumer's attention on an equal playing field.
Besides, the FDA serves a very important function, and that's to spank those companies that make false claims. The FDA, while not perfect, is there to *protect* us from harmful and fraudulent claims. It is not "restricting our personal freedom", it is restricting the freedom of charlatans to take advantage of an unsuspecting and vulnerable public, much like our justice system restricts the freedom of those who have been proven to be a danger to society (in theory).
Providing something like homeopathy with the same platform and legitimacy as chemotherapy, and simply giving the consumer "all the information" to allow him to make "his own choice for his own health" is counterproductive. This person is already sick, vulnerable, possibly desperate, and easy prey for fancy buzz words, pretty charts, and slick-talking, sciency-sounding "authorities". Any attempt to correct the misinformation can be easily spun as "trash talk" from their "competitor".
If there is no oversight by an independent agency to say "look, these guys over here with the chemotherapy are telling the truth. We checked it out, and their product does what they say it does. But those guys over there with the bottle of pills are lying - the pills are just sugar pills and don't do shit for your cancer." - if we don't have something like this in place, the average consumer is simply bombarded by companies vying for their attention and their dollar. There is *too much* information, and people cannot distinguish between the crap and the roses without the appropriate medical background.
The "free market" does not weed out those products that don't work, not in the health sector. It just doesn't. It's not like a TV that you can buy in the store where you know it doesn't work because you plugged it in and nothing happened. And even when a company is *known* to sell crap products, people still buy them. But an independent agency that reviews these things at least makes companies *recall* them when they're actively harmful, because you won't know that until after you've bought it - not unless there's someone out there specifically tracking this kind of thing, which, btw, is what these agencies do.
And with the health industry, it's a lot more complicated, and things that are known not to work, and things that are known to cause harm, are continually purchased and used by consumers, and many attempts to unmask these hucksters are quashed, often using our legal system for "free speech", which those who are touting the merits of "choice" in these matters are also fond of supporting.
The information *is* out there, for anyone to find if they're so inclined. But many are not, and many are not capable of understanding it even when they find it, and that's besides the point: we shouldn't *have* to dedicate our lives to biology and medicine in order to make decisions like which cold remedy to buy at Walgreens. We should have a method in place that prohibits and limits the exposure these quacks have, a method that does not allow them to compete with legitimate medicines as if they were actually comparable and a suitable alternative. SCAM artists (supplemental, complimentary, & alternative medicine) should not be allowed to play with the big boys because they are not playing the same game.
It's as if the medical community is the NFL, playing by an established set of rules that are complicated, but transparent, and anyone can watch a team to make sure it's playing fairly. But the SCAM industry is playing some bizarre version of Duck, Duck, Goose, only it randomly calls out "Antelope!" and that means something but since the rules aren't transparent, no one can tell. So SCAM comes to the doctors and says "we want to play on your football field with you. Yeah, we're totally playing football too! Pinky swear!", and then kicks out all the referees and enlists the audience in judging who the winner is by popular vote.
They don't explain what their Duck, Duck, Goose, Antelope, Pickup Truck game is or how to play it, but they like to spend a lot of time getting the audience up to participate in group cheers and booing the stuffy doctors with their rules for being all "restrictive" and "elitist" by denigrating their years of study and specialization as if that were a bad thing for medicine. The SCAM artists know what the crowd *really* wants! They want more kicklines and cheerleaders in short skirts! Not that boring old run from one side of the field to the other like every other game! And what about painting a hopscotch court onto the field? Those yardage lines are so *restrictive* and they stifle creativity!
Meanwhile, the legitimate doctors are standing on their field saying "what the fuck just happened? We have the rules right here. This is how you play the game. Hey, pipsqueak! Get off the field before you get hurt, or worse yet, drag some poor crowd member onto the field and *he* gets hurt! Go back to the playground and let the grown-ups get back to the real game here!"
OK, I think I've taken that analogy further than it should have gone. As I said, this isn't fleshed out yet, it's just my brain ramblings over being told "it's all about choice, right?" Anyway, back to the point. And that is that alt-med and legitimate medicine are not "all about choice" because they are not comparable options. One works, and the doctors will tell you how *well* it works, and the other either doesn't work, or hasn't been proven to work yet.
Sure, some alternative treatments turn out to be valid, after all, aspirin is the active ingredient in willow bark, which was often drunk as a tea for pain relief. When we discover that an alt-med practice works, it becomes ... medicine.
**UPDATE** Check out Common Questions about Science and "Alternative" Health Methods, which covers the "freedom of choice" issue, along with a few other common misunderstandings of science-based medicine vs. so-called alternative medicine.
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no subject
Date: 7/10/10 10:06 pm (UTC)From:Then I grew up and I decided that I'd rather have people be happy and well than have them have as much freedom as possible. I'd rather balance freedom with happiness and well being, because while sometimes freedom promotes happiness, sometimes it does not.
There are several issues involved and I think The Paradox of Choice is pretty much a must-read for anyone who thinks "freedom" and "choice" is always ideal. But first off, more choice means more work. I view having to look through more options as a tax that consumers pay. If those options are all of value, but have different pros and cons, then this is likely worth it. If those options are all of value, but some will be better for some people and some better for others, than those options are worth it. But choices that are actively harmful and bad are a tax consumers pay for no benefit. We don't view it as a tax, because we don't view being forced to use our time and cognitive resources as a cost, but it is a very real cost.
People have limited cognitive resources, and the more choices they need to sort through, the sooner these run out. And if they have to make choices for every little thing, they'll make poorer choices. Too many choices for pain killer and they'll make poorer choices with which phone company they use. That sort of human limitation is not accounted for in any of the market models I've seen, because the two areas do not interact at all.
They've shown that when you present workers with a small number of stock portfolios to pick from, all of them decent, they will end up generally benefiting from these investments. But when you let them pick from a very large number many of them will basically give up on making a good choice and choose fairly randomly, and this greatly increases their odds of doing poorly. By presenting a large number of options, you make people feel overwhelmed, and then they cannot choose what they want well. Giving people the ability to shoot themselves in the foot is not actually going to promote well being or happiness, and simply having to make the choice of whether or not to shoot yourself in the foot is going to cost everyone, even those who do not choose to, because they will have fewer resources for the next choice they face.
It is, of course, worse the more they have to do it in fields they do not even understand well. And if you're talking a medical situation, people often do not have the time to analyze the pros and cons, if they even have the ability. (I've often found I do not have the ability to assess the claims of various medical things I am considering trying. I am lucky to have a medical professional that will talk to me at basically whatever length I want to, do research for me, and not charge me for it, but most people won't have that.)
There is also the fact that options create the illusion of something really good being out there. If there are countless options and you can't look through all of them, you are more likely to feel that if you searched more or chose differently that you could have found something better. But this isn't necessarily the case. If we know there is nothing better out there, then this will just make people less happy with what they do choose and the outcome they do have.
Since people do not benefit from this in any way, I don't see why "freedom of choice" should always be our highest priority. I will fight for choices that people really care about, ones where the options really do make a difference. I think people should be able to choose who they live with, where they live, what jobs they have, which books they read, etc. There's some pretty good reasons to think that being forced into models you don't like in these areas is harmful. But for outright fraudulent "treatments" the only reason I am aware of that people feel bad if they cannot use them is because they were presented with false hope in the first place. The correct solution is to take away the false hope. And then let people focus their choice-making mental resources on the choices that matter.
no subject
Date: 7/10/10 10:22 pm (UTC)From:The person who made that statement also tried, among other things, ear candling, which has been outlawed in Australia for its harmful effects on those who purchased it. But if they were outlawed here, he would have a problem with that because it should be "his choice" to try them or not.
Of course, he also has Kevin Trudeau's book awaiting him on his nightstand, based on a recommendation. There is plenty of information available online about what a flagrant fraud and nutcase Trudeau is (he's one of those conspiracy theorists who thinks the medical establishment is trying to silence his Single Treatment For All Disease by censoring him from late-night infomercials & sicced the FDA on him with large fines), but even this person, with his belief that he can research his own options to make his own choice, this person still has the book on his nightstand and thought that putting a lit candle in your ear really did create a vacuum that sucked out all the ear wax and was safer that Q-tips. And this is a relatively well-educated, reasonably intelligent person.
People do not make good choices simply with "information", and too much information seems to be an active detriment to making good choices, even those "personal" choices that can vary from individual to individual.
no subject
Date: 7/10/10 10:30 pm (UTC)From:As one friend pointed out, think back to your high school math classes. How many of your peers really got math? Now think about how many of them could likely really make an intelligent choice with regards to compounding interest?
I felt it was a good point. And that's without choice-fatigue thrown in. If you throw too many choices at people, they just try to avoid them, which is often worse than any other option. Or they pick fairly randomly. Or they give up and ask someone else to choose for them. We need to concentrate mental power where it is useful. And removing harmful choices is highly beneficial to everyone. Because some choices really do matter and people really do need to make for themselves. And those choices will be hurt by people being forced to make countless trivial ones.