Economics and similar, for the sleep-deprived

Wednesday, July 28, 2010

 
As expected, the word "choice" features heavily in the government's response

... is the throat-clearing equivalent of "you couldn't make it up!" from this prize piece of woo-bashing in the Guardian, via Henry. I don't think it's particularly bacai (although I suspect that I might think otherwise if I had been the civil servant who wrote the rather clever and well-thought-out response it's having a go at), but it's pretty typical of what I consider to be the wrong approach to dealing with homeopathy.

That approach being, of course, roughly that of Monty Python's Bruces sketch - "you're allowed to teach Marx, as long as you make it clear that he was wrong". Actually the select committee report was a bit more aggressive than that - they appear at several points to be saying that it is unethical to prescribe placebos for patients per se, and the practice should possibly be banned and certainly not allowed under the NHS[1].

The phrase I've excerpted for my title is the one that set my bells off - it exactly summarises what I don't like about this approach, in dismissing the fundamental right of a patient to decide on his treatment as being some weirdo hippy shit that should be ignored by Real Men Of Science (he has a few paragraphs ridiculing the idea, which are roughly as hilarious as every other stand up comedy act on the theme of "I don't want all this choice ...").

Brass tacks. People want woo[2]. Actually, they want thoughtful, respectful and sympathetic treatment from general practitioners, but that's a) expensive and b) difficult to achieve given the social realities of the medical profession[4]. So woo is where we are now. It would be difficult and expensive to persuade the population of the UK to not believe in homeopathy, and the main consequence would be an additional burden on GPs. Since there is no special off-budget source of funds for skepticism and its consequences, this would also take money away from our household god, which we don't want to do. So we're left with:

1) on the one hand, some people who want thing X, which doesn't do them much harm compared to the comfort and enjoyment they get out of it,

2) and on the other hand, some other people who don't indulge in X themselves and are not affected materially by it, but who have a belief system and world view which makes them think that nobody should consume thing X.

We've pretty much decided on a schema for this sort of problem as a society, and the Enlightenment Values crowd can hardly object to the solution we decided on as it pretty much kept them from being burned at the stake[6] for two hundred years. That's what the government response is doing; threading the needle between endorsing woo and banning it (or putting unreasonable restrictions on people's realistic ability to get placebo treatments they want[7]), and as far as I can see the DoH response is doing so pretty sensibly.

Tidying up with some answers to questions in the Guardian piece:

You get a sense of this confusion very early on, with lines like: "given the geographical, socioeconomic and cultural diversity in England, [policy on homeopathy] involves a whole range of considerations including, but not limited to, efficacy." I actually have no idea what this means – do medicines work differently in Norfolk from the way they work in Hampshire? The report doesn't elaborate

Well, as discussed in a few comments threads here, the demand for homeopathy, and the kind of cases in which it is a good idea to practice placebo medicine, is built up in a particular set of common conditions (canonically, back pain and allergy medicine). And I would very much imagine that these conditions had geographical, socioeconomic and cultural variance.

One of the phrases Orwell that stuck with me from The Road to Wigan Pier, seems apropos here:

"The underlying motive of many Socialists, I believe, is simply a hypertrophied sense of order. The present state of affairs offends them not because it causes misery, still less because it makes freedom impossible, but because it is untidy; what they desire, basically, is to reduce the world to something resembling a chess-board"

There is certainly an equivalent motivation for people entering the medical profession and its adjuncts.

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[1] This would be such a crazy thing to do, and so far out of line with normal medical practice that I suspect that either the government response has taken the select committee out of context, or that I've just got the wrong end of the stick.

[2] A fact! Of actual science! Provable by sociological and economic[3] research!

[3] Sociology and economics! Both actual sciences! In which it is often possible to support hypotheses with evidence to a much greater degree than many areas of medicine!

[4] Also a fact![5]

[5] Actually an unsupported hypothesis, but the sort of statement that could certainly be supported by evidence and achieve the same degree of certainty as the fact referenced above in footnote 2.

[6] Historians who are aware of the very limited extent to which atheists were ever persecuted (heretics, not unbelievers, were largely the ones getting burned), please forgive me for that one.

[7] I could even say "need" here, because plenty consumers of placebo remedies do need them in any sense similar to which most people you'll meet in a GP waiting room[8] need whatever medicine they get prescribed. But actually "want" is all that's necessary for my argument. Giving the people what they want isn't a 'weird fetish' - it's the whole point of the exercise.

[8] Or at least, a GP waiting room in my neck of the woods; see point about social variation above.
posted by the management 7/28/2010 07:06:00 AM 45 comments