The Standing Invitation

Posts Tagged ‘Drugs

Fun with Friedman

leave a comment »

This will have to be another brief one because I’m away in parts foreign. For my travel literature I will be reading Mill’s Utilitarianism and probably getting some funny looks for it.

Someone else who I’m sure was a big fan of Mill was Milton Friedman. I’ve been watching a lot of videos of Friedman lately, trying to figure out exactly how I feel about him (I certainly hadn’t expected him to have a sense of humour). Here are some of the good ones on responsibility to the poor, on greed, on corporate responsibility (or lack thereof) and drug legalisation.

Have fun.

Advertisements

Written by The S I

October 19, 2011 at 11:59 pm

On the Relative Merits of AMPium

leave a comment »

“The problem with randomised controlled trials is that they don’t show how therapeutically useful homeopathy is.”

Statements like this elevate my blood pressure. They are often signify an oncoming attack against this wicked thing called Science. One encounters the word ‘homeophobia’: the denial by scientists that unknowable truths exist, motivated by the scientists’ fear that this would shatter their precious little calculations. (They are not so quick to offer a name for the phobia’s counterpart: the fear of being told you are not in fact a beautiful and unique snowflake endowed with mystical powers and the blood of Númenor flowing through your veins; in essence, the fear that there is such a thing as a wrong answer, and you might just have given it.)

Complaining about science in this way tends to be more about identity politics than a real issue of scientific methodology. Nevertheless, let’s take the above claim at its word, and make for it the best case that we can.

The assertion, minus the controversial H-word, is this:

“There exists, or might exist, such a treatment that has two properties: 1) it has some therapeutic value; and 2) it does so in a way that randomised controlled trials do not detect.”

This is the statement that proponents of randomised controlled trials (RCT) must disprove; and since the RCT is held as the gold standard, the burden of proof lies with its supporters.

Imagine a chemical called archibaldmatthewphillipsium or AMPium for short. This is a natural plant extract that has no medicinal value whatsoever – unless your name is Archibald Matthew Phillips. For this one lucky man, regular doses of archibaldmatthewphillipsium reduce the odds of cancer by 95%.

This is an extreme case. But it is well known that different people do react to some drugs differently, and personalised medicine is an important field. A patient with a certain illness will often be given a series of treatments in order to find out which one is best for him.

It so happens that AMPium is exactly the right treatment for Mr Phillips to take, and any systematic drug test that missed its value would let Mr Philips down. In this case, yes, a randomised controlled trial would not be the answer.

But this is unlikely. Nobody is that special. What is far more plausible is that what is 95% effective for Archibald Michael Phillips is, say, 90% effective for his immediate family; 80% for his extended family; 50% for people from a similar genetic or socioeconomic background, and so on, tailing away to a large proportion of the population for whom the drug is essentially valueless. Now we are back in the realms of ordinary statistics.

What should a doctor do when presented with a new patient? Of course the best thing to do would be to test him with every conceivable chemical compound, mystical trinket and shamanistic rite to find out exactly what the best treatment is best for him personally, and I would dearly love to see this happen. But this is impossible: it would take too long, and his symptoms might grow much worse before the tests were completed. This is a fact; not to acknowledge it is extremely irresponsible.

What we ask instead is: which group do we think he belongs in? The group for which treatment x is perfect? The group for which x is just an okay sort of treatment? Or the group for which it’s effectively useless?

Given our imperfect knowledge of the patient, we would base our decision on the sizes of the groups, and start him on the treatment that is most effective for the greatest number of people. And it is precisely that information that a randomised controlled trial provides.

 

REFERENCES

Jeanette Winterson OBE took the opposite view here. I advise you not to click. She doesn’t need the hit count.

Written by The S I

October 15, 2011 at 11:59 pm

Harris and Chomsky On Drugs

with 4 comments

One of the roles of government is to prohibit and enforce the prohibition of activities that reproducibly result in a lowering of the populace’s quality of life. Governments insist that people surrender certain freedoms in the name of the greater good: the freedom not to bash people over the head with mallets, for example.

The illegality of an act should be proportional to its harmfulness (to society, that is; to you is another matter). While I can understand and condone banning the sale of crack cocaine because it reproducibly creates a huge amount of misery and suffering, it is difficult to see why the government bans cannabis ­­– particularly when tobacco, a much deadlier poison, is sold quite legally. I have recently read two different explanations of this strange inversion. One is by the fascinating if slightly scary writer Sam Harris; the other is by Noam Chomsky.

Harris’s contention is that the enemy is religion. Many drugs, he says, allow one  to experience states of extreme bliss and personal fulfilment, often with no damaging side-effects and in the privacy of one’s own home. There should be no harm in that. But religion wants the monopoly on spiritual experiences, and sees drugs as being unwelcome competition. Drugs are deemed wicked for their positive aspects, for their ability to make you happy or alter the way you see the world; their harmfulness is not even considered.

Chomsky’s idea is, if anything, even more cynical. The crucial difference between tobacco and marijuana, he says, is that tobacco is difficult to grow. Weed is a weed: you can grow it in your back garden. Big businesses have no interest in its legalisation because it would give them no scarcity power – nobody would profit from it. Tobacco, on the other hand, is a difficult crop, requiring a substantial investment of technology and capital. A nation’s tobacco industry can be owned in the way a national marijuana industry could never be, and businesses can make huge amounts of money from monopolising it. It will stay legal, in spite of its harmfulness, because it pays.

I don’t know which of these two theories I like most, or even if either of them comes close to the truth. But until the illegality of what substances you choose ingest correlates with the damage it does to people around you, I will be suspicious of the motives of those who tell you what you can and cannot do.

Governments have the power to stop people doing things. Sometimes this power is used wisely and fairly; but often it is not. Whenever a government asks you to surrender one of your freedoms, it’s worth thinking about who benefits from it. And if it’s not you, it’s time to start worrying.

 

REFERENCES

Noam Chomsky – Understanding Power, p49.

Sam Harris ­– The End of Faith, also his blog post: http://www.samharris.org/blog/item/drugs-and-the-meaning-of-life/

Written by The S I

July 20, 2011 at 7:55 pm