Modern medicine: danger to public health and public purse?

Healthcare costs in the USA are now unmanageable, as illustrated by the common bankruptcies of people without good insurance and, just now, by the realization that the Republican promise to “repeal and replace Obamacare” is unworkable if many Americans are not to lose the insurance help they currently have.

One way to reduce costs that is not talked about, and that is unlikely to gain much traction until the crisis becomes catastrophic, would be to call a halt to medical  treatments that do harm rather than good. It comes as a surprise to learn, for example, that prescription drugs, used as prescribed, are the 3rd or 4th leading cause of death in developed nations (Gøtzsche, Peter C. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. Oxford & New York: Radcliffe, 2013
Healy, David. Pharmageddon. University of California Press, 2012).

A recent article at ProPublica and in  The Atlantic has much information  about unnecessary, often harmful practices that continue in routine medical practice:

“When Evidence Says No, But Doctors Say Yes
Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.
David Epstein, ProPublica    February 22, 2017
This story was co-published with The Atlantic.”

The interests vested in present ways of doing things are many and powerful — clinics, hospitals, professional guilds, but chiefly the pharmaceutical industry. So it will not be easy to change the system, despite the fact that dozens of books and articles over the last few decades have described in documented detail what’s wrong with modern medicine.

Science: A Danger for Public Policy?!

Public policies rely on advice and consent from science about an ever wider range of issues (environmental challenges, individual and public health. infrastructure and its safety, military systems). Surely this is unquestionably good, that public policies are increasingly pragmatic through respecting the facts delivered by science?

No. Not necessarily, not always.

The central problem is that science — humankind’s understanding of nature, of the world — doesn’t just deliver facts. Science is perpetually incomplete. On any given question it may not be unequivocal.

The media, the public, policy makers, the legal system all presume that a contemporary consensus in the scientific community can be safely accepted as true for all practical purposes. The trouble is that any contemporary scientific consensus may later prove to have been wrong.

If this assertion seems outlandish —theoretically possible but so unlikely as to be ignorable in practice — it is because the actual history and nature of science are not widely enough understood.

The contemporary scientific consensus has in fact been wrong about many, perhaps even most of the greatest advances in science: Planck and quantums, Wegener and drifting continents, Mendel and quantitative genetic heredity; the scientific consensus and 1976   Nobel Prize for discovering the viral cause of mad-cow diseases was wrong; that stomach ulcers are caused by bacteria had been pooh-poohed by the mainstream consensus for some two decades before adherents of the consensus were willing to examine the evidence and then award a Nobel Prize in 2005.

Historical instances of a mistaken scientific consensus being have seemingly not affected major public policies in catastrophic ways, although one possible precedent for such unhappy influence may be the consensus that supported the eugenics movement around the 1920s, resulting in enforced sterilization of tens of thousands of people in the USA as recently as the latter half of the 20^th century.

Nowadays, though, the influence of science is so pervasive that the danger has become quite tangible that major public policies might be based on a scientific consensus that is at best doubtfully valid and at worst demonstrably wrong.

The possibility that significant public actions might be dictated by an unproven scientific consensus was explicitly articulated by President Eisenhower. His warning against the potential influence of the military-industrial complex is quite often cited, but little cited is another warning he gave in the same speech:

“in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.”

That can happen when a contemporary scientific consensus is accepted as practical truth, as settled science. The crucial distinction could hardly be explained more clearly than Michael Crichton did in an invited lecture at CalTech:

“Consensus is invoked only in situations where the science is not solid enough. Nobody says the consensus of scientists agrees that E=mc². . . . It would never occur to anyone to speak that way.”

Crichton had in mind the present-day scientific consensus that human-caused generation of carbon dioxide is chiefly responsible for rising global temperatures and associated major climate-change. The fact that there are highly competent public dissenters — including such winners of Nobel Prizes as Ivar Giaever (Physics 1973), Robert Laughlin (Physics 1998), Kary Mullis (Chemistry 1993) — demonstrates that human-caused global warming is a consensus, not the unanimity associated with such “settled science” as the Periodic Table of the chemical elements or that E=mc².

The proponents of human-caused global warming constitute an effective elite. Since they represent the contemporary consensus, they largely control peer review, research funding, and which research gets published; and they hold important positions in the halls of power of individual nations as well as in such international organizations as the Intergovernmental Panel on Climate Change.

The history of science is unequivocal: Contemporary scientific consensuses have been wrong on some of the most significant issues. Those who determine public policies would do well to seek an impartial comparison and analysis of the substantive claims made both by proponents of a mainstream consensus and by those who claim that the evidence does not prove that consensus to be unquestionably correct.

In absence of an impartial comparative analysis, public discourse and public actions are determined by ideology and not by evidence. “Liberals” assert that the mainstream consensus on global warming equals “science” and anyone who properly respects the environment is supposed to accept this scientific consensus. On the other side, many “conservatives” beg to differ, as when Senator Inhofe flourishes a snowball. One doubts that most proponents of either side could give an accurate summary of the pertinent evidence. That is not a very good way to discuss or to make public policy.

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This little essay had been offered as an Op-Ed to the Wall Street Journal, the New York Times. the Washington Post, the Los Angeles Times, the Financial Times (London), and USA Today. That it appears here confirms that none of those media stalwarts wanted to use it.