Thanks to Phil Alexander and Casey Manion.
Two thought-provoking paragraphs from Matt Ridley:
From ancient Egypt to modern North Korea, always and everywhere, economic planning and control have caused stagnation; from ancient Phoenicia to modern Vietnam, economic liberation has caused prosperity. In the 1960s, Sir John Cowperthwaite, the financial secretary of Hong Kong, refused all instruction from his LSE-schooled masters in London to plan, regulate and manage the economy of his poor and refugee-overwhelmed island. Set merchants free to do what merchants can, was his philosophy. Today Hong Kong has higher per capita income than Britain.
In July 1948 Ludwig Erhard, director of West Germany’s economic council, abolished food rationing and ended all price controls on his own initiative. General Lucius Clay, military governor of the US zone, called him and said: “My advisers tell me what you have done is a terrible mistake. What do you say to that?” Erhard replied: “Herr General, pay no attention to them! My advisers tell me the same thing.” The German economic miracle was born that day; Britain kept rationing for six more years.
This is standard libertarianism. I like the stories but I don’t agree with the interpretation. I don’t think it is “economic planning and control” that causes stagnation in these examples. I believe it is expertise — more precisely, rent-seeking experts who know too little and extract too much rent. There are libertarian experts, too. They too are capable of doing immense damage (e.g., Alan Greenspan), contradicting Ridley’s view that “economic liberation” always causes prosperity. In both of Ridley’s examples, the experts give advice that empowers the experts. In the first example, Cowperthwaite is told by “LSE-schooled” economists to “plan, regulate and manage the economy.” All that planning, regulation and management require expertise, in particular expertise similar to that of the experts who advised it. Which you cannot buy — you have to rent it. You must pay the experts year after year after year to plan, regulate, and manage. Because the advice must empower the experts, there is a strong bias away from truth. That is the fundamental problem. (more…)
In Edward Jay Epstein’s new piece Gross Misunderstanding, in the Columbia Journalism Review, he writes
By focusing on the box-office race that is spoon-fed to them each week, journalists may entertain their audiences, but they are missing the real story.
Something similar happens with the Nobel Prizes. Journalists print what they are told — Scientists X and Y did beautiful “pure science” about this or that — and thereby miss the real story. In the case of Nobel Prizes in Medicine, the real story is the long-running lack of progress on major diseases (cancer, heart disease, depression, etc.).
Persons with Type 2 diabetes have an increased risk of heart disease and stroke. They are usually overweight. A study of about 5000 persons with Type 2 diabetes who were overweight or worse asked if eating less and exercise — causing weight loss — would reduce the risk. of heart disease and stroke. The difficult treatment caused a small amount of weight loss (5%), which was enough to reduce risk factors. The study ended earlier than planned because eating less and exercise didn’t help: “11 years after the study began, researchers concluded it was futile to continue — the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.” (more…)
As usual, there is plenty of disease and disability in the world: depression, diabetes, heart disease, cancer, stroke, obesity, autoimmune disease, and so on. As usual, the Nobel Prize in Physiology or Medicine — supposed to be given for the most useful research — is given for research with no proven benefit to anyone (except career-wise). Once again implying that the world’s best biomedical researchers — judging by who wins Nobel Prizes — either don’t want to or don’t know how to do useful research.
Once again the press release tries to hide this. “From surprising discovery to medical use” reads one heading. If you read the text, however, you learn there is no actual “medical use”. Here’s what it says:
These discoveries have also provided new tools for scientists around the world and led to remarkable progress in many areas of medicine. iPS cells can also be prepared from human cells. For instance, skin cells can be obtained from patients with various diseases, reprogrammed, and examined in the laboratory to determine how they differ from cells of healthy individuals. Such cells constitute invaluable tools for understanding disease mechanisms and so provide new opportunities to develop medical therapies.
Apparently you can make “remarkable progress” in medicine without helping a single person, which says a lot about what passes for medical progress. Although iPS cells are supposedly “invaluable tools” for understanding disease mechanisms, we are not told a single disease that has thereby been understood or a single therapy that has been developed.
The Guardian printed a roundup of responses to the award. I read it eagerly. Maybe one of the comments will explain how the prize-winning work actually helped someone (besides career-wise). After all, Yamanaka, one of the winners, had previously won the Finland Prize, given to research that “significantly improves the quality of human life today and for future generations”. Paul Nurse says the prize-winning work did such-and-such, “paving the way for important developments in the diagnosis and treatment of disease” unfortunately not saying what those “important developments” are. Martin Evans says:
The practical outcome is that now we not only know that it might be theoretically possible to convert one cell type into another but it is also practically possible. These are very important foundation studies for future cellular therapies in medicine.
Emphasis added. Another comment: “These breakthroughs will ultimately lead to new and better treatments for conditions like Parkinson’s and improve the lives of millions of people around the world.” A bold prediction, given that they have not yet improved the life of even one person. Julian Savescu, an ethicist at Oxford, says “This is as significant as the discovery of antibiotics. Given the millions, or more lives, which could be saved, this is a truly momentous award.”
Year after year, the Nobel Prize in Physiology or Medicine is given for research that, we are told by biologists with huge conflicts of interest, will — no doubt! — be incredibly valuable in the future. Indicating there was no research that might be honored that had already been useful. It is as if you have a baseball award for best hitter but all hitters all over the world strike out all the time so you end up giving the award to people who strike out best. They are the best hitters, you tell credulous sportswriters. They receive the prestigious award for best hitter at an elaborate ceremony, with toasts all around. Nobody says they cannot hit.
Thanks to Bryan Castañeda.
I recently came across a 2005 survey, done in Texas, that found people with poor sleep were far more likely to be depressed or anxious than people with better sleep. Huge risk ratios:
People with insomnia . . . were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety [than persons without insomnia.]
Other studies have found similar results. For example, a 1979 survey interviewed the same people twice, one year apart. People who had insomnia both times were 40 times more likely to be newly diagnosed with major depression during the intervening year than those who did not have insomnia at either time.
A simple thing to say about the sleep/mood correlation is that it supports my theory of depression, which says depression is often due to malfunction of two circadian oscillators (one controlled by light, the other by faces). If they are working properly (in sync, with large amplitude) you sleep well and are in a good mood when you are awake. If they are not working properly (e.g., not in sync) then you do not sleep well and are in a bad mood at least part of the time while you are awake. What is called depression (e.g., not wanting to do anything) is actually a good thing in the middle of the night. Not wanting to do anything — being still — is necessary to fall asleep.
A sad and more complicated thing about this correlation is that it is ignored. It is not explained by any theory of depression popular among psychotherapists, such as cognitive-behavioral therapy, not to mention a dozen other explanations of depression (psychoanalytic, etc.) that psychotherapists favor. Nor is it explained by any pharmacological theory of depression. In other words, if you seek treatment for depression within our healthcare system the treatment you will receive will derive from a theory that cannot explain this result. Yet the correlation is so strong it must be telling us something important.
You can read endlessly about the high cost of health care. What if the high cost is not the core problem? What if it is only a symptom of something less obvious? What if health care costs a lot because we have a poor understanding of health and disease (as the failure of popular theories of depression to explain the sleep/mood correlation suggests)? What if we have a poor understanding of health and disease because health research is too concerned with allowing healthcare providers to make money?
Thorstein Veblen might have gloated that this 2011 article — about the uselessness of law schools and legal scholarship — so thoroughly supports what he wrote in a book published in 1899 (see the last chapter of The Theory of the Leisure Class). Why are law schools useless? Because law professors feel compelled to imitate the rest of academia, which glorifies uselessness:
“Law school has a kind of intellectual inferiority complex, and it’s built into the idea of law school itself,” says W. Bradley Wendel of the Cornell University Law School, a professor who has written about landing a law school teaching job. “People who teach at law school are part of a profession and part of a university. So we’re always worried that other parts of the academy are going to look down on us and say: ‘You’re just a trade school, like those schools that advertise on late-night TV. You don’t write dissertations. You don’t write articles that nobody reads.’ And the response of law school professors is to say: ‘That’s not true. We do all of that. We’re scholars [i.e., useless], just like you.’ ”
Yeah. As I’ve said, there’s a reason for the term ivory tower. And seemingly useless research has value. Glorifying useless research has the useful result of diversifying research, causing a wider range of research directions to be explored. Many of my highly-useful self-experimental findings started or received a big boost from apparently useless research.
The pendulum can swing too far, however, and it has. A large fraction of health researchers, especially medical school researchers, have spent their entire careers refusing to admit, at least in public, the uselessness of what they do. Biology professors have some justification for useless research; medical school professors have none, especially given all the public money they get. Like law professors, they prefer prestige and conformity. The rest of us pay an enormous price for their self-satisfaction (“I’m scientific!” they tell themselves) and peace of mind. The price we pay is stagnation in the understanding of health. Like clockwork, every year the Nobel Prize in Medicine is given to research that has done nothing or very close to nothing to improve our health. And every year, like clockwork, science journalists (all of them!) fail to notice this. If someone can write the article I just quoted about law schools, why can’t even one science journalist write the same thing about medical schools — where it matters far more? What’s their excuse?
In this interview, a doctor who does research on biofilms named Randall Wolcott makes the same point I made about Testing Treatments — that evidence-based medicine, as now practiced, suppresses innovation:
I take it you [meaning the interviewer] are familiar with evidence-based medicine? It’s the increasingly accepted approach for making clinical decisions about how to treat a patient. Basically, doctors are trained to make a decision based on the most current evidence derived from research. But what such thinking boils down to [in practice -- theory is different] is that I am supposed to do the same thing that has always been done – to treat my patient in the conventional manner – just because it’s become the most popular approach. However, when it comes to chronic wound biofilms, we are in the midst of a crisis – what has been done and is accepted as the standard treatment doesn’t work and doesn’t meet the needs of the patient.
Thus, evidence-based medicine totally regulates against innovation. Essentially doctors suffer if they step away from mainstream thinking. Sure, there are charlatans out there who are trying to sell us treatments that don’t work, but there are many good therapies that are not used because they are unconventional. It is only by considering new treatment options that we can progress.
Right on. He goes on to say that he is unwilling to do a double-blind clinical trial in which some patients do not receive his new therapy because “we know we’ve got the methods to save most of their limbs” from amputation.
Almost all scientific and intellectual history (and much serious journalism) is about how things begin. How ideas began and spread, how inventions are invented. If you write about Steve Jobs, for example, that’s your real subject. How things fail to begin — how good ideas are killed off — is at least as important, but much harder to write about. This is why Tyler Cowen’s The Great Stagnation is such an important book. It says nothing about the killing-off processes, but at least it describes the stagnation they have caused. Stagnation should scare us. As Jane Jacobs often said, if it lasts long enough, it causes collapse.
Thanks to Heidi.
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