A brief case for evidence-based medicine

Few people would openly admit that they prefer irrational treatments and doctors.  But most people do in fact advocate irrational health practices – using pseudonyms for “irrational” as “holistic,” “alternative,” “homeopathic” and the deadly “natural.”

Medicine requires reason

The human body operates according to certain causal principles. If we wish to make a change in our health, we must understand some of those causal principles and act according to our understanding. To act without a rational basis is to disconnect our goals from their achievement. Irrationality does not guarantee failure — it just means that success, to the extent that it happens, will be due to other factors that our goals.

The study of human health is especially difficult

In the field of health, especially rigorous rationality is necessary for at least five reasons:

  1. The human body will solve, or at least try to solve most problems on its own. This makes establishing causality due external factors quite difficult and introduces biases such as the placebo effect and the regression fallacy.
  2. The body is very complex! Because it evolved over billions of years, the causal relationships in the body are extremely complex and interdependent.
  3. For example, even if we know that the body has too little of a certain substance, taking that substance may: a: not do anything b: cause the body to produce even less of the substance or c: cause an unpredictable side effect. On the other hand, if the body has too much of something, then the solution may be to a: consume less of that substance b: consume more of that substance or c: the consumption has no relationship at all to the level of that substance.
  4. It can be difficult to measure the extent to which medical problems are solved. While some things can be measured, many things, such as pain levels are very difficult to quantify.
  5. It is difficult to isolate causal factors in human beings since changes in health take time to develop and we can’t control every factor during an experiment or dissect human subjects when it is over.
  6. Humans tend to be irrational when it comes to their own mortality! We fear death, leading us to irrational over or under spending on health as well as being especially vulnerable to all the logical fallacies.

In medicine, rationality requires quality science research

There is a name for the field that applies rigor to the discovery of facts about nature: science. Science has been so successful in improving the state of human knowledge that many irrational, anti-scientific quacks have begun to use the term “scientific” to describe anti-scientific practices and ideas. In response to this, the medical community has come up with a term which identifiers the distinguishing aspect of rationality: “evidence based medicine.” This phrase is a necessary redundancy that identifies the essential characteristic of science: that it is based on sensory evidence. The alternative to non-evidence based science is not science at all, but emotionalism – “I feel it is true, so it must be.”

In the last hundred years, we have discovered certain practices for ensuring the conclusions of our medical experiments are valid. We know experimentally that observing these practices leads to more accurate conclusions. Let me emphasize that: the truth of medical claims is strongly correlated with the degree to which experiments follow accepted scientific standards. There are a number of objective scales for measuring the quality of an experiment.

Five characteristics of quality medical studies

  1. The experiment and its results are fully described in enough detail to reproduce and compare the results
  2. There is a randomized control group
  3. The selection of control subjects is double blind
  4. The methods of randomization and blinding are accurately described and appropriate
  5. There is a description of withdrawals and dropouts.

Further reading:

 


Addendum: How to judge health claims

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The one minute case for jury nullification

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The role of a jury is to apply the law to the facts

A trial ought to be, a fact-finding process, conducted in order to determine whether pre-existing legal principles are applicable to a specific case.  It should not be a religious, philosophical, or political discourse – that is, the rules by which guilt or responsibility is determined must be known beforehand.  It is not up to the judge or jury to determine what the law ought to be, only to apply it to the established facts.  If the law was determined rather than applied at trial, it would be impossible for anyone to obey it.  Furthermore, a just legal system should be uniform – people must have assurance that outcomes will not depend on the particular judge and juror they stand before.

We have a personal moral responsibility to treat other men with justice 

However, while it is not the job of the juror to determine whether the law is just, it is his moral responsibility to treat other men justly.  Someone who is hired to be a repo agent may not have a contractual obligation to determine whether the collateral he collects is for debts which are legitimately are in default, but he has a moral obligation to refuse his assignments if he suspects that he’s seizing legitimate property.  If he refuses assignments based on tenuous grounds, he may justly be fired, but if he has some certainty that he’s seizing legitimate property, he becomes as much a thief as his employer.  Likewise with the juror.

A law based on invalid principles is inherently unjust

One criticism of jury nullification is that a jury is not neither qualified to judge the law nor does it have any legitimacy in doing so.  And this is certainly true as a matter of law.  A juror who disagrees with the practical implementation of the moral principles behind a law ought to defer to the established process.  He can always exercise his disagreement and try to effect change in his role as a private citizen.

But, the situation is different when a juror disagrees with the moral principles behind a law.  A law based on incorrect moral principles is unjust regardless of the facts of the case.  The conviction of anyone based on such as law is necessarily an act of aggression.  Any participation in the process, even solely in the function of determining the facts, is an immoral act.  No judge can honestly ask a juror to breach his integrity, or blame him for refusing to do so.    Everyone, regardless of his role, has a personal moral obligation to treat others justly and refrain from willingly participating in injustice.

Jurors should refuse to enforce unjust laws

What should  a juror do if he objects to the morality of a law?  He should refuse to serve if he believes that the principles of a law are inherently unjust.  By doing so, he does not undermine the legal process, since another juror can be substituted, nor does he violate his own integrity.  A juror exceeds his role if he refuses to convict because he thinks that the punishment for an action is too harsh, but he acts properly if he refuses to serve because he does not believe the act being prosecuted to constitute an act of coercion at all.

If the court is unable to find enough jurors who accept the morality of the law, it has two choices:  either require the charges to be dropped, or offer the dissenting jurors to serve anyway.  If they do so, they cannot be blamed for acquitting the defendant based on their judgment of the law, in addition to their judgment of the facts. If laws are consistent with the basic moral principles of citizens, it should not be difficult to find sufficient jurors.

Further reading

The One Minute Case For Usury

There is no objective criteria for what rate of interests is “usury”

Usury originally meant the practice of charging interest on loans.  Sometime during Medieval times, the charging interest as such became politically acceptable and the term change to mean charging excessive interest rates.  However, there is no objective definition of what a “fair” interest rate is beyond the rate agreed to by the parties involved, so an attack on usury is an attack on interest rates as such.  There is no such thing as a single “just” interest rate because interest rates in a free market move towards an equilibrium determined by the time-preferences of individual debtors and lenders.

Traders have the right to trade by any terms they wish

The borrower of a loan voluntary enters into a contract. As long as the contract is voluntary, it is immoral for any third party to use coercion to prevent voluntary agreements.

Interest is essential to the investment process

Charging interest is essential to guiding the investment process, which cannot be sustained by charity even it were forthcoming due to the economic calculation problem.  Interest rates are required to direct investments to their most productive use.  Interest-driven investment is essential to economic growth, and therefore to the very existence of industrial civilization. If charging interest were outlawed, industrial societies would quickly collapse due to the inability to efficiently allocate savings.

“Loan sharking” is caused by government failure

Loan-sharking (charging high interest rates backed up by the threat of violence) reflects the fact that the loans are being given to creditors with a high risk of default. The need for violence is due to the failure of governments to see this fact, or to adequately enforce the loan contracts (such as with overly lax bankruptcy laws), rather than any immorality inherent in moneylenders.

Further reading

The one minute case against “special interests” as the cause of corruption in politics

It is often said that  “special interests” are to blame for economic problems and corruption. But “special interests” are only a symptom, not the cause of the disease.

Pressure groups are inherent in a mixed economy

In a populist democracy with a mixed economy, every group that participates in the political system is a “special interest”, with the incentive and the power to use the political system to extract benefits for its members at the at the expense of everyone else. Corporations, unions, disease-awareness organizations, “minority” groups, and anyone who organizes around a common cause has the power believes that their fate or cause is more legitimate, important, and “special” than that of everyone else.

In a mixed economy, the state functions as a redistribution mechanism

The welfare and regulatory systems are the primary means to coercively redistribute property and confer monopoly benefits to various groups. In a mixed economy, everyone is constantly on the defensive against organized groups extracting benefits from him, and on the offensive attempting to use the coercive power of the state to extract benefits from others. Interventionism creates a vicious cycle hardly unique to corporations: first a lobby tries to extract special privileges from some politically neutral group, the group hires lobbyists to defend itself, and ends up using the influence it has gained to extract privileges at the expense of another neutral group, which must defend itself in turn.

“Special interests” are a consequence of the coercive power of government 

The existence of “special interests” is just a symptom of the disease: the growth of government power to a degree that allows those in power to violate our rights and steal our property for the benefits of their constituents. Populist “maverick” politicians who claim that they will “fight special interests” and “change the culture in Washington” are just attempting to subvert the power of the state to favor their particular constituency. Campaign finance regulations are just monopoly privileges created by the political élite to hide corruption from the public and make it more difficult for those without political connections and money to get elected and in order to defend themselves or join in the looting.

The solution to special interests is to remove to interventionist power of the state

The only solution to the problems caused by interventionism is to end interventionism – to separate government and economy. Take away the power of the government, and you will remove both the incentive and the power of the “special interests.” As long as governments try to control people and businesses with laws that go beyond the protection of property rights, the “special interests” will have the incentive to control governments.

Further reading:

The One Minute Case For Philosophy

What is philosophy?

Philosophy is the field that looks at the most basic, universal questions about existence. While other sciences study certain aspects of things, or certain types of things, philosophy is concerned with the most abstract questions about existence and man’s role in it. Philosophy asks questions such as: How can we know what is true? What is our purpose in life? How should we act? How should we organize society?

Philosophy is inescapable

Why are you reading this? Do you want to learn something? Why value learning? Is it because you value knowledge or because you want to have a successful career? Why should those things matter to you? Is it because your parents said so, because you enjoy something, or because society needs it? Is your own happiness or obligation to others more important to you? How should you decide? If I tell you that something is good for me, does that also mean that it is good for you? Is the good the same for everyone or different because of culture or nationality or personality? Is something is true, is it true forever, or only for today? Are people good or bad? Are you? Why are some people more successful than others? Is happiness a matter of luck? What is a good life? How should you pick your friends? Can anyone know any of these things, with certainty, in the same way that we know that 1+1=2?

All these questions are answered by philosophy. You may never have thought about philosophy until today, but all conscious human action depends on a certain view of existence. All actions assume a certain view of existence, causality, and values. We have no choice about whether we have a philosophy. We can only choose what philosophy to adopt. We can subconsciously, passively, and uncritically accept the philosophy we are exposed to or, we can consciously, actively, critically, examine the ideas around us and accept them because they are true, not because we happened to live in a particular time and place.

Philosophy is the science of universal principles

Philosophy asks: what can we know and how can we know it? We re-examine the world as if discovering it for the first time and accept only that which we can prove to be true.

Why is this important? You might say that you know what is real because I can see and touch it. But not all knowledge is perceptual. If I tell you about an abstract idea, such as justice, how do you know if it is true? Because you feel it is true? Because others tell you it is true? Because you see it is true? But what can you point at to show what justice is? And can you be sure that something that is true to you is also true for everyone else and at all times?

The point of treating thinking as a science is to arrive at firm principles. You can live without an explicit philosophy if you live a primitive life and hunt animals in the jungle. But if you want to build an airplane to fly you across the world, you need a formal science of physics and engineering. And to live a successful life as a civilized human being and create a better future than the past, you need an integrated, scientific view of existence provided by philosophy. Philosophy has the power to make abstract concepts such as justice as clear as the things we can see and touch.

History is philosophy in action

The politics, culture, and economy of any society are formed by the ideas of the people who live in it. If most people believe that it is impossible for them to live without using violence against each other, than their society will be poor and violent. If people believe that whatever their ancestors practiced and believed is good enough for them, then they will continue to live just like their ancestors.

A few hundred years ago, most of the world believed that history was just an account of one ruling regime being replaced with another. If anyone believed in a better time, it was in the past, when great empires had existed and fallen. Today, people had a very different view of history. We believe in progress, in continuous improvement, in fundamental change in society and economy. These ideas have power: during the last 200 years, the world population increased from under 1 billion to over 7. Why did this happen? The world has embraced the technological and economic progress made possible by Western philosophy. A rational philosophy can offer a unifying explanation of man and his universe and a guide for people and societies to achieve values and peacefully coexist.


World human population (est.) 10,000 BC–2000 AD.

World human population (est.) 10,000 BC–2000 AD.