Tag Archives: medicine

The 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

Here is the essence 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.

How to judge health claims

Unfortunately, it is difficult to design good experiments and more difficult still to reach firm conclusions from most experiments. In the legitimate (“evidence-based”) medical community, the degree to which practitioners adhere to the principles varies greatly – but they at least try. Fortunately, in the “quack community,” while there is sometimes the pretense of evidence, basic scientific principles are so grossly violated and ignored that is becomes easy to distinguish fraud from legitimate science.

Here is an important point: it is difficult to make firm conclusions in medicine. But when valid scientific principles are not followed, it is easy to conclude that no valid conclusion can be reached. In other words, you can’t always be sure what’s good for you, but you can be sure when someone is talking nonsense.

Another important point: When someone makes irrational health claims, it does not mean that those claims are false. It just means those claims were not derived by rational (scientific) principles, and so we cannot say anything about their truth – we can only ignore them as arbitrary. It is as if someone claimed an invisible, undetectable pink unicorn in the sky – that which cannot be proven or disproved can only be dismissed.

How can we apply these ideas? It so happens that most health claims in the non-scientific media and many health “practitioners” are unscientific. This does not mean that they are wrong, or that people don’t feel helped by them. It means that their claims have no connection to reality.


In some cases, the practices that quacks suggest are helpful — but not for the reasons they identify. More importantly, in all cases following rational, scientific principles leads increases the likely hood of successful outcomes over quackery (aka emotionalism).

To conclude, to judge whether a medical claim is legitimate or arbitrary nonsense, check whether:

  1. It is based on quality experiments
  2. It is consistent with medical consensus (of evidence-based medicine)
  3. The certainty of the claim is well-established (by numerous studies, systematic reviews, etc




Filed under Essays

Do fat people deserve medical treatment?

Faced with an “obesity epidemic“, that has dramatic consequences for medical costs, pundits have proposed different solutions, ranging from excluding obesity from health insurance, government-run prevention campaigns, higher taxes on junk food, or higher premiums for fat people.

The possibility of greater government involvement in medicine with the passing of ObamaCare puts this debate in a new light. If the government decides who gets money for medical treatment, the question of whether fat people deserve medical treatment will become a political issue.

The question of who “deserves” treatment is only conceivable in a welfare state. In a free, capitalist society, people are able to allocate their wealth according to their judgment of the merit of their own and other’s health, including the degree to which they are culpable for their condition. However, there is no rational way to allocate property taken by force.

Does Jake, who became paralyzed because he liked extreme sports, or Kate, who has lung cancer because she is a smoker, or Mary, who has problems because has a tendency towards obesity which she does not try to control with diet or exercise, or Sue, who is dying from old age, and whose life might be slightly extended at tremendous cost deserve my money?

Once the idea that theft is justified because others need something is accepted, there is no objective way to decide which group is more “deserving” or which values are most “needed.” There is no way to make moral evaluations when “need” trumps justice and morality.

Justice and merit are moral concepts. To “deserve” someone’s property, is to have a moral claim to it. We create a claim to someone’s property when we engage in voluntary transactions – such as labor for wages, or goods for services, child care by choosing to bear children, or paying for injury if it is due to our neglect. But to claim that someone “deserves” our wealth merely by the fact of them being alive implies that some human beings have a moral claim on the life and values of others. That is a form of slavery. A modern, democratic and egalitarian form of slavery, but still slavery.

For someone to receive medical treatment, someone else must first create the wealth to pay for it. In a free society, people produce values voluntarily, and exchange them to mutual benefit. But the premise that someone has “a right to healthcare” means “a right to” seize values by force from those who produce them and give them to those who didn’t earn them. In such a slave society, people exist and produce values by permission, to the degree that those in power find them useful. Whether their values are seized directly, such as in socialism, or nominally theirs, but controlled by the state, such as in the fascist state our healthcare system is in, is irrelevant.

Some “moderates” argue that sick people “deserve” medical care when their misfortune is not their fault. But why should it matter whether they are responsible for their condition? People desire all kinds of values, whether cars, iPhones, shoes, friends, plastic surgery, or a long life. Sometimes they succeed in gaining those values, and sometimes they fail – whether it is due to a character flaw, ignorance, or just bad luck. But whatever the reason for their trouble, why does their misfortune give them a right to steal those values from an innocent third party?

If it is impossible to allocate socialized medicine objectively, how is it allocated? It’s simple – the group that ends up getting the loot is the one which has the most guns. In a democracy, where ballots are the bullets, the biggest, most corrupt, and politically-connected group wins. The implied message of their “awareness” campaigns is “my gang has more guns than yours.” The monstrosity of the welfare state is that the more virtuous and productive a person is, the more of his life and values he is forced to sacrifice, and the more unproductive and needy he is, the more he is rewarded for it. Like all forms of statism, medical socialism punishes virtue and rewards vice.


Filed under Politics