Mukherjee’s error and his critics’
I can’t help but take a moment to comment on the heated response to Siddharta Mukherjee’s New Yorker piece. Theral Timpson summarizes the kerfuffle very well, provides the appropriate links, and gives it its needed context. The two posts by Jerry Coyne are worth reading, if only as a good education about what’s at stake.
The only interjection I will make is to say that neither side is getting it right or can get it right. This is an example of the inevitable confusion that arises when one adopts the wrong metaphysical framework or, more precisely, when one pretends that metaphysics doesn’t matter because empirical science will tell us all we need to know. (more…)
Kathryn Montgomery’s How Doctors Think: Clinical Judgment and the Practice of Medicine is an excellent book that was brought to my attention by Dr. James Gaulte in the comment section of my post on phronesis. Indeed, much of Montgomery’s monograph deals with the Aristotelian concept of practical wisdom applied to clinical decision-making.
The author is Professor of Medical Humanities and Bioethics and Professor of Medicine at Northwestern University Feinberg School of Medicine. Her book is too rich to cover deeply in a short review, but I’d like to highlight some of its major strengths as well as a few minor weaknesses.
In the first part of the book, Montgomery thoroughly demolishes the notion that medicine is applied science.
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The war against the New England Journal of Medicine has gained visibility after Charles Ornstein traced its developments in the pages of the Boston Globe. The story was amplified in a number of trade publications, and was even picked up by a NPR-affiliated show.
This has emboldened the attackers to open fire on Twitter with calls for “transparency,” “open science,” and a “unified research community.” Their ideological alliance is with the BMJ.
Those who refuse to partake in the cause of transparency live in a world of “silos,” “conflicts of interest,” and “industry ties.”
The NEJM‘s lukewarm attitude towards the movement is “an oppression,” says Eric Topol, as quoted by Ornstein. Did he intend to use a term with Marxist connotation? The loose coalition of scientists, healthcare journalists, and muckrakers ready to overthrow the established order might as well be known as the Data Liberation Front!
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In the introduction to a talk I gave at the Mises Institute this year, I noted how, in the early part of the twentieth century, a convergence of interests between social progressivists and ideological empiricists led to the publication of the Flexner report and the subsequent enactment of licensing laws.
That historical context is further treated in an outstanding article by Alfred Tauber, who was professor of medicine and philosophy at Boston University School of Medicine.
In “The two faces of medical education: Flexner and Osler revisited,” Tauber contrasts the radically different views these two men held about the ethos of medicine and the proper approach to medical education. It is ironic that the victorious position would be the one pushed by Flexner who, as Murray Rothbard put it, was “an unemployed former owner of a prep school in Kentucky…sporting neither a medical degree nor any other advanced degree.”
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This is part 2 of my paper presentation at AERC 2016 at the Mises Institute. Find part 1 here
and the audio here
I would therefore like to entertain an interpretation of health rooted in the view that human beings are persons acting purposely, persons who select means to achieve chosen ends, which is the framework of praxeology.
Under a praxeological framework, I would distinguish external means such as land, labor, and capital, which are generally the concern of economic theory, from internal means, such as the physical and mental conditions of the person that allow him or her to pursue chosen ends.
Health, then, may be defined as the state that is present when a person’s physical and mental conditions allow the pursuit of his or her chosen ends. Disease, then, is the absence of health.
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This is the transcript of a paper I presented at the Austrian Economics Research Conference at the Mises Institute. I have included the slides below and you can hear the audio here
The title of the paper is “From reacting machine to acting person: a praxeological interpretation of the patient, his health, and his medical care.” For more info on praxeology, see my previous article here.
I have split the presentation into two parts. This is a very condensed talk, covering a lot of ground, but I will elaborate on various points I make in the paper in the ‘progress notes’ section of this website over the next few days and weeks.
Thank you for reading and for any feedback you might have.
The elephant in the room in healthcare is that there is no precise definition of health. I believe that this ambiguity plays a major role in our perennial healthcare crises, and I am hopeful that Austrian insights can be helpful.
Here is the outline of my talk.
I will first identify the two dominant modes of thinking about health in modern Western societies. I will show that those conceptual modes are counterproductive to fostering health, both economically and medically. I will then propose a praxeological interpretation of health, and sketch the possible benefits and ramifications of that interpretation.
The dominant mode of thinking about health in Western societies owes its origins to René Descartes who, at the beginning of the scientific revolution, proposed the machine concept of the organism. Descartes’ proposal was a radical departure from pre-existing notions which were rooted in the idea that organisms have essences and natures. Instead, he proposed that every material body is an assemblage of tiny particles moving mechanically according to physical laws. In the case of plants and animals, God directs the laws and the motions. In the case of humans, the mechanical bodies are under the control of a separate human soul acting like a “ghost in the machine.”
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Kahneman versus Klein on medical decision-making
I just finished reading Daniel Kahneman’s bestseller Thinking, Fast and Slow. Regular readers of this blog will probably surmise that I don’t share the Nobel prize winner’s interest in cognitive biases (not that they don’t exist, of course).
Kahneman, like most social scientists, generally espouses an empiricist’s outlook on the human mind (the Humean mind…). For him, decisions are essentially a matter of calculation, and he documents the many ways we fool ourselves, and the many ways we can fall short. In that respect, the book is very interesting and often amusing.
Of course, one benefit of the research Kahneman has conducted with Amos Tversky is to poke holes in the flawed model of the world as made up of fully rational and selfish “Econs” as Richard Thaler put it. That model underlies much of mainstream, neoclassical economic theory.¹
What I found most interesting in Kahneman’s book is chapter 22, which deals with expert intuition, and whether it can be trusted. In that chapter, Kahneman candidly discusses his differences with Gary Klein, for whom he shows much respect. I wrote about Klein and how his insights can help us think about medical decision-making in my post “How experts really decide.” (more…)
Peer-review and science’s funding problem
I enjoyed listening to Theral Timpson’s podcast interview of Jason Hoyt yesterday.
Hoyt is the co-founder of Peer J, an open access publisher that is also encouraging biologists to post pre-prints. Peer J offer pre-print hosting for free and is one of those entrepreneurial companies that is trying to find a remedy for the widely perceived science publishing gridlock. Hoyt gives good insights about some of the challenges present in that world.
A couple of years ago, Hoyt also co-wrote an article for Scientific American in which he traces back the history and evolution of science publishing. Amazingly, peer-review of papers was not mandated by most journal until the 1970’s. (more…)
A couple of weeks ago, I presented a paper about health and medical care at the 2016 Austrian Economics Research Conference, which was held at the Mises Institute. I will be sharing the content of the talk in the next few posts, but given that I use some terms and concepts borrowed from that school of thought (e.g., “praxeology”), I thought that I would first take the opportunity to give a brief introduction to Austrian economics for those unfamiliar with it.
Austrian school economics refers to a school of economic thought whose adherents generally share similar views on methodology. The originators of that school were mid-to-late nineteenth century Austrian scholars whose economic ideas were in opposition to the ones dominant in Germany at that time. The term “Austrian school,” given in disparagement by members of the German Historical School, stuck. The German school has disappeared, but the Austrian school remains vibrant today.
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Podcast interview: Mendelspod
A couple of weeks ago, Theral Timpson kindly interviewed me for his Mendelspod science podcast (an excellent show, especially for those interested in cutting edge biotech matters). We talked about philosophy of science and medicine. I really enjoyed the conversation, and I hope you will too. The link is here.