ControlsFreak
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User ID: 1422
ControlsFreak
3d ago
Historically commonplace, unfortunately. One of the most famous examples was JFK's "missile gap". Eisenhower couldn't publicly correct him, because it was actually important to keep the information classified. Yet IIRC, even after JFK was briefed about the truth, he kept on banging on about it. The nice version of an interpretation is that it was an honest deception operation, because if he just suddenly stopped talking about it, maybe foreign governments could figure out why. The more likely story is that the politics were too good.
ControlsFreak
4d ago
I don't really see how one reasons to the omnibus position.
Interestingly, I don't think one actually does reason to this position. Instead, someone makes a declaration and it forces people to reason out of it, but the rhetorical linking of the two issues significantly limits how they can reason out of it... and what that will mean for their preference ordering between all four.
This is where the heresthetian thrives. He finds out how to exploit the different groups, who have different preference orders. There's only a small group of hardcore pro-Jones Act folks, yet we still have it, because enough other folks will hold their nose enough at the economic issues in order to not do anything that might seem anti-union (as Biden is portrayed in Zvi's writeup). By linking the two things, even if only rhetorically, the goal is to split the groups with incompatible preference orders. If you can split the A/B groups enough that you can accomplish C (your stated preference after encountering it in this form), then that's a yuge dubya.
Others might have other rationales that end up with them having different preference orders, but if people like you can find yourself having mildly not caring about the Jones Act before but now being willing to throw it under the bus to stop tarifffs, society benefits immensely.
ControlsFreak
5d ago
I would love to see a Twitter-style poll with the following options:
A) Keep Jones Act, don't implement Trump tariffs
B) Keep Jones Act, implement Trump tariffs
C) Repeal Jones Act, don't implement Trump tariffs
D) Repeal Jones Act, implement Trump tariffs
I'd love to see not only percentages, but some mental models from the people in different categories. This in inspired by seeing both Zvi's latest on the Jones Act and MR linking one estimate related to possible Trump tariffs.
Zvi doesn't sum it up super nicely, but estimates I see of the value of repealing the Jones Act are \approx 3% reduction in cost of goods (just due to the flagging effect) and a claim that a plausible OOM estimate is \approx 3% GDP increase (I lost the thread the other day on how to put approximately signs in without strikeout). The randomly-linked twitter post estimates price increases due to tariffs mostly around 2-3%, with some specific sectors rising up to 13%.
I suspect that most people just don't mentally look at economic estimates and compare them to each other, but I don't know what else goes on in their heads. If they're trying to justify one or the other position, how do they go about it? Is it at all plausible if we apply their justification to the other question?
Finally, heresthetics. Could an 'omnibus' option (D) bill be pushed, saying, "That old, bad, just banning stuff style protectionism clearly failed; we shot ourselves in the foot and didn't even manage to actually protect an industry in the process. Instead, tariffs will be the way; at the very least, taxes are slightly more pleasing to the economist than specific bans, as they still allow price signals to work somewhat and inspire new solutions, while at least collecting some revenue for a debt-strapped gov't"? Obviously, people would horrifically oppose it, but what would they say when they oppose it? What would the reasoning be? How would that reasoning come across to the people who would respond with a different choice from the list?
ControlsFreak
6d ago
Why? Because, as I mentioned above, consumption is more equal than income, and wealth is less equal. This makes it much easier to sensationalize.
A few years back, there was a "splashy" "study", which surveyed people, showing them three pie charts. One was a depiction of the wealth distribution, by quintile, in the US. Opposed to it was a completely equal distribution, 20% for each quintile. Conveniently, in the middle, they put "Sweden", and they asked folks which wealth distribution they'd prefer. People were at least smart enough to realize that a totally equal distribution makes no bloody sense, as an indebted fresh medical school grad is not going to have the same amount of wealth as a nearing-retirement saver-of-forty-years. Nevertheless, it allowed them to blast in the media that however much percent of the population surveyed would prefer a wealth distribution more like Sweden, heavily implying that the US should adopt some unspecified set of policies that people associate with Sweden.
...but of course, this sensationalism was entirely built on a complete lie. "Sweden" was not Sweden, at least not its wealth distribution. They called it "Sweden", with quotation marks attached in the original survey, because they simply lied and substituted Sweden's income distribution and compared that to the US's wealth distribution. If you looked at Sweden's actual wealth distribution, it would be extremely visually similar to the US, so they needed to lie and make people think that there was the magical possibility that is totally magically achievable that is visually clearly different if we only let them implement whatever haphazard collection of policies they want.
ControlsFreak
6d ago
Cost should always be part of the "cost/benefit analysis".
ControlsFreak
6d ago
Yes there is an over supply of residency spots
All I'm saying is that this is not demonstrated clearly by the data you cited. Is there some additional source of data to support this claim?
ControlsFreak
7d ago
Ah yes, the classic restrict supply, subsidize demand model. Once someone has given in to restricting supply, the only way out is to subsidize demand. So they say in every industry that sucks because of this exact phenomenon.
But I'm not sure one needs to get into the details of which frictions cause the 5-10% of unfilled slots to have a sense that perhaps that data at least doesn't cleanly support the claim that there is a "surplus" of residency spots. It's at least messy.
ControlsFreak
7d ago
Figures 1, 3, and Table 5 might tell a different story to some folks. 5-10% unfilled can easily be chalked up to various frictions (see also discussions of things like the general unemployment rate), and one could think that the percentage unfilled would remain approximately constant if the number of slots were increased within some range.
ControlsFreak
8d ago
From first principles, active bodily processes to either heat or cool one's flesh likely consume calories. Temperature gradients need to be maintained. In fact, I've seen work posing the question of the effect of indoor environment control on caloric expenditure (if you have electricity doing the work of regulating your environment, you likely have to expend less). Given that most people maintain a body temperature above that of ambient, it is theoretically plausible (even likely) that increased body temperature would increase caloric expenditure.
Of course, the rub usually comes in terms of magnitudes. How big is the effect? A casual scan of the literature doesn't turn up anything all that great. So, I would maintain my personal belief that there is likely a positive effect, but extremely low confidence in any sense of an estimate for magnitude.
Concerning equations, the question always is what it is that you're trying to do. For very small groups, you can go through a very intensive process of measuring all sorts of body characteristics, down to the size of individual organs, and use some pretty detailed estimates to try to get really close. Most people don't do anything like that; it's just too much effort. Instead, people often want to collapse larger-group data into a handful of variables for ease of estimation, knowing that any such effort will inherently have variability and error bars. The equation that you get, and how much variability it has, depends on which type of population you're targeting and which variables you're trying to collapse it down to. Obviously, targeting larger/smaller population types tends to increase/decrease variability; similarly, increasing/decreasing the number of variables (under mild assumptions of them being correlated at all to the dependent variable and not entirely codependent) tends to decrease/increase variability. If you're considering fit and athletically-active populations, a lot of folks recommend the Cunningham equation. It also does not include typical body temperature. I'm not sure what the codependence will look like, what the rough magnitude of the effect will be, and how much additional variability you could cut out by including typical body temperature, just because I'm not aware of anyone who has taken the time and money to specifically explore it.
ControlsFreak
8d ago
People have comically false beliefs about all sorts of stuff in the world. We have not discussed what the constraints on marketing would be; I think your comment assumes that there would be none, but I think that is unlikely. So far, we've only been talking about the total ban.
ControlsFreak
9d ago
I'd be very interested in comparing the average outcome of a NP with the latest AI models trained on giving medical diagnoses vs a lone doctor.
Not exactly that, but Zvi's recent post had this and this. Of course, I'd say that this is one of those areas where we probably care about some measure other than average, but it gets complicated.
ControlsFreak
10d ago
I don't see how you can make that conclusion. People currently take a variety of things that don't hurt them; therefore, they will take huge and insane amounts of stuff that hurts them if we let them?
Imagine that we did ban personal auto repair. You have to draw the line somewhere, so there's some unregulated space where people could go ahead and buy, like, bumper stickers, stuff that hangs down from their rear view mirror, or even vortex generators. And someone observed that folks do a bunch of stuff with their car that is stupid and doesn't provably help the car go faster, run longer, or get better fuel economy. They then conclude that it would be a disaster if we stopped banning personal auto repair, because that obviously implies that masses and masses of people would severely hurt themselves. Why couldn't we end up with the world we have now, where most people still just take their car to a professional, but some do it themselves? Yes, some people hurt themselves doing it themselves, but I don't see why we should have concluded that it would be a huge, mammoth disaster.
I would note that I think there's probably a significant difference between a label that says, "These claims about being vaguely good for your hair health or whatever are not evaluated by the FDA," while still being cognizant that the product has been evaluated for safety... and a label that says, "This product will seriously harm or kill you if taken improperly; please consult a medical professional."
ControlsFreak
10d ago
the doctor
Makes it sound like there's only one. People often have many different doctors for many different things. It's more likely that they only have one pharmacist, or, rather, one pharmacy that may employ multiple pharmacists, but at least they're usually on the same computer system. That's the more natural bottleneck to have a pair of expert eyes on the medications you're taking.
In all sincerity, I want to check, for myself, to make sure that I am not completely off base in my interpretation of your phrase.
What are some scholarly ways that a person can investigate the reasoning behind an existing state of affairs, where the existing state of affairs in question is a law or policy?
Investigating the reasoning behind an existing law or policy can be approached from several scholarly perspectives, each employing a range of methods and analytical tools. Below are some approaches that can help uncover the rationale behind a law or policy:
1. Legal Analysis (Doctrine-based Inquiry)
- Statutory Interpretation: Scholars may start by analyzing the text of the law or policy, identifying its purpose, and exploring its language. This involves looking at the legal provisions and examining legislative intent, which can often be found in debates, committee reports, or legislative history.
- Case Law: Reviewing judicial opinions on the law or policy provides insight into how courts interpret and apply the law. A close reading of key decisions may reveal the underlying legal principles, norms, or objectives that shaped the law.
- Legal Doctrines and Principles: Analyzing whether the law or policy aligns with established legal doctrines (e.g., human rights, justice, equity, fairness) can shed light on its underlying reasoning.
2. Historical Analysis
- Historical Context: Investigating the historical development of the law or policy can provide valuable insights. This involves looking at the political, economic, social, and cultural context in which the law or policy was enacted. The scholar could examine the timing of its introduction, significant historical events that might have influenced it, and the role of key individuals or groups.
- Comparative Historical Approaches: Comparing similar laws or policies from different times or places can highlight the factors influencing their formulation and the lessons learned from prior implementations.
3. Political Science Approaches
- Public Policy Analysis: This involves analyzing the policy-making process, identifying the actors involved (e.g., legislators, interest groups, bureaucrats), their objectives, and the political dynamics at play. This approach may involve:
- Agenda-setting theory: Investigating how issues gain attention and become policy topics.
- Policy process models: Examining how the policy is formulated, implemented, and evaluated.
- Political Economy: Scholars may look at the economic interests that shape policy decisions, such as the role of lobbyists, political donations, and the influence of businesses or advocacy groups.
- Institutional Analysis: Understanding how the structure of political institutions (e.g., executive, legislative, judiciary) and their interrelations contribute to the law or policy’s formulation.
4. Sociological Approaches
- Social Theories of Law and Policy: Scholars from a sociological perspective often analyze how laws or policies reflect or enforce social norms, values, and power dynamics. This includes:
- Critical Legal Studies: Investigating how the law is shaped by social power relations and how it might perpetuate inequality or social control.
- Law and Society: Analyzing the broader societal context of law-making, considering how societal forces (e.g., public opinion, cultural attitudes) influence policy decisions.
- Social Movements and Advocacy: Investigating the role of activism or advocacy groups in shaping the law or policy. This includes understanding the strategies used by interest groups to influence legislation.
5. Economic Analysis
- Cost-Benefit Analysis: Economic scholars often investigate the efficiency of laws or policies by assessing their economic costs and benefits. This includes evaluating the outcomes of a policy in terms of economic indicators (e.g., growth, unemployment, income distribution) and assessing whether the law achieves its stated goals.
- Behavioral Economics: Examining how laws and policies affect individual and collective behavior, such as through nudges or incentives, can reveal the underlying rationale for a policy.
- Public Choice Theory: Analyzing how political actors (e.g., lawmakers, bureaucrats) make decisions based on their own interests and incentives, rather than public welfare.
6. Ethical and Philosophical Analysis
- Normative Theories of Justice: Examining the law or policy through the lens of ethical theories, such as utilitarianism, deontology, or Rawlsian justice. This can help clarify the moral rationale behind the law, including whether it seeks to promote fairness, equality, or liberty.
- Human Rights Perspectives: Analyzing whether the law or policy aligns with international human rights standards or principles such as dignity, autonomy, and equality. This is particularly useful when the law or policy in question affects vulnerable populations.
- Public Morality: Investigating whether the law reflects certain moral values or societal goals, such as social cohesion, moral order, or public health.
7. Empirical Research and Data Analysis
- Quantitative Analysis: Using statistical tools to analyze the effects of a policy. For example, if a law was intended to reduce crime rates, scholars may analyze crime data before and after its implementation to assess its effectiveness and the reasoning behind the policy's goals.
- Qualitative Research: Conducting interviews, surveys, or focus groups with stakeholders (e.g., policymakers, affected groups, experts) to gather insights into the reasoning behind the law. This can also involve ethnographic methods to understand the law's impact on everyday life.
8. Critical and Interdisciplinary Approaches
- Feminist Legal Theory: Examining laws or policies from the perspective of gender and power dynamics, considering how policies might reinforce or challenge gender inequality.
- Critical Race Theory: Analyzing how race and racial dynamics influence the creation, interpretation, and implementation of laws or policies.
- Intersectionality: Exploring how multiple social identities (race, gender, class, etc.) interact to shape both the policy’s creation and its effects on different groups in society.
9. International and Comparative Analysis
- Comparative Law: Analyzing how similar laws or policies in different jurisdictions (e.g., countries or states) reflect differing priorities or reasoning. This may reveal the influences of international legal trends, global standards, or local conditions.
- International Relations: Understanding how global agreements, treaties, or transnational issues (e.g., climate change, trade, human rights) shape domestic laws and policies.
By combining these various methods, scholars can develop a multi-dimensional understanding of the reasoning behind laws and policies, exploring their origins, implications, and effectiveness. This interdisciplinary approach helps reveal not only the practical considerations that led to the policy’s creation but also the broader social, economic, and political forces that shaped its development.
So, I don't think you're saying that the only thing we can do is start with Item 1 on that list (in fact, so far, I don't think this has been a significant point of discussion yet). I'm sure we can work through many of these methods, but I put in a bit of effort to make sure that we got Item 2 down, yet I can't tell what you think. Do you think we've gotten that one mostly figured out, or do you think that I'm still missing some information on that one?
EDIT: Just to triple-check that I'm not completely off base and got some aberrant first result, I asked:
If someone begins their scholarly approach by doing the second item on that list, historical analysis, would that be sophistic or shamanic?
Beginning a scholarly approach to investigating the reasoning behind a law or policy by engaging in historical analysis would neither be "sophistic" nor "shamanic" in a scholarly context. Rather, historical analysis is a legitimate and well-respected method in academic research, particularly in the fields of law, political science, sociology, and history itself.
Why it is not sophistic:
"Sophistry" refers to the use of fallacious reasoning or deceptive arguments, often with the intention of misleading others. Sophists in ancient Greece were known for manipulating language and logic to appear knowledgeable or persuasive without necessarily adhering to sound reasoning.
Historical analysis is grounded in evidence, documentation, and critical inquiry. When scholars use historical analysis to investigate the origins and development of a law or policy, they are engaging with primary sources, such as legislative records, political speeches, or societal events, to reconstruct the context and motivations behind the policy. This approach adheres to scholarly rigor and is not aimed at deceiving or distorting facts. It’s about understanding how a law came into being and the historical forces that shaped it, rather than manipulating or obscuring truth for rhetorical effect.
Why it is not shamanic:
"Shamanic" refers to practices associated with indigenous spiritual or religious rituals, often involving trance states, supernatural beliefs, or communication with spirits. In contrast, historical analysis in the scholarly sense involves using empirical evidence, documents, and critical thinking to understand past events and trends.
While some might see historical analysis as uncovering "hidden" meanings or interpreting events through a particular lens, it remains firmly grounded in empirical evidence and logical reasoning. It doesn't involve mystical or supernatural interpretation but rather seeks to understand the causes and effects of historical events through a scholarly, evidence-based process.
In summary:
Using historical analysis as a starting point for understanding the reasoning behind a law or policy is a valid scholarly approach. It is neither sophistic (which involves deceptive argumentation) nor shamanic (which involves mystical or spiritual practices), but rather a rigorous, evidence-based method that helps scholars understand the social, political, and economic factors that shaped a given law or policy.
ControlsFreak
11d ago
So, what I think you're saying is that you want to talk about the current operation of the farm, given the existence of the fence. That may be an interesting conversation, when we can get to it, but the current operation of the farm is designed around the fact that there is a fence there. That a current farmhand says, "I've kinda figured out at least something nice I can get out of this fence here," is not our first question. Our first question is why. What for. What problem was it designed to solve? I have tried to endeavor to understand why it was put into place. What for. What problem it was designed to solve. What information am I lacking on that question? If I am not lacking in information on that question, I would appreciate some acknowledgement on that point, and then we can move toward other issues. As of now, my sense is that you're saying that I'm just so completely lacking in any information that I still don't even have any idea why it was built, what it was for, what problem it was designed to solve.
ControlsFreak
11d ago
That is later then when the fence was erected. What information am I lacking concerning the how/why of the fence being erected?
ControlsFreak
11d ago
Please just explain anything to do with Chesterton's fence. I don't understand, and I want to understand. Perhaps you can bring more information that I am missing about the period of time when this fence was erected, if it is information I am lacking.
ControlsFreak
11d ago
After a nice sleep last night, I tried really interpreting my interlocutor's most-recent-at-the-time argument about Chesterton's fence, with as much charity as I could. I went on to produce what I thought was almost a quality contribution.
So let me ask you for some advice. I would like to be able to have a productive conversation with this person. I have tried to bring us back to productive conversations and put in effort on my side. What I've gotten in response is accusations of sophistry, that I don't know anything about anything relevant, and claims that if I even consider the questions asked, it will magically become clear to me. I suppose I will trust your read that those comments are actually me becoming more antagonistic, and I will have to review it in time to understand, but can you provide any advice for how I can bring such a conversation back into the realm of being productive? Or do I really just need to give up when this is the type of engagement I'm getting?
ControlsFreak
11d ago
You're not even trying.
Sorry that I'm sooooo stupid that after I have considered the answers to the question you've asked, I still find your position on my explanation of Chesterton's Fence unclear. You're gonna have to stoop down real low and actually explain what you're thinking in a way that is comprehensible to us normal 'little' people.
ControlsFreak
11d ago
I don't agree with your characterization of the fence, previous message describes why.
No, it does not. You lurched erratically off on a different direction. Please explain why you don't agree with my characterization of how/why the fence was put into place.
ControlsFreak
11d ago
Let's go a bit slowly here, as you've shown yourself very prone to erratically jumping between different arguments, without much logical connection to what has been said. We were discussing a specific aspect of medicine, and after you struggled mightily in using your vast domain-specific knowledge to make a coherent argument, you invoked Chesterton's Fence, again sort of erratically and not weaved into a coherent argument. Chesterton said:
There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
This was your pithy attempt to just tell me to shut up and go away. However, Chesterton explicitly said that one is to come back after they can explain what the use of it was, where usually, this is interpreted to mean that one has understood that reasonably intelligent humans went through the effort to erect the fence, and so this must have happened for some use for someone. In our case, the fence is the requirement that basically every drug requires a prescription.
I'm going to start needing some clear affirmations of the progress we've made if I'm going to believe that you're arguing in good faith and are willing to have an honest back-and-forth rather than just erratically lurching in every which way, mostly trying to wave your degree around and telling me to shut up. Do you clearly affirm that I have, in fact, described how humans found value in setting up this fence and why it came to be?
If you do not agree, then we need to return to that question. If you do agree, then we can come back to where we were. Let's talk testosterone. Let's hear your argument (only after you explicitly agree that we have satisfied the last demand you made, but before we lurch off onto another hundred erratic demands you'd like to make).
Sophistry (and gish gallops) is not a substitute for a coherent argument.
This is a nice moment to take stock of the situation. Up to this point, you have lost and abandoned every single object-level argument you have made, over and over again. In this comment, you have implicitly acknowledged that you have again abandoned another argument that you've lost.
You know nothing about
This is also a nice moment to reflect on the fact that while, "You're stupid," is a great and effective argument on the third grade playground, it's not very becoming in a place like The Motte... especially when you've just lost and abandoned every single argument you've made so far.
Now, to get to Chesterton's Fence, which is in a sense moving up to the meta level, mostly abandoning any actual argument that would benefit from real in-depth domain expertise at the level of the practice of medicine, but instead moving up to the question of the history/intent of the government action.
One thing that is always a bit tricky about Chesterton's Fence is its conceptualization of "intent". One doesn't have to go full Scalia to know that, when it comes to law, 'legislative intent' can be a tricky beast. Things are sometimes done for a variety of motives affecting multiple agents. Sometimes, it is just a banal compromise (something that no one really intends, but merely accepts). Sometimes, it's a confluence of surprisingly different intents; see also the famous Bootleggers and Baptists theory. So, with that in mind, let's go through a little of the history, and see what all we can say about it.
One could have a more expansive history, but I only have so much time in a day, so I think an acceptable place to start is 1937. Prior to this point, USP was a private organization that published their own compilations of drug information. (As Mitch Hedberg would say, they still do, but they used to, too.) Alongside this, the government did have a legitimate reason to ensure that consumers at least had some understanding of what products they were buying, so the 1906 Pure Food and Drugs Act adopted the USP and said that a drug was "adulterated" if it failed to meet the USP's standards. Then, a company brought an "elixir" to market that used diethylene glycol, causing lots of harm and about a hundred deaths. There was a clear gap in the law and standard, because if the product had been called a "solution" instead of an "elixir", there would have been no legal violation. (Note that liability damages are a separate question and plausible pathway to accomplishing some fence-like goals and may be a useful tool in the toolbox.)
Enter the Food, Drug, and Cosmetics Act of 1938. This was "intended", in the Chestertonian Fence sense, to be a more robust labeling law, in an extremely pre-information-age era. This fence was not intended to restrict a person's ability to self-medicate. With the above caveats about divining intent for fences from legislative history, FDA chief Walter G. Campbell said:
There is no issue, as I have told you previously, from the standpoint of the enforcement of the Food and Drugs Act about self-medication. This bill does not contemplate its prevention at all. . . . But what is desired . . . is to make self-medication safe. [The bill provides] information that will permit the intelligent and safe use of drugs for self-medication. . . . All of the provisions dealing with drugs, aside from those recognized in the official compendia, are directed towards safeguarding the consumer who is attempting to administer to himself. If this measure passes, self-medication will become infinitely more safe than it has ever been in the past.
Sen. Royal S. Copeland (D-NY) said:
There is no more common or mistaken criticism of this bill than that it denies the right to self-medication. . . . Nothing could be further from the truth. The proposed law simply contributes to the safety of self-medication by preventing medicines from being sold as “cures” unless they really are cures. It requires that drugs which have only palliative effect say as much on the label.
The House committee reported:
The bill is not intended to restrict in any way the availability of drugs for self-medication. On the contrary, it is intended to make self-medication safer and more effective.
It wouldn't have made sense for the elixir tragedy to be the impetus for a law requiring prescriptions, because almost all of the deaths that came from the elixir were under the direction of a government-licensed physician. (Prior to any mandates, I'll note, some manufacturers voluntarily made their products "prescription-only", and one would have to have a separate exploration as to whether the intent there was commercial or something else. That said, I don't believe that they had required this drug to be prescription-only, but I'm not sure.) Having a prescription requirement would have saved almost none of the precious lives in question. Since then, we have not had any splashy self-medication string of deaths that would justify a prescription requirement, either. One other additional note at this point is that, even in the absence of such government requirements, the vast majority of people who took this drug did so under the direction of a doctor; many many people leveraged the expertise of medical professionals, because they found it valuable. It was not banned to leverage a doctor's expertise. (It just happened to get them killed when they followed the doctor's advice in this case.)
So what happened? Who intended it? Who built the fence and why? Turns out, the problem was mostly that the FDA was part incompetent, part just unfortunately operating in a pre-information-age era. They set out extremely vague, but strongly-worded labeling requirements. Manufacturers were scared off by how vague the requirements were, not even being sure how much stuff they really needed to put on the label to remain compliant, and in a world where all that information pretty much had to be printed directly on the little bottle, at great expense, many manufacturers were unhappy. Of course, in every regulatory scheme where half the job is keeping consumers happy and half of the job is keeping producers happy (and rich), and especially when the latter group is likely the buddy-buddy industry counterpart to the regulators with a revolving door, sometimes, you gotta do something to make the industry happy. So the FDA, on their own, without Congressional intent or authorization, just exempted medications that the manufacturer designated as prescription-only from their labeling requirements. How much of this is due to the fact that they were just not competent to come up with a more acceptable and precise labeling requirement and how much of it is just due to pre-information-era constraints? Not sure.
In any event, since manufacturers found the FDA's hamfisted labeling requirements so vague/onerous, they generally preferred to just take the exception, presumably with the Chestertonian intent to make more money and reduce their regulatory risk. I'm not even sure that the physicians were part of the bootleggers or baptists; they might not have even lobbied for this exception, only realizing later how lucrative the arrangement would be for them as well as the manufacturers. The result was that many drugs which were actually totally safe to self-administer suddenly became prescription-only, primarily because the FDA went out on its own in making new rules, did a kind of bad job at it, and manufacturers would now make more money this way.
In the next decade or so, there was clearly some confusion. The rules didn't make sense. There was no consistency or logic in whether a drug was prescription-only or not. It was entirely up to the manufacturer, who would presumably decide based on money and risk (mostly regulatory risk rather than safety risk). So, two professional pharmacists in Congress (unsurprisingly named Durham and Humphrey) created the Durham-Humphrey Amendment of 1951, which codified the prescription-only/OTC divide and put the decision under the purview of the FDA. Of course, don't forget, those drugs would be dispensed by professional pharmacists, folks near and dear to those two congressmen.
So, that's the story. What is the "intent" of the fence? Well, sure, consumer protection is in there somewhere. But it's pretty confused with tales of differing motives, incompetence, and plain difficulty of living in the past. Is it a messy story of how we got to where we are today? Absolutely. Does that mean that there aren't possible good features of the system we have today? Of course not. Does anything in there imply that this is the only plausible way of doing things and we'll have megadeaths if we do anything differently? I doubt it. But since we've now gone through the exercise of going through how the fence got there and why, perhaps we can turn back to the real questions: today, right now, what are the real, serious, justifications for such mandates/bannings?
ControlsFreak
11d ago
Having someone who's more intelligent than you, knows a lot more about medicine than you, and has had a lot of practice managing patients instructing you on what to do helps a lot.
No one is talking about banning doctors. There are options other than "mandatory" and "banned". You can still have literally every word of that.
The doctor has a list of all the medications you are taking
ROFL. Only if you tell him. Or he works for the same conglomerate as your other doctors with the same records system. And again, no one is preventing you from doing these things. And again again, they're generally just a second set of eyes, and a pharmacist does this. There are so many ways that you can have some eyes on what you're taking and look for interactions without blanket bans on prescription meds. But if the point is to make sure you don't take specific different medications at the same time, they're gonna need to be in your house 24/7.
Would it? Most of the time, when industry advocates are here arguing this sort of point, they're implicitly assuming that the use of medical professionals will drop to zero (or be banned). Thus, they're imagining the least knowledgeable person deciding on their own medical treatment. But when we look at the car maintenance world, we see the vast vast majority of low-knowledge folks still using automotive professionals. The rate of self-injury is, indeed, low, but someone needs a bit more than arguments from bad imagination if they're going to rest on a claim that the rate of self-injury would surely be "quite a bit" higher.
You hear this same shit from the realtor cartel, and frankly, any cartel that wants to maintain its market power. "Oh real estate transactions are so complicated; can you imagine how the sky would fall if we didn't get our 3% cut of every transaction?! PEOPLE WOULD BE HARMED!" You know what really would happen if you lost some of the sketchier tools to maintain your market control? First, you'd probably have to clean up your act, but second, lots and lots of people would still use you, but for your actual expertise, rather than because they think they're basically forced into it. Sure, will there be some harm that didn't occur before? Probably. But there's some harm now that wouldn't occur then, too. You need an actual argument about magnitudes rather than just imagination.
EDIT: Remember when it was every state, rather than just two states, who banned you from pumping your own gas into your car? Surely there were folks saying how risky and dangerous it would be (gasoline is flammable, don'cha'kno?) to let ignoramus individuals do it. How's that argument looking for those two states that have held on to it?
What do you think about the Trump tariffs? I'm really curious about how these things interact.
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