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In order to have a conversation about increased patient autonomy you need to know the risks and benefits of increased autonomy. I'm not saying you are stupid, I'm saying you don't know anything about medicine or prescribing, which is the thing you are trying to alter. Demonstrating knowledge of the regulatory landscape is not the same as demonstrating the risks and benefits and you certainly have not intimated any knowledge of the many, many discussions about patient autonomy that have been going on for the last several hundred years.
You don't. And that's normal. If I was arguing for deregulation of nuclear energy and you told me you were an expert and that was insane and I blew you off by mumbling about something else, well...no bueno.
You are arguing that people have a right to walk along the train tracks without knowing about the existence of trains.
Since the 1938 date-
How much has the number of drugs increased since then? How much has polypharmacy increased since then? How much has comorbidity increase since then? How much has personal behavior in response to healthcare changed since?
Do you know to think about any of these things?
Sophistry is not a substitute for domain specific knowledge.
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:
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.
I don't agree with your characterization of the fence, previous message describes why.
With respect to test, previously I said:
"Do patients ask for these? What's the ratio of people who actually need them versus just think they need them? Are their side effects? Are they bad? Are the risks something that someone can easily understand and make informed decisions based off of? Are patients willing to try safer and more effective interventions first? What's the evidence base and recommendations, how sure are we about them? Are their bad actors involved who are incentivizing certain behaviors? What is the level of excess supplementation that production can carry? How many of these questions can you answer?"
Given your lack of response and changing the subject I think I can safely assume you can answer none of these things.
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-Benefits and risks of a given action exist, for oneself and for others.
-In order to determine the benefits and risks of this substance as a medication you need to know the answers to those questions, and others.
-You do not know the answers to these questions.
-Therefore you do not know the benefits and risks of testosterone.
-Other medications may or may not have similar risks and benefits.
-You do not know them.
-Therefore you do know if medications are safe, for the taker or for others.
-Expanding on that, you do not know the cost to the patient or others have a given medication.
-Decisions should be made with an awareness of the costs and benefits.
-You personally, and patients in general do not have the information to make these decisions.
-Therefore you shouldn't.
Smuggled in there is the premise that people should not be allowed to grossly harm themselves or others, if you are fine with that ....then sure, but if that's the case I'm not sure how you are going to argue against me putting one in the head when someone hurts others with their decisions.
You may say "well sure but they can harm themselves a little bit" but the same frame holds and you don't have the knowledge to know what actions will cause no, a little bit, or significant harm.
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.
If you consider the answer to the questions I asked it will be clear.
Attempt to understand what you are advocating for.
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.
You keep accusing me calling you stupid, I'm not. I'm saying you don't know what you are talking about...because you don't. These are not the same thing. Intelligence is not required to make a judgement on this, information is, and you haven't exhibited any evidence of training or knowledge that would address that absence.
Arguing in the way you are now may be evidence of lack of intelligence or character flaws...so don't do that.
Passion on a topic is not a substitute for information or understanding, I've given you a significant number of rabbit holes you could go down to educate yourself on considerations you seem unaware of, and you are resistant to doing that. I also simplified my argument to the bare bones premises and tellingly, you made no effort to engage with those.
Ultimately you've fallen into the same trap that the overwhelming majority of patients who bring up this kind of thing do you, you want to make your own decisions, damn the consequences, without awareness that consequences may even exist and when told "no, you must actually think about this" you become upset and sling mud.
It's fundamentally the same conversation I have every time a patient demands an antibiotic for a viral infection.
These conversations, for the record, are what establishes our stance - because most people become riotously upset when told they need to learn.
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.
Great sure, some suggested avenues of exploration-
"How much has the number of drugs increased since then? How much has polypharmacy increased since then? How much has comorbidity increase since then? How much has personal behavior in response to healthcare changed since?"
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You are being increasingly antagonistic throughout this thread. If you find someone is aggravating you, take a breath and maybe take a break from the conversation instead of seeing how cleverly you can imply they are stupid and dishonest without breaking the rules.
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?
What I see is that both of you are doing what is very common in Internet debates, which is, being very confident that you're right and the other person is wrong, adopting a rather condescending tone in explaining how wrong and ignorant the other person is. I do think @Throwaway05 is being a tad condescending, but we don't generally mod for being "a tad condescending." You, however, were getting increasingly heated, especially in your last post.
I very frequently find myself writing a post layered with sarcasm and condescension directed towards someone I think is being an ass. I usually (usually) rewrite it and manage to take a more neutral tone.
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