Category: Philosophy

Conflict-of-Interest Politics Reduces Medical Collaboration with Industry and Slows Down Cures

(p. A15) The reality of modern medicine, Dr. Stossel argues, is that private industry is the engine of innovation, with productivity and new advances dependent on relationships between commercial interests and academic and research medicine. Companies, not universities or research with federal funding, run 85% of the medical-products pipeline. “We all inevitably have conflicts all the time. You only stop having conflicts when you’re dead. The only conflict-free situation is the grave,” he says.
The pursuit of the illusion “to be pure, to be priestly, to be supposedly uncorrupted by the profit motive,” Dr. Stossel says, often has the effect of banishing or else discounting the expertise of the people who know the most but whose integrity and objectivity are allegedly compromised by industry ties. What ought to matter more, he adds, is simply “Results. Competence. LeBron James–it’s putting the ball in the basket.”
. . .
Zero-tolerance conflict-of-interest editorial policies, Dr. Stossel says, suppress and distort debate by withholding positions of authority. “If you have an industry connection, if you really understand the topic, you can’t say anything,” he notes. “If you’re an editor, and you have an ideological predilection, you have all this power and you can say anything you want.”
Dr. Stossel is equally scorching about the drug and device companies and their trade organizations, which he says drift around like Rodney Dangerfield, complaining they don’t get no respect. They prefer not to be confrontational, they rarely fight back against the conflict-of-interest scolds. “They’re laying responsibility by default to the patients, the people who actually have a first-hand connection to whatever the disease is: ‘Goddammit, I want a cure.’ ”
Which is the larger point: The to-and-fro between publications not meant for lay readers can seem arcane, but the product of conflict-of-interest politics is fewer cures and new therapies. The predisposition against selling out to industry is pervasive, while reputations can be ruined overnight when researchers find themselves in a page-one exposé or hauled before Congress, even if there is no evidence of misconduct or bias.
Better, then, to conform in the cloisters than risk offending the conflict-of-interest orthodoxy–or translating some basic-research insight into a new treatment for patients. Dr. Rosenbaum reports: “The result is a stifling of honest discourse and potential discouragement of productive collaborations. . . . More strikingly, some of the young, talented physician-investigators I spoke with expressed worry about how any industry relationship would affect their careers.”
. . .
‘Pharmaphobia”–part polemic, part analytic investigation, a history of medicine and a memoir–deserves a wide readership. . . . “I’d rather get a conversation started with people who are smarter than I am about how complicated and granular and nuanced and unpredictable discovery is. Let’s not slow it down.”

For the full interview, see:
JOSEPH RAGO. “The Weekend Interview with Tom Stossel; A Cure for ‘Conflict of Interest’ Mania; A crusading physician says medical progress is hampered by a holier-than-thou ‘moralistic bullying.’.” The Wall Street Journal (Sat., June 27, 2015): A15.
(Note: ellipses added.)
(Note: the online version of the interview has the date June 26, 2015, and has the title “A Cure for ‘Conflict of Interest’ Mania; A crusading physician says medical progress is hampered by a holier-than-thou ‘moralistic bullying.’.”)

The book mentioned in the interview, is:
Stossel, Thomas P. Pharmaphobia: How the Conflict of Interest Myth Undermines American Medical Innovation. Lanham, MS: Rowman & Littlefield Publishers, 2015.

Canny Outlaws in Education and at Hogwarts

(p. 174) Interestingly, the union members in some of the schools run by Green Dot Public Schools, a charter school group with a solid educational track record, did not boycott the benchmark tests. The reason that they refused is revealing. Green Dot’s exams are created by a panel of teachers from its schools and are regularly reviewed for effectiveness and modified by the teachers. The tests have more credibility with the teachers than the tests for the rest of the district’s schools, which are written by an outside company, imposed from above, and don’t mesh with year-round schedules.
The quiet resistance of canny outlaws and the vocal protests of others are signs that teachers dedicated to preserving and encouraging discretion and wise judgment are not going quietly into the night. These teachers are not people who simply rebel at rules or who are just committed to their own ways of doing things. They are committed to the aims of teaching, a practice whose purpose is to educate students to be knowledgeable, thoughtful, reasonable, reflective, and humane. And they are brave enough to act on these commitments, taking the risks necessary to find ways around the rules. We suspect that many of our readers are canny outlaws themselves or know people who are: practitioners who have the know-how and courage to bend or sidestep for-(p. 175)mulaic procedures or rigid scripts or bureaucratic requirements in order to accomplish the aims of their practice. We admire canny outlaws in the stories we tell ourselves about such people and even in some of our children’s stories. We read the Harry Potter tales to them because Harry, Ron, and Hermione are canny outlaws who gain the guts and skill to break school rules and stand up to illegitimate power in order to do the right thing to achieve the aims of wizardry, indeed to save the practice itself.

Source:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

Physicists Accepting Theories Based on Elegance Rather than Evidence

(p. 5) Do physicists need empirical evidence to confirm their theories?
. . .
A few months ago in the journal Nature, two leading researchers, George Ellis and Joseph Silk, published a controversial piece called “Scientific Method: Defend the Integrity of Physics.” They criticized a newfound willingness among some scientists to explicitly set aside the need for experimental confirmation of today’s most ambitious cosmic theories — so long as those theories are “sufficiently elegant and explanatory.” Despite working at the cutting edge of knowledge, such scientists are, for Professors Ellis and Silk, “breaking with centuries of philosophical tradition of defining scientific knowledge as empirical.”
Whether or not you agree with them, the professors have identified a mounting concern in fundamental physics: Today, our most ambitious science can seem at odds with the empirical methodology that has historically given the field its credibility.

For the full commentary, see:
ADAM FRANK and MARCELO GLEISER. “Gray Matter; A Crisis at the Edge of Physics.” The New York Times, SundayReview Section (Sun., JUNE 7, 2015): 5.
(Note: ellipsis added.)
(Note: the date of the online version of the commentary is JUNE 5, 2015, and has the title “A Crisis at the Edge of Physics.”)

The controversial Nature article, mentioned above, is:
Ellis, George, and Joe Silk. “Scientific Method: Defend the Integrity of Physics.” Nature 516, no. 7531 (Dec. 18, 2014): 321-23.

“You Can’t Get Married if You’re Dead”

(p. A15) On Friday my phone was blowing up with messages, asking if I’d seen the news. Some expressed disbelief at the headlines. Many said they were crying.
None of them were talking about the dozens of people gunned down in Sousse, Tunisia, by a man who, dressed as a tourist, had hidden his Kalashnikov inside a beach umbrella. Not one was crying over the beheading in a terrorist attack at a chemical factory near Lyon, France. The victim’s head was found on a pike near the factory, his body covered with Arabic inscriptions. And no Facebook friends mentioned the first suicide bombing in Kuwait in more than two decades, in which 27 people were murdered in one of the oldest Shiite mosques in the country.
They were talking about the only news that mattered: gay marriage.
. . .
The barbarians are at our gates. But inside our offices, schools, churches, synagogues and homes, we are posting photos of rainbows on Twitter. It’s easier to Photoshop images of Justice Scalia as Voldemort than it is to stare evil in the face.
You can’t get married if you’re dead.

For the full commentary, see:
BARI WEISS. “Love Among the Ruins; Hurrah for gay marriage. But why do supporters save their vitriol for its foes instead of the barbarians at our gates?” The Wall Street Journal (Sat., June 27, 2015): A15.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date June 26, 2015.)

Officers Used to Learn from Trial and Error in Training Their Units

(p. 156) In the army, wartime experience is considered the best possible teacher, at least for those who survive the first weeks. Wong found another good one–the practice junior officers get while training their units. The decisions these officers have to make as teachers help develop the capacity for the judgment they will need on the battlefield. But Wong discovered that in the 1980s, the army had begun to restructure training in ways that had the opposite results.
Traditionally, company commanders had the opportunity to plan, (p. 157) execute, and assess the training they gave their units. “Innovation,” Wong explained, “develops when an officer is given a minimal number of parameters (e.g., task, condition, and standards) and the requisite time to plan and execute the training. Giving the commanders time to create their own training develops confidence in operating within the boundaries of a higher commander’s intent without constant supervision.” The junior officers develop practical wisdom through their teaching of trainees, but only if their teaching allows them discretion and flexibility. Just as psychologist Karl Weick found studying firefighters, experience applying a limited number of guidelines teaches soldiers how to improvise in dangerous situations.
Wong’s research showed that the responsibility for training at the company level was being taken away from junior officers. First, the time they needed was being eaten away by “cascading requirements” placed on company commanders from above. There was, Wong explained, such a “rush by higher headquarters to incorporate every good idea into training” that “the total number of training days required by all mandatory training directives literally exceeds the number of training days available to company commanders. Company commanders somehow have to fit 297 days of mandatory requirements into 256 available training days.” On top of this, there were administrative requirements to track data on as many as 125 items, including sexual responsibility training, family care packets, community volunteer hours, and even soldiers who had vehicles with Firestone tires.
Second, headquarters increasingly dictated what would be trained and how it would be trained, essentially requiring commanders “to follow a script.” Commanders lost the opportunity to analyze their units’ weaknesses and plan the training accordingly. Worse, headquarters took away the “assessment function” from battalion commanders. Certifying units as “ready” was now done from the top.
The learning through trial and error that taught officers how to improvise, Wong found, happens when officers try to plan an action, (p. 158) then actually execute it and reflect on what worked and what didn’t. Officers who did not have to adhere to strict training protocols were in an excellent position to learn because they could immediately see results, make adjustments, and assess how well their training regimens were working. And most important, it was this kind of experience that taught the commanders how to improvise, which helped them learn to be flexible, adaptive, and creative on the battlefield. Wong was concerned about changes in the training program because they squeezed out these learning experiences; they prevented officers from experiencing the wisdom-nurturing cycle of planning, executing the plan, assessing what worked and didn’t, reevaluating the original plan, and trying again.

Source:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.
(Note: italics in original.)

Common Sense “Rules” Often Contradict Each Other

(p. 43) The world we face is too complex and varied to be handled by rules, and wise people understand this. Yet there is a strange and troubling disconnect between the way we make our moral decisions and the way we talk about them.
From ethics textbooks to professional association codes to our everyday life, any discussion of moral choices is dominated by Rules Talk. If we’re asked to explain why we decided to tell the painful, unvarnished truth to a friend, we might say, “Honesty is the best policy.” But if we’re asked why we decided to shade the truth we might say, “If you can’t say anything nice, don’t say anything at all.” It’s clearly not a rule that is telling us what to do. Both maxims are good rules of thumb, but we don’t talk about why we picked one and not the other in any particular case. “Better safe than sorry.” But “He who hesitates is lost.” “A penny saved is a penny earned.” But “Don’t be penny wise and pound foolish.” When we hear the maxim, we nod. End of story. It’s as if stating the rule is sufficient to explain why we did what we did.

Source:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

Empathy for the Absent

In Practical Wisdom the authors argue for empathy and against rules. There is something to be said for their argument.
But we tend to empathize with those who are present and not those we do not see or even know.
For example in academic tenure and promotion decisions, slack is often cut for colleagues who already have their foot in the door. We know them, their troubles and challenges. So they are tenured and promoted and given salary increases and perks even though there are others outside the door who may have greater productivity and even greater troubles and challenges.
Charlie Munger in an interview at the University of Michigan spoke of how hard it is for physicians to hold their peers responsible when they are incompetent or negligent. They have empathy for their peers, knowing their troubles and challenges. And Munger also says few physicians are willing to suffer the long-lasting “ill will” from their peers who have been held accountable. They do not know so well the patients who suffer, and one way or another, the patients are soon out of sight.
Just as in academics we do not know so well the students who suffer; or the able scholars who suffer, standing outside the door.
Following rules seems unsympathetic and lacking in empathy. But it may be the best way to show empathy for the absent.

The book mentioned is:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

The interview with Munger is:
Quick, Rebecca (interviewer). “A Conversation with Charlie Munger.” University of Michigan Ross School of Business, Sept. 14, 2010.

Under Perverse Institutions, It Takes “Canny Outlaws” to Do What Is Right

Practical Wisdom is a hard book to categorize. It is part philosophy, and one of the co-authors is an academic philosopher. But most of the book consists of often fascinating, concrete examples. The examples are usually of perverse institutions and policies that create incentives and constraints that reward those who do bad and punish those who do good. The authors’ main lesson is that we all should become stoical “canny outlaws” by finding crafty ways to do what is right, while trying to avoid or survive the perverse incentives and constraints.
Maybe–for me the main lesson is that we all should get busy reforming the institutions and policies. But whether their lesson or my lesson is the best lesson, their book is still filled with many great examples that are worth pondering.
In the next few weeks, I will be quoting several of the more useful, or thought-provoking passages.

The book discussed, is:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

Having Your Intellectual Property Stolen, Modifies Your Views on Piracy

(p. C18) Dear Dan,
My nephew has been downloading music and movies illegally from the Internet. Without sounding self-righteous, how can I get him to respect intellectual-property rights?
–Patricia
My own view on illegal downloads was deeply modified the day that my book on dishonesty was published–when I learned that it had been illegally downloaded more than 20,000 times from one overseas website. (The irony did not escape me.) My advice? Get your nephew to create something and then, without his knowing, put it online and download it many, many times. I suspect that will make it much harder for him to keep up his blithe attitude toward piracy.

For the full advice column by Dan Ariely, professor of behavioral economics at Duke , see:
DAN ARIELY. “ASK ARIELY; It’s Risky to Rely on Retirement Questionnaires.” The Wall Street Journal (Sat., May 23, 2015): C18.
(Note: italics in original.)
(Note: the online version of the advice column has the date May 22, 2015.)

Hamburger Grown in Lab from Cow Stem Cells

(p. D5) A hamburger made from cow muscle grown in a laboratory was fried, served and eaten in London on Monday in an odd demonstration of one view of the future of food.
. . .
The two-year project to make the one burger, plus extra tissue for testing, cost $325,000. On Monday it was revealed that Sergey Brin, one of the founders of Google, paid for the project. Dr. Post said Mr. Brin got involved because “he basically shares the same concerns about the sustainability of meat production and animal welfare.”
The meat was produced using stem cells — basic cells that can turn into tissue-specific cells — from cow shoulder muscle from a slaughterhouse. The cells were multiplied in a nutrient solution and put into small petri dishes, where they became muscle cells and formed tiny strips of muscle fiber. About 20,000 strips were used to make the five-ounce burger, which contained breadcrumbs, salt, and some natural colorings as well.

For the full story, see:
Fountain, Henry. “Frying up a Lab-Grown Hamburger.” The New York Times (Tues., Aug. 6, 2013): D5.
(Note: ellipsis added.)
(Note: the online version of the story has the date Aug. 5, 2013, and has the title “A Lab-Grown Burger Gets a Taste Test.”)