Friday, December 31, 2004

Sowell on Safety

Thomas Sowell has written a valuable reminder that absolute safety is a chimera. His article points out that individuals, not third parties such as governments, should determine the tradeoffs when it comes to using phamaceutical drugs. Governments typically look only at the harm and ignore the benefits that many people seek. An unacceptable risk to one person may be perfectly reasonable to someone else. Moreover, the doubling of the risk of, say, heart disease, from using a drug (such as Vioxx or Celebrex) may still amount to a tiny risk. Multiplying a very small number by 2 yields a small number. If you have a penny and I give you another, your holdings have doubled, but you still have very little money. The point is that individuals should have the freedom and responsibility to decide. The doctrine that the government should maximize safety at any cost is not only impossible, it is something people would never accept if they thought through the implications. (Anyone for outlawing left turns on the roads?)

Unfortunately, Sowell accepts the requirement that people have prescriptions before obtaining certain drugs; i.e., he doesn't take his commitment to self-responsibility far enough. See more from Sowell here.


At 12:16 AM, Blogger Nicolas Martin said...

If this is our only source, I'm not sure it is fair to infer from it Sowell's views on prescription drug laws. He may simply have chosen not to raise that issue in this context. But I agree that if he does support the prescription laws, his views are inconsistent, especially as he has written forcefully against illicit drug prohibition. In 1984 he wrote, "Like alcohol, drugs can be regulated for content, age required for purchasing, driving under the influence, etc." Regulating drugs for content is not something I consider an appropriate or necessary role for government, but it certainly wouldn't require the FDA monster we presently have. It would be odd for Sowell to support less restrictive regulation of drugs that are today illicit than those that are licit.

Even if the FDA is abolished we are not out of the woods, since we still would have the tort laws to strangle commerce. There need not be a coherent government doctrine of safety maximization, there need only be the incentive of massive wealth transfer via lawsuit. American law now obviates principle.

The large drug companies -- those that can afford the burdon of regulation -- surely find the lawsuit wildcard more daunting than regulation, whose costs they can pass along, and which they can address (to some extent) with consolidation and insulation from competition from upstarts.

I don't completely share your sanguinity about the risks of the drugs mentioned. They may turn out to present a much greater hazard than is yet known. And I would suggest that an important reason drug companies invent more hazardous drugs is the prohibition on the use of effective low-risk painkillers. More expensive and more hazardous drugs are inevitable outcomes of drug prohibition.

It got much less coverage, but (as Reuters reported) "People with advanced heart failure and who also have diabetes that requires insulin treatment have about a fourfold greater mortality rate than heart failure patients who don't take insulin..."

Doubtless the lawyers are gearing up to drive insulin off the market, thereby relieving diabetics of the responsiblity for choosing the risk of living longer.

At 7:22 AM, Blogger Sheldon Richman said...

"I don't completely share your sanguinity about the risks of the drugs mentioned. They may turn out to present a much greater hazard than is yet known."

I didn't mean to express sanguinity about those drugs. I was just relating a general principle that Sowell raised in his article.

At 2:08 PM, Blogger Mira de Vries said...

Sowell compares the trade-off of risk and benefit regarding the use of Vioxx or Celebrex to the same regarding protective padding during a football game or driving on a certain road. The comparison is skewed, because:
1. in the case of a prescription drug, the choice is made by a third party, a physician, who is empowered by the government to do so; and
2. while the football player and the driver have benefitted from training in their particular field, the consumer taking the prescription drug has been denied a medical education, and is therefore prevented from making an informed decision.

If medicine were included in elementary education like math and history, if Vioxx and Celebrex were available on a free market, and if pharmaceutical manufacturers had the same responsibility for correctly informing the consumer about their products that the manufacturer of every other product has, the comparison would be right.

At 3:00 AM, Blogger Lee Killough said...

In a similar vein, Charley Reese recently lapses when he argues:

"The best thing the government can do is to ban prescription-drug advertising on television. Drugs should not be prescribed because patients demand them after having watched the ridiculous television ads that make them seem like magic pills. Drug companies should not be allowed to bribe doctors with fancy vacations or other premiums, nor pay consulting fees to people in the research field."On the contrary, the best thing the government can do is to end prescription drug regulation. Drugs should be available because patients desire them. Drug companies, doctors, and patients should be able to work out terms on a consensual basis, without threat of government interference.

At 10:07 AM, Blogger Mira de Vries said...

Reese should take a look at the Netherlands, where prescription-drug advertising is allowed only in presumably closed medical circles (see: Supposedly this protects medically uneducated people from undue influence by the drug companies. In reality, the following happens:
a. Physicians’ decision-making processes regarding which drugs they prescribe remain hidden from patients;
b. The advertisements are guarded against scrutiny and criticism by the people who actually take the products they promote;
c. The drug manufacturers resort to advertisements disguised as neutral information and advice.
As to the drug companies courting and bribing doctors, this would be of little use to them if physicians were deprived of their prescription privileges by the revocation of laws restricting trade in so-called prescription drugs.

You, however, say: “Drug companies, doctors, and patients should be able to work out terms on a consensual basis, without threat of government interference.” If, as you and I both endorse, prescription drug regulation were ended, why make it a triangular relationship? The roll of the doctor would be to give advice only if the patient asks for it.

At 1:35 PM, Blogger Lee Killough said...

I was not trying to imply a triangular relationship. The consenual relationships would be between pairs of individuals.

For example, you could go to a doctor of your choosing, whether state-licensed or not, to get advice. You'd then make your own decision about which drugs to take. You'd then buy the drugs from a pharmacist willing to sell them to you, without any justification required other than your willingness to pay. The pharmacist and doctor would be completely separate, although such separation is not required, should a joint relationship be agreed to by all parties.

The point is that all parties in the transaction are voluntary, and agree unanimously to the terms. What those terms are, and who it involves, is left up to the parties to decide.

“Drug companies, doctors, and patients should be able to work out terms on a consensual basis, without threat of government interference" means whatever terms are agreed to by the parties involved. It does not imply any triangular relationship.

For example, if I want to buy drugs from a pharmacist without disclosing my doctor to him, then that's a term I've laid out and the pharmacist is free to accept/reject. If the pharmacist rejects it, then I either amend my terms and disclose my doctor, or I choose another pharmacist. The choice is mine, not the government's.


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