Assumptions

My thanks to Ken Houghton, who pointed out this post of Megan McArdle's.

McArdle posts that the government is inferior to the free market because the free market is checked by "countervailing market discipline" and the government is not. Her reasons are not very persuasive and are based on her assumption that the government is always worse than free market capitalism, as Larry Kudlow would say. Because of this assumption, McArdle misreads and misinterprets the information she used to give an example of government malfeasance in action.

Government power can perpetuate a bad paradigm. I'm currently reading a book called Cure Unknown by a science journalist who believes she and her family are suffering from chronic Lyme disease. I don't know if Chronic Lyme Disease
exists, or is a figment of the imaginations of people with some unspecified
systemic or psychological problem. But some of the things she's angry about ring
true to me because they sound a lot like other episodes from the history of science.

The spirochete that causes Lyme is hard to detect, so treatment
guidelines focus on the "bullseye rash", not because there's any particular
reason to think it must follow infection by the borrelia bacterium, but because
it's easy to diagnose, and . . . it's part of the diagnostic criteria. Everyone
who has "real" Lyme disease has the rash, because the definition of "real" Lyme
disease is having a rash. This, of course, makes it hard to test the theory that
the spirochete might cause symptoms other than a rash.

[yap yap]

[Pam] Weintraub makes a compelling case that these sorts of
hard-and-fast diagnostic rules [at the CDC] have, at the very least, left some
indisputable cases of Lyme undiagnosed, including that of Weintraub's son. The
CDC has turned this into a major problem, since of course most physicians do not
pour through the journals themselves; they glance at the CDC criteria, which are
quite restrictive. It's pretty clear that scientists who have a lot vested in
the current model of Lyme (their careers, possible malpractice accusations),
have at least for now won the debate. It's not quite so clear that they should
have. And the government imprimatur has done a lot to seal the fate of the
dissidents. This is all standard stuff to anyone who's read The Structure of
Scientific Revolutions. But those revolutions happen because there are
multiple possible centers of power. The government has the ability to
potentially shut the revolutionary centers down.

As I say, I am in favor of doing the research. But the dangers of this sort of government sanction are not quite so far off and imaginary as Matthew Yglesias and Hilzoy seem to think. I don't think conservatives have done a very good job of articulating those dangers (and don't get me started on the pharmaceutical industry!) But I still think they're worth keeping in mind.

Most unfortunately, McArdle did not read the book carefully and took away from the events in the book what she wanted to take. Because of her assumptions and prejudices, McArdle makes several embarrassing mistakes.

McArdle assumes the government will make errors that are never corrected and lazily followed without thought.

Science isn't always cut and dried, but government reports are supposed to
produce answers. There's a danger the bureaucrats will be more definite than the
science calls for. This is a risk in the private sector, too, but private sector
errors of this sort are rarely as powerful as government errors of the same
kind. Once the government establishes a standard of care, private companies will
probably follow, even if they are wrong, because it's:

Easier than doing their own analysis
A lot easier than getting sued
Possibly cheaper than the more effective treatment.

Because of these assumptions, McArdle thinks the CDC's rigid standards hinder the diagnosis of Lyme disease.

[Pam] Weintraub makes a compelling case that these sorts of hard-and-fast
diagnostic rules [at the CDC] have, at the very least, left some indisputable
cases of Lyme undiagnosed, including that of Weintraub's son. The CDC has turned
this into a major problem, since of course most physicians do not pour through
the journals themselves; they glance at the CDC criteria, which are quite
restrictive.

But McArdle also assumes that, to put it into terms McArdle would understand, protesters are fools interfering with the natural order of the free market. So McArdle suspects all interest groups as well, a fancier way of hating the dirty hippies who want equality and have no respect for their betters.

Government agencies are much more vulnerable to interest group pressure than private companies. Researchers will come under tremendous pressure to say that
things work when they don't--not just from big, bad Pharma companies, but from
patients who do not want their insurance company to cut off access to the
treatment. And see above: a government report saying snake oil might work has
more impact than a dozen private company reports saying the same.

This disdain leads her to say several very unfortunate things.

I don't know if Chronic Lyme Disease exists, or is a figment of the imaginations of people with some unspecified systemic or psychological problem. But some of the things she's angry about ring true to me because they sound a lot like other episodes from the history of science.

[from comments, to Weintraub herself] [...S]ometimes disease advocates are right--but as you undoubtedly also know, sometimes they're crazy. Indeed, sometimes they are both crazy and right.

Stupid, callous, and unkind. But McArdle isn't evil, she's ideological. She doesn't think beyond her comfortable, self-flattering assumptions. She doesn't think about the people who suffer for her ideals. She writes her little posts and flits off, to the next pet peeve or favorite concept. Oddly, they all end up supportive of those in power.

In the comments we see how far afield McArdle's prejudices have taken her. Ms. Weintraub, with some agitation, attempts to correct McArdle's mistakes. She tells McArdle that her son did not have Chronic Lyme disease and the issue was "that the FIGHT over chronic Lyme disease has caused doctors in the community to pull back from diagnosing even classic Lyme disease, creating a large population of late stage patients who are harder to treat." McArdle completely missed this point. Ms. Weintraub also says:

I am not an advocate. I am a very longtime national science journalist and senior editor at Discover Magazine, and tried to present a balanced view in my book even while relating my own experience for full and honest disclosure.

I have traveled around the country interviewing mainstream scientists not involved in the political fight over Lyme but working with the organism and its pathogenesis at the lab bench at major academic institutions. The interviews with these scientists are in the book.

They have given me a very different view than that put forth by the Infectious Diseases Society of America.

I hope we are not at the point where a journalist must either spout the chapter and verse of a single but powerful body or be called an advocate.

McArdle's response is insultingly dismissive:

I'm sorry if I sounded like I was dismissing you; I'm not. First of all, sometimes disease advocates are right--but as you undoubtedly also know, sometimes they're crazy. Indeed, sometimes they are both crazy and right.

But more broadly, I've read one book on the topic, yours. I'm sure we all have had the experience of reading a powerful book, being completely persuaded--then reading another book arguing the opposite, and being completely persuaded by that. I know it's frustrating for you--I've felt the same way many times--but I can't jump to the conclusion you're right without reading other works on the topic. As I say, you're persuasive. And what you describe is certainly behavior that has been described of doctors in other contexts--Semmelweiss, the 48 human chromosomes.

There are a lot of very important discussions to be had regarding the many facets of the health care system in the US. Thanks to McArdle's ideological blindness, this is not one of them.