Tom over on Fat Head links part 2 of an Australian TV series on dietary health, discussing statins and the inherent corruption of current medical incentives. Leaving aside the question of statins in particular, I’d like to focus on how the system is “broken.” It’s true, as the video says, that putting R&D in the hands of private companies leads to those companies very reasonably attempting to see the maximum return on whichever drugs finally makes it through the wringer of FDA approval. And it’s understandable that physicians are human beings, and like all human beings are willing to trust someone they believe is an expert authority on matters they don’t have time to fully investigate themselves. Which would work out all well and good… if men were angels. Or even if they were exceptionally moral, in the “I cannot tell a lie, I did chop down the cherry tree” way.
The problem is, our culture ain’t that moral anymore, if it ever was in the first place. Manipulating the data, massaging the statistics – I don’t think there’s a single scientific field in which lies-by-omission do not significantly affect the research. It doesn’t even have to be deliberate malfeasance, at this point – a simple unwillingness to challenge accepted dogma because “the science is settled” would be enough to render a great many “scientific studies” effectively worthless because they would be constructed to prove a hypothesis rather than attempt to disprove it. (Yeah, that step back in high school science class on “the scientific method” when they told you “test the hypothesis”? That means “attempt to disprove your hypothesis,” not “try to amass enough confirmation bias to ‘prove’ it.”)
Science, as currently practiced outside of any field but applied engineering, is rotten to the core. (And that, only because it’s kinda hard to hide the facts if a bride collapses or a plane falls out of the sky.) And it’s not only in the profit-driven private sector, either. Climate change, anyone? Those are government-funded groups and university-employed academic researchers who were committing terrible breaches of scientific ethics. Of course, the motives are the same – to line their pockets, to gain fame and power – but the “non-profit” sectors are obviously not a solution to the problem of money sources corrupting R&D. Modern nonprofit research is no more reliably honest than for-profit research.
Which is where the little history blurb about President Reagan cutting government funding for health research starts looking like a little gratuitous political jabbing rather than any kind of solution to the problem. Now, it may be quite true that once the government was no longer funding health research the way it had been previously, that the private companies took over, and lead to the mentioned incentives problems discussed in the video. My question is – were those bureaucratic R&D departments actually doing any better at the time they were slashed? Not what they’d done in previous years. What were they doing right then? Because institutions have this pattern, you see, of starting out quite lean and effective at achieving their goals… and then as time goes on, the sclerosis sets in, and the people in that institution begin to care more about process and office politics than about real-world results.
And that’s not even adding in the ability of politicians – who are generally notably ignorant of pretty much anything outside of politics – to use their “power of the purse” to pressure researchers. It wasn’t any eeeeevil for-profit corporation that saddled the United States with a ridiculous Food Pyramid that’s lead to ever-increasing rates of obesity and diabetes – that was a government commission. One that ignored what the researchers of the time were saying in favor of promoting one politician’s pet nutritional ideas. Excuse me if I find the idea of turning over a system already “corrupted by profit” into the hands of morons a supremely bad idea.
Is there a solution? Sure. But it’s not turning things over to the government. Not even passing new laws would really help – laws can help uphold an existing moral order by systematically recognizing it and codifying the penalties for breaching it, but they can’t supply what’s not there in the first place. Every new regulation would lead to a new loophole. No, the only solution would be to demand moral accountability on the part of every person involved in the entire system, from the researchers formulating grants, to the grant committees, to the corporate boards, to the FDA itself.
Good luck with that; it’s gonna be a long slog, but with the rise of the internet and information technology, I think we can do it. In the meantime… remember, nobody looks out for you like you do, and the “consumer protection” government regulation was supposed to provide… doesn’t actually work that way. Caveat emptor.