Marat

In the case of the Chief of Pathology, his tumor was smaller when the cancer was finally diagnosed than it had been thirty years before. Also, even if he was going to die thirty years after the first appearance of the tumor anyway, with the diagnosis he had something to worry about plus the horrors of cancer therapy to endure, both of which he could have avoided, for a while longer, without the diagnosis. So in this case either way you look at it the diagnosis made things worse. My concern is with the recent obsession with 'early diagnosis' as some miracle which will make everything in medicine better, when in fact there are many conditions in which early diagnosis just means the hideous psychological torture of worrying begins sooner, and the treatments which are worse than the disease start earlier. Of course part of the motivation for earlier diagnosis is that this amounts to a statistical manipulation to make the treatments look as if they are getting better, since the patients now live longer than they would have in the days before improvements in diagnostic technique -- but only because we set the clock ticking till their death earlier, not because the treatments actually help. Just consider how medicine triumphed over its new ability to detect the gene for Huntington's Chorea. When sensible people dared to point out that this could only have negative effects on the people diagnosed, since it would make them start worrying sooner and there were no treatments available, medicine shot back with the utterly fatuous observation that it would have 'counsellors' at all the Huntington's diagnostic clinics, so someone could hold your hand while you were considering whether to shoot yourself in the head or take poison after receiving the hopeless diagnosis.

There are a few suppressed steps in your inference which need to be developed; otherwise your proof remains unconvincing. Why, for example, assume that anything in the universe, whether human or not, was created (or simply passively developed as the side-effect of physical forces) for any purpose at all? Perhaps neither humans nor the non-sentient universe have any purpose, but just simply are, so there is no need to explain how the purported purposive value of the universe can only be realized by sentient humans perceiving it. Your argument does provide a useful basis for attacking the whole neo-pagan reasoning so popular today, which posits that animals and the planet/environment have 'rights' and 'interests' which humans 'have to respect.' Since rights and duties always entail each other, so that no being could possibly hold any rights if it did not also have duties (Hohfeld), the planet and the environment could not possibly have any rights against us, since they lack the sentience or moral capacity to acknowledge or observe any duties with respect to us. Thus in terms of moral rights and duties they can exist only for us, and we can owe them nothing, on analogy with your thesis.

I quite agree that there will never be a drug which provides that degree of longevity and serves as a panacea. But that was only a hypothetical construct to generate a thought-experiment showing that the whole society would rise up in rebellion against the same FDA rules which now slow down access to life-saving medicines for dying patients, were the need of the whole population comparable to that of the minority of seriously ill people. The example of co-enzyme Q10 you give is interesting, since the drug companies developing the new class of statin drugs recognized that these drugs would have seriously deleterious side-effects because they would deplete patients' co-enzyme Q10 levels. They proposed to market statins only in combination with co-enzyme Q10, but this never happened for a variety of reasons. The result has been that statin drugs, which are now taken by an enormous number of people, cause a huge range of severely damaging side-effects, from rhabdomyelosis to gum loss, and from renal failure to exhaustion.

I meant sensuality in its widest sense, so as to include the delight in smearing bread with butter, lying on the couch rather than exercising, and indulging a sweet tooth or a taste for salt. Because commercial interests now recognize that sex sells, even medicine cannot successfully adopt a Puritanical attitude toward sex any more. But in a less commercialized age it used to. For example, Kellog of the cereal fame originally developed products so anti-nutritious as to dull the sexual urge, and this was in the prudish standards of the time a selling point. Graham Crackers were orginally sold as part of a diet to control sexual desire in teenagers. The majority of medical students surveyed in America in 1959 thought that masturbation was harmful, and in this they were reflecting the merging of prudery and medical 'science' of the age.

I read the true story of a physician, the chief of pathology at a large hospital, who was infamous for his persistent, hacking cough all through his career. He stubbornly refused to have it checked, however, but he was allowed to continue his hospital work because of his status. Finally his colleagues prevailed on him to have a chest x-ray and a large carcinoma was found in his lung. He struggled with cancer therapy for less than a year and then died. When they were clearing out his employment records, they discovered the initial employment x-ray he had been required to have on being given his position. It showed a tumor in exactly the same spot as the tumor that killed him, but much larger than when it was detected a year before. Since employment x-rays are just pro forma in hospitals, dating from an era when tuberculosis screening was sensible, no one had checked the results so no one ever brought it to the pathologist's attention. It was obvious that while he could live for 30 years since his initial appointment with a much larger tumor in his lung without it bothering him, as long as he didn't know about it, he could not even survive a single year knowing that he had even a smaller tumor. This inverse placebo effect, where a diagnosis kills a patient who was doing fine prior to the diagnosis, occurs all the time in medical practice. So a rational approach to medicine would weigh this inverse placebo effect against the expected benefits of early diagnosis, which are almost nil for many diseases. Maybe it would be better just not to tell patients about some diseases just because of the inverse placebo effect. But even apart from the negative impact of a serious diagnosis on the physical health of the patient, its impact on the psychological health also has to be taken into account. Perhaps if you calculate the deleterious effects of early diagnosis on health and on mental state, and combine with this the additional suffering the patient undergoes from earlier initiation of some truly hideous treatments, such as chemotherapy, radiation therapy, and radical surgery, then the value of early diagnosis may be quite negative in many instances. Any gains from early diagnosis in the odds of survival, or any improvements in quality of life, have to be discounted in whole or in part by the countervailing negative effects identified here. Unfortunately, medicine always leaves these negative effects out of the equation, and to this extent it fails as a science dedicated to making the lives of patients better.

I stated the more general part of my thesis after the more specific. That is, given the increasing overlap between morality and medicine as 'good health' is conscripted into the role once played by 'good religious observance,' it is only to be anticipated that much of the public health advice given will resonate with older moral values, which the new health police pick up and augment with the newer morality of 'taking control of your own health.' So broken pieces of the old value system, such as gluttony being a sin, sensuality being evil, laziness being sinful sloth, etc., are swept up into the new religion of fitness and health, with all disease being imagined to be necessarily preventable, so that only those who sinned against the idol of fitness are punished.

In Canada there was a huge television advertising campaign a few years ago to discourage smoking by asserting that it causes men to develop erectile dysfunction. Well, it may have an extremely slight effect in that direction insofar as it promotes cardiovascular disease, but the main causes of impotence are diabetes and various forms of neuropathy, and cigarette smoking is nearly non-existent as an epidemiological factor for erectile dysfunction. Similarly unrealistic are the exaggered public warnings about the dangers of second-hand smoking, which generates what is in fact a minimal health risk, though it is an excellent scare tactic to make smoking mothers think they are significantly injuring their children by smoking. Many 'health' warnings are just exercises in social control. Every society needs some sort of social glue, a shared value and belief system, to hold it together, and with the drastic decline of religious belief as the standard device to fill the role over the past thirty years, there has had to be a corresponding increase in social control systems people do believe in, such as maintaining a healthy lifestyle. So now some companies refuse promotion to employees who are overweight or who have high cholesterol, just as in 1890 they might have refused promotion to employees who were not 'good, church-going men.' The new merging of morality and health is evident in the utterly unscientific pretense that health problems are avoidable if only we live a healthy lifestyle and devote our efforts to 'taking responsibility for our own health' by preventative rather than curative measures. But the diseases that really have a significant impact on morbidity and mortality -- half of all types of cancer, many cases of diabetes, all instances of lupus, other autoimmune conditions, cystic fibrosis, multiple sclerosis, muscular dystrophy, many cases of cerebral palsy, many cases of spina bifida, half of all cases of heart disease, and half of all cases of endstage nephropathy -- are not lifestyle diseases at all and are not preventable by any known means, but are genetically conditioned or caused by unknown environmental factors.

The symptoms in some patients with uncontrollable epilepsy can be relieved by a severing the corpus callosum and thus separating the two hemispheres of the brain. A number of interesting experiments have been conducted in such patients which demonstrate that the two hemispheres each constitute separate, autonomously functioning brains. But suppose that we could overcome the immunological and neurosurgical problems of transplanting one hemisphere of such a patient's brain into another person's skull after we had emptied his skull of its own brain. Then we would have hemisphere A still in person X where it started, and hemisphere B now in person Y in whom it had been transplanted. If I am person X, what would I experience after waking up from the operation? Would I sense myself and the location of my consciousness in my own original body as person X, or would I sense myself and see the world from my new body as person Y, where the other hemisphere of my brain now resided? Or would I become two consciousnesses? The error here is that there would be no 'mind' superintending the consciousness of both hemispheres, since each hemisphere would now be a separate mind. Thus there would be no consciousness to be seeing the world from two different bodies and two different perspectives at the same time, but rather, just two different identities, one in each head. But would this amount to a duplication of myself, with my consciousness, roughly the same in each hemisphere of the brain, now in two different bodies?

A major problem with war is that it is like throwing the dice on a gigantic scale. Since it is such a profound disruption of normal international relations, existing technology, society, political forces, and resources, it is impossible to predict what will happen, so making war is a fundamentally irrational enterprise, especially if done with the intention of generating some sort of economic benefit. For example, after 'winning' World War I, Britain was utterly bankrupt and lost the ability to retain its colonial empire, while Germany, as a 'reward' for 'losing' the war, had its economy modernized by the Marshall Plan so that it was able to outcompete the winners of the war. German friends of mine who came to visit me in England in the 1990s were still making comments like, "i never would have guessed England was so utterly shabby!" and much of that was still the effect of England having 'won' the war.

It is significant how American cost-benefit analyses of military expenditures are so completely irrational. Since America spends as much on the military as the rest of the world combined does, including America's allies, presumably America wants to be prepared in case the entire world declares war on it all at the same time. This represents a vast over-investment in protecting Americans against physical injury, economic loss, loss of political liberty, or death from enemy attack. But America grossly underinvests in protecting its citizens from every other, infinitely more real threat, such as serious disease, unemployment, environmental disasters, inadequate schooling, inadequate housing, etc. The explanation lies in the profoundly irrational ideology which directs American resource allocation at the political level.

Since the economies of all the world's developed nations are now thoroughly interconnected by globalization and international finance capital, it is extremely difficult to identify any one point in the economic spectrum and say the benefit of X has landed here at Y. The benefit of X may stimulate economy Z, but X may be owned by company A, which uses the profits made to make loans to nation B, which invests the money to develop country C, which sees its standard of development increase, so it can then compete with and undercut the export economy of country Z, so a cycle is created. So where does the benefit of the initial investment go or not go? Generally, spending money on a war is an extremely poor investment, since all the hardware purchased tends to be unproductive. A $10,000,000 tank never does anything except wreck infrastructure and kill people, while a $10,000,000 school, hospital, or factory continues to generate productive resources for decades into the future. The soldiers employed in a war also fail to generate capital, unless you count death as capital, but if they had been working in a factory, they might well have made useful, productive things. This consumption of resources in non-productive activities fuels inflation since for all the investment money flowing around there are no new products to absorb it, and this leads to yet further problems. Of course it is theoretically possible to steal another country's resources in war, and in this sense military investments might be profitable, but with the increase in fire power in World War I, wars became too damaging and costly to turn a profit, so that motive disappears as well.

Perhaps an even earlier thoughtcrime of which we have a record was the Egyptian Pharoh's effort to introduce monotheism, which was then rejected by succeeding rulers who sought to erase his name from the historical record.

Your question touches on issues raised by philosophers such as Kant and Wittgenstein. For them, consciousness, self-awareness, can only first come into existence if it is opposed by something distinct from it which is sufficiently determinate to bring consciousness into focus as the continuing stage of experience. If there were nothing constant outside of us, why would we ever think of distinguishing ourselves from the fugue of sensations going on around us? Would we even be able to perceive the fuge of sensations as a fugue or as sensations if there were total disorder and randomness outside us? Only if consciousness can lock onto something stable can it fix itself into a determinate sequence which is also stable, and this stability is itself the prerequisite of being able to 'see' consciousness, which is the same thing as being able to be conscious. Peter Strawson, 'The Bounds of Sense,' has a very nice statement of this necessary dependence of self-awareness on the existence of an ordered world outside of us.

While overweight may be a more significant population problem than underweight, why not at least inform people about both problems? If cigarette smoking prevents Alzheimer's Disease, why not at least tell people about it along with the information about the harm of cigarette smoking, so they can make their own cost-benefit analysis. Perhaps someone comes from a family where Alzheimer's Disease is much more rampant at an earlier age than cardiovascular disease or cancer, so it would make sense for them at least to know their options. Interestingly, although you constantly hear on the news now all the panic bulletins about childhood obesity leading inevitably to an increase in type 2 diabetes, the NHANES study failed to find any connection. I wonder if all these moral panics about self-indulgence leading inevitably to health problems are like the old myth that masturbation will make you impotent, blind, and cause hair to grow on the palms of your hands? The prude or the Puritan seeks support for his repressive beliefs in objectivity, since he knows he cannot convince people to imprison themselves by just communicating to them his own terror of pleasure.

If the War on Drugs has a rational purpose, it must be to prevent the harm to human health and life which drug use can cause, and also to prevent the disruption of normal consciousness and brain function by drugs which can make people more prone to dangerous accidents or irresponsible behavior. But diabetics using insulin create exactly the same social problems as the War on Drugs addresses. Because the insulin requirements of the diabetic body change spontaneously and unpredictably in response to hormal variations, stress, changes in gastric emptying rates with different kinds of food and degrees of neuropathy, and subclinical infections, the amount of insulin required cannot be precisely calculated. This results in diabetics unavoidably taking too much insulin on occasion, and excess insulin can cause hypoglycemia, which can result in brain damage, neurological pathology, and even death. Among type 1 diabetics, 2% to 4% of all deaths are due to hypoglycemia, and among those under 40, 6% of all deaths are due to the mismatch between insulin and calories. Hypoglycemia can also cause diabetics to experience diminished motor coordination and confusion, and this results in inability to work, irresponsible actions, and accidents, just as would happen in a drug addict on drugs. Insulin-dependent diabetes is an even worse 'drug problem' than the illegal drug issues addressed by the War on Drugs, since diabetics can never 'kick their habit,' and they cannot plan when they are going to become unconscious from hypoglycemia the way a drug addict can plan when to get high. Since the War on Drugs has a huge budget while diabetes research has always been grossly underfunded for the size of the problem the disease represents, shouldn't some of the War on Drugs budget go for a cure for insulin-dependent diabetes?

When the government gives health advice to its citizens, you would expect that that advice would be purely scientific and objective. But in fact it is not, and instead, citizens are advised only to do those things to benefit their health which will also force them to curtail their spontaneous pleasures. So all scientific health advice has to pass through a filter of Puritanism before it reaches the public. One example is that a large body of data now demonstrates that cigarette smoking powerfully protects people against Alzheimer's Disease. If government health information were objective rather than Puritanical, every cigarette packet would display the notice that tobacco use can cause cancer and cardiovascular disease, which is true, and also that it has the benefit of protecting people against Alzheimer's Disease, which is also true. Another example is that people who are underweight have a life expectancy which is just as much shortened as the life expectancy of people who are overweight. So a purely scientific government health service would advise us to pig out on food if we are underweight, but you never hear that message, since people naturally enjoy eating, but instead all you hear is the Puritanical message that people must lose weight.

Prior to the establishment of the precursor organizations of the FDA at the beginning of the 20th century, Americans could buy any substance they wanted to treat their diseases as they chose. After the FDA came into full control of medicine, people could only access drugs and treatment modalities to ameliorate or cure disease if the FDA had already tested them first to determine whether they were 'safe and effective.' Today the process to establish safety and efficacy has become so painstaking that it usually requires 15 years of testing and about $300,000,000 of investment to bring a new drug to market. But do these standards of safety and efficacy, which prohibit patients' access to these drugs on pain of criminal sanctions, make any sense for people who are either now in extreme suffering from incurable diseases or who are certain to die of their disease before the FDA approval process is finished? The FDA does grant some access to experimental, unapproved drugs on 'compassionate' grounds, but it is very slow and very stubborn in reaching these decisions, often giving in only after a long and expensive court battle. But who says that a government agency should have the right to make that decision or refuse to do so when dealing with a people who claim to be the freest in the world? What if there were a drug which promised to cure all diseases and provide humans with a youthful existence for 150 years, but it would take ten billion years, longer than the human race will survive on Earth, for the FDA tests on its safety and effectiveness to be completed? Wouldn't the government override the FDA in that case, because the majority, rather than just a small minority of sick people, couldn't wait? What if you were drowning in quicksand in an isolated swamp and there was only one tree branch within reach by which you could pull yourself up to save yourself? How would you react if an FDA official appeared as you were reaching up for the branch and forbade you to use it until 15 more years of testing of the branch for its safety and effectiveness were completed? Would that intervention seem rational, even if the official could demonstrate that pulling on a possibly rotten branch which collapsed might cause you to sink faster? Shouldn't a free people have the right to access all medicines as long as they carry some government-certified warning about their potential risks or their unknown potential for risk? It is perfectly legal for me to run into a burning building filled with dynamite if I want to in order to save my relatives inside, but for some reason it is illegal for me to risk my health to a much smaller degree by taking some medicine the FDA has not yet approved. But what should belong to my autonomy more than my right to try to save my health and life as I see fit?

If you read the trial of Socrates, you will find an earlier thoughtcrime, since he was convicted of discouraging belief in the gods of Ancient Athens. But religion is not always the motivation for thoughtcrimes, although it seems that any thoughts which encourage a critical, sceptical attitude to the most basic values which a society relies on for social cohesion are treated as crimes. Thus today, for example, in a secular age in which crimes against religious beliefs would be seen as ridiculous, it is a crime in many liberal democracies to deny the Holocaust. This is because anti-racism has taken on the role of a public religion, in that it now secures the foundation for social cohesion which religion used to, and so denying the Holocaust, which is the paradigmatic event demonstrating the evils of racism, has to be criminalized.

Since arthritis can be detected in human bones, and since the variation in tea consumption in different areas of the world over different historical periods is well documented (thanks in large part to the tax many countries placed on imported tea), it would be instructive to plot the incidence of arthritis in old cemetery bones against records of tea consumption. England, for example, was a coffee-drinking country until the beginning of the 19th century when colonial control over India became sufficiently stable for tea to be imported in large quantities, so if English bones prior to that time have significantly less incidence of arthritis, that would go some distance to confirming a positive correlation.

Science is a deliberately self-confined form of explanation which restricts itself to predicting the behavior of things in terms of their spatio-temporal qualities, i.e., those that can be measured mathematically. As such, it cannot explain everything and is not designed to do so. Questions which cannot be analysed into spatio-temporal relations and quantified are defined as outside its ambit, so issues of morality, value, aesthetics, existential truths, etc. cannot be answered by science. This does not make these latter issues any less real for human life and society, however, but it just means that their proper resolution is less easily demonstrated. Science can sometimes help clarify the factual material that goes into humanistic and social questions, but that does not reduce these questions to scientific solution. This is why it always seemed ridiculous to me that doctors are expected to have some special expertise in answering issues of medical ethics, which makes as much sense as asking an electrician who should be executed in the electric chair.

The University of Miami and some other schools have a separate tracks for admission to their medical schools for students who have already earned a Ph.D. in one of the natural sciences, even if it is something like physics or electrical engineering rather than physiology. It can be relatively easy to gain admission this way. Considering how minimal the effort can be to go from an M.S./M.A. to a Ph.D. if all you care about is using that as a stepping-stone to an M.D., this may be a useful option to consider.

An interesting aspect to this question is how things cross the boundary from subjective to objective. I can sit here and think of a three-headed cat on Mars who can read minds, but this almost fails to register at all (or would, if I had not just typed it here) in the world of intersubjective reality. But if eighty million Germans in the 1930s start thinking that racial purity is important, the creation of these subjective images and ideas in their heads connects with the objective world quite powerfully in the form of World War II. So causal power, one of the chief characteristics of objective as opposed to subjective reality, can have its ultimate root in subjectivity.

I think the problem lurking in the background of the original comment was that scientists often seem remarkably dismissive of any data that do not fit the existing paradigms of explanation, and in this they demonstrate a dogmatic attitude and lack of curiosity which is profoundly unscientific. This results from the two opposing roles of the scientist: One is to police the boundaries of the existing realm of established science and dismiss as 'rubbish' anything inconsistent with its basic commitments. The other, however, is to expand and, if necessary and after considerable resistance, to abandon the existing paradigms of explanation in response to data which do not fit the established belief system. Imre Lakatos describes this process in detail. Consider for example Isaac Newton's characterization of the gravitational attraction among planets as an 'action-at-a-distance' which was not mediated by Cartesian particles, waves in a subtle aether, or any other intervening mechanical agent. This was dismissed by contemporaries as 'supernatural,' since it was characteristic of magic that witches could make objects move without touching them, that clairvoyants could see what was happening hundreds of miles away, or that there would be some response of the dagger which had murdered a victim when the court brought the victim's killer into the room, etc. But because the data proved stubbornly resistant to re-description in terms of intervening mechanical agents, eventually science had to move the existing boundary between 'science' and the 'supernatural' to take gravitational action-at-a-distance into the realm of science and out of the realm of magic. This same thing can always happen again in science, and scientists today would do well to remember this, rather than concentrate on their 'policeman' role in maintaining the existing explanatory theories.

Fish and other sea creatures extract oxygen from the water to survive, and the human lungs can do this as well, although the amount of oxygen extracted would be inadequate for higher brain functions. I have seen it proposed that if a human were to drown in fresh water, and the person were able to overcome through some profound self-discipline the natural shock response at drawing water into the lungs and displacing their air content, then that person could continue living at the bottom of the lake or stream, provided it were warm enough. I wonder what other aspects of physiology would complicate this effort? E.g., the nature of human kidney function has been described as the response to the need to manage water and electrolyte content during long periods away from the water after humans evolved from the sea, so living in water would force the kidneys to work overtime to maintain the physiological levels of electrolytes required for neurological and muscle function.

As I commented in my original post, the theorem is deliberately overstated to be provocative. But consider it from an historical perspective: The great advances in life expectancy were mainly achieved not by medicine but by public health through improved sanitation and diet. Life expectancies were increasing through the decline of infectious disease long before there were effective treatments for many infectious diseases. Just look at the decline in death rates for tuberculosis long before BCG, or the decline in death rates for diphtheria long before it could be cured. In the 19th century improvements in anesthesia and infection control thanks to Morgan, Lister, Simmelweis, and others made sophisticated surgery possible. In the 20th century, with sulfa drugs and penicillin, infection control took another major step forward. The other great advance in medicine in the late 19th and early 20th centuries was in hormone replacement therapy, from adrenal gland extracts to insulin. Organ transplantation has never been significant from a public health perspective since there are so few organs available for transplant, but this could be added to the progress made through the immunological work of Medawar, Florey and others in the 1940s. But since the middle of the 20th century the problem has been chronic degenerative diseases, and in this area, which is the essential focus of medicine today and for the foreseeable future, the conservation of disease theorem seems to hold true. We get seriously inadequate results in the current efforts to manage these diseases through the palliative treatments now available, so the response has been to intensify the treatments. But this intensification ruins the patients' quality of life just as much as the disease does, so all we have succeeded in doing is transforming the natural burden of disease into the artificial burden of treatment. Perhaps we falsely think of this as 'success' because it allows us to feel in control of what is happening, even though this control contributes only to the arrogant self-satisfaction of the Medical Establishment rather than to the happiness of patients. Increasingly, an intensive propaganda effort is being conducted to induce the patients to believe that the transformation of the misery of disease into an equal misery of treatment is in some bizarre sense 'progress' for them. Unfortunately, the Medical Establishment believes its own propaganda, and this may itself retard future medical progress towards actually curing disease.