"Freedom of Choice"
Q. OK, I can see why scientists work the way they do. But this process takes time -- don't you think that some sick people that aren't being helped by scientific medicine get impatient and want to try something else?
A. You hit the nail on the head. This is the issue for the patient, which is why I have considerable sympathy for those who seek out dubious therapies. However, I have less for those that peddle them without being totally honest and forthright. The key issue for the patient is, "What will help ME?" However, physicians, policymakers, and society have a somewhat different question. Society must deliver the best possible health care to the largest number of people, in a timely fashion, with only limited resources. So, it should attempt (through the scientific method) to determine which therapies are effective. Of course patients are free to do anything they like, but should society, insurance companies, etc. have to pay for anything that patients decide they want? If I decide that bathing in water filled with gold dust is the cure for my ailment, should you [as a taxpayer or insurance purchaser] have to foot the bill if the process doesn't work? We also expect our doctors to give us good and reliable health care, both ethically and legally. Should physicians be held professionally or criminally responsible if they do not try, say, coffee enemas for cancer just because someone claims they help? Intelligent choice depends on the ability to separate what works from what is merely wishful thinking. The scientific method offers the best way to do this.
Q. Even with the scientific method, isn't it possible that scientists could be motivated by unethical desires in getting their therapies proved? Don't try to tell me that drug companies aren't equally interested in getting their drugs marketed and accepted!
A. Exactly. That's why claims must be backed by evidence. The scientific approach is designed to weed out ideas that we wish were true, but aren't. Of course drug companies want their drugs used and sold -- but they have to prove that they work and are safe enough. Why shouldn't every therapy be held to the same standard? Anyone profiting from a remedy or cure has a vested interest in selling it. Scientific scrutiny is the only way to know if we are getting our money's worth-a return to the days of unregulated health care (as in the 19th century) probably isn't in anyone's interest except those who want to make money without proving they are providing good value and honest advertising.
Q. Why shouldn't we have a system in which people can go anywhere they want to get the health treatment they want?
A. Most people would say that we have such a system. The tougher question is who should pay for unproven treatments. What are the limits of that which should be covered by insurance or government intervention? Science is the only objective standard on which we can all base measurements.
Q. If I am looking for new shoes or a new car, I have many choices. Why should government regulate or interfere with the claims made for various health-care approaches?
A. The free market does permit people to seek out anyone or anything they want for health care (assuming it is legal!). There are several differences between between buying a pair of shoes or a car and choosing health care.
It is fairly clear what cars or shoes do when we examine them. We can try on the shoes, test drive the car, compare their appearance or specifications, etc. The trial-and-error period of deciding can be postponed indefinitely, and we are even responsible (in the absence of fraud) to be fairly sure of what we are purchasing. Indeed, the legal maxim "buyer beware" (caveat emptor) presupposes such an approach.
The need for health care is not readily controllable or postponable. People don't plan to be hurt or sick; but it happens. We need the help now, not next week after we've shopped around a bit. And, time is often of the essence -- trying on five pairs of wrong shoes before we find one that fits is no loss; trying five useless therapies before hitting on the right one isn't so great a proposition! Furthermore, we cannot control the type of disease that we have and the treatment we will require. If I buy a car, I can settle for a Ford Pinto if I can't afford a Mercedes. People in liver failure can't decide to "settle" for a few aspirin if that's all they can afford.
Treating disease always has an element of uncertainty. Scientific health care is based on a statistical approach that determines which therapies offer the greatest odds of helping. Because diseases can wax and wane, and because the body has a marvelous ability to heal itself, it is very difficult to determine through one person's experience whether a therapy should be recommended to everyone.
It is difficult for non-experts (which is almost all of us, in most areas) to make intelligent decisions about healthcare. The body is mysterious to many people, and biology is probably among the most complex sciences. We depend on people with years of training and experience (hopefully) to advise us in areas in which we do not have the time, means, education, or (in some cases) even the consciousness to learn enough to make a truly informed and rational decision.
We count on our physicians to select what we need to understand to make a decision, and so we trust them to get it right. This is an enormous trust, which partly explains the respect given physicians and the abuse heaped on them when they fail us. Thus, there must be means in place to protect the public from those who would give inaccurate advice. The public is free to chose, but part of being "free" is the ability to clearly discern exactly what is being chosen.
There is, in my view, a "social contract" when one goes to a medical doctor. We ought to be able to trust that we are getting the best currently proven therapy. Patients should not have to worry about whether the physicians they choose are quacks. If they choose to go elsewhere, that is their right -- but free choice is hampered if patients have no way to distinguish between proven and unproven/disproven therapies. If science-based medicine doesn't meet your needs, you are of course free to look elsewhere, but you should realize that you are entering less-charted waters with much less assurance of reliability. It might be worthwhile to ask why some who sell methods which aren't proven want to blur or hide that distinction