Tuesday, April 1, 2014

The flawed mind of Richard Horton

Tyler Cowen talked a big game when he recently shared a link to an editorial by Richard Horton with the introduction "The editor of Lancet is anti-scientific and full of mood affiliation"

Big words, and after reading what Horton wrote, I see Cowen is entirely right.

Pick up any economics textbook, and you will see the priority given to markets and efficiency, price and utility, profit and competition. These words have chilling effects on our quest for better health. They seem to marginalise those qualities of our lives that we value most of all—not our self-interest, but our humanity; not the costs and benefits of monetary exchange, but vision and ideals that guide our decisions.

What Horton is saying is that he does not have the stomach for pragmatism, and believes surface-level emotions are more important than thwarting actual hardships.

To take what he wrote seriously, one would have to believe that Horton opposes using triage in a crisis.

The simple triage model I'm familiar with pictures a hospital overwhelmed with victims of a massive event. Say there are a few dozen staff members on hand, but hundreds of victims in various conditions. Instead of trying to treat everyone, the medical workers divide the patients into three groups: Those with minor injuries that are probably not life-threatening, those with life-threatening that can probably be saved and those with life-threatening injuries that will most likely die or that require a massive amount of work to save.

The first group is set aside to be worked on later, the second group is treated and the third group is left to die.

That's the reality of the situation, unfortunately, and triage isn't simply about coldly letting patients die. It is about saving as many lives as possible, and attempting to set aside emotions that would cloud judgment and end up hurting more people.

Economics gives us a path to make life better for everyone, especially the poor and sick, and that path is made up of markets, efficiency, prices, utility profits and competition.

Keep in mind that the American health care system is racked with economics problems, and going forward with Horton's mindset of trying to provide health care like a cruise ship buffet has made it unaffordable for many people, and has leeched a lot of money out of the hands of ordinary citizens.

How many people have to die needlessly so that Horton can be emotionally satisfied?

Horton went on in his essay to quote left wing critics of mainstream economics. Here's a sample:

Clare Chandler, a medical anthropologist (also from the London School), took a different view. She asked, what has neoliberal economics ever done for global health? Her answer, in one word, was “inequality”. Neoliberal economics frames the way we think and act. Her argument suggested that any economic philosophy that put a premium on free trade, privatisation, minimal government, and reduced public spending on social and health sectors is a philosophy bereft of human virtue... 
A year or so ago, I perhaps rashly suggested (on twitter) that economics was the biggest fraud ever perpetrated on the world. Many economists, understandably, disagreed profoundly with that view. But, please, think again.

This is just political claptrap. Chandler doesn't like bottom-up approaches politically, so therefor approaches that use bottom-up methods must not really want to make the world a better place. Free trade and a constrained role for government are methods for making like better for eveyone, especially the poor. There has never been a greater tool for eliminating poverty than capitalism and the free enterprise system, but Horton doesn't find it emotionally satisfying so he opposes it.

To pile on with Cowen's anti-science accusation, Horton has been the head honcho of the Lancet since the 1990's, and was editor in chief when the famous Andrew Wakefield vaccine-autisim study was published in 1998. I can give Horton a pass for publishing a study that was only later revealed to be a fraud, but with all the attention it got, it shouldn't have taken 12 years to issue a retraction.

A few years ago Bill Easterly specifically called out The Lancet out for publishing multiple medical studies with flawed economic analysis. All of these studies were published while Horton was in place.

As Horton reminded us in the essay, eliminating poverty promotes the general health of the public. Economics gives us the best methods to do that, and it doesn't not involve the snowflakes and rainbow approach Horton finds emotionally satisfying.

No comments:

Post a Comment