Regular readers will have figured out that Krugman is my hero among currently flourishing intellectuals, due to the value of his analysis, but even more so his attitude which embodies an unforgiving defense of honesty. (Strangely I have never even met him, except maybe at a seminar or something back when he was a prof and I as a student in the same town, but I do not remember it.) I do not give links to everything I cite to Krugman here, but it comes from his blog from the last 2.5 weeks; also keep in mind that if you click on them all you will burn up a lot of your month’s worth of free NYT articles before you hit the paywall.
There is a direct relevance to the health news since one of the critical maters under consideration is the support that will be provided for medical care financing. The Republican plan would do a lot of damage, as discussed in a post by an old friend of mine from graduate school days, Harold Pollack. American health care financing is quite a mess and does not work at all for some of us. (Those of us who have enough income to not qualify for public assistance for ourselves or our children, but not enough to be able to afford health insurance are faced with having to take particular jobs in order to get health insurance. Or to move back to Canada. Of course, many people have neither of those options.) The letter Pollack reprints points out how the Ryan plan would work to ruin even the bits of American medical financing that do work.
The “shape of the Earth” from the title of today’s post is borrowed from Krugman, a reference to the press covering very one sided “debates” as if there were two equally valid sides (as if they were giving “balanced” coverage to those who insist the Earth is flat). He used the phrase in reference to his critics wanting him to “to pretend that Republican nonsense has an equal and opposite Democratic counterpart.” This is after he pointed out at length that the details of the Republican plan rely on absurd assumptions and obviously flawed “studies”, as well as out-and-out pretending (e.g., Ryan claims that the huge tax cut will be made up for with adjustments to the tax code without explaining what those would be; Krugman another others have shown that this would be impossible).
It turns out to be rather more difficult to make a case that how no legitimate opposition then to make a strong case that has opposition but that overmatches it. If you try to tell the press that there is no other side to a case, they dig up someone who will pretend there is one, because they are erroneously taught that “balance” (i.e., finding someone to oppose a claim) is an adequate or even preferred substitute for critical assessment.
Ok, so the press has a strange convention they follow. But the problem is that people who just read the news and do not think about that come to think it is the right way to look at things – that everything has two defensible sides. That is, many otherwise intelligent people not seem to understand that the fact that someone was found to speak on each side of an issue does not mean that one of them is not totally out of touch with reality. But what is worse is they have been so brainwashed by this approach that they think that any analyst who denies that there is a legitimate case to be made for both sides must just be too partisan to be taken seriously. For example, Ryan accused President Obama of being too partisan when he introduced a reasonably realistic counter to Ryan’s oligarchic (which I would say is partisan) nonsense.
Needless to say, my advice that follows from this observation is “don’t do that”. Of course, there is no magic recipe for knowing who to believe in this epistemic strategy — it just keeps you from thinking that everyone needs to be believed. You can avoid falling into the trap of thinking there is any scientific case to be made against tobacco harm reduction, or in favor of banning BPA, or for requiring infant car seats on airplanes, or various other issues that indeed have only one side (as I have addressed previously). But there are lots of other issues where one side or both adamantly insist that the other side has no ground to stand on, and perhaps seem pretty convincing, but it is not true. The current fury over American policies to discourage the consumption of soda is a good example. Both those who support and those who oppose such policies have rather thin scientific backing for their arguments, and so the legitimate place to be is very uncertain, but both sides insist that there is absolutely no doubt that they are right, and probably both sound convincing to non-experts in isolation. Similarly, because there is a junk-science-based anti-vaccine political faction, defenders of vaccines have decided they have to insist that there is absolutely no reason to worry that there is anything at all wrong with them, and that all expressions of concern to the contrary are based on complete ignorance and idiocy. But there is legitimate concern about the effects of childhood vaccines, and whether there are ways to make them safer. So while you cannot assume someone is wrong when he says there is no legitimate other side to the story, you obviously cannot assume he is right.
A related theme can be found in Krugman’s objections to calls for “civility” in the debate. The Republicans presented their plan that was scientifically nonsense and would harm tens of millions of people to benefit the richest 1%, and Obama countered with something reasonable. Then, many of the pundits and media (which skew toward the political right in the U.S. on fiscal matters, even toward oligarchy, in case you did not know) started criticizing Obama for not expressing more appreciation for the dishonest plan of his opponents and called on him to compromise. But if you are saying that the world is round and you compromise, you end up with a planet that is perhaps curvy but you can still fall off the edge. That is, a compromise between reality and political fantasy is almost certain to be as undeniably wrong as the latter is by itself. It strikes me as being like the mathematical principle that if you assume to be true just a single claim that is actually false, you can “prove” any false statement. Krugman describes compromises, on matters like this as consisting of forming a committee of right-leaning Democrats and extremist-right Republicans, all of them beholden to the very wealthy and mostly quite wealthy themselves. That is, calls for civility are calls for those in power to quietly settle their differences without letting any uncivil populist concerns ugly things up.
Again, I am struck by the parallels. Have you noticed that in contentious matters of public health and even health science, a committee is formed that consists of powerful people with conservative ways of thinking, with no one speaking for the public? Legitimate scientific controversies are typically “solved” by forming a committee of the researchers/funders from one side of the debate. Public health political controversies are addressed by gathering “stakeholders”, a terms that should mean strong representation by the people affected by a policy, but that has been co-opted into meaning “special interest groups including government, medics, researchers in vaguely relevant fields, and maybe manufacturers, but not consumers”. Sometime manufacturers will stand up for their customers’ interests, but often not since they can often make as much or more money as a result of consumer-unfriendly rules.
The lesson for understanding health information is again perhaps too obvious to mention: Do not put too much faith in this committees or political compromises. They tend to demonstrate all of the great wisdom that committees are renowned for (that was sarcasm, in case it is not obvious), with the added bonus that they are often stacked in favor of the establishment position from the start.
This is already long (I have several more themes in mind, so maybe I will come back to it) so I will end with one of Krugman’s favorite themes, how some actors are considered to be the Serious People on particular matters, because they make particular claims (e.g., worrying about deficits, cutting benefits for the poor) that the pundits have decided are what the Serious people know has to be done. This is still the case even if, for example, they propose plans that do not actually reduce the deficit – they are still Serious because they say that deficit reductions is really important and thus we all need to be willing to suffer. My take on it is that credit for Seriousness seems to come more from being wrong with the right tone, usually in a way the calls for suffering, and especially saying something different from what people expect you to say, than from being right.
I am just amazed by how much this reminds me of health policy and the reporting thereof. The Serious People are the ones who expect people to suffer more in order to be healthy (e.g., pushing weight-loss even when it is not clearly of value, or abstinence from low-risk drugs or pain medication), unless they are suffering from something caused externally, in which case people are just paranoid whiners (Serious People do not believe the chemical pollution is ever bad for you). People who are concerned about the health effects of wind turbines are not Serious because they are just whining about some minor inconvenience instead of worrying about the shared sacrifice for green energy (not that wind turbines qualify, but that is another story). People who staunchly support tobacco harm reduction because it is clearly a good idea are not Serious – only people who sternly make it clear that they are extremely reluctant to support it can be accepted as Serious about it. People who make simple common-sense observations about themselves — that they quit smoking by switching to e-cigarettes or that they cannot sleep or concentrate when nearby wind turbines are spinning — are dismissed in favor of Serious People with epistemtically useless but fancy-seeming studies.
I have explored these specific themes in depth already, so I will just conclude with a lesson that I will try to hold myself to: In a matter where I do not know exactly what the science or the politics is, if there is a conventional wisdom that a particular faction are the Serious ones, I will try to not to assume the Serious ones are really right (or honest or serious). I will try to look for evidence about who is credible without deferring to the official declaration of Seriousness. That will be difficult, I know, even having observed what passes for Serious in fields I know. It is hard to resist looking for simple rules about who to believe when entering an area you do not understand. All we can do is try, and then try to catch ourselves when we get tricked.
I have commented before about the point about Serious People including only those who were once wrong — people who used to support abstinence-only policies toward nicotine use (or any other drug) but belatedly realized that harm reduction is a good idea are treated more seriously than those who understood the value of HR from the start. Here is another good example, from the CAGE blog, of someone who was part of the problem for so long is now supposed to be treated as a guru about how there is a problem: http://cagecanada.blogspot.com/2011/04/dr-fernand-turcotte-guilty-conscious-or.html