A rare, happy moment

I spend a lot of time bashing our political system. It’s a formula that has yielded a fairly consistent source of not only blog fodder, but commenter agreement as well. After all, who doesn’t love complaining about politics? It gives us an opportunity to appear erudite and superior to those who would try to represent themselves as the “ruling class”. Plus we get to spread indiscriminate blame on all politicians as being morally deficient hucksters.

It brings me no personal satisfaction, however, to live in a country with crappy politics. As a liberal, I believe that government can be a force for good in the world. That as a representation of the collective will of the populace, we can do more as a group than we can as individuals pulling for our own selfish ends. That there is room for giving up a bit of personal liberty to gain a greater measure of mutual success.

It is not the failures of the body politic that make me happy. It is stories like this: [Read more...]

Why are you hitting yourself? Part 5: this post is entitled

This is part 5 of an ongoing discussion of a paper by Jost, Banaji and Nosek discussing System Justification Theory. Read Part 1Read Part 2. Read Part 3. Read Part 4.

We left off last week discussing the relationship between where one stands in the power dynamic, and how we see those at the top. If we are part of the high-status group, we have an implicit bias toward ourselves, where as those in the low-status group have an out-group – which also favours those at the top. When pressure is high to justify the status quo, we reach for stereotypes and facile explanations to rationalize why things are the way they are. Interestingly, insofar as this effect (called system justification) is identical to political conservativism, we see these biases exacerbated in people who confess to being conservative.

One of the advantages of having the kind of education I did (broad-based – a hard science candy shell with a delicious nougaty humanities core) is that I can draw on a variety of analogies when trying to impart unfamiliar concepts. Most of you have taken at least some science courses, so you will perhaps be familiar with Boyle’s Law which states, among other things, that gas will expand to fill its container. It’s that concept I want percolating in the back of your mind as we charge forward through our exploration of System Justification Theory. [Read more...]

Anti-abortion or anti-contraception: pick one

One of my favourite bits of trivia about Christianity specifically is that the teachings attributed to Jesus say far more against hypocrisy than they do about sex. This, of course, does not seem to faze his ‘followers’ whose anti-sex crusade seems to be taking notes directly from Orwell (who are we kidding? They’ve never read Orwell). While the weird pre-occupation of the religious with sex is well-understood, this does not seem to dissuade the throngs of pious outrage from trying to interfere every time someone drops trou.

While we here in the north agonize with our southern cousins over the disgraceful erosion of that most sacred American ideal – the separation of church from state – a little known fact is that Canada has its own religious right that is intentionally mimicking the tactics of the “Moral Majority”. A bit of background before I launch into this news tidbit. More than a decade following the landmark decision in Roe v. Wade that found anti-abortion laws unconstitutional in the USA, Canada’s Supreme Court made its own finding that no laws could be passed against abortion in Canada the current abortion laws were similarly illegal (thanks to ibis3 for the correction). While Roe v. Wade was couched in the right of privacy enshrined in the Fourteenth Amendment, Canada’s court was a bit more explicit. It was ruled that anti-abortion laws violated the security of the person, as laid out in our own Charter of Rights and Freedoms. Most of this legalese is unimportant, particularly to those that don’t live in the USA or Canada, but bear with me.

Abortion has been, since then, a relative non-issue in Canada. Nobody has really brought a substantive case against abortion rights, and we don’t have nutjobs running doctors out of town (at least not any that make the news – if I’m wrong someone please tell me). However, the religious right – emboldened by a recently-elected majority government – have decided that if it’s fixed, break it: [Read more...]

Another victory of evidence over ‘common sense’ in Canada

There are few terms so intellectually offensive to me as ‘common sense‘. Every time someone invokes ‘common sense’ in an argument, I immediately stop listening to them. What they invariably mean is “I have no evidence to support my position, so I will substitute what I think is obvious”. The problem is that there is very little that is ‘common’ between people with different perspectives, and it very rarely makes any kind of ‘sense’. If you have an argument built from logical first principles, I will be happy to hear it; however, if it’s just based on your own particular handful of prejudices, please don’t waste my time.

It’s incredibly gratifying to see that even in this day and age where ‘common sense’ has become a mantra in our political and social life, we still see examples where evidence and reason win out:

Vancouver’s controversial Insite clinic can stay open, the Supreme Court said Friday in a landmark ruling. In a unanimous decision, the court ruled that not allowing the clinic to operate under an exemption from drug laws would be a violation of the Charter of Rights and Freedoms. The court ordered the federal minister of health to grant an immediate exemption to allow Insite to operate. “Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation,” the ruling said, written by Chief Justice Beverley McLachlin.

American liberals – our chief justice is a lady. U jelly?

A brief backgrounder – Vancouver is home to an unreal level of addiction and drug use. [Read more...]

Rationing, policy, and woo

I am a passionate believer in publicly-provided health care. Despite the narrative that seems to be fairly widespread among the Americans I speak to, public health care delivery is a much better model than for-profit care. Like any human system, it has its flaws that should be examined and improved upon. However, as both a method of caring for sick people and a method of controlling health care costs, public systems are the way to go.

The ‘dirty’ little ‘secret’ of health care is that demand will always outstrip supply. There are a nearly-infinite number of things that could qualify as ‘health care’, and we want all of them. As a result, we have to find where the limits are – where we are comfortable saying “if you want this, you’re on your own”. In the fights over health care reform in the U.S., this process got a dirty name for itself: rationing. Sounds scary, right? Your grandma needs a hip replacement, and some government fat-cat comes in and says “nope, sorry, all you are covered for is euthanasia!” Grandma gets wheeled into the back room against her will, and is put down like a stray dog. THANKS, OBAMA!

Of course the reality is that rationing happens in any health care system, including the American one. The difference is in how we ration. [Read more...]

News blast: police edition

Once again, because of time constraints and my lack of willingness to let things simply slip through the cracks and into my delete bin, I am giving you abstracted versions of news items that I think should have been developed into full-length blog posts, but for the lack of time. Sometimes my trouble as a blogger is finding enough material to get me going – this week I have the opposite problem. Here’s some stories about police, law, and justice.

‘Occupy Wall Street’ protest draws police brutality

The peaceful Occupy Wall Street protest march turned violent as the NYPD corralled and pepper sprayed the participants. Mass arrests were made and loaded onto a NYC bus further locking traffic. The protest march took a route from Zuccotti Park to Union Square on East 14th Street. The protesters were marching back to Zuccotti Park when the NYPD turned violent. Hitting, arresting and forcing protesters into a small area. At that point a NYPD supervisor yelled shut up to one of the protesters and shot pepper spray into her eyes point blank range and hitting a half dozen protesters (including 3 police officers) when they had nowhere to go. The same supervising officer was seen (photographed) laughing after the arrests while looking at his text messages. The peaceful protest march started as 300 participants but rose to over 1,000 as the event stopped traffic in lower Manhattan. People spontaneously joined the march over a 2 hour period.

I usually like to source these kinds of things from major media outlets, but sadly the trial of Michael Jackson’s doctor and Amanda Knox seem to be far more interesting to even outlets like the BBC. Maybe you hadn’t heard, but this vicious gang of thugs has destroyed billions (perhaps trillions) in wealth by manipulating markets and selling bad loans. Instead of being punished, incidentally, they were rewarded through concerted lobbying in the halls of power. If you’re pissed off, you can join a few hundred of your fellow citizens to demand that something be done about the surreal level of irresponsibility and fraud being perpetrated against the people of the world by a small group of elite jerkoffs. But don’t protest too hard, or you’ll get pepper-sprayed in the face.

Luckily the asshole who committed this assault is being named and shamed. Even if the police don’t prosecute him (and they won’t, because they circle the wagons around their own like the Catholic Church every time one of their officers breaks the law), he has been tried in the court of public opinion. Click on the link above to see some pretty graphic images of what happened that day.

Sixty percent of Toronto police arrests result in strip searches

More than 60 per cent of people arrested by Toronto police last year were forced to undergo a strip search, according to police statistics. But a police accountability group says routine searches are against the law and alleges Toronto police are using the practice to humiliate and intimidate people. Police figures show that 31,072 people were strip-searched in 2010, up from 29,789 the previous year. John Sewell of the Toronto Police Accountability Coalition (TPAC) said that means about 60 per cent of those arrested in Toronto were subjected to a strip search.

“Silly Crommunist”, you are probably saying while shaking your head and smiling indulgently “that’s an American story! Up here in our glorious north our police are respectful and kind! They’d never do that.” Yeah… seems not to be the case. Toronto cops, by their own statistics, have revealed themselves to be just as brutal, unforgiving and short-sighted as their American counterparts. Strip searches may be necessary in a small minority of cases, but unless Toronto criminals are in the habit of keeping dangerous goods taped flat to their bodies, a thorough search could be just as easily accomplished by a pat-down. This isn’t just my opinion, either – it happens to be the opinion of an Ontario superior court judge. If their goal is to humiliate and intimidate (which it seems to be), then I have no more sympathy for the Toronto police than I do for the fuckwads in New York.

Vancouver street cops still de facto mental health workers

Vancouver ‘street cops’ are still filling the gaps in B.C.’s flawed mental health system, despite recommendations in a powerful 2008 report on policing the city’s mentally ill, an updated report finds. The 2008 report, titled Lost in Transition: How a Lack of Capacity in the Mental Health System is Failing Vancouver’s Mentally Ill and Draining Police Resources, detailed flaws in B.C.’s mental health system and their effects on policing. The problems included the lack of available long-term care, lack of hospital space and difficulties in getting people assessed.

Because I opine on politics a lot, people have asked me what I would do if I had unlimited political power. Well, the first thing I would do is create some limits, because no one person should have that kind of power, but the second thing I would do is drastically increase the level and scope of mental health care we provide to our citizens. We spend an unbelievable amount of money on health care problems that should be handled through therapy rather than hospitalization. I’d certainly have the Vancouver police on my side, I’d bet. While they are not qualified as mental health workers, they are the ones who provide that service (at a level of pay far below what an actual mental health worker receives, and far below what such a person deserves). To get an idea of how serious the problems are here, take a gander at the blog written by one Vancouver beat patrol officer:

1515 hrs – Exit the courthouse in desperate need of coffee and breakfast. I’m supposed to be working one-man tonight, so I make plans with my old partner, Tyler, to visit Save-on-Meats for their all-day brekkie. But first we’ve got to deal with the shirt-less guy flipping out across the street. He’s flailing around, delivering spinning karate-kicks at phantom opponents and doing the kind of back-bends that would make even Bikram Coudhuryshudder. His behaviour, the track marks on his arms, and the needle and crack pipe in his pocket, give us a pretty good idea of what he’s been up to. We call for EHS, and 36 minutes later our friend is heading to St. Paul’s Hospital with the ambulance crew for some Narcan.

Not a glamorous lifestyle, to say the least.

So while I can sympathize with a police force that is overworked and whose positive contributions often go unrewarded, that is not enough to persuade me from my blanket condemnation of the insular, self-righteous environment that police forces in our country and others operate within. I treat police in the same way I do stray dogs – while they might look friendly, all it takes is one bad one for me to be in serious trouble.

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Ageing, health care, and sustainability – memes vs. evidence

One of the frequently-raised buzzwords in discussions of the Canadian health care system is the idea of ‘sustainability’. It is a bogeyman argument that crops up every now and then, particularly as a way of softening the rhetorical ground for increased private-sector involvement in health care. The argument often invokes the spectre of a meme called the ‘Grey Tsunami’. The argument goes something like this:

  • Canada’s population is aging
  • Health care costs are increasing faster than GDP
  • Older people use more health care resources than younger peopleTherefore, there is a rapidly approaching point when the expansion of health care costs, due to increased usage by older people, will become too large to sustain and will collapse the health case system.

The implication is usually that the only way to control health care costs is to increase privatization (which doesn’t work) or to introduce a parallel public option (which also doesn’t work). Since the premises are all true, people nod sagely and cluck their tongues and say ‘what a shame’, as though the conclusion followed logically. It’s entirely possible that the conclusion might follow logically from those premises, but it’s not necessarily the case. What would strengthen the argument is some actual evidence.

Luckily, such evidence is recently forthcoming:

To shed new empirical light on this old debate, we used population-based administrative data to quantify recent trends and determinants of expenditure on hospital, medical and pharmaceutical care in British Columbia. We modelled changes in inflation-adjusted expenditure per capita between 1996 and 2006 as a function of two demographic factors (population aging and changes in age-specific mortality rates) and three non-demographic factors (age-specific rates of use of care, quantities of care per user and inflation-adjusted costs per unit of care).

We therefore conclude that population aging has exerted, and will continue to exert, only modest pressures on medical, hospital and pharmaceutical costs in Canada. As indicated by the specific non-demographic cost drivers computed in our study, the critical determinants of expenditure on healthcare stem from non-demographic factors over which practitioners, policy makers and patients have discretion.

This is a particularly cleverly-designed study done by some colleagues of mine at the University of British Columbia. They used a statistical procedure to model the relative contributions of population age, age-specific mortality, cost of dying, and cost of surviving (within a given age range). Their analysis also included variables to account for resource utilization and cost that are separate from age. British Columbia keeps excellent electronic records for all provincial residents, meaning that they were able to apply this model to a cohort of over 3 million people, using actual real-world expenditure rather than relying on evidence from clinical trials.

Their analysis found that aging has contributed only minimally (1%) to total medical expenditures between 1996 and 2006. Using forecasts from the provincial ministry of health, they estimate that these expenditures will return to current levels beyond 2026. The major factors for health care system expenditure increase had more to do with policy decisions and the purchase cost of equipment, drugs and other technology than it did with a ‘grey tsunami’.

Another article in the same issue says the same thing, albeit a bit differently:

Conventional wisdom holds that Canada suffers from a physician shortage, yet expenditures for physicians’ services continue to increase rapidly. We address this apparent paradox, analyzing fee-for-service payments to physicians in British Columbia in 1996/97 and 2005/06. Age-specific per capita expenditures (adjusted for fee changes) rose 1% per year over this period, adding $174 million to 2005/06 expenditures. We partition these increases into changes in the proportion of the population seeing a physician; the number of unique physicians seen; the number of visits per physician; and the average expenditure per visit. Expenditures on laboratory and imaging services, particularly for the elderly and very elderly, have increased dramatically. By contrast, primary care services for the non-elderly appear to have declined. The causes and health consequences of these large changes deserve serious attention.

Using a similar data set and a different method of analysis, McGrail and colleagues found that, like overall spending, physician-specific spending was increasing. However, there has not been a corresponding increase in those users of the health care system who are not older adults. Even given this increase, the percentage of health care expenditure that is attributable to aging is small.

Given what we know about health care costs – namely, that the increase in price is due largely to the cost of innovation, we have powerful policy levers we can use to make appropriate changes that will preserve the ‘sustainability’ of the system for years to come. Our growing paranoia about the effect of the aging population does not seem to be supported by evidence from actual increases in health care expenditure. While we will undoubtedly have to change the way we think about and practice health care in light of an aging population, it does not follow that we will have to necessarily abandon the way the system is currently structured.

Above and beyond this direct message, I want to take the time to point out that health services and policy research is an important avenue of inquiry. We should make our policy decisions – health or otherwise – based on what is evident, not what is obvious. Whatever our endeavour, we should be constantly asking ourselves questions and measuring our level of success or failure honestly. The authors of this paper, rather than accepting what has been more or less ‘orthodoxy’ when it comes to the health care system, have found ways of directly testing the ‘grey tsunami’ hypothesis. This is a good thing – we should always be challenging our entrenched ideas. Failing to do so will result in us tilting at imaginary windmills, chasing ghosts and false ideas to the point where our efforts are legitimately unsustainable.

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Behind the 8 ball

This morning I went on a bit of a tear about the ludicrous idea of a ‘culture of poverty’. I suppose calling it ludicrous is not fair, since on the surface, if you’re ignorant of a lot of facts, the idea at least has some superficial credibility. What I didn’t get around to is the illustration of what might be a better explanation. It will probably come as an eye-rolling lack of surprise to most when I point to racism as a potential explanation. I am not referring simply to the active kind of racism whereby black and brown kids are discriminated against by teachers, or wherein employers don’t hire people with funny sounding names. No, the kind of racism I am referring to is far more structural and ephemeral than that.

Imagine you were born with a limp. In our modern society, that’s certainly not a major hurdle to overcome. We have, through conscious effort as a consequence of advocacy, built mechanisms into our infrastructure to allow people with mobility issues to live fulfilling and productive lives. We have actively reduced structural discrimination against people who, through no fault of their own, have a disadvantage. Now sure, you’re not going to be an Olympic sprinter or anything like that – your physical condition precludes that. But, there’s no reason you couldn’t be a physicist or a spot welder or any other occupation that doesn’t require extraordinary leg strength or mobility.

Contrast what your life would be like if you had been born with the same limp in, say, ancient Sparta. Because you would need full mobility to participate in even the basic parts of your society, you’d be in serious trouble. Not only would you be unable to access things you need to live, but you’d be excluded from involvement in social and political life – not because you couldn’t do them, but because you’d spend all your time struggling just to keep your head above water. Your inability to thrive would likely be seen as some kind of curse from the gods, or worse still as your own fault. If you want to succeed, you have to work harder than your more able-bodied peers to achieve anything.

These are the two different models of society we can contrast – one that puts the necessary effort to ensure that physical traits like a limp don’t preclude you from engaging in activities for which a limp is not a real handicap, and one in which no attempt is made to overcome a disability in such a way as to make it essentially impossible to participate even in those things that your disability doesn’t apply to.

Which society do you think we live in when it comes to race?

Click image to enlarge

I put it to you that being born black or hispanic puts you at a disadvantage. That being in one of these groups, even before we get into issues like a ‘culture of poverty’, places extra hurdles in your way. Not hurdles that are actually related to your success, but hurdles that prevent you from reaching it nonetheless. This kind of systemic racism operates in the background without any kind of conscious intent or active discrimination on behalf of a secret cabal of bigots. It has the same force as active racism though, since your racial identity is a strong predictor of your chances of success, even though this connection is highly erroneous.

The question we must ask ourselves is whether or not we’re interested in fixing this problem. If we’re content to allow this state of affairs to continue, then there’s no reason to make any changes. Of course, as I suggested before, this ends up hurting everyone. It would be much better for all members of society for there to be fewer poor people. If we’re interested in seeing that happen, then we have to work to reduce these inequalities. Otherwise we’ll have a segment of society still stuck behind the 8 ball, with no hope of getting ahead.

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Fighting fire with gasoline

Sometimes the road to hell is paved with the best of intentions. Oftentimes things that seem like good ideas completely fail to improve the situation. In some cases, because we are fallible human creatures with flawed brains, we often devise solutions to problems that actually make those problems worse. Our politicians, in theory, should be less prone to making these types of mistakes than we lowly civilians – after all, they are selected because of their superior leadership and merit, right? It seems to be the cynical case that this is not a reasonable expectation of our leaders:

The country’s foremost legal organization has delivered a grim assessment of the Harper government’s get-tough-on-crime agenda, attacking mandatory minimum sentences and questioning Ottawa’s eagerness to put offenders behind bars. With a series of blunt statements and policy resolutions, the Canadian Bar Association’s annual conference bristled at inaccessible courts, inappropriate jailing of mentally ill offenders and costly measures that threaten to pack prisons.

The Canadian Bar Association likely knows a thing or two about crime. After all, they are far more intimately familiar with the issues than the average Canadian. They see the way that people move through the justice system – both its successes and failures are the stuff of their professional lives. It is therefore a resounding condemnation of the upcoming omnibus crime bill to have such a sharp and public criticism from this sector.

“There are too many people who are mentally ill and should be dealt with in the health system as opposed to the criminal justice system,” [Nove Scotia prosecutor Dan] McRury said. “We need more sentencing options. One size does not fit all. “Being tough on the most vulnerable in our society is not humane,” Mr. McRury added. “Unfortunately, deinstitutionalizing our mental hospitals has meant that we have exchanged prison cells for hospital beds – but without having enough supports in the community.”

Another resolution passed by the 37,000-member organization called for governments to stop toughening laws without regard to the historic plight of aboriginal people and the over-representation of aboriginal offenders in prison.

If I had a magic policy wand and one item to use it on, it would definitely be to find better solutions for mental health care. So many broad social problems – crime, homelessness, health care spending, workplace productivity – all of these have strong links with undiagnosed and undertreated mental health issues. The CBA seems to recognize that fact. And yet, the new bill would have no provisions for providing mental health services to those in need, and would in fact mandate that they be put in jail instead of in hospitals where they could actually get some help. Even though it seems like creating harsher sentencing rules seems like it should result in less crime, the evidence suggests otherwise. Even purposeful rational thought (rather than appeals to ‘common sense’) reveals that factors besides legislation are responsible for crime, and can be manipulated to achieve the desired effect of reduction in crime rates.

Of course, that presumes that our political leaders are interested in either evidence or purposeful rational thought. There may be some hope for the system here in British Columbia:

The traditional risk factors for joining gangs — poverty, family dysfunction, a sense of alienation and lack of social supports — don’t appear to hold true for Vancouver gangs, a gang-prevention researcher says. As anti-gang experts work to head off retaliatory attacks for Sunday’s gang shooting in Kelowna that killed Red Scorpion Jonathan Bacon and wounded Hells Angel Larry Amero and three others, researcher Gira Bhatt is looking at ways to prevent kids from joining gangs in the first place.

Bhatt, a psychology professor at Kwantlen Polytechnic University, says the gang demographics in B.C. are unique. “[For example,] if you look at the Bacon brothers, they come from a good family — a rich family — where the parents are very supportive of their kids,” Bhatt said. “We can’t borrow solutions from Toronto or Los Angeles and apply them here.”

Many people may not be familiar with the significant gang problem facing British Columbia. Because of how lucrative the drug trade is, gangs command a great deal of resources and influence. As Dr. Bhatt notes, there are factors unique to the region that make B.C. gangs different from gangs in other areas of the world. The proposed solutions must reflect this uniqueness:

“Police are asking for more resources, and yes, they need more resources. But if that’s all we do, the need for more and more police will simply grow over time,” Bhatt said.

[MLA, former solicitor-general and former West Vancouver police chief Kash] Heed called for a “comprehensive strategy” to combat gangs, including a universal anti-bullying program in schools, early-intervention programs for families and meaningful opportunities for kids to get involved in their community. “You are not going to arrest your way out of this gang situation that we have,” Heed said. “We’re just reacting to the problem. We’ve reacted to this problem since 1994 here in Vancouver. We still have this absolutely astounding display of public violence on our streets.”

Critics on both sides of the political divide (although primarily on the right) tend to decry ‘one size fits all’ solutions to social problems. I think there is merit to this position – each region must have some leeway to solve its own problems in its own way. However, despite being aligned with the right, the Republican North Party has taken the decidedly non-conservative step of giving the federal government the authority to take decision-making power out of the hands of the justice system. If it were a left-wing government proposing this kind of program, that would at least be consistent with the idea of government intervention in individual lives. Coming from a government that at least pretends to be conservative, it is a stark revelation of their own hypocrisy.

What’s my proposal? I say we decide policy on a case-by-case basis and look at what the evidence says. If the evidence says mandatory minimums work, then let’s do that. If the evidence says that coddling criminals works, then we do that. No matter how uncomfortable it might make us. Failing to make our policy responsive to observable reality, rather than a slave to our ideological prejudices, will only serve to exacerbate problems to the detriment of everyone.

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Exploring the alternative

I live in Vancouver. Vancouver is home to quite a bit of what is wildly-inaccurately called “alternative medicine”. What people think they mean by this term is medical treatments that fall outside of the conventional combination of surgery, pharmaceuticals, and other forms of medicine that one expects to find in a hospital. Some even fancy these treatments as operating in a different medical paradigm – an entirely new way of looking at the human body and human health.

The truth is that “alternative” medicine has been around forever – it’s how we treated illness before we understood anything about immunology, biology, biochemistry, physics… basically it’s what we did while we were all idiots. Apparently some of us are still wedded to our historical idiocy, and are promoting this prescientific bafflegab under the label of “alternative”. However, there’s nothing alternative about it – it’s just the stuff that doesn’t qualify as real medicine.

People here in North America don’t seem to appreciate this line of reasoning. They accuse people who recognize the importance of basing our health care decisions on scientific evidence of being “closed-minded” and “reductionist”. This is an inaccurate characterization, since the whole principle of the scientific method requires open-mindedness and evaluation of truth based solely on observed phenomena. However, cloaked in a certainty borne of smug arrogance (“science doesn’t know everything – there are other ways to know things”), people readily flock to nonsense ‘treatments’ like reiki, homeopathy, acupuncture, reflexology, and a whole host of others.

However, there are millions of people who turn to these ‘alternative’ therapies because they can’t get actual medicine:

Ignoring the red-and-white danger sign, Sri Mulyati walks slowly to the train tracks outside Indonesia’s bustling capital, lies down and stretches her body across the rails to seek electric therapy. Like the nearly dozen others lined up along the track, the 50-year-old diabetes patient has all but given up on doctors and can’t afford the expensive medicines they prescribe. In her mind, it is only option left. “I’ll keep doing this until I’m completely cured,” said Mulyati, twitching visibly as an oncoming passenger train sends an extra rush of current racing through her body.

Side effects may include headaches, nausea, cramps, and being crushed by a motherfucking train. It is sad to see that a complete lack of a social safety net has resulted in conditions being this bad (are you paying attention Americans? Republican North Party?). It’s stuff like this that lights the fire under me to keep defending a well-run and publicly-funded health care system.

Back to my original point though. I challenge anyone who promotes ‘alternative medicines’ to explain why this particular therapy is stupid, but your treatment of choice isn’t. For those promoting science-based medicine, this task is easy: rigorous examination of patients reveals that those that lie on train tracks to cure their diabetes experience the same rate of cure as those that pursue homeopathy, reiki, crystals, ‘distance healing’, and whatever other nonsense term you’d like to throw out there.

If you’re not of a mind to call this therapy stupid and think that there’s something to it, then I really have to question your sanity. These are people risking their lives for a cure that not only doesn’t work, but can’t possibly work. Diabetes is not a condition of the nervous system. Electrical shocks would have no effect on the ability of the pancreas to produce its own insulin. The only thing that repeated and prolonged shocks might do is the same kind of effect you see in electroconvulsive therapy – massive release of endorphins and neurotransmitters, causing temporary feelings of euphoria. It would certainly explain the types of testimonials available in the article:

But Mulyati insists it provides more relief for her symptoms — high-blood pressure, sleeplessness and high cholesterol — than any doctor has since she was first diagnosed with diabetes 13 years ago.

Illness is a complex and multifaceted concept. I am entirely willing (and so is the medical community) to grant that there is a psychological role to all disease. This doesn’t mean anything quite so Chopra-riffic as being able to think yourself well from cancer, but it does suggest that management of any kind of illness requires an understanding of patient psychology. Anyone who can tap into a patient psychologically can provide “relief” of a certain kind, but that doesn’t do anything to treat the underlying biophysical problem.

Then again, some problems are not exactly biophysical:

The Philippine government has warned against using geckos to treat various diseases, including Aids and cancer, saying the traditional and common practice across southeast Asia could put the ill at greater risk. A Philippine health department statement said on Friday that the use of geckos as treatments had no scientific basis and could be dangerous because patients might not seek proper treatment for their diseases. “This is likely to aggravate their overall health and put them at greater risk,” it said. Treatments for asthma are easily available and affordable, while there are antiviral drugs to control the progress of HIV, the statement added.

Sometimes the problems are more deeply entrenched than even an adequately-funded health care system can address. Proponents of ‘alternative medicine’ often point to the age and popularity of their nonsense as evidence that it must work. After all, the reasoning goes, why would people stick with something that doesn’t make you better? Surely people are inherently rational and will abandon bogus medical intervention once they have been shown not to work. As difficult a time as alt-med types have with evidence, it seems to point in the opposite direction of this hypothesis.

And sure enough, just like in the Phillippines, there are always those who are hovering around the crowd of desperate sick people, circling like vultures and waiting for an opportunity to make a quick buck. The problem is that there will always be hucksters and charlatans who are more interested in making money than making people feel better. Worse, there are those that honestly believe they are helping, but who don’t bother to follow up or investigate their ‘patients’ longer than it takes to pocket their fee and hear a testimonial.

This is a problem that can be addressed only in part by legislation – we can’t really legislate people into rationality. It is for this reason that I am a partisan skeptic: we need to be actively promoting the ideals of basing our decision-making on scientific evidence, rather than simply saying “well people are going to do what they want.” This kind of arch-liberal hands-off cowardice is laying out the path for more abuse, fraud, and ultimately preventable deaths.

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