What is a Bad Choice?
My Vioxx post below got me thinking about choices, and in particular, how we "grade" other people's choices.
My first thought on this topic is that assessing the "right" choice for an individual, when a decision affects only that one individual, can only be made by that person. That seems like a dumb and obvious statement, but actually its fairly relevant to public policy nowadays. Want to ride your motorcycle without a helmet? Sorry, we think that is a bad decision and we aren't going to let you make it. Want to reduce excruciating pain even at the risk of future heart problems? Sorry again, can't let you do that. Want to let Florida State continue to use your tribe's name (Seminoles) for their mascot? Sorry, but that is degrading to you, even if you don't know it. Want to enjoy some french fries (maybe even some Snuffers cheese fries, for those who have ever lived in Dallas) at the risk of a future heart attack - well, you can still do that, but we're working on it. I wrote much more on this topic here.
Beyond the moral problem I have with having the government limit our ability to make decisions for ourselves, the fact is that we are generally really bad at assessing other people's choices. I will make the analogy using blackjack. I remember sitting at a table in Vegas and watching some woman take a hit on 18. For those who don't know blackjack, trust me - you are always statistically reducing your odds of winning when you hit an 18. Anyone, the woman draws a three, for a perfect 21, the dealer reaches 20, and she wins the hand. Several people around the table said to her "great decision to take another card". No it wasn't! It was stupid! It was a bad decision that, in this particular case, she was bailed out of by good fortune, but over the long haul of hitting 18's, she's going home broke.
Lets take a second example. I buy liability insurance for my company every year. Because I am in a public contact business, which makes us a particular target of the litigation industry, we pay nearly $100,000 a year for the policy. Last year, we had no claims. Does this mean that I made a bad decision buying insurance last year, because it turned out that we had no claims? No, of course not. It would be irresponsible in today's litigious environment to engage in unprotected business. The insurance is a smart decision, even in years without claims.
But juries always assess choices based on the outcomes, not on the inputs the individuals involved were facing when they made the choices. In the hands of a good litigation attorney, a jury will always find that hitting on a 12 in blackjack and drawing a king was a bad decision, even when the dealer is showing an ace and the odds say you HAVE to draw.
Which brings us back to Vioxx. Lets imagine ten thousand people who have excruciating pain, pain that prevents them from actively participating in and enjoying life, that choose to take Vioxx, knowing that there is a tiny risk of heart problems. 9,999 live a better life. One man dies. A jury eventually decides that the one man made a bad decision (since he died). I would argue that the man who died did not make a better or worse decision than the other 9,999. He made what he thought was a good decision, the same decision all the others made; he just happened to be the one who came out unlucky, but they all knew going in that someone in their group would probably draw the short straw.
Postscript: Of course, no one ever thinks its going to be them who draws the short straw. There is a famous story from WWII about a soldier being told with his company that two out of every three of them would likely die in the coming D-Day invasion. The soldier looked to his comrade on his left, and then the man on his right, and thought "poor bastards".
honestpartisan:
"Individual choice" is not meaningful when you are talking about prescription drugs. Not having an epidemiology background or the wherewithal to test drugs myself, I have no idea what the benefits or risks of various drugs are. Before the first food and drug laws in the early 1900s, most medicines on the market just plain didn't work. People could exercise their individual choices to their hearts' content, but they weren't getting the cure that they were paying for.
One way to address this problem is to pool resources and have a public agency test drugs to make sure that they're effective. If this process works like it should, then maybe it should confer some type of immunity from liability. The only problem with that is that the FDA just tests drugs to see if they work better than a placebo to a certain level of statistical likelihood. The FDA doesn't do a good job of teasing out unforeseen side effects.
The leaves the other way of addressing the knowledge gap with prescription drugs: hold the producers accountable, as they have the financial incentive to make the drugs, and they also have the lopsided information advantage. I don't know the specifics of the jury verdict you blog about, but if Merck should have known about dangers and didn't do enough to stop the inappropriate marketing of the drug, then it should be held liable. (That may not be the case on those facts; I don't know).
As a consumer of medication I care a lot less about the means (the power of my individual choice in taking drugs) than the ends (having a medication that works and won't screw me up in other ways). The performance of drugs after testing regimens were imposed by Congress in the 1930s is a vast improvement over the Medicine Show-era snake oils and elixirs that proliferated previously.
August 24, 2005, 3:53 pmPaulNoonan:
But this is not the 1930s. Information travels a lot faster now than it did then, and much of the structural bureaucracy put in place during the first half of the 20th century is now obsolete because of it.
With regard to drugs, there are several nearly costless ways that you could discover information in the absence of regulation or tort law. Some Consumer Reports type venture would probably spring up. You could ask your doctor. You could ask the pharmacist. You could Google for personal stories about the drug.
Why are drugs any different than cars (or tires) or bicycles, or lighters, or slip-n-slides?
August 25, 2005, 11:02 amSergio:
Re: Motorcycle helmet laws
August 26, 2005, 5:22 pmAs a motorcyclist, I strongly support helmet laws, despite being a staunch Conservaterian. In a perfect world, I would not care what others do to their heads. But in this world I do care, because I (and the rest of "We The People") are on the hook to pay for the unfortunate soul's medical bills and recuperation (disability?) costs after he/she hits his/her head and is injured.
So, in short, if it truly did not affect me, I could not care less if a rider wears a helmet or not. But I do care, because it may cost me money if the person suffers a serious preventable head injury because they chose not to protect their cranium.
I have ridden for 30+ years, helmeted. Haven't needed it (yet).
michael hammond:
Now after the Texas Vioxx decision Big Pharma's stooges are flooding their editorial outlets ( USA Today, the New York Times, Wall Street Journal) with demands that the government protect the drug companies.
August 26, 2005, 7:12 pmPS The decision by the Texas jury was rendered because the defendant couldn’t explain their faulty “science†to the common man. Something that contains lies is very hard to explain as it gets very complicated whereas that which is true is simple and easy to understand.