Sunday, July 17, 2011

Don't Twist the Facts, Even in Service of Good Policy

The findings from this so-called "pragmatic trial" may change the way British doctors prescribe drugs for the prevention of asthma flares. Patients may be told that it doesn't really matter what controllers you take, although intensive clinical trials suggest otherwise. In effect, the recommendations will be dumbed down, because some (or even most) patients simply aren't very good at following directions. Even savvy patients—the ones who are perfectly able to handle the more complex and better treatments—would be treated the same as everyone else...Should patients be separated by ability groups, as some students are in schools?
I can sympathize with this viewpoint from a pragmatic financial and clinical perspective, but I have a couple of problems with it. One is personal--the dumbed-down, lowest-common-denominator, one-size-fits-all perspective sacrifices too much for those who aren't dumb. For instance, if you don't have high blood pressure and aren't salt sensitive, there may not be much reason to deny yourself the gustatory delight of salt.

The second is more a matter of philosophy, and its long-term implications for public policy. In a nutshell: in the long-run, no good comes from deceit, even deceit borne of the best intentions. People will start to figure it out, sooner or later, and that will breed distrust at best, conspiracy theories at worst.

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