[Studies on how often, and for how long, antibiotics should be prescribed] are much easier to conduct in countries where medicine is largely socialized and prescriptions are tightly regulated. Recently, researchers in Israel, where most citizens receive their care through such a system, showed that refraining from empirically prescribing antibiotics during the summer months resulted in a sharp decline in ear infections caused by antibiotic-resistant microbes. (In the United States, a 1998 study estimated that fifty-five per cent of all antibiotics prescribed for respiratory infections in outpatients—22.6 million prescriptions—were unnecessary.) In Sweden, the government closely monitors all infections, and has the power to intervene as needed. 'Our infection-control people have a lot of authority,' [Dr. Christian Giske, a clinical microbiologist at Karolinska University Hospital in Stockholm] said, 'This is power from the legislation.' Once a resistant microbe is identified, stringent protocols are put in place, with dramatic results. Fewer than two per cent of the staphylococci in Sweden are MRSA, compared with sixty per cent in the United States. 'Of course, it’s only around ten million people, so it’s possible to intervene because everything is smaller,' Giske said, adding, 'Maybe Swedes are more used to this type of intervention and regulation.'
Friday, August 08, 2008
The New Yorker has a feature on 'superbugs' - antibiotic and drug-resistant bacteria such as multiply resistant Staphylococcus aureus (MRSA). On page 4, you'll find this:
So says Dennis Shanahan:
On Wednesday I raced to the new [GroceryChoice] website to see how I was to be empowered as a consumer and use detailed information to save money on my weekly grocery bill. Unfortunately, like so many other consumers ... I was disappointed as a shopper and vindicated as a political editor.Status at last!
Tuesday, August 05, 2008
Another Great Dickhead of History
Thanks to the internet, the ideas, and reputation, of Herbert Spencer have been enjoying a modest revival recently. According to Damon W. Root, at Reason On-Line (hat tip to Jason Soon), Spencer's reputation as the father of Social Darwinism is undeserved - Spencer was fitted up by ideological opponents who misread and misquoted his works, particularly his first book Social Statics: or, The Conditions essential to Happiness specified, and the First of them Developed.
Social Statics begins with a rebuttal of Jeremy Bentham's utilitarian philosophy - that the basis of morality, and law, should be to secure the greatest happiness for the greatest number. Spencer produces some astute, and telling, criticisms of Bentham's philosophy then begins expounding his own theory of morality:
There is no way of coming at a true theory of society, but by inquiring into the nature of its component individuals. To understand humanity in its combinations, it is necessary to analyze that humanity in its elementary form—for the explanation of the compound, to refer back to the simple. We quickly find that every phenomenon exhibited by an aggregation of men, originates in some quality of man himself...After examining the human constitution, Spencer concludes that each of us - each 'social atom' - is endowed with a 'moral sense'. The way to a happy society lies in each man pursuing his own happiness, according to the dictates of his moral sense and reason. If each pursues his own happiness in this way, the happiness of society as a whole is guaranteed. Unhappiness is nature's punishment on those who do not live according to the dictates of good moral sense and sound reason. Later, Spencer devotes a whole chapter (Chapter 2: 'The Evanescence of Evil') to elaborating this idea with illustrative examples, without adding much to it, beyond the complacent assurance that, in the long run, nature will find a way to get rid of those of defective moral sense and reason.
This fact, that the properties of a mass are dependent upon the attributes of its component parts, we see throughout nature. In the chemical combination of one element with another, Dalton has shown us that the affinity is between atom and atom. What we call the weight of a body, is the sum of the gravitative tendencies of its separate particles. The strength of a bar of metal, is the total effect of an indefinite number of molecular adhesions...
This consideration, though perhaps needlessly elaborated, has an important bearing on our subject. It points out the path we must pursue in our search after a true social philosophy... it hints that the first principle of a code for the right ruling of humanity in its state of multitude, is to be found in humanity in its state of unitude — that the moral forces upon which social equilibrium depends, are resident in the social atom — man; and that if we would understand the nature of those forces, and the laws of that equilibrium, we must look for them in the human constitution. (Social Statics, Introduction: 'The Doctrine of the Moral Sense'
The conclusion of Spencer's musings on morality is that the only morality worthy of the name is the morality of the perfect man:
... the moral law must be the law of the perfect man—the law in obedience to which perfection consists. There are but two propositions for us to choose between. It may either be asserted that morality is a code of rules for the behaviour of man as he is—a code which recognises existing defects of character, and allows for them; or otherwise that it is a code of rules for the regulation of conduct amongst men as they should be. Of the first alternative we must say, that any proposed system of morals which recognises existing defects, and countenances acts made needful by them, stands self-condemned; seeing that, by the hypothesis, acts thus excused are not the best conceivable; that is are not perfectly right—not perfectly moral, and therefore a morality which permits them, is, in so far as it does this, not a morality at all. To escape from this contradiction is impossible, save by adopting the other alternative; namely, that the moral law ignoring all vicious conditions, defects, and incapacities, prescribes the conduct of an ideal humanity. Pure and absolute rectitude can alone be its subject matter. Its object must be to determine the relationships in which men ought to stand to each other—to point out the principles of action in a normal society. By successive propositions it must aim to give a systematic statement of those conditions under which human beings may harmoniously combine; and to this end it requires as its postulate, that those human beings be perfect. Or we may term it the science of social life; a science that, in common with all other sciences, assumes perfection in the elements with which it deals. (Social Statics, Chapter I: 'Definition of Morality.')Spencer's morality of the perfect man has one first principle 'the law of equal freedom':
Every man has freedom to do all that he wills, provided he infringes not the equal freedom of any other man. (Social Statics, Chapter VI: 'First Principle.')This is similar to the definition of liberty given by John Stuart Mill in his essay On Liberty but Mill's topic in that essay was political, or civil liberty, not morality. At first sight, Spencer's 'law of equal freedom' - do what you want, so long as you leave others free to do what they want - doesn't look like much of a basis for a moral system.
Suppose I get up one day and take it into my head that it would be a good day to wander the streets, kicking random strangers in the testicles. Would this violate Spencer's law of equal freedom? Not as long as I am prepared to accept the possibility that others might exercise their equal freedom by kicking me in the testicles. True, that would have incapacitating results, leaving me unable to pursue my freedom to kick others in the testicles, but that incapacity would only be temporary - there would be nothing to prevent me, at a later date, from seeking out my attacker and returning the kick. While this example might suggest that the 'Law of equal freedom' might need a little modification, Spencer gives short shrift to the idea that there is anything missing in this first principle of his moral system:
Upon a partial consideration this statement of the law will perhaps seem open to criticism. It may be thought better to limit the right of each to exercise his faculties, by the proviso that he shall not hurt any one else—shall not inflict pain on any one else. But although at first sight satisfactory, this expression of the law allows of erroneous deductions. It is true that men, answering to those conditions of greatest happiness set forth in the foregoing chapter, cannot exercise their faculties to the aggrieving of one another... The giving of pain may have two causes. Either the abnormally-constituted man may do something displeasing to the normal feelings of his neighbours, in which case he acts wrongly; or the behaviour of the normally-constituted man may irritate the abnormal feelings of his neighbours; in which case it is not his behaviour that is wrong, but their characters that are so. Under such circumstances the due exercise of his faculties is right, although it gives pain; and the remedy for the evil lies in the modification of those abnormal feelings to which pain is given.(Social Statics, Chapter VI 'First Principle.': (original emphasis))So, if one day you're walking down the street and a complete stranger bounces your knackers off your tonsils with a well placed size 11 Blunny there are two possible explanations: your assailant is a person of defective moral sense and you have every right to feel aggrieved, or your own character is so defective that you cannot recognise the rightness of his action. In view of the latter possibility, we must regard the various laws prohibiting assault as an affront to morality, as Spencer defines it. Unless the assault results in the death of the victim; that would deprive him of the right to life which is such an obvious corollary of his first principle 'as scarcely to need a separate statement'. What, exactly, society should do to uphold and protect your right to life, Spencer declines to say:
Into such questions as the punishment of death, the perpetual imprisonment of criminals, and the like, we cannot here enter. These implying, as they do, antecedent infractions of the law, and being, as they are, remedial measures for a diseased moral state, belong to what has been elsewhere termed Therapeutical Ethics, with which we have now nothing to do. (Social Statics, Chapter VIII: 'The Rights of Life and Personal Liberty')In fact, looking to part III of Social Statics, there are good grounds for thinking that Spencer's 'law of equal freedom' prohibits the state from doing anything to protect your right to life, if that involves the use of punishment to deter criminal behaviour:
Derived ... as it is, directly from the Divine will, and underlying as it does the right organization of society, the law of equal freedom is of higher authority than all other laws. (Social Statics, Chapter XVIII 'Political Rights')So high is the authority of the 'law of equal freedom' that every individual has the right to ignore the state (Chapter XIX) and become an outlaw, voluntarily giving up the protections of the state. This might be the proper thing for any perfect man who finds himself living in our society to do because government is 'essentially immoral':
Is it not the offspring of evil, bearing about it all the marks of its parentage? Does it not exist because crime exists? Is it not strong, or, as we say, despotic, when crime is great? Is there not more liberty, that is, less government, as crime diminishes? And must not government cease when crime ceases, for very lack of objects on which to perform its function? Not only does magisterial power exist because of evil, but it exists by evil. Violence is employed to maintain it; and all violence involves criminality. (Social Statics, Chapter XIX: 'The right to ignore the state')So it appears that in a properly constituted moral state - one which doesn't use criminality to maintain magisterial power - you'd just have to cop it sweet if a random stranger made you the victim of a random act of violence as you were walking along the street. Any punishment for murder which involved depriving the offender of life or liberty would be equally criminal - a truly moral state which upholds Spencer's law of equal freedom would do nothing about it. But nor would it interfere if someone decided to exact a private revenge - in fact, the private revenge, in Spencer's terms, can be justified as the natural penalty for being so deficient in moral sense and reason as to assault or kill someone.
The state's duty - its only duty - is 'to protect — to enforce the law of equal freedom; to maintain men’s rights, or, as we commonly express it—to administer justice.' (Chapter XXI).Beyond this it should not go (Chapter XXII). In particular, it should not infringe on trade by regulating commerce (Chapter XXIII), support an established religion (Chapter XXIV), provide relief for the poor (Chapter XXV), Run schools (Chapter XXVI), establish and administer colonies (Chapter XXVII), come between charlatans and their dupes (Chapter XXVIII) regulate the currency, run a post office, or build lighthouses and other public works (Chapter XXIX).
All these activities are prohibited by 'the law of equal freedom'. They also interfere in the natural process which punishes the immoral and unreasonable for their moral and intellectual deficiencies and weeds them out of the population bringing us ever closer to the perfect society of perfect men. Here's Spencer's argument against preventing the sale of quack medicines ('empirics'):
Inconvenience, suffering, and death, are the penalties attached by nature to ignorance, as well as to incompetence — are also the means of remedying these. And whoso thinks he can mend matters by dissociating ignorance and its penalties, lays claim to more than Divine wisdom, and more than Divine benevolence. If there seems harshness in those ordinations of things, which... visit a slip of the foot with a broken limb — which send lingering agonies to follow the inadvertent swallowing of a noxious herb — which go on quietly, age after age, giving fevers and agues to dwellers in marshes — and which, now and then, sweep away by pestilence tens of thousands of unhealthy livers... be sure it is apparent only, and not real. Partly by weeding out those of lowest development, and partly by subjecting those who remain to the never-ceasing discipline of experience, nature secures the growth of a race who shall both understand the conditions of existence, and be able to act up to them. It is impossible in any degree to suspend this discipline by stepping in between ignorance and its consequences, without... suspending the progress. If to be ignorant were as safe as to be wise, no one would become wise. And all measures which tend to put ignorance upon a par with wisdom, inevitably check the growth of wisdom. Acts of parliament to save silly people from the evils which putting faith in empirics may entail upon them, do this, and are therefore bad. Unpitying as it looks, it is best to let the foolish man suffer the appointed penalty of his foolishness... [T]o guard ignorant men against the evils of their ignorance — to divorce a cause and consequence which God has joined together — to render needless the intellect put into us for our guidance ... must necessarily entail nothing but disasters. (Social Statics, Chapter XXVIII.: 'Sanitary Supervision')It's thanks to passages such as that one, that Spencer is quite justly regarded as the founding father of Social Darwinism. As remarkable as the fact that he wrote this book in earnest is that he still has his earnest defenders. That they should be on the internet isn't so remarkable.