A libertarian argument for an FDA

Whoa! Yeah, I’m going to do this, but let me start with some caveats. First, this is an argument, not the argument. Every silver lining has a storm cloud, and acknowledging the silver lining doesn’t mean you’re in favor of tornadoes. Second, I’m being sloppy with the term libertarian; classical liberal is closer to the truth, but doesn’t make for as good a title. Most importantly, I think my argument is swamped by the traditional libertarian arguments against the FDA. All that said, this argument has some interesting implications for how we think about intervention generally. Here goes…

The human body is a complex system that we do not fundamentally understand. Although every complex system is unique, they have similarities. In the case of both the human body and society/markets, interventions lead to unintended consequences which can offset the (ostensible) gains from the intervention. At the end of the day, although the FDA intervenes in the complex system of human society, it also prevents intervention in the complex system of human physiology.

The Hippocratic Oath instructs its speaker to not play God and to avoid over-treatment, and the justification for that is made clear in a recent Econ Talk. The guest was on to promote his book which discusses the problem of medical reversal–the phenomenon of medical practices that are adopted and subsequently abandoned after evidence shows the practice to be ineffective or worse. From this position he argues that the FDA’s mandate to ensure not just safety, but efficacy, is especially important. His argument is that because of the cost of type II error the FDA ought to go further.

Let’s look at two extreme cases. In the “anything-goes” world, we might have a lot of people trying good and bad interventions with a lot of harm being done to the unlucky ones. You and I know that the real problem is one of information and that in a perfect world we would have “anything-goes-that-consumers-with-access-to-good-information-from-Consumer-Reports-®-or-a-competitor” but this world still leaves us with the problem (which we face in today’s FDA-evaluated world) that consumer trial-and-error is a poor substitute for randomized control trials.

At the other extreme we have the “first-do-no-harm-second-do-real-good” world of an ideal FDA. This world has very steep type I errors but instead of two steps forward, one step back, we would have one step forward, then another, and never any steps back…. but of course each step forward would cost a few billion dollars.

Neither extreme is ideal, but the second world is one where standards of evidence are taken very seriously. In that world I’d be a third grade teacher instead of a college professor. The standards of evidence are at the core of the problem of medical reversal, but also the problem of economic intervention (which is far less likely to be reversed, even in the face of good evidence indicating that it should be).

As far as medical intervention is concerned, my position is bullish on better efficacy evaluation of medical procedures but still bearish on the FDA itself. But looking at the FDA from this angle opens up an interesting thought experiment: what might be the effects of an Economic Intervention Standards Authority? In practice it would probably be awful (my guess is a federal bureau that attempts to quash Tiebout competition), but in a libertarian utopia it would be the bureaucracy that libertarian kids with administrative bents would dream of heading.

Polystate, part 2

After much distraction I’m back to continue my review of Polystate: A Thought Experiment in Distributed Government (part 1 is here). But now that I think about it, this isn’t so much a review, as a book club (of one…) where I respond to the book.

In this section, ZW gets into the benefits of polystates. He starts with the benefit of choice. Someone born into North Korea is utterly screwed, but someone born into an unattractive anthrostate can simply leave when they reach the age of consent. The reverse is also true: someone may join an anthrostate that the rest of us see as distasteful. Want to join a cult? You’re free to. The thought of that possibility will certainly make your inner-paternalist squeamish, but remember that if you aren’t free to make mistakes, you simply aren’t free.

Another benefit I wouldn’t have thought of is that traditionally problematic systems of government have a higher chance of success when they are separated from geography. For example:

It may be that the failure of collectivization has not got to do with the individual so much as the aggregate. If 95% of people work poorly in a collectivized environment, any random collectivized farm will perform poorly. But it may be the case that 5% of people would excel in such an environment.

I would expect a communist to protest that geographic seclusion is necessary to create New Communist Man. How are people supposed to learn how to shed their egoism if they cannot help but see the vulgar bourgeoisie all around them? But that sword cuts both ways and shows a benefit of polystates ZW didn’t bring up: a child raised in a fascist anthrostate can see non-fascists and so make a more informed decision of whether to stick with fascism when they get older.

ZW sees the polystate as offering a sort of decentralized Tiebout competition. That covers the demand side (what benefits to provide to whom). Adding in the supply side (who will face what opportunity costs) raises the problem of economic calculation in socialism. But ZW takes it in a different direction, hypothesizing that sorting between anthrostates would lessen decision making costs due to more homogeneous populations.

Choice ensures we get more of what we want with less hassle but also provides the option of exit at low cost. Taking geography out of the equation means that there is a larger number of potential state-competitors, as well as more credible movement on the part of citizens.

He raises an interesting problem related to a recent post of mine:

[T]here may be a difference between good governance and governance which pleases one’s constituency… But, regardless of the philosophy of good government, there is an extent to which good governance must have to do with what voluntary citizens decide is good.

First off: No! Government and governance are two different things! But putting that aside, the big problem we face is how to not just aggregate preferences (a difficult problem in itself), but how to ensure that (or even determine if) our method of aggregation results in something good.

I think cable TV is pretty good at giving people what they want, but I also think that the product is overwhelmingly bad. It’s not a big deal with TV because there are so many alternative sources of entertainment and information (although cable news might have existential dangers). Similarly, I think government broadly gives people what they want (not peace and prosperity, but xenophobia, “doing something,” paternalism, and the like) but that’s not a good thing. The idea of the U.S. senate was to prevent people from having too much choice so that good institutions could be preserved. So could the degree of choice offered by polystates be to much? On the other hand, how could you determine an answer without incorporating the revealed preferences of the governed?

Finally, ZW gets into an especially meaty benefit of anthrostates: peace. It’s hard to start a war with a disbursed enemy (“semi-random geographic distribution), and hard to finance one when your citizens can switch to a more peaceful government. This could be especially important in avoiding territory disputes as humans explore and colonize space (for example, if resources on the moon become valuable enough to justify the expense of following Newt Gingrich up there).

That concludes Book 1 of Polystate, and that’s where I’ll stop for now. I’ll be picking through the book fairly slowly, so I recommend that you buy the book for yourself!