September 08, 2004

Taboo Medicine

Marcus J Longley wrote a fun little essay about the psychological impact of going to private health care, The three paradoxes of private medicine, BMJ 2004;329:579 (4 September) (I also blogged about it at Blog)

Basically, the problems with private health care are that the people are too friendly and eager to please, not visibly greedy enough and it makes die-hard socialised health care people feel guilty about going there.

Stop laughing, it actually points at a problem. Many instutitions are so embedded in ideological and symbolic structures that we are unable to approach them rationally, and that this makes them sacrosanct (or hated) beyond what they should be. Any challenge based on practicality or other secular values is taboo, just as in the value coflict/taboo trade-off theory developed by P.E. Tetlock. The ending of the essay is a vivid example of how the author seeks to morally cleanse himself after having done a taboo tradeoff - his daughter's health (!) vs. the righteousness of the national health care system (OK, some/all of that outrage is certainly played and parodied, but the general emotion is probably not that far from reality). It is a real collision of value systems, and one that slows the adoption of many useful institutions. If trading health for money is seen as inherently evil, people will not trust those who do it - private health care and pharmaceutical companies.

I have repeatedly heard people say that the new pharmacology, stem cells or nanotechnology are great for the future of health, but at the same time that they don't wish such research to be commercialized. But how are drugs and treatments supposed to be developled? Here the strong value of the human life limits vision, making economic realities (that also exist within government run health organisations) immoral to consider - people either ignore them, cleanse themselves by promoting overly altruistic acts (OK, lets fund it all by even more taxes!) or seek to limit profits to "proper" levels, ignoring the slowdown of research and loss of opportunity/lives this causes.

In another CNE blog I discussed Robin Hanson's theory about the evolution of health altruism. Given that we seem to be strongly health altruistic this might explain some of the value-accretion around our health institutions.

[In a case of google-synchronicity, I also found a paper by Tetlock et al. about why the DARPA policy futures market became so disliked (Robin is the originator of the information market idea). It feels good to see that Tetlock himself attributed the fierce reactions to the same mechanics I described in one of Eudoxa's policy studies. OK, hammers and every problem a nail, but there seems to be a nice confluence of thinking here. ]

So, if health care naturally tends to become sacred - regardless of cost, utility or being pleasant - we have a real problem with health instutitions in the near future. Health care altruism does not seem to cover enhancing medicine. As the border between curative and enhancing medicine blurs the issue of what resources to allocate to what (and by whom) will become fiercer. If the traditional institutions cannot be effectively criticized, they may block the development of both new institutions providing new services (like, say, private hospitals for enhancing treatments not covered by state insurance) and necessary changes in their own structure to remain flexible and effective (such as information-enabled medicine and realtime cost tracking). We end up with a sacred albatross around our necks.

Posted by Anders at September 8, 2004 07:19 PM