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  • The “Public Health” Non Sequitur

    Posted by Jonathan on December 15th, 2004 (All posts by )

    Clayton Cramer criticizes Arthur Kellerman’s objection to home defibrillators:

    So what device is it that Arthur Kellerman wanted the government to block you from having? No, not a gun. He was resisting government approval of automated external defibrillators (AEDs). His reasoning about AEDs is as specious as his reasoning about guns.

    [. . .]Kellerman says. “If you have $2,000 burning a hole in your pocket, join a health club; get help stopping smoking; get help lowering your cholesterol. Sure, AEDs have saved hundreds of lives. But we have saved hundreds of thousands of lives with primary prevention of heart disease. And we don’t know whether having an AED in the home will make a family less interested in prevention.”

    Kellerman’s statement — “Sure, AEDs have saved hundreds of lives. But we have saved hundreds of thousands of lives with primary prevention of heart disease” — is an excellent example of a logical fallacy that is popular among “helping professions” busybodies. It takes the general form: You shouldn’t do X for yourself. We should do Y as a society. These statements are typically made sequentially, and appear to respond to objections but really do nothing more than brush them off.

    The problem is that the statements are not logically connected. X does not imply Y, nor are X and Y necessarily mutually exclusive. In this case, Kellerman does not explain why individuals’ purchasing of their own defibrillators is incompatible with improved preventive-medicine or public-health measures. By presenting preventive medicine as a false alternative to individual behavior that he disapproves, he appears to suggest that either 1) he does not believe that individuals have as much standing to make their own medical and insurance decisions as do bureaucrats, institutions and academic researchers, 2) he is arguing dishonestly, or 3) he is extremely sloppy in his thinking. Whatever his motives, his arguments deserve close scrutiny, especially since he has made similar badly reasoned arguments against individual decision-making in the past.

    When confronted with a public-health non sequitur, or any argument that uses group data to prescribe (or proscribe) individual behavior, be alert to the possibility of statistical and logical sleight-of-hand. Often, the biggest questions concern who gets to decide rather than which decisions to make. The most important part of Kellerman’s argument may be the unstated (and hence unexamined) premise that he should decide for you.

     

    13 Responses to “The “Public Health” Non Sequitur”

    1. tipperography Says:

      Who gets to decide rather than which decisions to make

      I think I was just talking about something similar to this. Jonathon Gerwitz at Chicago Boyz give us Arthur Kellerman’s objections to home defibrillators.

    2. Lorien Hiteshew Says:

      I can’t say I know much about the medicine discussed here, but I did just complete a senior level Ethics class at UMCP.

      Typical Utilitarian thinking:

      x results in z
      y results in 100z

      Since we “ought” to maximize results, regardless of individual need, it is therefore best that everyone employ y to achieve 100z.
      —-
      But, I agree with you here. It is not for Kellerman to recommend what we “ought” to do. This sort of flawed reasoning is outlined by Hume (Hume’s Law). Just because it “is” the case currently, doesn’t mean it “ought” to be so. You can’t derive an “ought” from an “is”.

    3. Jonathan Says:

      Lori, thanks. You hit the nail on the head. The modern “public health” mentality is crudely utilitarian. What makes it crude is that it treats decision making as a simple, godlike activity, done from on high by experts, and ignores the enormous aggregate utility that comes from the unfathomably complex matrix of individuals making their own decisions. Utility for whom? — that is the question.

    4. Engineer-Poet Says:

      I think that the fact of what is in public policy may imply what ought to be… for public policy.  But when it comes to an individual looking after their own health, the statistics and interests of the general public do not apply.

      It is obviously better for people to eat better and exercise than to let their health slide and get implantable defibrillators, but how then do you justify Dick Cheney?

    5. Steve Says:

      Johnathan,
      I must commend you for your writing style. It was a swift read, with adept use of italics, links and logics formulas. Your numbered points serve as easy stepping stones leading directly to your concise warning.

      What a delight to read – Wheaties for the Brain!

      Now on to Ginny and the Cole Kerfuffle.
      Happy holidays, Steve

    6. Jonathan Says:

      Steve, thanks. Happy holidays to you too.

    7. sjvan Says:

      He confuses an important point: the difference between what I can do for myself and what I can do for others,

      I can buy my father a membership on a gym, or a box of bran cereal, but I can’t make him excercise or eat right. But I can buy him an AED. An important distinction.

    8. Jonathan Says:

      I suspect that Kellerman’s central problem is hubris — he thinks that he can decide better for other people than they can for themselves.

    9. Verde Says:

      What an amazingly rich country, where people can afford to have their own defibrillators at home! Many hospitals in third world countries don’t have a single functioning defibrillator.

      Anywhere moderate to large numbers of people congregate, a defibrillator should be available. I won’t be buying a defibrillator for myself or loved ones anytime soon, but I’d contribute to help buy a defibrillator for a local high school (for athletics), Little League, or church.

    10. chel Says:

      I think Verde’s point is really great. Having AEDs in public places makes sense.

      But back to the original article that contained Kellerman’s comments. I didn’t get that Kellerman wanted to “wanted the government to block you from having” as Jonathan said in his post. They way I read it, Kellerman had two points:

      1.) A downside of AEDs in the home is that it may delay a 911 call. And it’s not clear what is more likely to save lives… attempting to use the AED and delaying a 911 call or calling 911 immediately.

      2.) Every time a family spends dollars on one thing, these are funds that are not being spent on something else. For a lot of people joining a health club or a smoking cessation group would be a better way to spend this money.

      (article at:
      http://my.webmd.com/content/article/92/101640.htm)

      But as far as I could tell Kellerman was not arguing that AEDs be illegal. (Perhaps they might be available only by perscription if the FDA changes course. But a perscription is not much of an obstacle for someone who is at risk.) He was just offering his opinion on whether it made sense for individuals to choose to buy them. That’s the type of content that WebMD is known to provide — advice for individuals who are in the midst of health decisions. As they say, “WebMD provides valuable health information, tools for managing your health, and support to those who seek information.”

      Let me know if I’m missing something here…

    11. Jonathan Says:

      chel, I think that individuals and families can, in this as in other areas of life, make such decisions for themselves better than Kellerman can make them for them. Kellerman’s problem is that he doesn’t appreciate this point. Adam Smith had people like Kellerman pegged:

      The statesman, who should attempt to direct private people in what manner they ought to employ their capitals, would not only load himself with a most unnecessary attention, but assume an authority which could safely be trusted, not only to no single person, but to no council or senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it.

    12. Chel Says:

      Hi Jonathan,

      Sorry it’s taken me a while to get back to you on this. I’ve been a bit busy lately.

      My point was that from what I read of the WebMD article, Kellerman was just trying to provide information to individuals who are going to make health decisions for themselves. Health decisions can be very complicated and my understanding of the purpose of the WebMD site is to provide info to individuals making decisions.

    13. Jonathan Says:

      Chel, thanks. I understand what WebMD is doing but I’m interpreting Kellerman’s current behavior in light of his past behavior. He has a history of making heavy-handed, essentially political recommendations based, as I see it, on a combination of hubris and faulty interpretation of data.