In my previous post, I talked about how we ought to think about the unanticipated outcomes of our actions, and how we should expect those consequences to play out. If you haven’t read that post yet, it might be worth checking out just to get the background. That said, let’s set the stage for a situation I think is analogous to the issue at hand.
Suppose I find myself in the presence of someone who is having a medical crisis, but with whom I can’t clearly communicate (perhaps they’re too catatonic due to illness, or speak a different language). I can see evidence of various symptoms – the patient is clearly in distress and in pain, sweating, running a high fever, along with many other indicators of problems. However, against all odds, a mad philosopher has locked me and this person together in a room that just so happens to be the world’s largest medical supply warehouse. Every possible drug and form of medical equipment you can possibly imagine is available to me. So here’s the question – should I try to use the vast supplies available to me to administer treatment to this person?
The case in favor: clearly something is wrong. This person is ill, injured, and suffering. If I can render aid to them, I should do it – it would be terrible of me to simply ignore the problem when I could do something to help.
The case against: despite having watched a significant amount of House, M.D., I am not a doctor. I don’t have anything close to adequate knowledge to intervene properly. I can sort of see what various symptoms are – the presence of fever and vomiting are evident, their pulse is racing, etc., but I don’t have any reliable way to determine what is causing these symptoms. And I have no way of knowing which, if any, of the drugs available to me would be helpful. Nor do I have an understanding of this person’s medical history and the complications it entails. Perhaps they’re already on some form of medication that would have a terrible interaction with something else I might give them. I simply have no way of knowing what the consequences of my attempts would be.
Now, someone might suggest at this point that since I have no way of knowing what the outcomes of my intervention would be, I also have no way to know if the result would be better or worse. Technically, that’s true – I can’t know that. But in this case, do I have good reason to think that my attempts are more or less likely to do harm or good?
It seems extremely obvious in this case that I’m far more likely to do harm than good if I intervene. Michael Huemer has described a similar thought experiment, where he points out that for most of human history, doctors usually did more harm than good. This is because for most of human history, we understood next to nothing about how the body works. Huemer talks about how George Washington was given ineffectual treatment by the doctors of his day meant to help him, and that almost certainly contributed to his death. As he put it, “Washington’s doctors were respected experts, and they applied standard medical procedures. Why were they unable to help him? Put simply, they could not help because they had no idea what they were doing. The human body is an extremely complex mechanism. To repair it generally requires a detailed and precise understanding of that mechanism and of the nature of the disorder afflicting it – knowledge that no one at the time possessed. Without such understanding, almost any significant intervention in the body will be harmful.” That is, when acting from a state of ignorance in carrying out medical interventions, it’s technically possible that the unknowable results of your intervention might be positive, but it’s far more likely that the outcome will be negative.
This is due to the fact that there are simply far more ways to harm the human body than there are to heal it. In the same way, and for the same reasons, there are far more ways to increase the disorder of a complex system than increase order. There are far more ways to disrupt the natural balance of an ecosystem than to stabilize it. This is why most new ideas are terrible. When intervening in a complex adaptive system you don’t understand, the valence of unanticipated consequences is far more likely to be negative than either neutral or positive.
But, you might say, not everyone shares my ignorance of medicine. What about a trained medical professional, with years of experience? Wouldn’t medical intervention be a good idea if they were the one doing the intervening?
That certainly does change things. Clearly the intervention of such a person would be justified. Of course, this doesn’t depend on claiming that the doctor possesses perfect knowledge and their attempts are guaranteed to be a success – that’s an absurdly high standard. Doctors can still make mistakes, and sometimes there are unexpected complications they couldn’t reasonably anticipate. The standard here is not perfection. What makes the difference is that a doctor can justifiably believe that their intervention is significantly more likely than not to help the patient recover. They won’t get it right in every case, but they’ll get it right more often than not.
However, at the risk of testing the reader’s patience, there is one more layer I can put on this thought experiment. While I am no medical expert, I do know at least a few things about basic first aid. Nothing fancy, but stuff that I can usefully apply if needed. I could, for example, bandage a wound to stop bleeding, or clear out an obstructed airway – simple things like that. Those are interventions I can justifiably engage in – but if I attempt to go beyond that I may inject the patient with a massive amount of warfarin and melt all their skin off because hey, since I don’t know if the outcome of using this drug will be bad or good, it’s all indeterminate so there’s no reason not to try!
The relevant question here is whether technocrats, politicians, and policymakers are analogous to skilled medical professionals treating a patient whose condition and medical history they thoroughly understand, or if they’re in a position more similar to me locked in a warehouse with the hypothetical patient, or George Washington’s doctors.
Michael Huemer argues that policymakers “are in the position of medieval doctors. They hold simple, prescientific theories about the workings of society and the causes of social problems, from which they derive a variety of remedies–almost all of which prove either ineffectual or harmful. Society is a complex mechanism whose repair, if possible at all, would require a precise and detailed understanding of a kind that no one today possesses.” I think this somewhat overstates the case. I’d say policymakers are more analogous to me in the warehouse with the patient than medieval doctors. That is, there really are a few basic things that are understood well enough to be implemented – things at the level of general rules like protecting property rights, a system of stable laws, prohibitions on violent crime, etc.
These kinds of basic, general rules are the equivalent of my ability to render basic first aid. But advocates of technocratic policy see themselves as being more like skilled medical professionals with a detailed understanding of their patient, capable of carrying out complex interventions in a complex system in a way that reliably produces beneficial results.
That mindset is not new, of course – that level of overconfidence has always been present. And that very mindset is part of what horrified Edmund Burke at the ideas animating the French Revolution. Burke, too, used an analogy of someone sick and in need, and thought our approach to social problems should reflect the way we’d approach “the wounds of a father, with pious awe and trembling solicitude.” And he saw those motivated by the pretense of their imagined knowledge as being like me rushing to the patient with a syringe full of warfarin, describing such people as “children of their country who are prompt rashly to hack that aged parent in pieces and put him into the kettle of magicians, in hopes that by their poisonous weeds and wild incantations they may regenerate the paternal constitution and renovate their father’s life.”
READER COMMENTS
Thomas L Hutcheson
Aug 13 2024 at 11:56am
The bottom line of this is that it is proper to advocate for marginal changes in policy that one has made some effort to assess the positive and negative consequences of. This is the spirit of cost benefit analysis of policy. Granted that the logic of this is only of infinitesimal changes. I may be on strong grounds that one more immigrant to the US would be a good thing. But how far does this go? 10 more 10,000 more 10,000,000 more?
Another problem is knowing what not advocating leads to. Maybe we think that an increase in a minimum wage will led to unemployment of the least skilled workers but there is some political momentum for such a policy. Is it better to advocate for no change or for an alternative way of transferring income to low paid workers like a more generous EITC?
Richard W Fulmer
Aug 13 2024 at 2:03pm
There is another relevant question: What are the technocrats’, politicians’, and policymakers’ incentives? As Thomas Sowell observed:
If, in the marketplace, an entrepreneur comes up with a solution to a problem, he can sell it and make a profit. If, in politics, a congressman or senator solves a problem, he loses an issue and maybe a voting bloc.
Richard W Fulmer
Aug 13 2024 at 2:30pm
Is it possible that government regulation has made us less safe? Increased safety is a function of innovation and wealth. Innovation leads to safer products and processes, and, because safety comes at a price, the wealthier we are, the more safety we can afford. If regulation – taken as a whole – has significantly slowed innovation and wealth creation, could it have cost more lives than it saved? Is there any way in which to answer this question?
Jon Murphy
Aug 13 2024 at 5:22pm
It’s a good question. I think certain regulations probably have had greater negative effects while others have had net positive effects. FDA regulations have almost certainly caused more harm than prevented. Probably airline regulations, too.
john hare
Aug 13 2024 at 6:04pm
Probably add in general aviation. Most light planes seem to be either antiques or homebuilt now since advances are so difficult to get approved. If similar restrictions had applied to cars, we would still be trying to get another decade out of the 73 Pinto and 55 Chevy.
nobody.really
Aug 13 2024 at 3:13pm
Kevin Corcoran continues his valiant quest to articulate a principle of governance: Governments should engage in the RIGHT AMOUNT of intervention, but not TOO MUCH—a principle with which I surmise everyone agrees. The challenge arises from trying to draw the line between RIGHT AMOUNT and TOO MUCH.
I enjoy this discussion, and I like the medical metaphor—but it looks as though the answer still boils down to relying on someone’s judgment/preferences. According to Corcoran, enforcement of property rights falls on the RIGHT AMOUNT side of the ledger—an outcome that I surmise happens to correspond with his own judgment/preferences about the things governments ought to do.
We could quibble: Which version of property rights should governments enforce? Lords claimed a property right in receiving services/taxes from their vassals; slavers claimed a property right in their slaves; etc.
But consider the following actions of the US government: Rebelling against King George. Establishing a central bank and currency. Buying the Louisiana Territory. Recognizing fictitious persons (a/k/a corporations) and granting them limited liability. Freeing slaves at the point of a bayonet. Subsidizing public education and research & development. Actively participating in WWII. Imposing sanctions on private firms that discriminate on the basis of suspect categories. Financing public health projects. Sending humans into space. Developing computers and the internet. I defy anyone to say that any government agent could have anticipated even half of the consequences of pursuing these activities. If you had been in a decision-making position, would you have nixed these activities on the grounds that the results would be unforeseeable? Or would you say that, even with their unforeseeable consequences, at least some of these choices provided a sufficient degree of foreseeability that, combined with the exigent circumstances, justified government intervention?
A final query: What course of action would you have recommended to medieval physicians? And if they had taken your advice, what actions would contemporary physicians be able to take today? Corcoran appears to be fighting a hubristic human tendency for action. But there’s a school of thought that says that humans evolved a bias for action—not because action is always adaptive, but because action provides a better opportunity for learning, and LEARNING is adaptive.
Recall that experience is what you get by acting without the benefit of adequate experience….
Richard W Fulmer
Aug 14 2024 at 10:24am
The Constitution did a pretty good job of it: defend the nation’s citizens, suppress rebellion, coin money, regulate interstate and international commerce, make treaties, establish standard weights and measures, establish post offices, construct post roads, establish courts of law, and make the laws and raise or borrow the money required to carry out and fund its assigned duties.
Not because the results were unforeseeable, but because some of them were unconstitutional.
Rebelling against King George
Predated the Constitution
Establishing a central bank and currency
Establishing the currency is constitutional, establishing the central bank probably wasn’t.
Buying the Louisiana Territory
Jefferson acted without Congress’ approval, so unconstitutional. Congress did ratify the treaty after the fact, however.
Recognizing fictitious persons (a/k/a corporations) and granting them limited liability
Could be filed under regulating interstate commerce.
Freeing slaves at the point of a bayonet
Suppressing rebellion is constitutional. Freeing the slaves furthered that end.
Subsidizing public education and research & development
Unconstitutional
Actively participating in WWII
Falls under defense. We were attacked.
Imposing sanctions on private firms that discriminate on the basis of suspect categories
Unconstitutional. That said, the sanctions probably wouldn’t have been necessary if federal courts had shut down “separate but equal” and Jim Crow. In a free market, discrimination is costly, and many private companies resisted Jim Crow.
Public health projects
Unconstitutional
Sending humans into space
Maybe constitutional since the work had military value.
Developing computers and the internet
Constitutional. Done as part of military research.
Monte
Aug 13 2024 at 4:03pm
Just as the medieval practice of trepanation was occasionally successful at treating head injuries, government interventions are occasionally successful at correcting market failures, unintended consequences notwithstanding. So to say that we need another government program like we need a hole in the head can actually, if rarely, be a good thing.
nobody.really
Aug 13 2024 at 5:30pm
That’s clever, Monte! That said, if people had embraced Corcoran’s thesis in the past—would anyone really embrace Corcoran’s thesis today?
Joseph Henrich, chair of Harvard’s Department of Human Evolutionary Biology notes a distinction between WEIRD (Western, educated, industrialized, rich and democratic) people and the rest of the people in the world, who tend to be more clannish. He notes that in the Middle Ages, the Western (Roman Catholic) Church established a general prohibition on marriage to cousins, step-relatives, in-laws, godparents, and multiple wives. Marriage was the institution that provided for centralizing and maintaining property and control in the hands of a clan’s patriarch; if you died without a “nuclear family,” you would still likely have heirs within your clan with the right to inherit your property. By banning certain kinds of marriage, the Catholic Church broke up kinship lines and the property that flowed along those lines; now if you died without a nuclear family, your property would flow to the church. In effect, the church was abrogating certain property rights with a foreseeable consequence of enriching the church.
But a less foreseeable consequence was the decline of the importance of clans, the corresponding rise in the importance of the nuclear family—and a shift in the psychology of the individual. Kin-based institutions reward conformity, tradition, nepotism, and obedience to authority, traits that help shield assets from outsiders. In contrast, individualism favors independence, creativity, cooperation, and fairness with strangers.
I surmise Corcoran would have argued that authorities such as the Church should not have interfered with traditional property rights, and should not have altered marriage laws in a manner that would trigger unanticipated consequences. But if the Church had taken this advice, we might never have developed the WEIRD culture that underlies the thesis Corcoran is expounding.
In making this point, I don’t mean to make a general argument in favor of triggering unforeseen consequences. (At least, I don’t THINK I mean that.) I merely note the irony.
Monte
Aug 14 2024 at 11:50am
Sure, just as some today still embrace pure laissez faire capitalism, but with much less enthusiasm and in far fewer numbers than was once the case. Contra Edmund Burke, some of our greatest achievements (and, to be fair, worst disasters) were “motivated by a pretense [of] imagined knowledge” by those willing to accept the unintended consequences of their actions.
Nothing ventured, nothing gained.
Richard W Fulmer
Aug 14 2024 at 2:25pm
That’s fine when you’re venturing your own life and property. Less so when you – or the government – ventures what belongs to others.
Monte
Aug 14 2024 at 4:17pm
Valid point, but decisive action must sometimes be taken governments on behalf of the people when confronted with circumstances that involve the prospect of declaring war, managing a public health crisis, or avoiding an economic collapse.
Richard W Fulmer
Aug 14 2024 at 5:22pm
Agreed. But can you name an American financial crisis that didn’t have the government’s fingerprints all over it?
nobody.really
Aug 15 2024 at 11:12am
I can’t even imagine such a thing. Throughout US history, governments have engaged in such intrusive acts as defending property rights and enforcing contracts, which have greatly enhanced people’s ability to acquire wealth. If only government had refrained from such activities, I expect vastly more people would have been living in abject destitution–unwilling to lend and unable to borrow–thereby shielding them from financial crises.
Those who live their lives in a prone position are releived of the fear of falling.
Monte
Aug 15 2024 at 12:00pm
The dot-com bubble, Lehman Bros collapse, and Enron scandal were largely driven by the private sector. In fact, one could argue that a lack of regulatory oversight precipitated these crises.
Richard W Fulmer
Aug 15 2024 at 1:07pm
Dot-Com Bubble
The Fed’s loose monetary policy during the late 1990s was a key factor in creating the Dot-Com bubble. When new money enters the economy, it must go somewhere. As in the run up to the Great Depression, that “somewhere” was the stock market. In addition, the Fed’s bailout of Long-Term Capital Management signaled to investors that it would support financial markets, encouraging riskier investments.
Lehman Brothers
Following the Dot-Com bust, the Fed again pumped money into the economy. Government policy and tax rules all but guaranteed that much of the money would flow to housing construction. When the Fed raised interest rates, the bubble burst. Lehman Brothers was collateral damage. That said, there were a lot of contributors to the bubble and its collapse including:
o The Federal Deposit Insurance Corporation – For bailing out Continental Illinois in 1984, convincing financial firms that they could make risky investments knowing that they would be bailed out if the investments failed.
o The Federal Reserve – For bailing out Long-Term Capital Management in 1998.
o The Federal Reserve – For pumping money into the economy and inflating the currency.
o Congress – For pushing Freddie Mac and Fannie Mae to purchase sub-prime mortgages and for lowering borrowing standards.
o Jimmy Carter – For signing the Community Reinvestment Act (CRA).
o Bill Clinton – For putting teeth into the CRA, which fueled the housing bubble.
o George W. Bush – For signing the American Dream Down Payment Initiative, which further fueled the housing bubble.
o The SEC for requiring companies to follow mark-to-market accounting, which amplified the effects of both boom and bust. Mortgage-based securities, overvalued when housing prices soared, became undervalued as the panic grew, and financial institutions saw their assets become virtually worthless almost overnight.
o The Basel Accords – An international banking agreement that encouraged banks to use bundled sub-prime mortgages as “reserves.”
o Loan originators who, realizing that they would have nothing to lose once they sold their mortgages to Freddie Mac or Fannie Mae, recklessly gave loans to people who couldn’t afford to pay them back.
o Home “flippers” – Who drove up housing prices then walked away from their mortgages when the values of the homes they purchased dropped.
o States whose laws allowed people to walk away from their mortgages with no penalty.
Enron
First, the Enron bankruptcy didn’t rise to the level of a financial crisis. Second, Enron was the poster child for crony capitalism. The company lived in the nooks and crannies of state and federal regulations. Its aggressive lobbying and manipulation of the regulatory environment played a key role in its collapse.
Richard W Fulmer
Aug 15 2024 at 3:17pm
nobody.really
The federal government doesn’t foment financial crises when it restricts itself to performing its constitutional duties. It is its unconstitutional actions that cause problems.
Governments are capable of providing Adam Smith’s formula for prosperity: “peace, easy taxes, and a tolerable administration of justice.” When they try to do what they cannot – right history’s wrongs, ensure equal outcomes for all categories of people, heal the planet, control the economy, ameliorate all pain – they will fail to do what they can.
Monte
Aug 15 2024 at 5:26pm
Fair enough, although I’d argue the Lehman Bros debacle was probably more a failure of the market to self-regulate. In each case, we can surely hold gov’t indirectly responsible for fostering an atmosphere of excessive risk-taking and over-speculation. So…wouldn’t regulatory oversight have helped to mitigate or prevent each of these crises and improved corporate transparency?
Richard W Fulmer
Aug 15 2024 at 6:39pm
The right regulations would, by definition, ensure good and prevent bad, but don’t forget that a lot of the wrong regulations led to, or at least contributed to, the crises. This shouldn’t be surprising given that regulators suffer from both knowledge and incentive problems.
Richard W Fulmer
Aug 14 2024 at 11:25am
You highlight a key problem with the precautionary principle: every action and inaction necessarily have unpredictable, unintended consequences. A real problem with top-down action – especially at the level of a nation or a world religion – is that the consequences are widespread and often irreversible.
steve
Aug 14 2024 at 11:49am
Since you have chosen the medical metaphor we may as well continue it. You note that a doctor trapped in the room would have a better chance of treating the ill person. What isn’t apparent in that statement is that the knowledge developed over the years is only because many people were willing to risk unintended consequences in trying to figure out how to better practice medicine. If you let fear of unintended consequences freeze you into remaining with the status quo then you never move forward.
In the past safety issues were secondary or largely ignored so the risk of unintended consequences were pretty high. With better knowledge of physiology and pharmacology and an emphasis on safety the risks are lower but still remain. We still occasionally catch problems with therapies and devices after they are released. At any rate, as a result of people ignoring the risks of unintended consequences we can now diagnose and treat thousands of problems we could not in the past.
Steve
Richard W Fulmer
Aug 14 2024 at 12:10pm
Mediaeval doctors weren’t scientifically using patients as guinea pigs, searching for real cures by trial and error. They were treating patients according to dogma.
steve
Aug 14 2024 at 3:12pm
I dont think you can make a good case that science in general was not much practiced in the Medieval period and certainly not by the huge majority of doctors. However, trial and error medicine was pretty common in folk medicine and how they discovered stuff like willow bark actually has positive effects. I would think Jenner’s smallpox vaccine falls into that category also. We certainly didnt understand viruses and the human immune system at that time.
Kevin might certainly believe that you are more likely to get remedies from the unintended consequences from private actions but as been noted here before libertarians really want to believe that courts are fair and impartial, the one part of government you can actually trust. In reality the party with the most funding and best political connections has often won through history.
Steve
nobody.really
Aug 14 2024 at 12:56pm
Nice insight. This does illustrate a weakness of the medical metaphor.
This blog regularly rails against the costs that the Food and Drug Administration imposes on us all due to its too-cautious approach to approving anything new. FDA is very concerned about unanticipated consequences–which has the unanticipated (and sometimes lethal) consequence of delaying innovation.
I expect Kevin Corcoran would emphasize that unanticipated consequences of from government action differs from unanticipated consequences from private action–perhaps reflecting a notion that harmed parties can more often seek redress from private actors than from government. Or he may have a different argument in mind. In any event, this objection illustrates the complexities that arise from pursuing even an apparently unobjectionable goal of avoiding unanticipated consequences.
steve
Aug 14 2024 at 10:48pm
The complaints about delay have some merit but are greatly overstated. If a drug only has phase 1 testing how would I as a clinician know how to use the drug? What kind of dosing? How well does it work compared to available drugs? How many PBMs will want to carry drugs that dont have FDA approval? One of th ewmany reasons it takes the FDA a while to approve stuff is it relies upon academic doctors to review data on new drugs and those docs dont work for the FDA. Many, probably most, practicing docs would hesitate to use a new drug without hearing the opinion of the reviewers of drugs from their own specialty.
Steve
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