I appreciate the response and I agree that it does “seem wrong” at first glance.
However, I think this appearnace is part of why the FDA is dangerous.
From what I can tell, the FDA is optimized to have a vaguely satisfying answer to every first order query that people raise “in general”. The problems show up in the second and third order analysis, and then the messed up practical details that actually arise after people stop questioning and start following bad laws.
The FDA actually DO NOT make things particularly easier for competent doctors.
The signal provided by the FDA is too noisy and confused and tentative for doctors to actually use to actually do their job properly just by relying on that and nothing more.
Example: the FDA has not approved melatonin for sleep. Melatonin is simply a supplement, like concentrated lime juice or St John’s Wort. I think lime juice is yummy and nutrious, I’m substantially more wary of St John’s Wort, and melatonin is one of my “staples” that I keep in my medicine cabinet for “just in case”. However, doctors treating the FDA as a source of “actual medical advice” miss all of this.
(The FDA’s essential power is the power to veto coercively. They do this by default for everything new, and then sometimes they loop back around and remove things from the market for various reasons which might sometimes be “because someone who the formerly legal drug competed with wanted the legal drug to no longer be able to compete with them so they lobbied for removal”. Once you’re able to buy or not-buy anything (drug, food, healthy food, spice, or whatever) the FDA’s input is done and over.)
The service you’re thinking that the FDA provides is actually provided by multiple groups, and the best one I know of (for everyone in general) is the Cochrane Review folks.
Cochrane provides an actual useful service. They try to break things down to the point of actionability, and review their reviews as more research comes in, sometimes changing the practical upshot, which the FDA basically never does.
Then separately there are often semi-large medical systems like Kaiser where they practice “evidence based medicine” where specifically their patients and their systems are subject to focused optimizing pressure of a similar sort. I’ve heard Kaiser doctors grouch about how they don’t enjoy their job as much when it feels like they are just following corporate treatment policies and not actually “practicing medicine”. Some doctors (who aren’t burned out yet?) seem to like unusual patients where they don’t have the EBM policies memorized, but maybe some doctors are happy to become “implementers of the policies of others” for the same handful of general practice problems, over and over and over.
But if you doubt doctor competence at anything but being a subservient lackey of wise bureacrats (which, maybe that’s valid, because maybe some doctors ARE burned out and phoning it in) then getting treatment from a corporate system like Kaiser can make a lot of sense, precisely because “the kind of service you’d naively expect from the FDA” is actually being offered by that corporate system’s best efforts towards generalized executive competence at science based medicine in an organizationally realistic way.
If there is a coherent positive argument for the FDA that round trips through the actual medical ecosystem… I’ve never heard it… and I’ve been looking for one since the FDA killed over half a million Americans just over 18 months ago.
The FDA has blood on their hands and I’m still can’t figure out why this isn’t common sense to the American voter, and also not even among particularly smart people!
Maybe I am missing something really obvious and big? The FDA has existed for longer than it has had legal support (it started out as a non-profit, basically, and then the government threw money and power at them during a crisis roughly a century ago) and so surely there are good and proper “Chesterton’s Fence” style reasons to support them out of common sense non-hubristic conservatism?
And I do love common sense non-hubristic conservatism.
I appreciate the response and I agree that it does “seem wrong” at first glance.
However, I think this appearnace is part of why the FDA is dangerous.
From what I can tell, the FDA is optimized to have a vaguely satisfying answer to every first order query that people raise “in general”. The problems show up in the second and third order analysis, and then the messed up practical details that actually arise after people stop questioning and start following bad laws.
The FDA actually DO NOT make things particularly easier for competent doctors.
The signal provided by the FDA is too noisy and confused and tentative for doctors to actually use to actually do their job properly just by relying on that and nothing more.
Example: the FDA has not approved melatonin for sleep. Melatonin is simply a supplement, like concentrated lime juice or St John’s Wort. I think lime juice is yummy and nutrious, I’m substantially more wary of St John’s Wort, and melatonin is one of my “staples” that I keep in my medicine cabinet for “just in case”. However, doctors treating the FDA as a source of “actual medical advice” miss all of this.
(The FDA’s essential power is the power to veto coercively. They do this by default for everything new, and then sometimes they loop back around and remove things from the market for various reasons which might sometimes be “because someone who the formerly legal drug competed with wanted the legal drug to no longer be able to compete with them so they lobbied for removal”. Once you’re able to buy or not-buy anything (drug, food, healthy food, spice, or whatever) the FDA’s input is done and over.)
The service you’re thinking that the FDA provides is actually provided by multiple groups, and the best one I know of (for everyone in general) is the Cochrane Review folks.
Cochrane provides an actual useful service. They try to break things down to the point of actionability, and review their reviews as more research comes in, sometimes changing the practical upshot, which the FDA basically never does.
Returning to the example: For melatonin, Cochrane is in favor of it for jet lag but unconvinced for use in ICUs even after hearing the pitch in favor, and looking at studies.
Then separately there are often semi-large medical systems like Kaiser where they practice “evidence based medicine” where specifically their patients and their systems are subject to focused optimizing pressure of a similar sort. I’ve heard Kaiser doctors grouch about how they don’t enjoy their job as much when it feels like they are just following corporate treatment policies and not actually “practicing medicine”. Some doctors (who aren’t burned out yet?) seem to like unusual patients where they don’t have the EBM policies memorized, but maybe some doctors are happy to become “implementers of the policies of others” for the same handful of general practice problems, over and over and over.
But if you doubt doctor competence at anything but being a subservient lackey of wise bureacrats (which, maybe that’s valid, because maybe some doctors ARE burned out and phoning it in) then getting treatment from a corporate system like Kaiser can make a lot of sense, precisely because “the kind of service you’d naively expect from the FDA” is actually being offered by that corporate system’s best efforts towards generalized executive competence at science based medicine in an organizationally realistic way.
If there is a coherent positive argument for the FDA that round trips through the actual medical ecosystem… I’ve never heard it… and I’ve been looking for one since the FDA killed over half a million Americans just over 18 months ago.
The FDA has blood on their hands and I’m still can’t figure out why this isn’t common sense to the American voter, and also not even among particularly smart people!
Maybe I am missing something really obvious and big? The FDA has existed for longer than it has had legal support (it started out as a non-profit, basically, and then the government threw money and power at them during a crisis roughly a century ago) and so surely there are good and proper “Chesterton’s Fence” style reasons to support them out of common sense non-hubristic conservatism?
And I do love common sense non-hubristic conservatism.
But at some point the weight of logic, evidence, and sanity has to pile up such that you fix the giant obvious death machine in your midst? Right? Eventually?