I was reading an article my wife sent me when I discovered something I did not realize, there is a single accrediting agency for medical schools nationwide. I knew this was the case with law schools, but students who attend non-ABA schools may still apply for entry to the bar, at the discretion of the state bar committee. I don't think the same pertains in medicine.

I know that many disagree with me about the problems of medial licensing, but does no one else see the problem with a single accrediting agency?

Suppose you have come up with what you are convinced is a better way to teach medicine. How do you get that information out? Well, in any other industry, you would spend your money, or borrow some, and start a school. But in this case, that money could be entirely wasted, if the accrediting agency disagrees with you. You would not have the ability to change their minds either, as no one would attend your school if they couldn't practice. So you would not even have a chance to change minds or prove yourself right. Everything rests on the whim of a small group. Even if they were not human, and thus subject to irrational emotions which make this even less of a good idea, they are not possessed of perfect knowledge, and so can judge good ideas bad and bad ideas good. Finally, even if they were perfect, the fact remains that perhaps there is more than one way to teach something, perhaps differing methods work for different student, so the assumption that a monolithic set of rules is best is absurd.

This is akin to the way the FDA keeps the drug companies an oligopoly. If you have a drug idea, even for a miracle cure which could make you rich, would you go through all the trouble of opening a drug company? In a free market, yes. If convinced of your drug's effectiveness, you would. However, under out system, you would not. It is not the high startup cost, including FDA compliance that makes it a problem, but the arbitrary FDA decisions. The FDA is supposed to guarantee drugs are "effective", but that is no longer the truth. Just look at Vioxx. It worked, it prevented deaths due to the gastric and bleeding problems caused by other analgesics. But it had very small unadvertised risks of coronary complications. No drug is without risks, even water can kill.However, thanks to all the publicity, I guarantee the next drug that is effective but carries a small risk will either be denied, or required to bear a lurid warning label ensuring no one will use it voluntarily.

And that is the FDA problem, the incentives are wrong. Bureaucrats are charged with ensuring drugs are not just "effective", but "safe". Both are terms so vague no one could reasonably define them. Everything carries risks, if we define "safe" as without any risks, then we would have no drugs. However, for the bureaucrat, that is precisely the problem. He knows all drugs are risky, but he also knows if he approves a drug that later gets media attention about "dangerous" side effects, his career is over. So it is in his interest to deny almost everything. Rather than realistically state the risks, and let the doctors and consumers decide (which could still result in career-ending bad media), he is pushed by the innate pressures of his job, to deny any drug unless the benefits so far outweigh the risk that he can explain away any future scandals.

And that is what makes the drug companies an oligiopoly*. Many drug companies were built on a single wonder drug. Sure, generic manufacturers may pop up, but they don't do R&D. New drug companies start up on a new cure. But would you risk everything on whether or not a bureaucrat will approve your discovery? Even if every trial is positive, even if the side effects are minimal, there is still the chance you will hear "no" and lose your shirt. Why not just sell to an existing firm, let them bear the headaches, and get out?

And that is the pattern of regulation everywhere. As soon as we substitute the judgment of a man, or men, even the most intelligent men, for that of all individuals everywhere, we end up distorting the market and making things less pleasing to those same people. Granted, some of those people may make "the wrong" decision from our point of view, but that is not our call to make. It is their money, their happiness, their lives, we cannot say what is better or worse for them when it comes to spending their labor and wealth.

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* Patent laws also play a role here, but those are another matter entirely. Even without them, the FDA alone would probably keep competition out of the market, so we can safely ignore patent laws for the moment.

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POSTSCRIPT

One problem with medical laws is they posit "health" as an absolute value, above all else, and thus define as "irrational" any decision which contradicts our current health beliefs, allowing us to intervene. It is how we ban some drugs, restrict cigarette smoking, control access to pharmaceutical, even force children to get treatment against their parents' wishes.

However, there are three problems with this approach.

First, as I wrote elsewhere, the government does not have the power to coerce a man to act unless he has violated the rights of others. But as the idea of absolute individual rights is often ignored even on the right*, that is (sadly) the weakest argument.

Second, health is not an absolute value. Just ask anyone who has refused a second or third round of chemotherapy to enjoy what time they have left. For that matter, many who oppose cigarette smoking, arguing the enjoyment of smokers is irrelevant, as health is an absolute value, themselves drink to excess at times, violating their own principles, or engage in unprotected sex. So, they inconsistently apply their "health is an absolute value" rule only to those matters which they find distasteful. Which make sense in a way, as applied consistently, health as an absolute value would leave little in our lives the government could not control.

Finally, even if I were ready to credit health as an absolute value, then we would also have to posit our understanding of medicine is perfect. If we are wrong about something, then aren't we doing more harm than good by forcing our imperfect understanding on others? Is it not better to allow them to choose? Or allow competing theories? At least if we are not absolutely omniscient in all health matters? And as we do not have perfect understanding of these health matters, doe sit make sense to deny people of their rights based on an imperfect understanding? Doesn't that risk actually making people less healthy through mistaken beliefs?

Well, I will right on this later, as it is yet another argument, or set of arguments, against medical licensing, drugs laws, pharmaceutical access restrictions, and so on. So I will be returning to this in the near future.

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* Just look at how many on the right think the government has the power to restrict foreign trade, or even give unions government authority, or just make unions mandatory. I know it is more common on the left, but, as usual in a bad economy, it seems the more fair weather friends of individual rights are drifting into the authoritarian paleo-con camp and suggesting a nominally conservative authoritarian solution including protectionism, unionization, and other traditionally liberal positions.

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POSTSCRIPT II

My essays on medical regulation (including pharmaceutical regulation) are the following (in chronological order):

Standing By My Principles
For Your Own Good
Medical Regulations
Shameless Self-Promotion
Unintended Consequences I
Unintended Consequences II
A Question
Who Does It Harm?
Manipulating the Law
It Doesn't Matter to ME...
Medical Regulation II

I have written rather extensively on drug laws and pharmaceutical regulation in particular, so I may have missed some. However I think this covers all the important essays. (You may want to examine my other blog, Examining the War on Drugs, for a more thoroguh discussion of medical issues related to this.)

NOTE: If you read all those articles, you will note a disparity. I say in one place I was cut off twice from opiates, in another three times. Blame a faulty memory or perhaps slip of the pen. I did go through opiate withdrawal three times, but only twice against my will. One time I did it voluntarily, as the original back problem, which came before my other problems, was cured through injections of steroids into my spine. So I went "cold turkey" and went through three or four days of discomfort. The doctor wanted to "taper down" my doses, or offered to do so anyway, but I was reluctant to do so, as it just seemed to be spreading the discomfort over a longer time. Four days of intense discomfort seemed better than weeks of malaise. So one of those withdrawals can be laid at my feet. The other two in that year were purely from doctors cutting off my medication. (On the plus side, discontinuing one of my current medications can be lethal, so I know I will always have that. Sadly it is not a pain reliever, but it does stop muscle spasms which caused a lot of my pain some time ago.)