Joe

Reason on House

At Hit & Run, Reason’s Jacob Sullum takes issue with the first three episodes of season 6 of House. Now some of you probably already know of my unabashed love for House. Well, Jacob also manages to hit on another of my hobby-horses, namely, the stupid way in which Americans stigmatize drug use. (To be clear, I think that it’s pretty stupid to abuse drugs, but I also think that it’s pretty stupid to jump out of non-crashing airplanes. I think, however, that you should be free to do either, if you please.) Unfortunately, in this case, I think that Jacob’s assessment is a bit wide-of-the-mark in this case. Here’s a snippet (warning: spoilers):

In this week’s episode, House, on the advice of his psychiatrist after he’s released from the hospital, quits his job and tries to find a “hobby” to distract himself from the leg pain, which is so severe that it prevents him from sleeping. He and his psychiatrist ultimately conclude that what he really needs is to go back to work, even though the stress and drug-associated surroundings may increase his risk of “using,” because that is the only thing that will engage his mind enough to make the leg pain bearable.

This plot is stupid in several ways. First, unless House plans to diagnose disease 24 hours a day, going back to work is not a solution to the pain that keeps him up at night. Second, if all House needed to relieve his pain was his work, why was he taking the Vicodin to begin with? Third, we never get a clear explanation of why House is forever forbidden to use painkillers, no matter how much he is suffering, especially since he managed to do his job brilliantly while he was taking them.

Jacob’s questions are meant to be rhetorical, but I think that there are actually some pretty decent answers to most of them.

First, the show has pretty much always indicated that House’s use (abuse?) of Vicodin increases when he’s bored. That’s a plot device lifted straight from Sherlock Holmes, on whom, if you didn’t already know, House is very much based. Holmes’ drug of choice is cocaine, which he uses between cases. “Give me problems, give me work, give me the most abstruse cryptogram, or the most intricate analysis,” he tells Watson, “and I am in my own proper atmosphere. I can dispense then with artificial stimulants. But I abhor the dull routine of existence. I crave for mental exaltation. That is why I have chosen my own particular profession, or rather created it, for I am the only one in the world.”

We’ve seen evidence of House having the same issues. In the S2 episode, “Skin Deep,” House begs Cuddy for a spinal injection of morphine to combat his rising leg pain. Cuddy complies reluctantly, and House improves. Or he improves as long as he’s working on his case. She notes later that his pain came back — surprise — just an hour after he completed the case. And, even bigger surprise, his previous injection was saline.

What’s more, House has been Vicodin free once before. In between S2 and S3, House is completely free of the drug. An experimental medical procedure has eliminated House’s pain. S3 begins with a scene of House jogging apparently pain free. The Vicodin begins again not because of physical pain, but because of House’s depression at (apparently) failing to solve a case.

IOW, House’s writers have offered ample evidence that House is psychologically dependent on painkillers. Yes, there is real physical pain. But there is also a far more troubling psychological addiction to the drug, one that transcends it’s palliative properties. And that, of course, is at least part of the answer to Jacob’s second question. House takes the drug even when working because he is dependent on it, even when he doesn’t need it to combat the pain (as, for example, when he’s working).

It’s also the answer to why House’s new psychiatrist calls him an addict and keeps him away from painkillers. Remember, this is the same House who, after a bad day, ends up in a stupor on the floor, covered in his own vomit, having downed the better part of a bottle of oxycodone. House is labeled an addict because he’s an addict. House is not simply a chronic pain-sufferer who responsibly takes pain medication under a doctor’s supervision. He’s a guy who steals his best friend’s prescription pad to get more Vicodin, who hides pills inside Lupus textbooks and sneakers and the like, who pops pills because he’s bored or stressed or just had a bad day.

Now I’ll gladly join with Jacob in saying that we vilify narcotic use badly enough that many who are in chronic pain are unable to get the relief that it is possible to give them. Prosecuting physicians who provide high levels of painkillers to their patients who are actually in high levels of pain is beyond dumb. It’s even dumber when we’re talking about terminally ill patients who are left to suffer needlessly lest they * gasp * end up addicted to morphine. I’m just not at all convinced that Greg House is the ideal posterchild for the Why Are We Taking Their Pills Away? movement.

Words Have Meanings

So, I’ve been accused of writing a lot. But the truth is that I actually spend most of my days reading, rather than writing. Besides the (usually boring) stuff I read for work (texts of bills, transcripts of speeches, reports from think tanks, that sort of thing), there’s also the fiction I read for pleasure, the nonfiction I read as background for work (lately a lot of econ), and the philosophy that I still try to keep up with. And then there are the blogs. Lots of blogs. I have about 50 of them in my RSS feed and nearly that many more that I look at when I have time.

One of those blogs is Cato@Liberty, the blog of the Cato Institute. I have a bit of a love-hate relationship with C@L. I actually agree with a lot of their conclusions on domestic policy. Hell, if they didn’t make you wear a tie every day, I might send ’em a resume. But some of the scholars there have a distressing tendency to run with absurd talking points. And sometimes otherwise sensible posts end up with these absurd claims thrown in. Case in point: Malou Innocent’s post today on illiteracy in the Afghan army.

Now I don’t actually agree with Innocent (or, for that matter, with most of Cato’s foreign policy folks) all that often. They are mostly of the realist school of IR, with a pretty strong predisposition toward isolationism. But I read their posts regularly because I find it a useful check on my own liberal interventionist tendencies. And Innocent generally produces pretty thoughtful work. But then she throws in stuff like this:

It’s also ironic that many conservatives (possibly brainwashed by neo-con ideology) who oppose government intervention at home believe the U.S. government can bring about liberty and peace worldwide. These self-identified “conservatives” essentially have a faith in government planning–which is socialism.

Now rag on conservative hypocrisy all you want. Lord knows there’s plenty of it to criticize. (And, yes, there’s plenty on the left side of the aisle, too.) But this is…what’s the word?…oh, yeah, crazy.

I mean, look. It’s true that government planning is a feature — arguably even a necessary feature — of any sort of socialist society. But c’mon. “All socialist states require faith in government planning” simply doesn’t entail “all faith in government planning is socialism.” I feel really confident that just about any government in the world could successfully plan to rob its citizens blind. Does that make me a socialist? This is like Hayek on steroids. Forget the road to serfdom. It’s anarchy or bust.

That, of course, is a view that one can hold. But it’s a very strange one for a Cato scholar to hold. They’re more limited-government than no-government types. Indeed, it’s a particularly odd view for someone who works in international relations to hold. And I think it’s pretty doubtful that Innocent actually holds such a view. This seems more like an instance of joining the movement to label any sort of government activity we don’t like as “socialism.” It’s not true, obviously. But “socialism” polls well (or poorly, depending on what you’re looking to accomplish). So we’ll just throw it out there.

That’s fine for the Sarah Palins and the Joe the Plumbers of the world. It’s maybe even fine for the FreedomWorks activist types. Obviously I’d prefer intellectual honesty in politics. But I’m realist enough to know that intellectual honesty doesn’t win elections. Though intellectual honesty and several hundred million dollars might. Still, I’m reasonably tolerant of crap being flung around by political types. Hey, it keeps me in a job!

But I really expect better of Cato scholars. If you want to play the Serious Public Intellectual, then you have to check the demagoguery at the door.

Rights and Health Care

So, a week or so ago, I posted a half-snarky status message on Facebook poking a bit of fun at a then-popular meme about health care reform. Jim Arnold, who was good enough to give me a job a couple of years ago, and Mike Taylor, a career diplomat, both took some exception to my way-too-brief remarks. Their criticisms were fair in light of what I’d posted. I think that there are important responses to both, but making that case requires going into a bit of detail about rights. Those of you who think that philosophy majors talk too much as it is (you know who you are) may want to click something else right now. And those of you who had to endure my philosophy classes can probably skim pretty quickly through much of this, as there’s not a whole lot here you haven’t heard before. The rest of you…eh, you’ve been warned.

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Necessitudo ad bellum?

It’s starting to sound a lot like 2005 again.

Remember 2005? Iraq was a big, fat mess. American troops were dying at an alarming rate. Iraqi civilians were dying at an alarming-er rate (not that many Americans gave that much thought). The insurgents seemed to be gaining the upper hand. And there was a growing call from left-of-center pundits, bloggers and activists (joined by a small handful of their right-of-center counterparts) that we should get out of Iraq. Eventually, the non-blogging Americans joined in the call, and by the following November, a whole bunch of Republicans were swept from office by Democrats promising to stop the madness in Iraq. (That clearly worked out well.)

Here in late 2009, I’m starting to see a lot of the same things said about Afghanistan that I was seeing about Iraq back in 2005. Plenty of left–of–center types are starting to put out feelers about withdrawing. Military officials are outlining new strategies for moving forward. And a handful of right-0f-center types are joining the call. And so history repeats itself.

But should it?

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Normativity and Economics, cont.

Quick follow-up on my last post on the Is/Ought distinction. I argued there:

The very discipline of economics is loaded with normative assumptions. Consider two propositions:

  1. All goods can be exchanged.
  2. Money is a useful proxy for value.

Plenty of people reject these propositions.

In a post today, Mark Kleiman points out yet another normative assumption built into economics: the value of distribution.

Formal benefit cost analysis counts everyone’s gains and losses equally. But common sense and the principle of diminishing marginal utility agree that a dollar’s worth of gain is more valuable to someone with few dollars than it is with someone with many. Obviously, taking $1 each from 900,000 poor people to give $1 million to a hedge-fund billionaire doesn’t reflect a social gain, but a formal benefit-cost analysis will show that it does: after all, the net benefit is $100,000. Thus gains and losses should be adjusted by (at least) dividing each gain or loss by the income or wealth of the person bearing it, so that a $20 gain to a family with an income of $20,000 weighs as a heavily as a $10,000 gain to a family with an income of $1 million.

I don’t think that this framed quite right. Formal cost benefit analysis does take into account diminishing marginal utility. But what it doesn’t do is to take into account interpersonal comparisons of diminishing marginal utility. That is, while it’s certainly true that my one millionth dollar has less value to me than did my first dollar. But it doesn’t automatically follow from that that my one millionth dollar has less value to me than your one hundred thousandth dollar did to you. Knowing that would require us to accurately determine just exactly how much value you and I really got. Certainly there’s no particular reason to think that Kleiman’s exact calculation is correct.

Still while interpersonal utility comparisons cannot be rigorously calculated, there’s certainly something to Kleiman’s objection. I can be pretty confident that my one millionth dollar has less value to me than that same dollar would have to a starving Bengali, for whom a single dollar might represent half a year’s wages.

More to the point, though, questions about interpersonal utility calculations in general, and about the actual distribution of wealth rather than the maximization thereof in particular, are normative questions. They are questions about what sorts of things we ought to value. And, as Kleiman rightly points out, cost benefit analysis builds in a particular answer to that question.

Which once again leads us back to my earlier point. Policy doesn’t fall out of purely scientific economic analysis. Oughts are still necessary — and simply embedding them into your analysis doesn’t let you escape defending your normative commitments.

Political Sleight-of-Hand, in Which Pundits Attempt to Derive an Ought from an Is

Every once in a while I find myself banging my head against the wall watching some pundit or making the claim that Pure Science tells us exactly what we should do. Why this is supposed to be a point in the pundit’s favor is beyond me. Is there anything more frightening than the image of a bunch of folks in white lab coats cooking up a set of rules we all must follow? And yet I seem pundits making the appeal again and again, from both the right and the left.

For example, Michael Peroski, writing for the left-leaning Center for American Progress, argues that bioethics should be a “data-driven” inquiry, a process that “entails considering the best available evidence before making decisions.” That process would require one to “gather information about public sentiment on the topic, carefully analyze the costs and benefits of proceeding with or prohibiting the research, and offering [sic] a pragmatic recommendation that takes all of these considerations into account.”

In other words, if we simply gather the right facts and maybe attach a few numbers, the correct policy will just fall out.

Bryan Caplan, a libertarian economist at George Mason University, makes a similar case for economics, claiming that a correct economic analysis will point the way to correct policy, whatever moral perspective one might have.

Caplan and Peroski both seem to misunderstand the role that normative (philosopher-speak for “ought”) claims play in setting public policy.

Let’s start with Peroski, whose conflation of facts with morality is much more egregious. Now don’t get me wrong – I’m all for getting facts right. But facts are only part of the story. They’re an important part, and when the facts are wrong, policy decisions are likely to go astray. Facts tell us how the world is. But policy – and indeed, politics more generally – is about what we ought to do. And those two things, the is and the ought, are very different.

The 18th-C Scottish philosopher David Hume is usually credited with making this point. In A Treatise of Human Nature, Hume writes that it seems “altogether inconceivable” that we can deduce anything about what we ought to do from claims about what is the case. Philosophers have called this the is/ought problem, though I prefer the more colorful if less frequently used “Hume’s Guillotine.” To put Hume’s point in the preferred jargon of philosophers everywhere, we can say that normative claims (or value claims like ought or should) cannot be derived from descriptive claims (which are just claims about the way the world is – the sort of claims that science makes, for example.) The late Oxford and University of Florida philosopher R.M. Hare calls Hume’s point a logical rule, and states the principle formally as:

No imperative conclusion [i.e., statement about what one ought to do] can be validly drawn from a set of premises which does not contain at least one imperative.

A nice way of demonstrating Hume’s point is to borrow a method from another British philosopher. In Principia Ethica, G.E. Moore presents what he called the open-question argument. Moore was actually asking whether we can use natural terms (like “pleasant”) to define good. Moore says that since we can answer sentences like, “This is pleasant, but is it good?” with a no, then it must be an open question whether pleasant and good mean the same thing.

We can use the same method to show that ought claims don’t follow from is claims. Suppose we ask something like: “Reducing carbon emissions by 20 percent will reduce overall carbon levels to 550 parts per million, but should I do it?” As long as it makes conceptual sense to answer such questions with a “no,” it can’t be the case that the fact alone is sufficient to justify the normative claim. The point is that any argument that ends with the claim”We ought to do ____” can’t appeal just to a set of facts.

Of course, some philosophers will tell you that there are normative facts. The arguments on this score are as complicated and abstract as they are esoteric. And even if this view (which philosophers call “moral realism”) is correct, those moral facts are of a very specific sort (e.g., “violating autonomy is wrong” or “desire-satisfaction is good”). Even the most ardent moral realist wouldn’t take a straightforward scientific claim about, say, carbon emissions to be a normative fact. The fact (as it were) is that normative conclusions have to be supported by at least one normative reason.

Caplan, for his part, recognizes the necessity of ought claims. His claim is rather that one can combine economic analysis with any reasonable moral premise and the same policy will fall out. Caplan says, for example, that if economists were able to demonstrate conclusively that allowing people to sell organs (as in, body parts, not the things you find in cathedrals) “would make sick people healthy and poor people rich,” then there couldn’t possibly be any plausible moral reason to object to an organ market. Caplan’s fellow-libertarian, Will Wilkinson of the Cato Institute, objects to that characterization. Wilkinson points to a number of perfectly plausible reasons for disapproving of a market in organs, even if such a market really would “make sick people healthy and poor people rich.” But even leaving Wilkinson’s objection aside, Caplan has falsely blurred the line between normative and factual disputes.

The very discipline of economics is loaded with normative assumptions. Consider two propositions:

  1. All goods can be exchanged.
  2. Money is a useful proxy for value.

Plenty of people reject these propositions. You might very well reject the first claim, holding, as the English philosophy John Locke did, that you cannot morally sell yourself into slavery. For Locke, individual freedom and material wealth simply were not exchangeable. Similarly, you might join the ancient Greek philosopher Aristotle in believing that lots of things that we consider to be good can’t really be directly compared with one another. After all, Aristotle might say, just how many units of honesty will a dollar buy? How much would it cost to purchase your best friend from you?

But to make a cost-benefit analysis (sort of the bread-and-butter of economics) work, you have to assume that both (1) and (2) are true. In other words, economic models like a cost-benefit analysis simply build in the normative claim. But this isn’t getting us around the problem, so much as it is obscuring it.

And that, at the end of the day, is my objection to both Peroski and Caplan. Both reach ideologically-driven conclusions while pretending that they are operating in a morally neutral fashion. Indeed, there is just not any way to go about making policy in a completely neutral way. You simply must have normative claims somewhere if you’re ever going to make a conclusion of the form “we ought to do X.”

Caplan and Peroski would have us smuggle normativity in with our data. That strikes me as a dangerous path.

Just Following Orders

Today’s Washington Times features an opinion piece by GEN  Michael Hayden, whose most recent two gigs were as head of the CIA and the NSA. Given that background, it’s probably not much of a surprise that his op-ed blasts the Obama administration for its plan to release another cache of documents relating to the CIA’s “enhanced interrogation” practices. (Say what you want about the program, but I loathe the euphemism. Aren’t we adult enough to simply argue over whether certain forms of torture ought to be permitted? It’s a legitimate question, but we shouldn’t paper over its seriousness with comfortable euphemisms. </rant>)

I’m going to leave aside all questions about the legality/morality of the actual practices. If you’re really curious, you can go to Amazon and buy War, Morality and Ethics; the collection includes an essay on torture with which I agree 100 percent.

I want to focus instead on one of Gen. Hayden’s particular arguments:

The second task is to explain to the intelligence work force that the government still has its back. This too is a tough sell, especially when the work force reads in a Newsweek cover story that, in supporting the release of the first set of DOJ memos, the leadership of the Department of Justice calculated that “if the public knew the details, … there would be a groundswell of support for an independent probe,” and that when the decision to release those memos had been made, the DOJ leadership “celebrated quietly, and waited for the national outrage to begin.”

Now, in one of those neato coincidences, I happened to attend an event this morning at which Gen. Hayden and former DHS Secretary Michael Chertoff spoke about private contractors in the intelligence community. (Don’t be too impressed by this; mostly it involved getting up absurdly early, putting on a tie and going to the 13th floor of my own building. Tell people you’re a reporter and they’ll let you into pretty much anything. Especially at 8 a.m. in a city that everyone with any sense leaves in August.) At any rate, several people asked Gen. Hayden to elaborate on his op-ed. Hayden explained that he was worried that investigating rank-and-file CIA operatives who were simply following directives handed down by the president and approved by DOJ and the CIA chief would prevent them from “pushing the line” and encourage “timidity.”

This, to me, is a puzzling response, particularly coming from a retired general. [ed — I was going to put an Air Force joke here, but it seemed too easy.] In the military, “I was just following orders” isn’t a legitimate defense. Indeed, chapter 8 of Army FM 27-10, The Law of Land Warfare, has an entire section (IV if you’re wondering) dealing with “Defenses Not Available” to those soldiers accused of war crimes, the very first paragraph of which reads:

a. The fact that the law of war has been violated pursuant to an order of a superior authority, whether military or civil, does not deprive the act in question of its character of a war crime, nor does it constitute a defense in the trial of an accused individual, unless he did not know and could not reasonably have been expected to know that the act ordered was unlawful.

The rest of the section goes on to say that following orders might be considered mitigating, and that courts martial should take into account the fact that soldiers are expected to obey orders. There’s a lot of leeway. But there is also an expectation that soldiers actually pay attention to whether or not they are being ordered to break the law.

It’s curious, then that Gen. Hayden wants to hold CIA operatives to a lower standard than the one that applies to a 19-year-old fresh from AIT.

Again, this is all separate from asking whether or not any CIA operative ought to go to jail. Even if we apply something like the Law of Land Warfare standard to CIA operatives, there’s a good case to be made that they still ought not go to jail. After all, an opinion from DOJ that something is legal (however shoddy the reasoning) is still prima facie evidence that the act really is legal. Whether we should hold a CIA operative morally accountable for accepting John Yoo’s legal advice is a judgment call (Professor Yoo now teaches at Berkeley’s law school, so the “he’s obviously incompetent” line is going to be a tough sell).

Still, Gen. Hayden’s argument isn’t that we shouldn’t convict CIA operatives of wrongdoing. It’s that we shouldn’t even be investigating them, since doing so may make them less good at their jobs. This is an argument that we ought not even consider the possibility that CIA employees may be individually guilty for following bad orders. It’s hard to see a principled reason why the CIA should be held to lower standards than the Army.