Friday, February 22, 2013

On Milton Friedman's Barking Cat

Let's start off with some vintage Milton Friedman:
 In a recent column (Newsweek Jan 8, 1973), I pointed out that approval of drugs by the Food and Drug Administration delays and prevents the introduction of useful as well as harmful drugs. After giving reasons why the adverse effects could be expected to be far more serious than the beneficial effects, I summarized a fascinating study by Prof. Sam Peltzman, of UCLA of experience before and after 1962, when standards were stiffened. His study decisively confirmed the expectation that the bad effects would much outweigh the good.    The column evoked letters from a number of persons in pharmaceutical work offering tales of woe to confirm my allegation that the FDA was indeed "Frustrating Drug Advancement," as I titled the column. But most also said something like, "In contrast to your opinion, I do not believe that the FDA should be abolished, but I do believe that its power should be" changed in such and such a way - to quote from a typical letter.    I replied as follows: "What would you think of someone who said, " I would like to have a cat, provided it barked"? Yet your statement that you favor an FDA provided it behaves as you believe desirable is precisely equivalent. The biological laws that specify the characteristics of cats are no more rigid than the political laws that specify the behavior of governmental agencies once they are established. The way the FDA now behaves, and the adverse consequences are not an accident, not a result of some easily corrected human mistake, but a consequence of its constitution in precisely the same way that a meow is related to the constitution of a cat. As a natural scientist, you recognize that you cannot assign characteristics at will to chemical and biological entities, cannot demand that cats bark or water burn. Why do you suppose that the situation is different in the "social sciences?"

In other words, to wish for an efficient, non-corrupt, economical government service is to wish for a "barking cat".  
Now let's go to something more recent, from the UK's Mail Online.  Britain's dreaded National Health Service has killed something like 1,200 people through sheer godawful neglect, and the government flunkies have responded by (pick one) simply 1) firing those responsible 2) privatizing their system 3) vowing to keep government out of citizens' lives, or 4) paying whistleblowers to shut the hell up.  
Hit the link.  Check out the comments.  A good number of the Brits are saying sensible things, but far too many are wishing for a barking cat.  And there's no such thing as a barking cat, no matter how you design it, or what was intended.  Sad.
If these idiots spent the money on 750 nurses, they probably won't need to gag any one !

The original principle was beyond reproach but sadly I believe it has lost it's way, been allowed to get too big, and 'governed/controlled' by self serving idiotsIf the government was serious about tackling this abuse of power, they would declare all these gagging clauses null and void. Also they would take steps to ensure that the authoritarian, bullying managers who are responsible for this state of affairs, are sacked.

Revelation after revelation but what will be done ? NOTHING ! What will change ? NOTHING ! It never does. This would be bad enough if it was confined to the NHS but it isn't ! Every public sector departments are riddled with overpaid, 3rd rate middleweight, incompetent managers who are never held responsible for their failures as they would be in the private sector. They demand to be paid the going rate for a first class manager but none would last 5 minutes in the real world. There needs to be a complete pay and conditions restructuring from the top down in all departments not just the NHS. Without this things will only get worse !

Being open and honest and fully accountable about problems and accepting and recognising there is a problem is the first step to resolving the problem. Preventing legitimate organisational operational concerns and problems being discussed, resolved and publicly available lead to the same problems being repeated and cause serious problems for patient's blighted by hospital blunders and mistakes. Only by learning from previous mistakes and taking real decisive action to prevent repeating mistakes with a genuine will, can the preventable suffering of future patients be avoided. It does not take a consultant to work this out do why does continue to be the case inquiry after inquiry for decades? The culture of secrecy surrounding mistakes needs to stop now and the superiority culture of the medical hierarchy that say they are always right must end.

Sorry boys.  You can fire all the government managers, you can re-structure your government programs, and you can rant and moan and express your outrage in the comment fields of your newspapers all you want.   
You can't make a barking cat.  


MingoV said...

Can you please not use gray type?

The Whited Sepulchre said...

I'm having computer problems when I copy and paste. Trying to work it out, Mingo!!