Choose for Yourself, Not Others
Don’t let your own perceived limits cause you to use force on others who have different views.
Over at Cafe Hayek, Don Boudreaux quoted one of my favorite passages from my book The Joy of Freedom: An Economist’s Odyssey:
The FDA may have some expertise when it comes to drug safety and efficacy, but on the only issue that matters – your trade-offs between various risks – you are the expert, and the FDA’s scientists are rank amateurs.
One of his commenters, Thomas Hutcheson, agreed with that, writing:
True, but so what? With virtually zero information of the risks of millions of drugs and potential drugs, I’m not in a good position to act on my risk preferences. I’m happy to delegate a large chunk of that to the FDA. Do I think (based on snippets of information) they are generally too cautious about risks? Yes. I’d like them to do better cost benefit analyses, but not get out of the regulation business.
Don, and many of his commenters, replied well, pointing out that there are alternate sources of information available and that other sources would be available if the FDA did not have life-or-death power over drugs. My co-author Charley Hooper and I made this point recently in the Journal of Clinical Pathways. We wrote:
The second change we propose is to allow drug companies to sell drugs that are not FDA-approved as long as the drug company states clearly, in large letters, in the package insert and on the container in which the drug is sold, “This drug has NOT been certified by the FDA.” Pharmacists could help disseminate this caution. This second reform sounds radical; but it can actually make all patients either better off, or at least not worse off, by their own standards.
Patients can be divided into two categories: (1) those who insist on FDA certification of any drug they take, and (2) those who are willing to take drugs that are certified by non-FDA certifiers. These non-FDA certifiers could include: U.S. Pharmacopeia, U.C. Berkeley Wellness Letter, Consumer Reports, Drug Facts and Comparisons, medical journals, the multitude of guideline-setting bodies (e.g., American Academy of Pediatrics, American Thoracic Society, National Comprehensive Cancer Network, National Kidney Foundation, and American Heart Association), the Agency for Healthcare Research and Quality, and even HMOs, hospitals, health insurers, or patients’ doctors. These organizations review the available evidence and, using a variety of criteria, make recommendations about which drugs are safe and efficacious for various conditions and which ones aren’t. Indeed, many of these organizations are more knowledgeable about diseases and their treatments than FDA employees. Drugs that are approved by any of these other certifiers, but not by the FDA, will not be taken by patients in the previously described first category; therefore, they will be neither better nor worse off under the new proposed system.
But consider patients in the previously described second category. These patients will not have to wait for a drug to be approved by the FDA before they can take it. Therefore, some drugs will be available to them more quickly. Therefore, these patients, by their own standards, will be better off. One might argue that people should not be allowed to take drugs that have not been approved by the FDA. But a large majority of Americans now take drugs that the FDA has not certified; we refer to off-label uses of drugs. An off-label use is a use of a drug that the FDA has not approved for that particular use. Off-label prescribing is legal, widely practiced, and actively encouraged by Congress, the National Institutes of Health, Medicare, the Veterans Administration, and the National Cancer Institute. [italics ours]
Commenter on Cafe Hayek Ken MacDonald makes some similar points. I’ll quote two of them. First, his point that drugs are not that different from other things:
“With virtually zero information of the risks of millions of drugs and potential drugs, I’m not in a good position to act on my risk preferences.”
This is, literally, true with thousands of things in our lives for which there is no government agency telling you what you can and cannot buy. Somehow you manage to get by. Why do you suppose that is? Do you think it has something to do with the fact that sellers of a particular product have great incentive to provide you with information about the products they are trying to sell you?
Second, MacDonald, says what my first response to Hutcheson would have been, pointing out that Thomas Hutcheson is substituting his own preferences for those of others:
“I’m happy to delegate a large chunk of that to the FDA.”
And in your “happ[iness]” you’ve callously taken away everyone else’s liberty because YOU felt insecure in YOUR decisions.
Well done, Ken MacDonald.