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Wednesday, August 10, 2005

Decision-making and Our Well-Being

My aging hippie friend advised me that I should avoid immunizing my 5-year-old son because Bobby Kennedy Jr. was on the Today Show and "reported" that the increase in autism is caused by the sera. My friend, no scientist, but staunchly anti-capitalist and with a lot of time on his unemployed hands, advised me I was making a serious mistake. I told him I would immunize my son and avoid the known risk of disease rather than risk his health based upon Kennedy scare tactics.

Walter Williams discusses this dilemma we face in so many decisions in "Making intelligent errors". He says "We are not omniscient."

He looks at the decision to depose Saddam Hussein. We had intelligence from our own and international experts that he had WMD. We knew he was likely to use it as his past actions had proved. But as we were not 100% sure, we faced the repercussions of invading Iraq and the naturally expected (though the degree has shocked some people) problematic aftermath of a leaderless nation that we would have to occupy. To me, the downside was minimal compared to the risk of allowing his regime to continue.

Williams discusses the likely inaction of the FDA on new drugs. Approving a drug comes with the potential of harmful side effects. But:

A classic example [of over-caution] was beta-blockers, which an American Heart Association study said will "lengthen the lives of people at risk of sudden death due to irregular heartbeats." The beta-blockers in question were available in Europe in 1967, yet the FDA didn't approve them for use in the U.S. until 1976. In 1979, Dr. William Wardell, a professor of pharmacology, toxicology and medicine at the University of Rochester, estimated that a single beta-blocker, alprenolol, which had already been sold for three years in Europe, but not approved for use in the U.S., could have saved more than 10,000 lives a year. The type I error, erring on the side of over-caution, has little or no cost to FDA officials. Grieving survivors of those 10,000 people who unnecessarily died each year don't know why their loved one died, and surely they don't connect the death to FDA over-caution. For FDA officials, these are the best kind of victims -- invisible ones.

Economists will tell you that the market ferrets out the hoaxes, the dangerous and inefficacious products. The problem is when public officials fail to weigh the cost of not only acting but not acting. About 13 years ago I was worrying about purchasing my first house. I was unsure about my employer's financial condition, the increased cost of a mortgage over renting and the added responsibility of maintenance. I asked my boss what he thought. He looked at me as if I has 3 heads. I bought and and have been rewarded financially beyond what I ever thought possible and had a roof over my head to boot.

Humans err by nature. Nothing is fail-safe. We recognize this and are cautious. But I recall many people criticizing the government for not acting on imprecise and disjointed intelligence prior to 9-11. Do we choose to act in our own interests or wait for the perfect moment? What is it people?

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