The Squeaky Wheel Gets the Snake Oil

President Trump was ill with COVID-19; President Trump was treated with certain new and expensive drugs; therefore President Trump was cured by his treatment with those new and expensive drugs, and demand for them will therefore rise. Why should presidents get all the best treatment?

Such is likely to be the effect of his episode of illness, at least if he suffers no relapse, and there will soon be conspiracy theorists who argue that his illness was contrived as a stock-price manipulation (which in my opinion was quite possibly the explanation of why a terrible and scientifically worthless paper about remdesivir in The New England Journal of Medicine earlier in the epidemic was published). There are conspiracies in the world, of course, but not one-hundredth as many as conspiracy theories, because paranoia never lies far beneath the surface of even the most highly balanced person’s mentation. Conspiracy theories appeal to our strongest political emotion, which is hatred. Admirable Evasions: Ho... Dalrymple, Theodore Buy New $15.99 (as of 03:59 EDT - Details)

One of the greatest though generally unsung medical advances of the last century is the recognition of the inadequacy of testimonial evidence. Many diseases are self-limiting in the sense that, left to themselves, patients will get better by natural processes. Moreover, both diagnosis and treatment are frequently probabilistic rather than absolutely certain. Many drugs are given to patients on the basis of probabilities, though the patients to whom they are given often do not understand this. They believe that drugs are prescribed to do them good here and now rather than on a chance, sometimes quite remote, that they will do them good at an unspecifiable time in the future. In addition, few treatments are 100 percent successful, and whether a treatment with a low but definite rate of success, though with unpleasant side effects, is worth taking depends on the seriousness of the disease to be cured or ameliorated. In other words, therapeutics is an art as well as a science, in the sense that it requires judgment as well as knowledge; and patients may differ as to whether they consider a treatment worth the effort of taking it.

Life at the Bottom: Th... Theodore Dalrymple Best Price: $4.57 Buy New $8.83 (as of 07:45 EST - Details) It has long been the case that treatments given to prominent persons with alleged success have been the staple of advertisers. In the 19th century, mass advertising was invented by a purveyor of a patent or quack remedy, Thomas Holloway, who made a vast fortune from the pills and ointment that bore his name and that at least did no harm, unlike the potions of the orthodox doctors of the time. Revenue from advertisements for such medicines was a financial pillar on which rested much of the provincial press, whose owners and editors often doubled as sellers of them to the public. It was an excellent business model, to take revenue both from advertisements and from the sale of the goods advertised, admirably efficient from the point of view of maximizing profits; and in turn the testimonial, real or invented, of General This or Lord That, or some other prominent person, to such and such a remedy for his biliousness, was taken by the public as proof that it worked. The testimonials were an appeal both to social climbing and magical thinking. If one took the same medicines as a prominent person, one somehow became a little closer to, or like, him. Incidentally, roughly half of the advertisements for patent medicines were for the treatment or prevention of syphilis, never mentioned by name.

The attention given to the opinions of prominent persons on matters about which they may be no more qualified to speak than the most ignorant illiterate is rather curious, but I suppose that to protest against it is pointless.

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