December 11, 2014
I apologize for a bit of a digression here for personal reasons (my wife has chronic Lyme disease), but if you’ll bear with me, I think I can make some connections. The immediate prompt for this post is a snide article in Slate by Brian Palmer, warning readers that, “New York is about to change its medical misconduct law to protect quacks.”
The “quacks” referred to in the article’s sub-headline are doctors who provide long-term antibiotic treatment for people who have chronic Lyme disease. As the article tells us, chronic Lyme does not exist:
“The Infectious Diseases Society of America—the association of scientists and clinicians who study this sort of thing—has repeatedly characterized chronic Lyme disease as ‘not based on scientific fact.'”
It’s great that Palmer can be so confident of this assertion, but it turns out that the evidence is far weaker than the association of scientists and clinicians who study this sort of thing might lead you to believe. There are actually very few studies that have tried to evaluate the effectiveness of long-term antibiotic treatment of people who believe themselves to be suffering from chronic Lyme.
As explained in an analysis by Brown University researcher Allison DeLong, one of the studies was poorly designed so that it would have been almost impossible for it to have found a significant effect from antibiotic treatment. A second study did find evidence that treatment alleviated symptoms, however this finding was dismissed because the symptoms returned after the treatment stopped. (Effectively this study was testing whether six months of treatment would cure patients, some of whom had years of prior treatment. It really shouldn’t have taken too much background in science to know the answer to that one would be no.)
The third study actually did find statistically significant evidence that treatment improved patients’ outcomes by its main measure, a survey on fatigue. However it dismissed this finding because the researchers decided that the blind nature of the study had been compromised. When surveyed after the fact, 70 percent of the control group wrongly guessed that they had been treated. However two-thirds of the treatment group somehow recognized that they were being treated. Therefore the researchers decided that they could not accept the results, since the people in the treatment group knew they were being treated.
I’m not making this up. You can find the study here. It was published in a major medical journal and its negative findings are routinely cited by doctors arguing that chronic Lyme disease does not exist and long-term antibiotic treatment is pointless. (If you haven’t figured it out yet, the study found exactly what you would want in the comparison between the control and the treatment group. The same percent of people in each group thought they were being treating. This means that the blind nature of the study was not compromised.)
What does this have to do with the Trans-Pacific Partnership? Much of the thrust of this deal, and its cousin the Trans-Atlantic Trade and Investment Pact, is about imposing a structure of regulations that is ostensibly based in science. This would deny democratically elected governments the right to set regulations (at least without facing sanctions), if the science said the regulations were not necessary.
For example, if scientists determined that fracking did not pose a hazard to groundwater, then state or local governments would not be able to ban or restrict fracking without paying a penalty to aspiring frackers. The same would be true of restrictions on food additives, the use of chemical pesticides, etc. Scientists would make the determination, and governments and voters would have to accept their call.
If we had great confidence in the competence and impartiality of the people who did the science, then assigning them the authority on these issues might not be a bad idea. However the conduct of the medical profession around the treatment of chronic Lyme disease does not inspire great confidence. (Nor does the conduct of the economics profession in the years of the housing bubble.)
Note: Typos corrected.
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