Category: Health

Briefly put, right-to-try laws give terminally ill patients the right to try experimental treatments that have completed Phase 1 testing but have yet to be approved by the FDA. Phase 1 testing involves assessing the immediate toxicity of the treatment. This does not include testing its efficacy or its longer-term safety. Roughly put, passing Phase 1 just means that the treatment does not immediately kill or significantly harm patients.

On the face of it, no sensible person would oppose the right-to-try.  This right is that people who have “nothing to lose” are given the right to try treatments that might help them. The bills and laws use the rhetorical narrative that the right-to-try laws would give desperate patients the freedom to seek medical treatment that might save them and this would be done by getting the FDA and the state out of the way. This is powerful rhetoric that appeals to compassion, freedom and a dislike of the government. As such, it is not surprising that few people dare oppose the right-to-try. However, the matter does deserve proper critical consideration.

One way to look at it is to consider an alternative reality in which the narrative is spun with a different rhetorical charge, a negative spin rather than positive. Imagine, for a moment, if the rhetorical engines had cranked out a tale of how the bills would strip away the protection of the desperate and dying to allow predatory companies to use them as Guinea pigs for their untested treatments. If that narrative had been sold, people would probably be opposed to such laws. But rhetorical narratives, positive or negative, are logically inert and are irrelevant to the merits of the right-to-try. How people feel about the proposals is also logically irrelevant as well. What is needed is a cool examination of the matter.

On the positive side, the right-to-try does offer people the chance to try treatments that might help them. It is hard to argue that terminally ill people do not have a right to take such risks. That said, there are still some concerns.

One concern is that there is an established mechanism allowing patients access to experimental treatments. The FDA already has as system that approves most requests. Somewhat ironically, when people argue for the right-to-try by using examples of people successfully treated by experimental methods, they are showing that the existing system already allows such access. This raises the question about why the laws are needed and what they change.

The main change is usually to reduce the role of the FDA. Without such laws, requests to use experimental methods must go through the FDA (which seems to approve most requests).  If the FDA routinely denied treatments, then such laws would seem needed. However, the FDA does not seem to be the problem as they generally do not roadblock the use of experimental methods for the terminally ill. This leads to the question of is limiting patient access.

The main limiting factors are those that impact almost all treatment access: costs and availability. While the right-to-try grants the negative right to choose experimental methods, they do not grant the positive right to be provided with those methods. A negative right is a liberty, and one is free to act upon it but is not provided with the means to do so. The means must be acquired by the person. A positive right is an entitlement, and the person is free to act and is provided with the means of doing so. In general, the right-to-try does little or nothing to ensure that treatments are provided. For example, public money is usually not allocated to pay for them. As such, the right-to-try is like the right-to-healthcare: you are free to get it if you can pay for it. Since the FDA does not roadblock access to experimental treatments, the bills and laws would seem to do little or nothing new to benefit patients. That said, the general idea of right-to-try seems reasonable and is already practiced. While few are willing to bring them up in public discussions, there are some negative aspects to the right-to-try. I will turn to some of those now.

One obvious concern is that terminally ill patients do have something to lose. Experimental treatments could kill them earlier or they could cause suffering. As such, it does make sense to have limits on the freedom to try. At least for now it is the job of the FDA and medical professionals to protect patients from such harms even if the patients want to roll the dice.

This concern can be addressed by appealing to freedom of choice, provided patients can provide informed consent. This does create a problem: as little is known about the treatment, the patient cannot be well informed about the risks and benefits. But, as I have argued often elsewhere, I accept that people have a right to make such choices, even if these choices are self-damaging. I apply this principle consistently, so I accept that it grants the right-to-try, the right to get married, the right to eat poorly, the right to use drugs, and so on.

The usual counters to such arguments from freedom involve arguments about how people must be protected from themselves, arguments that such freedoms are “just wrong” or arguments about how such freedoms harm others. The idea is that moral or practical considerations override the freedom of the individual. This can be a reasonable counter, and a strong case can be made against allowing people the right to engage in a freedom that could harm or kill them. However, my position on such freedoms requires me to accept that a person has the right-to-try, even if it is a bad idea. That said, others have an equally valid right to try to convince them otherwise and the FDA and medical professionals have an obligation to protect people, even from themselves.

 

Before getting into the discussion, I am not a medical professional and what follows should be met with due criticism and you should consult an expert before embarking on changes to your exercise or nutrition practices. Or you might die. Probably not. But maybe.

As any philosopher will tell you, while the math used in science is deductive (the premises are supposed to guarantee the conclusion with certainty) scientific reasoning is inductive (the premises provide some degree of support for the conclusion that is less than complete). Because of this, science suffers from what philosophers call the problem of induction. In practical terms, this means that no matter how careful the reasoning and no matter how good the evidence, the inference can still be false. The basis is that inductive reasoning involves a “leap” from the premises/evidence (what has been observed) to the conclusion (what has not been observed). Put bluntly, inductive reasoning always has a chance to lead to a false conclusion. But this appears unavoidable as life seems inductive.

Scientists and philosophers have tried to make science entirely deductive. For example, Descartes believed he could find truths that he could not doubt and then use valid deductive reasoning to generate a true conclusion with absolute certainty. Unfortunately, this science of certainty is the science of the future and (probably) always will be. So, we are stuck with induction.

The problem of induction applies to the sciences that study nutrition, exercise and weight loss and the conclusions made in these sciences can always be wrong. This helps explain why recommendations change relentlessly.

While there are philosophers of science who would disagree, science is a matter of trying to figure things out by doing the best we can do at this time. This is limited by the available resources (such as technology) and human epistemic capabilities. As such, whatever science is presenting now is almost certainly at least partially wrong; but the wrongs often get reduced over time. But sometimes they increase. This is true of all the sciences. Consider, for example, the changes in physics since Thales got it started. This also helps explain why recommendations about diet and exercise change often.

While science is sometimes idealized as a field of pure reason outside of social influences, science is also a social activity. Because of this, science is influenced by social factors and human flaws. For example, scientists need money to fund their research and can be vulnerable to corporations looking to “prove” claims that are in their interest. As another example, scientific subjects can become issues of political controversy, such as race, evolution and climate change. This politicization tends to be bad for science and anyone who does not profit from manufacturing controversy. As a final example, scientists can be motivated by pride and ambition to fake or modify their findings. Because of these factors, the sciences dealing with nutrition and exercise are, to a meaningful degree, corrupted and this makes it difficult to make a rational judgment about which claims are true. One excellent example is how the sugar industry paid scientists at Harvard to downplay the health risks presented by sugar and play up those presented by fat. Another illustration is the fact that the food pyramid endorsed by the US government has been shaped by the food industries rather than being based entirely on good science.

Given these problems it might be tempting to abandon mainstream science and go with whatever food or exercise ideology one finds appealing. That would be a bad idea. While science suffers from these problems, mainstream science is better than the nonscientific alternatives. They tend to have all the problems of science without any of its strengths. So, what should one do? The rational approach is to accept the majority opinion of qualified and credible experts. One should also keep in mind the above problems and approach the science with due skepticism.

So, what does the best science of today say about weight loss? First, humans evolved as hunter-gatherers and getting enough calories was a challenge. Humans tend to be very good at storing energy in the form of fat which is one reason the calorie rich environment of modern society contributes to obesity. Crudely put, it is in our nature to overeat because that once meant the difference between life and death.

Second, while exercise does burn calories, it burns far less than many imagine. For most people, most of the calorie burning is a result of the body staying alive. As such, while exercising more could help a person lose weight, the calorie impact of exercise is surprisingly low. That said, you should exercise (if you can) if only for the health benefits.

Third, hunger is a function of the brain, and the brain responds differently to different foods. Foods high in protein and fiber create a feeling of fullness that tends to turn off the hunger signal. Foods with a high glycemic index (like cake) tend to stimulate the brain to cause people to consume more calories. As such, manipulating your brain is an effective way to increase the chance of losing weight. Interestingly, as Aristotle argued, habituation to foods can train the brain to prefer foods that are healthier. You can train yourself to prefer things like nuts, broccoli and oatmeal over cookies, cake, and soda. This takes time and effort but can be done.

Fourth, weight loss has diminishing returns: as one loses weight, one’s metabolism slows, and less energy is needed. As such, losing weight makes it harder to lose weight, which is something to keep in mind.  Naturally, all these claims could be disproven tomorrow, but they seem reasonable now.