Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Posts Tagged ‘ethics’

Sunday musings 12/17/17

Sunday mornings are quiet mornings at Casa Blanco. Re-rack after feeding the dogs, catch up with newspapers that have piled up in addition to the Sunday papers, a third cup of coffee just for the linger. Over the course of a week I collect thoughts and ideas for either musings or an eventual longer piece here, but as often as not it’s something that I read over coffee that turns up in my little Sunday piece. One fertile hunting ground is The Ethicist in the Sunday NYT Magazine, and it is here that I found my muse this week.

I have offered, here and elsewhere, that it is perfectly proper to make an enemy as long as you do it with forethought, and do it on purpose. In my long-held opinion to make an enemy by accident is the second greatest insult one can extend to another human being; it suggests that the newly formed enemy was not even significant enough to consider that they existed prior to your actions (or inactions). This leads, of course, to the single greatest insult that you could ever foment: to actively and purposely choose indifference to the existence of another.

This is a part of a topic addressed by The Ethicist on Sunday. He defines a “decent person” in part by whether or not they have what philosophers call appropriate “reactive attitudes”. In short how we react to others, and by extension how we react to what others in turn display toward us. The philosopher Peter F. Strawson mentions resentment, gratitude, and anger that we may have in response to how we perceive that others have treated us, or treated someone who we care about. Simply feeling these emotional reactions acknowledges that we feel the others are a part of our lives. They exist. They matter.

This time of year is fraught with the entire spectrum of emotions as we come into close contact with family and others with whom we have history. The simple fact that we come together means that we are not, cannot be, indifferent to either them or their feelings about us. Now to be sure there are some among us who have family members who are truly disturbed and either cannot or will not extend any type of goodwill or positive emotion whatsoever. Those, I believe, are rare exceptions, and to you who may be in this position you have my deepest, heartfelt sympathy. For the rest of us, though, in North America the Holiday season presents us an opportunity to re-boot our “reactive attitudes” toward family and friends.

Do you remember what it felt like to go home those first couple of years after you got out of high school? Remember how excited you were to see your folks, your grandparents, and your siblings? There was a buzz in your circle of friends as you conspired to sneak away and re-convene right where you left off the last time you were together. Remember? Trust me, the feeling was at least mutual (if not even stronger) on the part of your parents (and grandparents).

Families are complex and messy, but for all of that no matter what your particular story may be families are never indifferent. You could certainly take the position that we should always be connecting with family, and that the pressure of the Holidays would be lessened if we made more of an effort to be with those who trigger our “reactive attitudes” throughout the year. I’m OK with that. Actually, as a son, brother, in-law, father and grandfather I’d be thrilled with that. But here we are during Hanukkah, with Christmas a week away, so how much we see folks over the year is a topic for another Sunday.

Today, it’s time to go home.

 

Better Understanding Conflict of Interest By Studying Bias

So much strum und drang in the air. So many panties in a bunch. The offensitive are on the warpath about, well, everything. We seem to have a surfeit of ethicists among us, proclaiming in nearly real time where anything and everything fits on some mythical ethics grid. To them I offer my own filter, the question I ask before I expend an iota of energy of any kind on the type of “news” that has them all so agitated:

Is what I am viewing unethical, or simply unseemly?

Ethics is a synonym for morals. As such it should be universal and timeless. Ethics should bear nothing in common with fashion.

Speaking of which, it is fashionable in pretty much any field in which expertise can be obtained and the label “expert” attained to lay waste to those so acclaimed by accusing them of having a “conflict of interest”. Traditionally this meant that one might enjoy some sort of tangible gain by trafficking in one’s area of expertise, thereby rendering the expert’s stated opinions somehow tainted. Of late it means that being employed by someone with whom your critic has a beef means your standing to hold an opinion at all is nullified.

Nonsense.

We would be a wiser society if we instead made an effort to sort through the biases held by experts in any field. To demand that one not express any opinion that would support your employ should disqualify the individual who holds such a position, not the expert. To look at the bias that may be present in any expert opinion allows the audience to better evaluate both the veracity of the opinion, as well as its relevance to their own situation. For example, in my day job I have a strong bias to treat any condition that produces meaningful symptoms in my patients.

In truth, in many of the general categories that I cover my remuneration is identical whether or not I treat. Those who bleat on about conflict of interest would seek to nullify all of my thoughts simply because I make my living in the arena on which I opine. Again, this is silly. It is far more useful to read my professional writing through the prism of my pro-treatment bias. In so doing it is far easier to compare and contrast my public opinions with others in my space who may differ. Do they differ on substance, or do they differ because or a countervailing bias?

This is not to say that conflicts of interest do not exist, or that if they do exist that they are never a problem. If you have invented a medical device and choose to use your own device rather than a competitor’s you have a COI. Disclosure of your COI should be mandatory (I disclose all consulting contracts around prescription drugs, for example). If they are of equal quality (equal safety, equivalent outcomes), the COI is mooted. If your device is much more expensive (thereby generating much more income to you), your conflict of interest is unseemly but not necessarily unethical. It should be obvious on its face that using your invention if it is less effective (or Heaven forbid, unsafe) is unethical.

Expertise exists everywhere. Here, on CrossFit.com in the fitness world. Would you disqualify Greg Glassman because CrossFit has been a successful business? How about Jeff and Mikki Martin who have launched a business in the same space? Is their competition a conflict that nullifies their contributions to youth fitness? Among the bureaucrats at the EPA in the care of the environment. Do they not have a contribution to make despite their tax-supported position? Is their (presumed) anti-business bias a reason to dismiss all federal policy? Among the various and sundry talking heads on all of the financial offerings on cable news channels. Don’t you really want them to be rich and successful, especially if you are going to follow their advice?

If we seek to understand the biases that exist underneath the opinions of experts we can better evaluate the conflicts of interest that they inevitably carry along with those opinions. From there is is an easier task to evaluate the character of those conflicts, and better decide whether or not we accept their guidance.

Getting paid to be an expert and to share your expertise is only a meaningful conflict of interest if it is unseemly or unethical, not just unfashionable.