Hsieh Forbes Column: UK To Experiment on Cardiac Arrest Patients Without Their Consent

My latest Forbes column is now up: "UK To Experiment on Cardiac Arrest Patients Without Their Consent".

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics...

(For more details and discussion, read the full text of "UK To Experiment on Cardiac Arrest Patients Without Their Consent".)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I'm not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

More Benefits of Medical Marijuana?

An intriguing report: "In States With Medical Marijuana, Painkiller Deaths Drop by 25%".

In the study, published today August 25 in JAMA Internal Medicine, the researchers hypothesize that in states where medical marijuana can be prescribed, patients may use pot to treat pain, either instead of prescription opiates, or to supplement them—and may thus require a lower dosage that is less likely to lead to a fatal problem.

As with most findings involving marijuana and public policy, however, not everyone agrees on a single interpretation of the results...

Perhaps the science will become clearer as more states continue to legalize medical (and recreational) use.

Architecture and Hospital Rooms

The New York Times had a fascinating article on innovative thinking for hospital room architecture: "In Redesigned Room, Hospital Patients May Feel Better Already".

Some of the ideas seem simple ("same handedness", more natural light, and "double door lock boxes" for medications).  But in aggregate, they could reduce medical errors and improve patient outcomes.

I love reading about innovations in health care!

Edison on Narrow Networks

Pediatrician Dr. Megan Edison recently described what it's like to be on the receiving end of patients who lose their doctors because of ObamaCare: "Confessions of a Narrow Network Doctor".

She describes the problems patients faced by the loss of choice.  And she offers some solutions:

The solution seems so clear in my little corner of the world. I want my patients to have control over their own health care dollars regardless of employment status or political party in power. I want to work directly with my patients to help them choose how to best use those dollars in a price transparent healthcare environment. I want them to choose me. I want competition to push me to provide the best care at a good value, knowing that my patients always have a choice to see another doctor if I’m not doing a good job. In short, I’d love folks to own a high-deductible HSA for life, in a healthcare system that is transparent and competes for those dollars.

But that would give power directly to the patient and all the healthcare choices between the patient and the doctor. Turns out, there are more powerful players that want control over what happens in my office...

I recommend reading the full text of "Confessions of a Narrow Network Doctor".  If you like what you read, check out the rest of the RebelMD site!

Hughes On VA, FDA, and American Health Care

Monica Hughes recently gave an excellent talk on, "The Transformation of American Healthcare: Lessons from the Veterans Administration and Existing FDA Standards of Care" to Liberty On The Rocks at Flatirons.

Her talk is now available on YouTube (3 parts).

Part 1


Part 2


Part 3



Disclaimer and synopsis:

DISCLAIMER: The speaker is not a medical doctor or health care practitioner. The ideas in this video are not intended as a substitute for the advice of a trained health professional. All matters regarding your health require medical supervision. Consult your physician and/or health care professional before adopting any nutritional, exercise, or medical protocol, as well as about any condition that may require diagnosis or medical attention. In addition, statements regarding certain products and services represent the views of the speaker alone and do not constitute a recommendation or endorsement or any product or service.

Synopsis: In January 2014, Robb was diagnosed with glioblastoma multiforme (GBM), one of the deadliest brain cancers in existence. Nicknamed "The Terminator" the median survival time is around 11 months. Robb had brain surgery on January 16, which was performed by a team of surgeons while Robb was awake. The surgery was a success.

Monica's research into the post-surgery treatments that worked best for other survivors showed that they were not approved by the Food and Drug Administration, so they'd have to go to a cancer center that sprouted up in Tijuana, Mexico for treatment which included a 100 year-old immune system booster called Coley's Vaccine.

Bio: Monica Hughes has bachelor's, master's, and PhD degrees in biology and has taught college biology since 2006. Previously, Monica served as a medical writer for National Jewish Health, a premier research hospital for respiratory and immune disorders, and is now a patient advocate specializing in literature research.

Robb LeChevalier has served in the Air Force and has a bachelor's degree in electrical engineering. He designed his own home situated in the foothills outside of Denver, and currently develops high speed electronics for his own company, Astronix Research. He has been an Objectivist for 40 years.

More: Robb was given 2 months to live without surgery, a maximum of 6 months to live with surgery only, and an unspecified amount of time with additional therapy due to the unusually aggressive nature of his particular tumor. He and his wife Monica faced seemingly insurmountable hurdles by the Veterans Administration along the way, including timely care from the VA and a delay of emergency surgery that could have cost Robb his life had they not pushed for a special dispensation from a panel of VA doctors within the 48 hours leading up to his scheduled surgery. They are currently contesting 58 claims denials by the VA totaling nearly $250,000 in unpaid medical bills.

In the days following Robb's surgery, they discovered that immunotherapy held the best chance of long-term and quality survival for this cancer. Historical 3 year survival with FDA-approved standard of care for GBM is around 7%. 3-5 year survival for some GBM patients in clinical trials using cancer vaccines is between 20%-50%, depending on the vaccine. Yet they discovered that due to FDA regulations, it is impossible to enter these clinical trials without first or concurrently undergoing FDA-approved standard of care, and that such care would greatly reduce his likelihood of responding to immunotherapy, if he was lucky enough to meet the criteria for the study and be placed in the treatment arm of such a trial.

Given these poor odds, Robb chose to forego all standard of care therapy after surgery, and opted for an immunotherapy protocol abroad that, according to current MRI results, has left him without evidence of disease. As of June 10, 2014, their new low deductible PPO health insurance policy, purchased on the Obamacare exchange, has not paid out a single penny of reimbursement for Robb's cancer treatment.

(Note: I also discussed their case in my 5/28/2014 Forbes piece, "VA Denies Coverage For US Air Force Veteran With Malignant Brain Tumor".)

Quality Is In The Eye Of The Beholder

Dr. Saurabh Jha has penned a great essay, "Who is the better radiologist? Hint, it’s not that easy."

A couple of comments:

1) "Quality" is in the eye of the beholder.  And as the federal government starts setting more payment rules to govern "quality", that beholder will increasingly be the government.  Which won't necessarily be what patients would regard as "quality".

2) This is one of the best discussions of ROC and the trade-off between sensitivity-vs-specificity, without the jargon.

Dr. Brian Forrest on How To Start a Direct Primary Care Practice

Dr. Brian Forrest recently gave an interview with Concierge Medicine Radio on "How You Can Start a Direct Primary Care Practice for less than $10k".

Some of the topics he discussed include:

• The shockingly simple math behind how reducing overhead and eliminating collections allows primary care physicians to spend more time providing better care while improving their take home pay. 
• How Brian kept his total operating expenses to $50k in the first year and how you can too. 
• The rule of thumb Brian uses to make all his purchasing decisions. 
• The two most effective forms of advertising for Brian’s direct pay practices. 
• How to choose your billing software and Brian’s recommendations. 

For more details, listen here.  Here's more information about his particular practice, Access Healthcare.

Online Medical Shopping

The American Interest Blog discusses MediBid: "Online Shopping Finally Comes to Health Care".

More information from Kaiser Health News: "Patients Seeking Cheaper Care Are Soliciting Bids From Doctors Online."

(Via Debby Witt.)

Doug McGuff on Government Controls In Emergency Medicine

On Thursday's episode of Philosophy in Action Radio, Diana Hsieh interviewed emergency medicine physician Dr. Doug McGuff about "Government Controls in Emergency Medicine." The podcast of that episode is now available for streaming or downloading. You'll find it on the episode's archive page, as well as below. You can automatically download podcasts of Philosophy in Action Radio by subscribing to Philosophy in Action's Podcast RSS Feed:

• Enhanced M4A Feed: Subscribe via iTunes or another podcast player
• Standard MP3 Feed: Subscribe via iTunes or another podcast player

Podcast: Dr. Doug McGuff about "Government Controls in Emergency Medicine" The practice of emergency medicine is heavily regulated by the government. What is EMTALA? What are its effects? What have the effects of ObamaCare been so far? How do these laws compromise patient care and make the practice of medicine more difficult? How could emergency medicine be made more free? Dr. Doug McGuff is an emergency medicine doctor practicing in South Carolina. He graduated from the University of Texas Medical School at San Antonio in 1989, and then trained in Emergency Medicine at the University of Arkansas, where he served as Chief Resident. From there, Dr. McGuff served as Faculty in the Wright State University Emergency Medicine Residency and was a staff Emergency Physician at Wright-Patterson AFB Hospital. Today, Dr. McGuff is a partner with Blue Ridge Emergency Physicians. Diana interviewed Dr. Doug McGuff about fitness, weightlifting, and high-intensity exercise in December 2012 and about avoiding the emergency room in May 2013. Listen or Download:

• Duration: 1:11:49
• Download: Standard MP3 File (24.7 MB)
• Tags: Business, Free Society, Government, Health, Laws, Medicine, Politics

Topics:

• Emergency Medicine
• EMTALA and the history of government controls in medicine
• ObamaCare and its Accountable Care Organizations
• Practicing under ObamaCare
• Quality measures
• Government versus private insurance

Links:

• The Objective Standard: Moral Health Care vs. "Universal Health Care" by Lin Zinser and Paul Hsieh
• Western Canada Waiting List Investigators
• Surgery Center of Oklahoma
• First Choice Emergency Room
• KevinMD: ACOs and the modern day leper

About Philosophy in Action Radio

Philosophy in Action Radio applies rational principles to the challenges of real life in live internet radio shows on Sunday mornings and Thursday evenings. For information on upcoming shows, visit the Episodes on Tap. For podcasts of past shows, visit the Show Archives.

Concierge Medicine Article in Med Monthly

The medical professional magazine Med Monthly has reprinted (with permission) one of my Forbes pieces in their August 2014 issue: "Is Concierge Medicine The Correct Choice For You?"

Thank you, Med Monthly and creative director Tom Hibbard, for the wider circulation!

(Original Forbes link.)

Unintended Consequences of FDA Regulations

Eye surgeon Dr. Brian C. Joondeph described a crazy "unintended consequence" of FDA rules designed to "protect" patients.

Here's an extended excerpt from his blog post:

In my medical specialty of retina surgery, compounded and off-label Avastin is used in the treatment of macular degeneration, diabetic retinopathy, and other retinal conditions. At a cost of 40 times less than the FDA approved options, using compounded Avastin instead of the on-label expensive alternatives could save Medicare $3 billion per year. Studies have shown the lower cost Avastin is equivalent to the much more expensive Lucentis in treating macular degeneration. Many physicians will try Avastin as the first line of treatment in their patients and continue using it if it is working well.

As Avastin is being used “off-label” in a much smaller dose than used for its approved use in cancer treatment, it must be divided into extremely small doses suitable for injection into an eye. This is done by a compounding pharmacy. Most patients receive injections every four to six weeks for many years, with many physicians deciding at the time of the eye exam whether or not to give an injection. Most patients are elderly and/or visually impaired, meaning that a friend or family member brings them to their eye appointment.

Back to the FDA, which recently issued guidance in response to the new, compounding law. Specifically they “will require a patient-specific prescription for all drugs compounded.” While this may allow easier tracking of the rare cases when drugs are contaminated, it won’t alter the actual compounding process and won’t reduce the chance of contamination.

But once the retina surgeon examines the patient and determines that they need an injection, instead of using a preordered syringe from their inventory, they will instead have to send a prescription to the compounding pharmacy and have the patient return on a separate day for their injection. For a patient receiving monthly injections, this translates to 24 office visits rather than 12 each year. Depending on insurance, there may be a copayment for each visit. Not to mention the friend or family member doubling their driving duties and the physician further loading their already busy patient schedules. Imagine going to the family doctor for a flu shot and after a quick exam, having to return a week later for the shot after the doctor writes a prescription for it rather than simply pulling a vial of flu vaccine from the refrigerator and giving the injection.

The simple alternative for the surgeon is to abandon any intention of being a good steward of societal and patient monies by simply using the FDA approved, but far more expensive, drugs. This avoids the hassle of writing several hundred injection prescriptions each month and making patients return a week later for each injection. Good financial stewardship of government money loses appeal when the government complicates the physician’s business processes by such mandates. And when the government threatens physicians with a 30% cut in reimbursement via the SGR cuts, why should physicians jump through hoops to save Medicare a few dollars?

These FDA rules increase the "hassle factor" for patients and doctors. And cost more money in the long run.

Hsieh Forbes Column: "No, Gun Violence Is Not a 'Public Health' Issue"

My latest Forbes piece is now up: "No, Gun Violence Is Not a 'Public Health' Issue".

I discuss 4 reasons we shouldn't frame "gun violence" as a "public health" issue, including:

1) Gun violence is not an “epidemic”, except in a metaphorical sense.

2) If “public health” includes “gun violence”, then intellectual fairness demands that we consider pro-gun arguments as well as anti-gun arguments.

3) Expanding “public health” to include “gun violence” diverts us from genuine public health threats.

4) Guns are not the doctor’s “natural enemy.”

Although I think gun crime should not be shoehorned into the category "public health", I recognize that others may disagree. In that case, lives saved by allowing concealed carry should be just as much of the “public health” discussion as lives lost to gun violence.

For more details on each of the four points above, see the full text of "No, Gun Violence Is Not a 'Public Health' Issue".

Hiding Wrongdoing Behind "Privacy"

NPR has a good report on "When Federal Privacy Laws Protect Hospitals Instead Of Patients".

From the article:

In the name of patient privacy, a security guard at a hospital in Springfield, Mo., threatened a mother with jail for trying to take a photograph of her own son.

In the name of patient privacy, a Daytona Beach, Fla., nursing home said it couldn't cooperate with police investigating allegations of a possible rape against one of its residents.

In the name of patient privacy, the U.S. Department of Veterans Affairs allegedly threatened or retaliated against employees who were trying to blow the whistle on agency wrongdoing.

When the federal passed in 1996, its laudable provisions included preventing patients' medical information from being shared without their consent and other important privacy assurances.

But as a litany of recent examples show, HIPAA, as the law is commonly known, is open to misinterpretation — and sometimes provides cover for health institutions that are protecting their own interests, not patients'...

Another issue is that patients are often being told they can't get a copy of their own medical records, in the name of "privacy"(!)

Armstrong on Halbig

Ari Armstrong takes a deeper look at the Halbig ruling in his latest post for The Objective Standard, "ObamaCare, Nonobjective Law, and Brothers' Keepers".

Money quote:

That ObamaCare pervasively violates the rights of individuals to control their own wealth and to freely negotiate terms of health insurance and health care on a free market is bad enough; that ObamaCare does so via ambiguous, nonobjective statutes is even worse. Not only through its ambiguous wording but through its deliberate deference to the whims of bureaucrats, ObamaCare substantially empowers the executive branch and hordes of bureaucrats to create whatever health policies they wish.

The basic problem is not that the Supreme Court will substantially decide how ObamaCare is interpreted. On the legal front, the basic problem is that Congress breached its Constitutional authority by ignoring its legally enumerated powers. On the moral front, the basic problem is that many American politicians—along with the Americans who voted for them—accepted the premise that, in health care, “we are our brothers’ keepers,” which now means, in practice, that elected officials, appointed judges, and unaccountable bureaucrats are to a substantial degree the keepers of each of us when it comes to health care. If Americans don’t want their health care controlled by bureaucrats, they must reject the premise that we are our brothers’ keepers and vote accordingly in the future.

Catron Vs. Roy On Halbig Rulig

Here are a few more responses to the recent federal court ruling on ObamaCare.

David Catron: "Obamacare Slowly Succumbs to Its Birth Defects" (PJ Media, 7/23/2014)

Avik Roy: "Halbig Court Opinion: A Victory For The Rule Of Law, But Merely A Speed Bump For Obamacare" (Forbes, 7/23/2014)

At this time, I think reports of ObamaCare's demise are premature.  But it's not a slam-dunk that it will survive intact either.

Halbig Ruling

Big legal news on ObamaCare. Here's a good description from Jonathan Adler, "D.C. Circuit strikes down tax credits in federal exchanges":

This morning the U.S. Court of Appeals for the D.C. Circuit released its much awaited opinion in Halbig v. Burwell.  In a 2-1 opinion, the Court held that the Internal Revenue Service regulation authorizing tax credits in federal exchanges was invalid.

Judge Griffith, writing for the court, concluded, “the ACA unambiguously restricts the section 36B subsidy to insurance purchased on Exchanges ‘established by the State.”  In other words, the court reaffirmed the principle that the law is what Congress enacts — the text of the statute itself — and not the unexpressed intentions or hopes of legislators or a bill’s proponents...

Although this decision is faithful to the text of the PPACA – that is, faithful to the text Congress actually enacted, as opposed to the health care reform some wanted or now wish they had gotten — it will provoke howls of outrage from ACA supporters.

On the other hand, William Jacobson notes: "4th Circuit upholds Obamacare federal exchange subsidy after D.C. Circuit rejects".  And related thoughts from Adler.

Given this split, the issue will almost certainly end up in the US Supreme Court.

(I also expect that many on the political Left to argue that this shows why the patchwork kludge of ObamaCare should be replaced by a simpler "single-payer" system.)

Bad Science, Bad Medicine

Forbes contributor Bill Frezza recently discussed the growth of bad science in his piece, "Bad Science Muckrakers Question the Big Science Status Quo".

In particular, he notes how a combination of publish-or-perish job pressures and the race for government grants produces an enormous amount of sloppy (and sometimes outright fradulent) science.

Fortunately, there are websites like RetractionWatch that keep on eye on scientific fraud and misconduct.

Another issue Frezza points out is the bias against privately-funded research.  One excerpt:

To make matters worse, private research dollars are being choked off by ill-conceived regulations, making researchers even more dependent on government grants, as Dr. Thomas Stossel at Harvard Medical School points out.

Stossel calls overly restrictive conflict of interest regulations “a damaging solution in search of a problem.” A self-described “typical academic socialist, totally living on grants for the first third of my career,” Stossel says his eyes were opened in 1987, when he was asked to serve on the scientific advisory board of Biogen (now Biogen IDEC), a fledgling biotech startup that went on to become a tremendous success. “I realized how fundamentally honest business people are compared to my academic colleagues, who’d run their grandmothers over for recognition.”

While working with Biogen, Stossel learned how difficult it was to translate academic research into products that actually help people. “It was during that time that conflict of interest mania emerged.” In 1988 Harvard Medical School instituted the first conflict of interest rules, largely as a result of an incident at the Mass Eye and Ear infirmary that was sensationalized by The Boston Globe.

Stossel characterizes this rationale as, “If I am paid by a corporation to do research, I am going to lie, cheat and steal.” Based on his experience at Biogen, he calls this a “total inversion of reality.” He notes that, “95 percent of the scientific papers retracted for falsification, fabrication, or plagiarism have no commercial connection.” And yet, conflict of interest rules continue to proliferate, choking off what could be a critical alternative to taxpayer funding...

In other words, "privately funded" is presumed to be corrupt whereas "government funded" is presumed noble and pure.

It's bad enough when taxpayers are obliged to fund sketchy science.  The problem gets worse when sketchy science is used to set "clinical guidelines" for physicians to follow -- guidelines that may be harmful to patients.

Dr. Robert McNutt and Dr. Nortin Hadler discuss this issue in more detail in, "How Clinical Guidelines Can Fail Both Doctors and Patients":

At best, these guidelines are recommendations based on scientific studies with results that pertain to the average among us. They do not adequately incorporate the personal differences and preferences of each of us as individuals. Furthermore, while these recommendations are based on clinical science, rarely is the science complete or incontrovertible.

Hence, the recommendations are consensus statements reflecting the perspectives of those charged with the production of the guideline. Of the thousands of clinical practice guidelines that have been produced, the majority is based on inadequate science and therefore reflects the conjecture of the “thought leaders” recruited to the task.

Unfortunately, under the new health law physician pay is going to be increasingly tied to various "quality measures" including adherence to clinical guidelines of dubious reliability. 

Do you want your physician to be rewarded for putting patients on anti-cholesterol drugs based on population guidelines that might not apply to you as an individual?  Or do you want your physician to be able to freely exercise his or her best individual discretion on your behalf? 

Physicians will be facing these sorts of questions in coming years.  You'd better hope your physician will stay loyal to you as a patient.

(National Institutes of Health; photo credit Wikipedia)

Hiding Misdeeds Behind Privacy Laws

Stewart Baker asks an interesting question in the Washington Post: "Who is protected by patient privacy laws? Hint: not patients."

He quoted from this recent Washington Post story, "VA uses patient privacy to go after whistleblowers, critics say":

Citing patient privacy, managers have threatened VA employees or retaliated against those who complain about agency misconduct, according to a key congressman and the union that represents most of the department’s employees.

“VA routinely uses HIPAA as an excuse to punish into submission employees who dare to speak out,” said Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans’ Affairs. He is leading a probe into the coverup of long wait times for VA patients.

David Borer, the American Federation of Government Employees’ top lawyer, listed a number of cases involving a VA claim of patient privacy used to stifle whistleblowers in a June letter to the department.

The Office of Special Counsel (OSC), which investigates whistleblower retaliation cases, is “very concerned about the misuse of HIPAA,” said Eric Bachman, an OSC deputy special counsel. “The potential chilling effect of even a small number of these HIPAA retaliation cases is a serious issue and one that should be addressed by the VA in short order.”…

Valerie Riviello is one VA employee who felt the lash of the department’s culture of retaliation.

A registered nurse at the Albany Stratton VA Medical Center in Upstate New York, Riviello said she was threatened with suspension and stripped of managerial duties after she complained last November about how a veteran was treated.

Riviello said the vet was unnecessarily restrained, with an arm and leg strapped to bedposts.

“They scared the hell out of me,” Riviello said with worry clear in her voice. “They sent me a letter saying I could go to jail.”

That threat came in the form of an e-mail to Riviello’s lawyer, Cheri L. Cannon, a partner with the Tully Rinckey law firm. The VA e-mail said that information Riviello provided Cannon “unlawfully includes medical records of a VA patient” and noted that violating HIPAA “is a felony offense subject to imprisonment and a fine of up to $250,000.”

If the government punishes whistleblowers, it's all the more remarkable that they are still willing to speak out.  Which is all the more reason to punish those covering-up misdeeds, not those doing the right thing.

Physician Autonomy Under Siege

Steve Jacob recently reported on how, "Physician Autonomy Is Under Siege".

One excerpt from a physician in the trenches:

Dr. Robert Monteiro, an internist in New Bern, N.C., said, "There is a huge amount of interference into the doctor-patient relationship, and that has a large impact on your professional satisfaction. You want to come to treatment decisions without someone telling you what to do and how to do it."

Monteiro said preauthorization for medications, imaging, and treatments requires increasing amounts of time. He said the uncompensated time required to complete paperwork associated with patient care limits patient access, because physicians run out of hours. He added that the constantly shifting insurance-plan changes and requirements can be overwhelming.

"It's as if you are playing a game and don't know the rules. Then rules constantly change and maybe you get penalized for new rules, even if you don’t know what they are. As doctors, we have no problem justifying how we take care of patients. But having to fill out a three-page form to get a generic blood thinner is ridiculous," he said.

He also linked to an article in JAMA (Journal of the American Medical Association) detailing the new pressures on physicians.

In particular, the JAMA article notes: "Clinicians increasingly are expected to substitute social and economic goals for the needs of a single patient."

Patients may want to start asking: Is my doctor really working for me?

(Link via Dr. Matthew Bowdish.)

Interview on 3 Languages of Politics

Philosopher (and my wife) Dr. Diana Hsieh recently interviewed me about "Understanding the Three Languages of Politics" on her live internet radio show, Philosophy in Action. You can listen to or download the podcast any time. You'll find the podcast on the episode's archive page, as well as below. About the Interview:

How many times have you been in political discussions with friends where you find you're talking past one another? You'll make points they consider irrelevant, whereas they'll focus on issues you consider nonessential. Such problems can be overcome, at least in part, using Arnold Kling's concept of the "Three Languages of Politics."

Paul Hsieh will explain how freedom advocates (e.g., Objectivists and better libertarians), conservatives, and liberals tend to use three vastly different metaphors in political discussions, which can create unintentional misunderstandings and miscommunications. He will also discuss how to frame discussion points so they better resonate with those speaking the other "languages" without compromising on principles.

Listen or Download:

• Duration: [51:15]]
• Download: Standard MP3 File (17.6 MB)

Topics: Topics:

• About the "three languages of politics"
• The differences in the three languages
• The difference that the three languages make
• Examples of the three languages
• Conflict between camps
• Alliances between camps
• Political argument between camps
• The debates over the Hobby Lobby decision
• Using the three languages to become more persuasive
• Caveats and cautions
• Three take-home points

Links:

• The Three Languages of Politics by Arnold Kling
• EconTalk: Arnold Kling Interview

For more about Philosophy in Action Radio, visit the Episodes on Tap and Podcast Archives.