The Mind-Body Dichotomy

The editors of The New York Times are outraged by the idea of government agents reading their email and listening to their phone calls. They also object to the government requiring librarians to disclose what books they happen to be reading. But they have no apparent problem with the government having access to their medical records. Theirs and everyone else’s.

One of the goals of the Affordable Care Act (ACA) ― fully supported in editorial after editorial ― is to accumulate medical records in a national data base, so that researchers can better study what works and what doesn’t. In fact this has already happened in the state of Hawaii. Of course, the accumulators of your health records are supposed to respect your privacy. But so is the National Security Agency.

If you find these ideas strange, you probably haven’t spent much time studying the history of western philosophy. Either that or you haven’t absorbed the mindset that tradition has produced.

Ever since the time of Plato, philosophy has been dominated by the mind-body dichotomy. Other variations on this theme are the physical vs. the mental, the material vs. the spiritual and the world of commerce vs. the world of arts and letters.

In all its guises the idea is that there are two different realms, with a different set of principles applying to each. Plato even thought that people engaged in the world of ideas (the philosopher kings) should live by a different set of rules than people engaged in every day affairs.

Returning to the editors of the Times, email and telephone calls and book reading are affairs of the mind. Medical records are affairs of the body. One realm is sacred. The other profane. The former is too important to trust to government. The latter can be regulated.

Could it really be that simple? I’m afraid it is.

The editors of the Times (operating in the world of the mind) believe they should be able to dispense any and all political advice ― no matter how wrong. But they apparently have no problem with the government (in the world of the body) making it a crime for Pfizer to send to doctors reprints of a journal article describing the medical benefits of off-label uses of one of their drugs.

They are mortified by the idea of government censoring newspapers or determining which newspapers are allowed to enter the market. But they seem to have no problem with government telling us what therapies we can have access to, including keeping us from drugs that could save our lives.

What makes this especially surprising is that it seems to turn common sense on its head.

I would be annoyed if a bureaucrat somewhere were reading my email or listening to my phone calls, even though the intruder would probably be bored to death. But I would feel a sense of personal invasion if someone were snooping through my medical records.

Even a bumbling regulator of newspaper editorials would probably cause only modest harm. If you zapped out of existence every New York Times political editorial for the past two decades, it’s not clear that the world would be worse for it. Yet actual regulators of new drugs ― apparently trying to do a good job ― have needlessly cost thousands of lives.

Of course, health care isn’t the only example of the regulation double standard. Take campaign finance laws. The Times believes it (representing the world of arts and letter) should be able to run an unlimited number of editorials trying to influence an election. But it wants the government to stop a donor (who acquires wealth in the world of commerce) from buying an unlimited number of ads in the same newspaper, to present an opposing point of view.

If I appear to be picking on the Times, it’s only because I am allowing then to serve as a proxy for a whole bunch of people who from time to time have called themselves “liberal” or “progressive” and if they decide to re-label again, I would suggest the term “Neo-Platonist.”

Some may be familiar with the standard economic case for government intervention in product markets. Primarily, it concerns public goods, externalities, imperfect information and transaction costs. It’s rarely pointed out, however, that those “market failures” are far more prevalent in the market for ideas. After all, a good idea is a quintessential public good. A bad idea is a public bad. In a world of laissez faire, good ideas will be under produced and bad ideas will be over produced. As for externalities, isn’t the whole point of an editorial or a political speech to create external effects? And as far as imperfect information and transaction costs are concerned, there wouldn’t be a market for ideas if everyone had perfect knowledge and could obtain it at zero cost.

I’m not advocating more government, mind you. I’m merely pointing out that the economic case for free speech is actually weaker than the economic case for free markets in goods and services. Even so, I prefer free minds and free markets.

There are good reasons to hold government intervention to a minimum in both realms in my view. There is no reason to create artificial distinctions that may have made sense in Plato’s Republic, but make no sense in 21st Century American politics.

Indeed this way of thinking is so strange and yet so pervasive that I’m inclined to recommend it as a diagnostics category the next time the DSM updated by the psychology profession.

Comments (27)

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  1. August says:

    Wikipedia on the Mind-Body Dichotomy:

    “The mind–body problem in philosophy examines the relationship between mind and matter, and in particular the relationship between consciousness and the brain.

    Most are either dualist or monist. Dualism maintains a rigid distinction between the realms of mind and matter. Monism maintains that there is only one kind of stuff, and that mind and matter are both aspects of it.”

  2. Cabaret says:

    “After all, a good idea is a quintessential public good.”

    For the non-economists: a public good is a good that is both non-excludable and non-rivalrous in that individuals cannot be effectively excluded from use and where use by one individual does not reduce availability to others.

    Interesting idea.

    • Baker says:

      So is the knowledge of my email contacts and medical condition a public good? Or is it a public bad?

      Because it definitely isn’t rivalrous and may not be excludable.

  3. Greg Scandlen says:

    John, I don’t think it is a mind/body dichotomy. Progressives certainly think certain bodily functions (abortion, sodomy, contraception) are too sacred to be interfered with by the government. It is more a secular-socialist vs. traditional-capitalist dichotomy. They may condemn Pfizer sending around those articles because Pfizer is a successful capitalist company. They would applaud the CDC doing the same because it is not “tainted” by profit. (It may be tainted with other motives, but those are not evil like profits are). Ditto with conflict-of-interest disclosures in research. The only conflict that concerns progressives is financial, they are unconcerned about other conflicts (ambition, power, political, etc)

    • Allan (formerly Al) says:

      What an interesting alternative idea. I like both equally, but I am used to looking for one common answer.

    • Tom says:

      So both sides are wrong for blindly championing one alternative for social remediation. I don’t buy that any one ideology is the solution for all. We just don’t get that human nature exposes any system or ideology by allowing our negative traits to perverse the system itself.

      • Greg Scandlen says:

        Well, there is pretty strong evidence that some systems work better than others. It would be foolish to ignore the evidence in favor of ideology.

  4. Dewaine says:

    I think it is simpler than that, they just want to protect themselves. Simple self-interest to protect their brand by insulating themselves from scrutiny, competition, etc.

  5. Ken says:

    Brilliant.

  6. Dewaine says:

    Free markets are really just an extension of free speech. Freedom to act is a logical extension of Freedom of thought.

    • JD says:

      Are you saying that people should just be able to do whatever they want without consequences?

      • Dewaine says:

        No, I have no right to tell you how to act, just like you have to no right to tell me. If I violate your right (i.e. injure you), then you have the right to recourse. This is the same as it is in thought (the freedom which we hold most dearly). You can think whatever you want as long as it doesn’t violate somebody else.

  7. Dewaine says:

    “I’m merely pointing out that the economic case for free speech is actually weaker than the economic case for free markets in goods and services.”

    Dead on. While there may be a case to be made about market failure in free markets, the market of ideas is much, much more susceptible.

  8. Marshall Ackerman, M.D. says:

    Of far greater concern is the extent to which we have gradually accepted the government’s intrusion into all aspects of our lives. Hayek anticipated this in “The Road to Serfdom” in 1944. The following quote is from his preface:
    “The most important change which extensive government control produces is a psychological change, and alteration in the character of the people. This is necessarily a slow affair, a process which extends not over a few years but perhaps over one or two generations. The important point is that the political ideals of the people and its attitude toward authority are as much the effect as the cause of the political institutions under which it lives. This means, among other things, that even a strong tradition of political liberty is no safeguard if the danger is precisely that new institutions and policies will gradually undermine and destroy that spirit.”

    • Dewaine says:

      It is a terrible consternation knowing that we are headed toward disaster, but not being able to stop it. Like watching a car wreck in slow motion. What is worse is the realization that most people won’t even know what happened and will never realize the significance of what they’ve lost. It makes you wonder what we have accepted that our predecessors feared most.

  9. Dwight M. Mazzone, CDHC says:

    I agree with Greg Scandlen – for some “strange” reason the idea of one making a profit runs against the core of the left. Business “should” spend money with no thought to taxes, overhead and the like as long as the 47% are supported by other people’s money. Profit is the dirty motive. No matter that the “profit” is what builds businesses and funds R&D and allows people to live a better life. Socialism always fails, capitalism when allowed to flourish helps us grow.

  10. Devon Herrick says:

    On the one hand, million of observations would provide better evidence of which therapies work and which ones provide little benefit. Unfortunately, to work well, millions of individual people will need to be tracked over their entire lives. This suggests medical information will have to be personally identifiable to be of any real value.

    • Greg Scandlen says:

      I’m not so sure, Devon. Millions of observations may show the Treatment A works best 37% of the time, Treatment B 32%, and Treatment C 31%, But what does that tell my doctor about how to treat me?

    • Paul Nelson says:

      A large data base assumes that all members of a study group are the same. I am aware that a small but significant number of people do not absorb Amoxicillin. Or, there are nearly 3,000 genetic causes of cystic fibrosis, the most common cause of chronic progressive lung disease in children. Clearly, the genetic variation is profound. So, large population studies are not uniformly useful for testing alternative treatment protocols.

      Also, the philosophical tradition of voluntarism (not volunteerism) applies to this discussion: a view that the brain has two over-lapping memory functions, the “will” and the “intellect.” The simultaneous interaction of these two memories is, then, the basis for consciousness.

      • Centrist says:

        Isn’t a large part of the reason for the government’s collection of data–since they will become even more of a stakeholder with cost sharing and credits–to keep a paper/electronic trail to validate procedures, abuse, and costs?

  11. Patrick Pine says:

    Even though I am one of those probably labeled as ‘progressive’ or ‘liberal’ – I generally agree with your tone on this. Here is another dichotomy in the health arena – our federal government and several state governments have passed laws in the recent past that specifically provide additional ‘privacy’ protections for certain health conditions – such as HIV/Aids and also have limited the use of genetic information for employers. But we will soon have thousands of individuals who will have access to personal information – including SSNs, addresses, age,
    familial relationships, etc., for the purposes of ‘advising’ individuals considering enrolling in public exchanges.
    This seems to me to be a different kind of dichotomy -where we do a poor job of distinguishing between the needs for ‘public’ health vs. personal health. For instance, when SARS broke out a few years ago, extensive additional screening procedures were undertaken in the US and elsewhere including scans at the entrance to certain employer sites (especially high tech), at hotels, restaurants, and other public gathering places in SE Asia, the West Coast, Toronto, and others.
    This suggests that there are multiple dichotomies – resulting in highly inconsistent applications of philosophies and policies.
    This is the reason I am suspicious of labels like “conservative”, “libertarian”, “liberal”,
    “progressive”, “moderate”, “extreme”, “media” (news or entertainment?), “religious”, “secular” – many of these terms have lost real meaning due to overuse and incorrect application.

    • Centrist says:

      “This is the reason I am suspicious of labels like “conservative”, “libertarian”, “liberal”, “progressive”, “moderate”, “extreme”, “media” (news or entertainment?), “religious”, “secular” – many of these terms have lost real meaning due to overuse and incorrect application.”

      Invaluable observation and position Patrick.

  12. Linda Gorman says:

    The health databases are being sold as a way to find out what works. But in order to find out what works, they’d have to have all of the data required for clinical studies. They won’t have that kind of data.

    What they are is a control mechanism.

    State laws give All Payer Database authorities complete ownership of your medical record, information on the relationships among the people covered by your health policy, your address, your contact information and so on. They will contain your every medical contact in their states, along with diagnosis, treatment, and discharge information.

    Claims that the data are HIPAA protected are misleading. HIPAA has an exemption that lets owners of data do whatever they wish if state law authorizes it in the name of health oversight. Claims that the data are de-identified before being sold provide little protection if they include geographic data below the state level or dates other than years. Leaving out geographic information and dates fulfill the HIPAA safe harbor requirements. If the data owner does plan to sell records with geographic locations and dates, the information can be combined with commercially available marketing lists to identify people even without names, addresses, or SSNs.

    Worse, in states like Colorado there is no opt-out, a feature that North Carolina legislators had the good sense to include.

    For details on the Colorado database see http://completecolorado.com/pagetwo/2013/07/15/state-all-payer-claims-datbase-protections-less-than-they-seem/

  13. Harry Cain says:

    John, your general theme reminds me of a slim but most impressive work by Hayek, The Fatal Conceit, which speculates on the very early history of markets, which broadened into an “extended order” — which tribal instincts do not like. Todays’ “tribalists” are now called “socialists.” Some wonderful insights here.

    • Al Baun says:

      Hey, great idea … why doesn’t John devote another entire article on modern (tribalism) socialism. On how ‘they’ are so alien to ‘normal’ thought processes and of their distain for freedom, life, free markets, and self reliance. He could tell us what is in their dark hearts, closed minds, and play books on how to enslave real people.

  14. Wanda J. Jones says:

    John and Friends:

    The mind-body dichotomy, a gift from the Middle Ages, permeates our healthcare system. Payment arrangements, facilities, clinical specialties, licensure, and concealment of true diagnosis all reinforce this old world philosophy. In this century, we need to pull together an integrated whole person concept, as we now know how much the body’s condition affects the mind, and the mind affects the body. Brain science is on the upswing, and tools are being offered for brain function enhancement as an entrepreneurial venture, not as a remedial effort of the healthcare industry.

    A beautiful and timely topic.

    Wanda J. Jones, President
    New Century Healthcare Institute
    San Francisco