Why Andrew Sullivan is right about Megan McArdle, but not in the way he thinks.

I very rarely read Megan McArdle.  She gets filtered by the “life is too short to read stupid people” mesh.  Specifically, in the area in which she claims expertise, economics, especially political economy she has neither formal training (Lit degree as an undergraduate, and an MBA for post-graduate work) nor any demonstration of subsequently acquired understanding.

But, some will say, she’s got an MBA!.  Well, yes.  That and a token gets you (showing our age here –ed.) on the T.

It’s not as well known as it should be — at least for those trying to get a quick read on the knowledge and skill of unmeritedly popular pundits, but MBA courses do not teach economics as real economics departments understand the subject.

Just take a look at the MBA offered by the management program to which I am closest (at least geographically), MIT’s Sloan School.  You get a required semester of economic analysis applied to business decisions…and that’s it for the baseline experience.  If you enter the entrepeneurship track you can (but are not required) to choose a couple of electives on the economics of particular industries.  You can get a very strong background in finance if you want, which certainly expects and hones proficiency with quantitative problems — but though numbers are involved, as are thoughts about money, the problems considered are not those that lead to a deep, or even a superficial analytical understanding of the kind of problems that MIT’s top-five (some years, top one) econ. department thinks are important.

Take note of a couple of things here:  I’m not saying that there is anything wrong with business schools that base their curricula on what their graduates will need to succeed in businesses.  Economics as an academic discipline, or even as an applied social science within the wider world is not what managers and entrepeneurs use as primary tools when making decisions on an enterprise or project basis.  It’s just a fact:  B-schools teach managerial skills and the methods useful in some fairly well defined fields, consulting, management, and finance, for the most part.  Economists do something quite different, and the knowledge and methods needed to do that work are taught at a different place in the academy.  Fine so far.

But the punchline for this story is that Megan McArdle in fact knows very little — not nothing, but not much either — of the formal apparatus of modern economic thought, nor of the rich bodies of content knowledge real economists have developed on a number of important questions, including, most important for the present discussion, medical economics and political economy.

Which brings me back to my headline.  I don’t read McArdle much because I know she doesn’t know what she’s talking about, and the glibness of her ignorance and the infantile quality of her ideology (that brand of libertarianism present in populations that include my nine-year-old and that can be summed up “you can’t tell me what to do”) piss me off.  Why read annoying, uninformed –if glibly written — dreck?

But Andrew Sullivan, who is one of the most infuriatingly variable bloggers in the quality of his bullshit detector, pointed me to this post by McArdle, calling it a “must-read.”

Well, if I must, I must, and so I did.

Now, the reviews are already coming in on this essential wisdom, and they ain’t charitable.  I’m not going to take the time here to piece together the complete takedown that she deserves, but I’d like to take a few quotes and hold them up to the light.

First — gamed assumptions:

in the absence of a robust private US market…

Only if the public option proves to be so much more satisfactory than all others will there fail to be a private market for health care.   And in fact, because the public option is a payment option, and not a provider (like the British NHS with which the proposed plans are often deliberately and deceitfully compared (are you listening, Andrew?)), there will be lots of markets within what is properly called the health care sector, even in the presence of a single payer.  See, e.g. Medicare. (And Canada, et al.)

Of course, if your analysis needs to assume a pure government fiat control of health care, then such an assumption becomes required even when false.  McArdle is a bad faith debater — and she has to be, because she knows the answer (markets (a usually unexamined term) good, government bad) that must be reached.

Neexxxt:

So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure.  Innovation benefits future constituents who aren’t voting now.

Well — here’s the rub.  The argument McArdle wants to make against government control of health care (not that she’s demonstrated that the plans under discussion would lead to that eventuality…see above) turns on her demonstration that the government will constrain  “future lives, and future freedom…”  And yet her argument begins with the assumption that the government will do one thing and not another — and of course assuming that which is to be proved makes the pesky problem of developing a robust sequence of cause and effect a whole lot easier.  Did I say that McArdle’s faux-naive libertarianism leads directly to bad faith arguments?  I did?  Good.

To take the next step, McArdle is simply wrong, factually challenged, intellectually too damn lazy to do even the minimum googling to test the claim she makes in the passage above and in the remarks taht follow.  Innovation benefits future constituents who are voting now…duh.

Case in point:  The history of the anti-cancer agent Taxol, a compound initially isolated in the bark of the Pacific yew tree.  Samples of the bark were collected in the early 19602.  An interesting compound was then identified in 1967 with its structure being deciphered in the early 1970s in research funded by the National Cancer Institute.  It was identified as a drug candidate in 1979, once its method of action became understood, and phase I clinical trials started in 1983.  Its path to approval was slowed by the limited amount of precursor plant material available, a roadblock that was ovecome when an alternate path to the synthesis of the drug in large quantities was found through the use of the needles from a different yew species.

With a pathway to production in hand, the drug received initial FDA approval in 1992 for treatement resistant ovarian cancer, with approvals for a wider range of diseases following over the next decade.

Among those who would benefit from this development:  A woman who was 35 years old and voting for Pat Brown for governor of California in 1962; 40 in 1967, looking toward a vote for Gene McCarthy in the Democratic primary of ’68, and HHH for president in the fall; 52 in 1979, disappointed with but determined to vote again for Jimmy Carter against a former California governor she knew all to well;happy to go for young Bill Clinton in ’92; and in 1995 would be diagnosed with the stage IIIb non-small cell lung cancer for which she would receive Taxol — a treatment that extended her life to the point where she could bless the marriage of her third child, the writer of this blog post, ten days before she died.

That is to say, as McArdle appears not to know (or to be unwilling to grasp that which might confound her received knowledge), biomedical innovation does not take lifetimes to complete, these days, and hasn’t for some considerable time.  My mother was a voter at the pure natural history stage of the research that led, within her lifetime (and a series of cast ballots) to the biologically active chemical that extended her life.

And so it goes.  There’s a lot more wrong in McArdle’s screed.  She has very little understanding of the actual daily life of biomedical research — this next paragraph is so full of false statements it wearies the critic, which may be a deliberate feature rather than a bug of McArdle’s prose.  Think of it as a form of rhetorical pesticide, an analogue to the tactics of plants that generate so much poison that those that would munch its leaves recoil in horror at its bitterness:

In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does.  They are no more interchangeable than theoretical physicists and civil engineers.  An academic identifies targets.  A pharma researcher finds out whether those targets can be activated with a molecule.

This is just a cartoon, laughable if it weren’t even a little influential (remember that encomium from the Most Read Blogger Alive™, Mr. Sullivan).  Academics don’t look for molecules?  Has she ever asked any of them?  I could throw a stone from where I sit and hit dozens of MIT researchers pounding molecules into receptors and so on…just check out these films, made by my students three months ago, within the Lindquist Lab at the Whitehead Institute on research into an anti-Parkinson’s molecule/drug candidate.  Or further down the same page for the story of two dedicated researchers within the Sinskey Lab in the MIT department of biology, tracking down a novel antibiotic in a two year hunt.

Seriously:  McArdle writes what she wants to be true.  She is wrong on all significant points in this post.  The second half is, if anything, even more ludicrously miswrought than the section I’ve focused on here.  She objects to public health research, in a nutshell, because it might produce findings that encourage changes in behavior.

The fact that obesity is getting some attention as a health problem in the context of a debate about the cost of health care in the US is for her conclusive evidence of … what?   Oh — it turns out, in her “analysis (sic) that the attempt to provide coverage for 50 million uninsured Americans and to reduce the impact of a disastrous incentive structure within the health care sector so as to reduce the per-insured cost of health care is in fact merely a cover for rich white people to make everyone thin like them.  I’m not kidding.  In her own words:

Look at the uptick in stories on obesity in the context of health care reform.  Fat people are a problem!  They’re killing themselves, and our budget!  We must stop them!  …How far are we willing to go beyond calorie labelling on menus to get people to slim down?

How far indeed?  McArdle tells us–measures, unspecified that “aren’t just a way to save on health care; they’re a way to extend and expand the cultural hegemony of wealthy white elites.  No, seriously.”

No, seriously Megan, shut up.  This is just crazy….birtherism for the gliterate crowd.

The proposition with which this post began was that McArdle knows nothing of economics or political economy, beyond that minimum of jargon needed to cloak her adolescent Randian delusions in the veneer of policy knowledge.  In this post, her manifesto on why she opposed national health care, she demonstrates the arguing skills of a six year old (that conclusion contained within an assumption not in evidence); the reportorial effort and acuity formerly celebrated in The National Enquirer (the too-good-to-check school of journalism), and an understanding of modern biomedical research exceeded by the potted plants in Building 68 at MIT.  (Really — go check out the Sinskey videos mentioned above.)

That which to be demonstrated has been done…q.e.d.

Which brings me back to Sullivan.  Did he read that piece he celebrated as a must-read?  If so, did he think it added something essential, true, valuable to this debate?  If so, what does that tell you about the rest of his comments about the health care policy struggle now underway.  If you answered that he don’t know sh*t — you get a gold star.  Sullivan’s view of the health care debate is grist for another post on another day when I can stand the stupid, but for now it seems to me to be composed of equal parts Thatcher nostalgia, and Sullivan’s well known innumeracy, his inability to get his head around issues with significant technical or quantitative components.  It’s easier for him to wax romantic about free peoples and free markets than to examine the actual nature of markets and their distortions as they operate in health care.  That is all.

Image:  Hans Sebald  Beham “The Little Fool,” 1542

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