What's Wrong with Work for the Dole

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Over at Public Address Tze Ming Mok has a great post describing why the Maori Party's got it wrong with work for the dole.

Unfortunately, in comments, some buffoon tries to correct her on a minor point and ends up being spectacularly wrong himself. Sigh, some people never learn...

Surf Blogging...

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Normally I'm not one for surf blogging. But this, even if you aren't a surfer is well worth a watch.

A Counter-Counter Revolution

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In the New York review of Books Paul Krugman has a very interesting run over the life, economics and politics of Milton Friedman.

To Krugman, Friedman's real achievements were as a technical apolitical economist. In particular, his permanent income hypothesis and the Non Accelerating Inflation Rate of Unemployment.

Much less successful in Krugman's eyes was the doctrine with which Friedman is most strongly associated: Monetarism

"Everything reminds Milton of the money supply. Well, everything reminds me of sex, but I keep it out of the paper," wrote MIT's Robert Solow in 1966. For decades, Milton Friedman's public image and fame were defined largely by his pronouncements on monetary policy and his creation of the doctrine known as monetarism. It's somewhat surprising to realize, then, that monetarism is now widely regarded as a failure, and that some of the things Friedman said about "money" and monetary policy—unlike what he said about consumption and inflation— appear to have been misleading, and perhaps deliberately so.

And practical application of Friedman's theory has been far from successful.

First, when the United States and the United Kingdom tried to put monetarism into practice at the end of the 1970s, both experienced dismal results: in each country steady growth in the money supply failed to prevent severe recessions. The Federal Reserve officially adopted Friedman-type monetary targets in 1979, but effectively abandoned them in 1982 when the unemployment rate went into double digits. This abandonment was made official in 1984, and ever since then the Fed has engaged in precisely the sort of discretionary fine-tuning that Friedman decried. For example, the Fed responded to the 2001 recession by slashing interest rates and allowing the money supply to grow at rates that sometimes exceeded 10 percent per year. Once the Fed was satisfied that the recovery was solid, it reversed course, raising interest rates and allowing growth in the money supply to drop to zero.

Even Friedman himself appeared to eventually accept this. Stating, when interviewed by the Financial Times in 2003, that:

"The use of quantity of money as a target has not been a success," ... "I'm not sure I would as of today push it as hard as I once did." (ref here: scroll down to Monetarism)

On Friedman's role as an anti-government activist, Krugman has this to say:

Milton Friedman the great economist could and did acknowledge ambiguity. But Milton Friedman the great champion of free markets was expected to preach the true faith, not give voice to doubts. And he ended up playing the role his followers expected. As a result, over time the refreshing iconoclasm of his early career hardened into a rigid defense of what had become the new orthodoxy.

Krugman start's his essay with a metaphor: Classical economics as the Catholic Church, Keynes as Martin Luther, and Friedman as Ignatius of Loyola, founder of the Jesuits.

So he concludes:

In the long run, great men are remembered for their strengths, not their weaknesses, and Milton Friedman was a very great man indeed—a man of intellectual courage who was one of the most important economic thinkers of all time, and possibly the most brilliant communicator of economic ideas to the general public that ever lived. But there's a good case for arguing that Friedmanism, in the end, went too far, both as a doctrine and in its practical applications. When Friedman was beginning his career as a public intellectual, the times were ripe for a counterreformation against Keynesianism and all that went with it. But what the world needs now, I'd argue, is a counter-counterreformation.

Those, in my opinion, are pretty strong words for a mainstream academic economist of this day and age. And what struck me reading them was just how much Krugman appears to have traveled left as an economist in recent years. Krugman the younger, was always slightly left of centre (liberal in American parlance) , but key word was slightly. If you read a book like the Accidental Theorist you'll find that Krugman spends far more time clubbing the left than he does the right. This includes attacking members of the Clinton administration for being too interventionist. Krugman would probably argue that he's always attacked bad economics and that now his guns are turned mostly to the right because that's where the errors are coming from. However, I'm not so sure: now days you can read the Krugman who once ridiculed the Seattle protesters admitting to feeling conflicted about globalisation; you can read the Krugman who used to see red at the mere sight of the Surname Galbraith (James or John it didn't matter) quoting John Kenneth Galbraith approvingly; you can see Krugman as an unqualified supporter of public health care; you can read Krugman saying that the Democrats shouldn't worry about balancing the budget in the short term; and you can read Krugman again and again on inequality (which, to be fair he has always been concerned about).

So, if you were to ask me, has the world changed or has Krugman, I'd say the latter.

Perhaps we have a contender for our head contra-contra?

[update: put the word mainstream in front of academic in my third to last paragraph as that seems more accurate]

Comparing Apples with Hamburgers

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One of my least favourite right wing canards goes like this:

"Markets are great. Look at the market for hamburgers. Markets distribute hamburgers in New Zealand and no one goes without. It's only when the government gets involved - like in health care and education that provision starts to lack."

###missing text

Just briefly here's what's wrong with the 'Great Health Burger Comparison' (this ain't rocket science):

1. Burgers are a heck of a lot cheaper and simpler to produce than medical treatments - for this reason alone the comparison is nonsense. There may be limitations to the provision of health care in New Zealand at present, but they are nothing like the number of people who would miss out if we fully marketised health care.
2. Markets may, when functioning well, provide efficient distribution, but they never guarantee provision. This means that if New Zealanders shy away from the thought of many of their compatriots (and probably themselves) going without health care - then there is going to have to be some sort of state involvement.
and 3. minimal state involvement - as exists in the States - proves to be less efficient than state involvement social democracy style.

In short, providing health care is much more difficult than providing 'universal burger coverage'. Because it's more difficult and because, as New Zealanders, we like the universal aspect of universal coverage, we get the state involved. What results is not perfect, but this doesn't reflect so much as the limitations of the state vis a vis the market but more the difficulty of keeping a nation healthy.

Goodbye Horatio Alger...

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a great article in the Nation about the decline of social mobility in the USA.

When Alternative Medicine Conspiracy Theorists Get Nasty

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Oh, my, god.

[update added the term conspiracy theorists into the heading, so as to be fair to all the mild mannered alt. med folks out there]

"Post Abortion Syndrome"

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Last year, David Ferguson's Dunedin longitudinal health study made headlines here in New Zealand when he started publicising the fact that his data appeared to show a correlation between having an abortion and increased risk of subsequent mental illness for the women involved.

As I understand it Ferguson's abortion dataset was too small to actually be statistically significant, and it didn't include the sort of controls you would need to separate cause and effect etc. But this didn't stop the study from generating a whole heap of column inches. If I recall correctly, none of these made mention of research from other countries on the same matter. That seemed kind of strange, surely we weren't the first country on Earth to cover this ground?

As it turns out we weren't. Not by a long way. This interesting piece from the NYT magazine covers the US debate on the 'abortion harms women's mental health.' As it turns out there is little evidence corroborating Ferguson' study.

Academic experts continue to stress that the psychological risks posed by abortion are no greater than the risks of carrying an unwanted pregnancy to term. A study of 13,000 women, conducted in Britain over 11 years, compared those who chose to end an unwanted pregnancy with those who chose to give birth, controlling for psychological history, age, marital status and education level. In 1995, the researchers reported their results: equivalent rates of psychological disorders among the two groups.

A couple of recent studies do indicate a relationship; however, these appear to contain errors and are open to refutation.

Above and beyond the evidence based debate, there were two random things I wanted to add:

1. In the States it is the anti-abortionists who are so keen to prove the link between abortion and subsequent mental illness. That's predictable, but I wonder whether they ever stop to consider their own potential role in this state of affairs: by stigmatising the process as they do, it seems entirely possible that they contribute to the increased distress of those who go through it.

2. Even if it is eventually shown that abortions can have adverse psychological effects then surely, given that struggling to raise an unwanted child can presumably have similar effects, you'd think that the 'anti-abortion for the sake of women's health' groups would be strongly in favour of contraception, sex-education. etc.

Um. No. No they're not actually. Which says quit a lot about their motives if you ask me.

Putin's Russia

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And from the other review of books, a fascinating article on Putin's Russia.

Holocaust Revision In Iran

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This open letter to the New York Review of Books, written by Iranian emigrants, pretty much says it all when it comes to the Holocaust denial conference that was held in Iran recently.

One notable snippet:

Emphasizing that this is not the first time that the government of the Islamic Republic of Iran has resorted to the denial and distortion of historical facts;

Recalling that this government has refused to acknowledge, among other things, its mass execution of its own citizens in 1988, when thousands of political prisoners, previously sentenced to prison terms, were secretly executed because of their beliefs;

Ahmadinejad is not only repulsive, a threat to Israel, harmful to the people of Iran, but also the worst sort of ally to the Palestinians.

More China

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Will Hutton has an interesting comment on Mao and his role in China's economic lift off.

A Liberal Dilemma

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Johann Hari has a good book review in Dissent. It's an interesting read and notable for the well-deserved kicking it gives to Bat Ye’or.

On a slightly different note, when I read it, this little snippet started me thinking.

Bawer had belly-flopped into the continent’s paradox: Europe’s warm and capacious tolerance was being extended to some of the most fanatically intolerant people on earth.

While I would quibble with some of Hari's review, I think this quote gets to the heart of something that I call the liberal dilemma*. That is: how does a world-view that has tolerance (and an element of cultural pluralism) at its centre deal with those who are fundamentally intolerant.

The standard answer to this is often the somewhat platitudinous "tolerant of everything but intolerance." A reasonable principle in a static sort of way, but it doesn't help so much when it actually comes to policy etc.

At a policy level, as I see it, there are several choices, none of them - I think - perfect.

(1) First, there's the answer favoured by the right-blogosphere, and pandered to too often by politicians: that is to become less tolerant ourselves. On its own and at a large scale, this seems like a terrible idea to me for two reasons. Firstly, fighting intolerance with intolerance guarantees only one thing - less tolerance. Which is a pity if tolerance is what you were concerned about in the first place. Secondly, the tools associated with this approach usually alienate the people whose hearts and minds you are trying to win over and pushes potential recruits to the ideal you are opposed to further in that direction.

(2) Second, there is the do nothing approach/dismiss the threat approach. This is what 'muscular liberals' often accuse the rest of the left of. I don't think that this is really a fair characterisation of what the 'rest of the left' really think; however, at the same time, I'm a lefty and I have to admit that I have a tiny slither of sympathy for this approach after all. This is because, given the potential counter-productivity of 1 above, and given that the threat may be overstated, you can make a plausible case that it is better to do nothing and let the attractions of our system, and time, win the race for us.

Not totally floored in my mind but not a good idea either. This is because if you try and follow this path, the abhorrent acts that will occur will, while being not truly civilisation-threatening, will still harm numerous innocent people. Many of these people will be the sort of people that liberal most want to protect (immigrant women for example). On top of this, the backlash at these crimes may well lead to 1 occurring anyhow.

(3) Finally, there is the option (which I think is a truer representation of what most of the left wants) which is to, if I can mangle some terms from political philosophy, go beyond negative integration** (simply opening the gates and letting people get on with things) and make sure that positive integration occurs as well. This involves providing higher-education, job opportunities, support, support against racism etc.

This last approach, to me, seems like the best one (with a pinch of 1 and bearing 2 in mind). But it is much easier said than done...more (hopefully) in a future lunch break.

*I'm borrowing this term from Amartya Sen - his Liberal Dilemma is a variant of Kenneth Arrow's Impossibility Theorem.
** The terms I'm mangling are Negative and Positive liberty.

Nuance Strikes Back!

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Amen (erk!) to this.

Field Notes from a Conference

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I attended a development studies conference recently and being there was a reminder that I needed to note down these two academic phenomena before I forgot:

1. The Questionment

As the name suggests this occurs during the question time that follows a talk. However, what's on offer isn't a question at all, it's a statement, usually with the subtext of 'hello everybody I actually know rather a lot on this subject too.'

Example: "Thank you for your very thought-provoking talk, I couldn't help but think - when you mentioned the current sugar crisis in Fiji - that what we are really seeing is a two pronged attack on the industry. One prong being changing trade rules; the other being race relations. With a colleague I've been doing some similar work on Solomon Islands, with regards to the Chinese...[fade to multiple blahs]...So, um, do you see any similarities between the Solomons and Fiji in this regard?"

2. The Overweight Caveat

This is where you note the killer counter-argument to your own hypothesis, claim that you are not disputing/discounting it, and then to proceed by totally ignoring it. The old saying "I'm not a racist but..." is a pub form of the same technique.

In the Development Dictionary (the crappiest development book with the most misleading title ever written) one of the authors performs a classic execution of this maneuver. The example runs something like this. The author is writing an article about 'problematising poverty'. In particular, claiming that the west often 'invents' poverty in the developing world as an excuse for intervention. Now, upon reading this, the not 100% credulous reader might ask: "But what about those people for whom poverty isn't a western invention?"

Aha! The killer counter argument!

But, it turns out, our author is ready for that one, writing early on in the essay: (paraphrase) "this is not to discount the fact that millions of people live lives of grinding poverty..."

No, not to discount it at all [/sarcasm]. Not to mention it again in the article either.

Still I suppose you can't fault the logic. If you exclude the billions (not millions) of people who live in grinding poverty, everyone else who those nefarious agents of western hegemony (development workers) claims is poor probably is just a creation of the discourse.

Dial One for Democracy

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WARNING THE FOLLOWING BLOG POST IS SEVERELY HINDERED BY AUTHOR'S TERRIBLE MEMORY WHEN IT COMES TO NAMES (EVEN THE NAMES OF COUNTRIES)

Last year I went to an interesting talk hosted by the Institute of Policy Studies here in Wellington. Speaking was a well regarded academic from the East West Centre in Hawaii. His subject matter was the state the Pacific Island Countries and their relations with us and amongst the usual "what should be done" stuff he mentioned a thoroughly commendable sounding political initiative taking place in Tuvalu (or maybe Kiribati - I did warn you).

It involved live broadcasting of political debates, but with a twist: people listening to the debates on their radio could, if they so desired, phone into parliament and table a question, which then had to be addressed by the politicians.

:)

Now my New Zealand-centric experience of broadcasting parliamentary debates is that they make for thoroughly depressing listening - far too many school ground taunts instead of substantive deliberation; however, when you combine this with something else that I also normally despair of - talk back radio - you get an end product which sounds really worthwhile. Particularly in a small dispersed island nation.

Great Fiji Analysis

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I started reading Jonathan Edelstein's blog The Head Heeb during the Lebanon Crisis. It wasn't such a surprise to discover that he was a knowledgeable commentator on the Middle East. More of a surprise was to find out that he was writing some great stuff on the Pacific too. If you scroll down to the bottom of the index page linked to above, you will find lots of his excellent analysis on the current Fiji coup.

Happy New Year

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Welcome to 2007, most probably the year of one of the most significant moments in human history: the moment when, for the first time ever, the globe's urban population will outnumber its rural one.

China - twists, turns and troubles ahead

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China's long brutal march to development is staggering in it's magnitude, scale and ramifications. It's an omelet that has been millions of broken eggs in the making. It's a tale full of ironic twists: Marx is stood on his head, capitalism didn't pave the way for communism, communism paved the way for something resembling capitalism; the legacy of Mao has been a privatised health system which fails many Chinese, the legacy of Chang Kai-Shek is public health insurance, which ensures almost universal provision in Taiwan. It's a story, the outcomes of which will impact not just on Chinese, but on all of us.

At the heart of the tale is China's decades long spurt of high economic growth (averaging 8% annually for the last 25 years). Growth which followed the introduction of market based reform and the decollectivisation of rural agriculture (and was probably facilitated by previous investment in health and education). Growth which has been accompanied by dramatically rising income inequality but at the same time also accompanied by a probable fall in both absolute income and consumption poverty.

In not all areas has life improved for the Chinese, however: the privatisation of their health care system has led to a situation where half of all Chinese surveyed in a recent survey had had to forgo medical treatment because of cost; while democracy is as far away as ever, and human rights abuses still frequent; and recourse for those whose land is appropriated in the name of progress (or in the name of the Olympics for that matter) is minimal.

Economic growth has also brought with it massive environmental degradation, something that has impacted on the lives and health of many Chinese. And the rapidly rising gulf between city and hinterland has precipitated what Max Sawicky calls (and I am paraphrasing because I can't find the link right now) "the largest migration that has ever, and will ever, take place in human history." And while corruption doesn't appeared to have stopped China's growth miracle (and because of this China is uncomfortable evidence for those who believe that corruption is the sole obstacle to growth in the developing world) corruption and lack of democracy have meant denial of worker's rights, and human rights, and a political system that is straining under its own contradictions.

What does all this mean?

This has to be once of the biggest questions facing the world over the next few decades. It has ramifications not only for the people of China, but for the rest of us too – for the environment, for the global economy, for global politics. The reverberations from China’s great takeoff can even be felt in tiny Pacific States.

It’s also a question that contains within it many smaller questions, all important in their own right.

The first of these is “Can it last?” Which is a complicated question in its own right. Will Hutton, in two excellent articles in the Observer/Guardian thinks no.

To Hutton, corruption and democracy may not prevent economic take off in the short run, but in the long run they are a recipe for social turmoil. Turmoil that can already be seen in the huge number of strikes and demonstrations sweeping across China at present. Turmoil which may, ultimately, undermine China’s economic progress.

Things may not, however, be that simple as Andrew J Nathan writes in this Foreign Affairs article human rights and labour abuses are bad of their own accord, but the people running China are not – at present – crazed despots. They are ruthless, certainly, but also aware that social harmony and improved living standards are important if they wish to maintain power. Accordingly they are acting to try and address some of the problems facing the country and its people.

The key question is will it be enough.

And, if it is, what then.

Economically, for the rest of the world, a rising China will in the short-term mean increased cheap goods. A boon on one hand, but something that will – to varying extents in different countries – undermine existing manufacturing industries. In the longer term, China ought to become a significant importer, with positive benefits in most areas. Except for natural resource shortages of the kind that we are already seeing with oil.

Resource shortages will of course not be the only global environmental problem that China contributes to; China’s impact on climate change could be staggering if they continue to follow the fossil fuel model of economic development used by the west.

Politically, China, along with India is on the way to becoming something of a new super power: welcome to a multi-polar world. Quite what this will mean in the long run, other than the end of hegemony as usual for the US, is hard to say. Some authors such as Martin Jacques argue that by focusing on the Middle East not the Far East, and through its disastrous adventurism in Iraq, America has significantly hastened the waning of its power. Whether Jacques is right or not, one thing is clear, the United States is already dependent on Chinese savings to make up for the lack of its own. On the other hand China needs the US as a market for its products. Something that could all become awfully tricky for both countries in tensions flair between China and Taiwan, and China and Japan (two countries which the US is officially allied with). And in both cases, particularly the Japanese, tensions have been on the rise. The image that springs to my mind here is one of those knife fights you used to see in old western films, where two combatants, circle each other warily, knives drawn in their right hands, while their left hands are tied together with a leather strap.

In the world of international development China has recently emerged as a major donor nation. The impact of this on resource rich, yet poor, Africa is already being felt.

Similarly, in the Pacific, China is starting to donate heavily, often as part of a bidding war against Taiwan but also in exchange for resources such as fish.

On one level more aid could be a good thing; however, at present China appears to be giving aid primarily to further its own ends, rather than to genuinely help. And as the cold war showed, aid given in this way often goes no further than lining the pockets of corrupt officials.

As with everything China, the outcomes of aid to the Pacific are unclear. Just what China’s ongoing rise will mean to us is even less certain than whether it will continue or not.

Trying to Muddle Through: Living (and Learning) with Disease

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DISCLAIMER: EVERYTHING THAT FOLLOWS IS SIMPLY A TALE OF MY OWN EXPERIENCE. IT IS NOT A SUBSTITUTE FOR GOOD MEDICAL ADVICE.

Last year I wrote about why there is no good name for the illness that afflicts me. Of the two alternatives, Reactive Arthritis is the better but, as I wrote back then, when people hear the word ‘arthritis’ they think joint pain – and that’s only half the story. Exhaustion, skin problems, eye problems, and mild fevers have all accompanied my ‘arthritis’ at one stage or other. Heck I’ve even had painful stores on the inside of my nose. Even on its own, joint inflammation has been enough to hobble me – reducing me to crutches at times – but, add to this everything else associated with the illness and, hey presto, you’ve got a life where, when the disease it at its worst, simple things like driving to the library can be near-impossible.

This isn’t a cry of self pity on my behalf: things could be much worse. (Indeed, I’ve got friends for whom they are much worse.) All I’m saying is that there has been quite a change in my life since the carefree, globetrotting, surfing days of my 20s.

Naturally enough I haven’t taken this lying down. I’m lucky enough to come from a relatively wealthy family, meaning that I am in the position where – within reason – if I come across a potential treatment pathway, I can afford to follow it. I’m also reasonably well-educated, with access to the internet meaning that I can supplement the knowledge of the medical professionals I see with my own research.

So right from the moment – sometime over the summer of 2002/03 – when it looked like I wasn’t going to shake the second bout of arthritis as easily I had the first (which came and went of 1999), I started to take an active role in overcoming my illness. Or, at least, in attempting to overcome my illness.

Since then the ride has been up and down.

In late-summer/autumn of 2003 I got much better; over the winter much worse. I improved again over spring 2003, but relapsed very badly in December 2003. For the next year, until late 2004, my life was pretty severely limited by illness. I did manage to complete my masters degree (including a research component in Brazil), but by the end of this process I was knackered – on crutches, in pain and fatigued. And for the whole year I couldn’t surf: something that might sound frivolous but surfing’s been central to my life ever since I was 13 and it’s something I really value; so in many ways it’s my yardstick of wellness.

Over the summer of 2004/05 I got somewhat better. I was freed from my crutches, and able to surf again. And generally found life much easier to live. I was far from rid of pain though, and not even as good as I had been in 2003, but I was mobile enough to live a relatively normal life. Or I was up until June 2005 when, probably due an ear infection I caught surfing, I relapsed big time. By far and away the worst my arthritis had been – out of the water, back on crutches, and taking strong medication on top of this just to be able to get around.

From this low point things started to slowly and shakily get better; the rate of improvement increasing dramatically in early 2006 when I changed treatment regimes (more about this later). Which leaves me, at present, well enough to surf again. And – for the first time since 2002 – able to go for recreational walks. This is great: I’m not out of the woods, but the foliage has thinned. And I can see some daylight between those trees.

The journey here has been far from straightforward. Along with the twists and turns in the level of illness there have been different treatments taken, bifurcations, and dead ends. Here are some of the paths I’ve investigated, what I’ve learnt, and the pitfalls…

Mainstream Medicine

The wonders of modern medicine never cease to amaze me – in the space of just a few hundred years it has contributed to a staggering rise in life expectancy. It has provided us with the means to eradicate small pox and almost rid the world of polio. Its achievements mean that if you were to catch the Black Death on holiday in Mongolia, on returning to New Zealand you would – rather than being responsible for wiping out a third of our population – be cured with a nice easy course of antibiotics.

Mainstream medicine hasn’t, however, managed to come up with easy answers to all the diseases that ail us. And, unfortunately, Reactive Arthritis is one of those diseases where there is, as yet, no cure. Instead, there are a variety of potential treatments that may work to an extent but which also come with costs of their own (side effects). This means that there are tradeoffs to be worked through.

My first brush with conventional medicine came as I limped my arthritic way around Charring Cross Hospital in London (1999). There – a misdiagnosis at the GUM clinic and a bad experience in ophthalmology not withstanding – I received excellent treatment. The doctors in Rheumatology were great; they didn’t do much other than prescribe Non Steroidal Anti-Inflammatories and drain the fluid – ow! – off my knees; but the disease started to trend for the better pretty quickly and what they excelled at was helping me learn about the condition – and treating me like a human being. Which, particularly in a big dehumanizing city like London, meant something.

My second brush was back here in New Zealand (2002/03) where I – after waiting for several months for an appointment with a registrar – had a fairly brief appointment, during which the consultant was called in and in which I was prescribed Methotrexate, given an A4 handout informing me about the drug, directed to the door and told to come back in 6 months. Within an hour of getting home I discovered enough about Methotrexate to make me decide not to take it. Methotrexate is an immunosuppressant which can have considerable side effects. Can doesn’t mean will. And Methotrexate also has a reasonable track record when it comes to significantly reducing the effect of arthritis. Yet, at that point in time, where I’d only been badly arthritic for a couple of months and given my previous experience, in which I got significantly better after a few months whilst doing nothing in particular, I thought that taking such strong medication was jumping the gun just a little. My confidence wasn’t boosted by the fact that the doctors forgot to schedule me the regular blood tests which are critical in detecting if any damage is being done when taking Methotreaxte. So, I never took the Methotrexate.

And began considering the alternatives.

Richard Dawkins (I think) once wrote about alternative medicine that (paraphrase), “once an alternative medicine is proven to work, it’s no longer alternative, it becomes part of the mainstream.”

If only things were that simple. The scientific method that Dawkins champions and which is central to mainstream medicine has much to be said for it. Logic, cause and effect, evidence, double blind trials – we take these for granted but each represents a small revolution in its own right. And a vast improvement on what came before. Yet there are limitations to the process.

The first is economic: developing a treatment and getting it tested thoroughly costs – a lot. This means that the type of treatments more likely to make it into the mainstream are those where money can be recouped through patents. That means drugs – as opposed to things like diets. The economics of medicine also means that the large drug companies that develop many modern medicines, having sunk considerable costs into their development, are loath to see a medicine ruled out at the last minute when it fails to prove efficacy in double bind trial or shows adverse side effects. And this in turn means that drug companies often find ways of increasing the chances that the studies they pay for produce the results they want.

According to Richard Smith, a former editor of the British Medical Journal:

Paula Rochon and others examined in 1994 all the trials funded by manufacturers of nonsteroidal anti-inflammatory drugs for arthritis that they could find [7]. They found 56 trials, and not one of the published trials presented results that were unfavourable to the company that sponsored the trial. Every trial showed the company's drug to be as good as or better than the comparison treatment.

In the same article Smith refers to other meta-studies (studies of studies) which found similar skewing – drug company funded trials producing more favourable results than independent trails etc.

It’s important to remember here that not all medical studies are funded by drug companies – the majority are in US journals, but not in the British Medical Journal – and it’s also important to restate that, even studies produced by medical companies are often accurate. However, the economics of the process does mean that the scientific method, which as an ideal is certainly the best way to assess treatments, becomes somewhat tainted by the reality on the ground.

Compounding this is the inherent conservatism that comes with the scientific method: science requires that something be proven before it is accepted as truth. And that’s fine – this is the scepticism that has rid us of leaching and alchemy. Yet there’s a quasi-sociological component to this scepticism too, I think. Something which means that for experts in a field, an element of self-worth becomes attached to defending the existing consensus against new ideas. No longer is reason the reason for people’s scepticism – emotion plays an active role. I don’t want to overstate this, I think it’s much less prevalent than in the social sciences (where I have some experience). Yet the history of science – and scientists who have been ostracised until they were eventually accepted as correct – shows that this really is a problem, at least in the short term. In the long term, usually, the strengths of the scientific method mean that the truth prevails – eventually. This isn’t much use if you are sick now though.

Which brings me back to Dawkins’ quote – what if there is an alternative treatment out there that might cure Reactive Arthritis but which hasn’t become mainstream yet because, say, it can’t be patented, and so money can’t be made off it? Or because it simply hasn’t been round long enough to win over the mainstream?

Alternative Medicine

It’s this ‘what if’ that led me to try several alternative treatments – dietary supplements, homeopathy, iridology – and to consider others. None of these alternatives had any of the potential adverse side effects of Methotrexate, nor did they – as far as I can tell – help with my illness. To be fair to the alternatives one of the things the iridologist prescribed – eliminating gluten from my diet – is similar to something I am doing at present, and I may not have tried the other alternative remedies for long enough.

There is a good reason why I didn’t persist with the alternative remedies for that long though – their cost. None of the alternatives were cheap. And while it’s fair to say that, with most alternative remedies, even if they don’t work they probably don’t do much harm (unless you are duped into taking them instead of conventional medicine and then are harmed by the disease), they certainly cost. Which means that – when they don’t do what they claim to do – their continued sale is basically a consumer rip-off. And this brings me to the main limitation of alternative medicine. While their being freed from the rigours of having to be tested forever until the scientific establishment is won-over means that their might be alternative treatments out there that can do things that conventional medicine can’t, it also means that there are a whole heap of alternative remedies out there that make claims that simply can’t be backed up. Whether this is the result of the people who produce these remedies genuinely wanting to believe or simply the rip-off instincts of snake-oil salespeople I don’t know – I suspect the former more often than the latter, but the main point is that my experience with alternative remedies is that they have typically failed to live up to the certainty of efficacy expressed by their practitioners and by product advertising. This doesn’t mean that they will never work for you, just that an element of scepticism is best brought with you when travelling down the alternative road. This may compensate for the lack of scepticism that you will find amongst your fellow travellers.

Side Stream Medicine

For suffers of Reactive Arthritis, mainstream medicine and alternative medicine aren’t the only places to go in search of a cure. There’s a third alternative: something which I’ll call side-stream medicine.

[SPECIAL DISCLAIMER: The next few paragraphs are represent an area of my understanding that is limited – please don’t take them as gospel]

As the name suggests, Reactive Arthritis almost always occurs as a ‘reaction’ to another (trigger) illness. Typically these trigger illnesses take the form of bacterial infections (although viruses can be involved too). Most of the bacterial infections are common diseases which most people catch and never experience any symptoms other than those associated with the immediate infection (vomiting, diarrhoea etc). However, a small proportion of people who catch these triggers go on to experience the symptoms of Reactive Arthritis. This occurs – usually – because their bodies contain a particular antigen (Human Leukocyte Antigen B*27) [or at least the genetically encoded predisposition to create this antigen – I’m not 100% sure]. The combination of trigger illness and antigen is typically what leads to the subsequent arthritic episodes (I say typically because, as I understand it, occasionally people get Reactive Arthritis while not having the antigen).

The relationship between the antigen and the trigger, and the illness is not fully understood, as I understand it. Most mainstream medical professionals believe that a combination f antigen and trigger lead to Reactive Arthritis through an auto-immune process . An auto-immune process being, in lay-persons terms, your immune system ‘freaking out’ and ‘attacking’ otherwise healthy parts of your body. So in the case of Reactive Arthritis, according to most medical professionals, the only problem with your joints is that your immune system – confused in some way by a combination of antigen and trigger illness – thinks there’s a problem with your joints, and starts ‘attacking’ them, which causes the inflammation.

There is, however, a minority view amongst medical professionals (our side-stream). These side-streamers believe that there is something wrong with your joints, something vaguely akin to an ongoing infection in them. And that your immune system isn’t malfunctioning – it’s trying, ineffectively, to rid the inflamed part of your body of foreign organisms. These foreign organisms may possibly only be fragments of the initial bacteria.

Why does all this matter? It matters because it affects how you treat the disease. If you believe that it an autoimmune illness, then you will treat the disease with Methotrexate, or something similar, which impedes the erroneous immune response. However, if you believe that something along the lines of ongoing bacterial presence is the problem then you’ll want to try something different. Most probably diet and long-term low dose antibiotics.

My first experience with the ‘side-stream’ approach was through a local rheumatologist who I went and sought treatment from outside the public health care system. He was recommended to me by friends of my mother, one of whom he had treated for Fibromylagia (I think). His recommendation for me was eliminating grains from my diet as well as to start taking minocyclin, sulfasalzine, and – later – clindomycin. (The antibiotics in relatively low doses).

I think, as much as anything else I chose the side-stream approach because it offered some hope of a cure, rather than just suppressing inflammation for the rest of my life.

The initial results, taking the medication prescribed by this Rheumatologist (I put the diet in the too hard category, initially, and kept on eating as I pleased) were good – not a cure but a dramatic improvement in my quality of life. Slowly, however, it seemed like my body adapted to the drugs and things became less effective. And eventually, the rheumatologist ran out of bright ideas. And suggested methotrexate.

Serendipity

Purely by chance at about the same time, as one particular side-stream seemed to be mergeing back into the main current, I was introduced to the friend of a friend – a chap who had suffered from reactive arthritis but had seen his condition dramatically improve after seeking treatment in Melbourne from a naturopath and GP who worked together. He was the first person I’d met with Reactive Arthritis, his experience with the illness was similar to mine, and his experience in Melbourne once again provided me with hope of an alternative and cure. So off to Melbourne I went.

My experiences with the doctor/gp there were – at a personal level – kindof difficult (the subject for a future blog post). But the main thing was the treatment they suggested – eliminate all grains but rice from my diet, eliminate dairy from my diet, several new antibiotics – has, apparently, led to my most recent dramatic improvement. I say apparently because it is possible that my illness has gone into spontaneous remission over the same period of time (possible but probably not likely). At present, at least, my muddling through appears to have worked (somewhat).

So What Have I Learnt Thus Far

1. It pays to learn up on your illness and prospective treatments. An element of self-empowerment will help you decide what’s best for you. It will also make you feel better (I know for me some of the lowest emotional states in the course of my illness occurred at the beginning when I really didn’t know what was happening to me). Where there are treatment options it may also assist you in choosing what is best for you. Having said all that, there are people who dedicate their medical careers to learning this stuff (rheumatologists in my case). It’s worth listening to what they have to say (even if not 100% uncritically).

2. The Internet – I could never get it to live up to its promise when it came to leaning. It had lots of stuff from medical dictionaries, and some alternative remedies (lots of promises and costly stuff for sale). I was never able to find the main thing I wanted – other sufferers’ experiences and what worked for them. That being said I’m not a patient searcher.

3. Alternative Remedy Schmemedy. I’ve lost count of the number of people I’ve spoken too and websites I’ve read which portray natural herbal remedies as nice healthy, bound-to-succeed alternatives to mainstream medicine. Bollocks. I’m not saying that alternative remedies have nothing to offer. The big one that seems to work for me is diet. However, they aren’t a panacea. And the silly dichotomy that you often hear – western medicine bad, alternatives good – is simply wrong.

4. Don’t underestimate the psychological impacts of chronic illness. This is the topic for another post really but for now I’ll just point out that debilitation is hard work mentally as well as physically. That probably sound like stating the obvious, but it came as a surprise to me.

5. What if, what if… What if I’d started taking methotrexate right from the start? I might have spent the last few years mostly symptom free. I might have been hamstrung by side-effects. I might have been trapped into dependency on a drug that was slowly damaging me. In not taking it I may have led to my joints being permanently damaged as a result of ongoing inflammation. These trade offs aren’t easy, and I’d be sceptical of anyone who told me that they didn’t exist.

6. Meeting your fellow sufferers is well worthwhile. Don’t blindly follow their advice, of course, what works for them may not work for you. Nevertheless, no one else will have the same intimate relationship with your disease as your fellow sufferers.

7. Always keep searching.

8. Don’t be surprised if it is hard to find the time to devote to overcoming your disease. Just dealing with it, on top of all the pressures of modern life, will take time enough.

9. If you have Reactive Arthritis and want to learn more about the treatments/practitioners I’ve mentioned please email me (following carefully the advice besides the words email me up at the top right of the blog).

10. These people are supposedly the centre of the antibiotic arthritis treatment movement: http://www.roadback.org/ . Have a look (I have to admit I haven’t yet – I have read their book though).

That’s all I can think of for now.