Thoughts on rationalism and the rationalist community from a skeptical perspective. The author rejects rationality in the sense that he believes it isn't a logically coherent concept, that the larger rationalism community is insufficiently critical of it's beliefs and that ELIEZER YUDKOWSKY IS NOT THE TRUE CALIF.
Disapproving Of Tactics Isn't Grounds For University Discipline
I don’t know what I think of Boghossian’s hoax. I’m fully convinced these subjects fundamentally lack any truth-relevant standards. However, I haven’t actually read the papers in question and some of the rebuttals have claimed that the papers made observational claims. Peer review isn’t meant to challenge those kind of claims but it is meant to reject nonsense. So, before I settle on a view about the hoax I’d need to see if the papers themselves were obviously absurd even taking the factual claims for granted. However, how you feel about the underlying hoax doesn’t really matter here. There is no question that the hoax was undertaken as a rhetorical tactic to demonstrate the intellectual weakness of certain academic disciplines via the normal practice of submitting journal articles (even if there was dishonest intent). Moreover, many prominent academics praised it as an important contribution. Even if you think this was a pointless, dishonest and mean spirited attack on these disciplines it is well within the traditional academic role. This makes the use of human subject experimentation rules to punish Boghossian for his antics raises serious academic freedom concerns.
While Boghossian’s punishment was, in one sense, a slap on the wrist the particular form it took (essentially a complete ban on participating in human subject research) is very concerning. It is suggestive (though not conclusively) of a desire to bar him from doing further work on this question and not just a desire to see the niceties of IRB review followed. Regardless of the motives of his punishment the value laden choice to apply human subjects rules to a context where they are generally not applied raises concerning questions about academic freedom.
To illustrate the fact that we don’t normally think of human subject rules as being applicable to interactions with other academics in anything resembling normal practice consider the following examples.
Consider the case of Professor Wood debunking N-rays by surreptitiously removing part of the apparatus (without effect) to show it was a hoax. If this episode happened today should we punish Wood for performing an experiment on professor Blondlot without his knowledge? As this episode illustrates, misrepresentations in academic discussion have a long history and as such shouldn’t just be pushed outside the protections of academic freedom.
But maybe you’d object that Boghossian’s research was systematic in a way that Professor Wood’s was not. In that case consider Nosek’s Open science Collaboration. This collaboration literally asked people (other researchers) to perform a task (replicate these existing results) and published papers evaluating the percentage of those tasks that succeeded (successful replications). The project was expressly designed both to prompt researchers in the field to engage in these representations (so wasn’t merely observational) and then to do a systemic evaluation of how the researchers performed (successful replications or not). That’s the archetypal structure of research that requires IRB approval in other contexts.
Or what about going to a philosophy conference and asking your colleagues how they feel about some interesting moral dilemma you thought up. Is it human subjects research to write a philosophy paper noting that this dilemma seems to divide philosophers in such and such a fashion? Does making sure you ask a wide range of colleagues mean it suddenly qualifies? What if your goal is to write a paper arguing that other philosophers are deeply confused about some issue? Surely we don’t want to be running to an IRB every time we get a gestalt sense of what our colleagues believe or accept as evidence. Is it somehow that one is being inexact and summarizing a gestalt sense one’s colleagues believe that saves ones from needing IRB approval?
In that case consider all the conferences, such as the American Geophysical Union meeting, which have taken to releasing the race/gender breakdown of submitted/accepted papers to facilitate analysis and publication. That’s an archetypal experiment which any IRB would deny in another context. The reviewers (subjects) surely didn’t give meaningful consent as they risked professional consequences if they tried to back out after being informed the data summarizing their behavior would be released, if they were informed at all. I mean imagine what your colleagues would think of you if you backed out after finding out that your work would be statistically analyzed to determine racial and gender fairness. Worse, the research would convey potentially highly disturbing information directly to friends and colleagues aware of your status as a subject (perhaps even able to infer how you affected the data if conference organizers gossip).
I’m not saying that any of these behaviors is comparable to Boghossian’s misrepresentations. But I think they show that the choice to apply the human subject rules to Boghossian was highly value laden. Indeed the case with Wood shows we approve of this behavior when we believe the victims truly are charlatans suggesting it’s the belief that grievance studies researchers aren’t charlatan that is driving this application. No matter how wrong you may think that conclusion may be, not being punished for advocating (even in a mean, disrespectful and unpleasant way) for an incorrect view is at the heart of academic freedom.
I mean if universities can use human subjects research ethics as an excuse for condemning Boghossian in this situation I see no reason why they couldn’t do the same next time a philosopher talks to a bunch of colleagues at the APA to get a sense of their view on some controversial topic, e.g., the argument that we have a moral obligation to abort the disabled. I happen to be a fan of what Boghossian was trying to do (even f I might quibble with his implementation) but even if you aren’t you should recognize the potential to apply human subjects rules to do an end run around academic freedom guarantees and use their interactions with other academics, attempts to achieve more transparently on racial/gender fairness and other normal aspects of academic life as an excuse to apply them to controversial academics.
For instance, even though it’s a normal practice to get widespread feedback on a philosophical puzzle or argument from colleagues and reference the overall nature of those opinions in subsequent papers one can easily imagine that in the face of a public controversy about a philosopher advancing a a version of the (very philosophically reputable) argument that women have a moral duty to abort a disabled fetus the same excuse might be used. Just gather evidence that they had indicated their intent to poll colleagues about this argument at the conference (say because they planned to write a paper arguing that philosophers are insufficiently responsive to unpopular moral views) and use that to claim it was a systematic investigation of human subjects.
So I was initially aghast at the opinion granting the government a stay in Trump v. Sierra (the emergency funding for the wall case). How could the court have done something so obviously wrong. But then I went and read the briefs and came out with a different view.
However, a key caveat here is that it’s only reasonable if Judge McFadden’s decision decision the House lacked standing to challenge is overturned on appeal. If the Supreme Court upholds that then, precedent or no, they’ve endorsed the position that the president could just start spending money without the fig lead of an excuse and no one could challenge it.
First, the court’s stay wasn’t based on whether or not the expenditure was unlawful (obviously yes IMO) but the court’s conclusion that the plaintiffs probably lacked standing. Personally, I would have voted with Bryer to allow the transfer of money but not the start of construction (thus avoiding harm to both parties) but the fact that they convinced Breyer to at least stay the injunction on the transfer of money suggests there was a pretty good argument for this point of view. And, indeed, after reading the briefs (there is only a super short opinion as it was an order) I came away thinking that this was a plausible outcome.
The most important point here is that the court has a long held rule for prudential standing that the interests of the plaintiffs raising a statutory challenge has to fall within the zone of interests the law was intended to protect. For instance, in Tax Analysts the court denied standing to an oil company seeking to challenge an IRS ruling that gave competitors tax benefits it argued were barred by law. I think it’s a stupid rule (uniform application is always an interest of the legislature).
This puts the plaintiffs in a tough spot since they are obviously not within the zone of interests protected by section 8005 (the law that allows the DoD to transfer money in an emergency) so they argue that it’s a constitutional violation of the spending clause since that means the government is spending money without congressional authorization. However, this is a dubious move as in some sense all government actions in violation of a statute are unconstitutional1. I think the fact that any claim of statutory violation could be turned into a constitutional violation to be a reducto of the supreme court’s precedent but the precedent is what it is. Indeed, there is some pretty explicit precedent in Dalton that seems to establish that when the executive makes a decision in a way that violates some constraint congress placed on that decision it doesn’t thereby become a constitutional violation (in the sense that’s relevant for standing). Specifically, the court held that
Our cases do not support the proposition that every action by the President, or by another executive official, in excess of his statutory authority is ipso facto in violation of the Constitution. On the contrary, we have often distinguished between claims of constitutional violations and claims that an official has acted in excess of his statutory authority. See, e. g., Wheeldin v. Wheeler, 373 U.S. 647, 650-652 (1963) (distinguishing between “rights which may arise under the Fourth Amendment” and “a cause of action for abuse of the [statutory] subpoena power by a federal officer”); Bivens v. Six Unknown Fed. Narcotics Agents, 403 U.S. 388, 396-397 (1971) (distinguishing between “actions contrary to [a] constitutional prohibition,” and those “merely said to be in excess of the authority delegated . . . by the Congress”).
I think this distinction is kinda arbitrary and unreasonably provides the (arguably more important) rights protected by structural features of the constitution less protection than explicitly named rights. The plaintiffs try to distinguish Dalton by suggesting it applies only when the decision is ultimately relegated wholly to the discretion of the president but I think this misreads Dalton2.
The government also argues the constitutional violation would occur when the money is transferred between accounts not when it is spent. This feels too clever by half since the intent of section 8005 is obviously to prevent the expenditure of funds on projects congress disapproves of not to change DoD accounting procedures3.
Finally, even if we accept that the challenge should be considered based on a constitutional violation there is some debate over whether the zone of interests test still applies.
The government argues that it does based on an absurdly strained reading of the phrase “statutorily created” arguing that because the courts of equity are a creation of congress that any cause of action arising out of them are statutorily created. Frankly, that’s absurd (if that was true what function does “statutorily created” have?). But from a structural point of view it’s not implausible to think that for derivative constitutional claims, i.e., constitutional claims that arise because a statutory constraint is violated, that the zone of interests test still applies and that zone of interests is determined by those specified in the statute. Indeed, if one accepts the principle behind the zone of interests tests it seems like it applies just as strongly here (though if you, like me, don’t one would want to limit it’s application).
I’d note that the government’s argument that the transfer of funds here was legal is just absurd. It relies on a technical distinction between the budget item in the DoD and the funding of the very same project via DHS (which congress denied). That’s ridiculous and would let the president fund absolutely anything just by changing the names or agencies under which it was funded.
I mean why can’t the competing business in Tax Analysts just allege that issuing their competitors a refund (after estimated tax payments) based on this interpretation is an expenditure without congressional authorization or just generally rely on the fact that the constitution vests legislative authority with congress to challenge any contrary administrative ruling. ↩
Specifically, in Dalton the president’s only power was to either accept in whole or reject in whole a proposal by a commission on what military bases to close and the plaintiffs alleged the commission’s proposal was crafted in violation of law. I can’t see how the fact that the president ultimately had to approve or reject is relevant to the standing. ↩
To steelman the argument as best I can consider this. Imagine the Trump admin had refused to say on what exact pieces of land it was planning to build the wall on before transfering the money. In that case the plaintiffs could surely not claim injury when the transfer happened (the mere fact that the government might do something isn’t enough) and surely standing can’t turn on what you believe the government plans to do with the money. However, I’d respond that in this case if the defendants would (if they otherwise would have had standing) gain standing when that money was spent (or about to be spent) in a way that injured them. ↩
Everyone talks about social media increasing polarization. I wonder if our ability to pre-screen our romantic partners has something to do with it as well. We can now ensure we don’t ever have to date people we don’t want to.
I don’t understand why all the press about hypersonic missiles has only focused on their risks. Some risks are real but there are also strategic benefits and it irks me that it seems like the media is just reasoning based on their gut level feeling that a new fancy weapon must be bad. I’m sure experts have considered both costs and benefits and I’d love to see them but articles that don’t even stop to refute potential benefits irk me. Much like tech workers who refuse to work on military applications on principal rather than weighing the pros and cons of helping the US acquire that particular tech.
Despite claims that they undermine deterrence it seems to me the exact opposite is true for the major nuclear powers. If anti-ICBM defenses destabilize deterrence it stands to reason tech which can’t be defended against could improve deterrence.
The expense and technical difficulty of hypersonic weapons means that only the major powers will likely be able to build them. So now we get the best of bost worlds in that we can build out full anti-ICBM tech to reduce the danger of attacks from rogue nations like NK (unlikely to be able to afford a massive barrage or a huge number of decoys) without undermining the balance of nuclear deterrence with the other major powers. Indeed, the sheer speed of hypersonic weapons offers the tantalizing possibility of anti-ICBM weapons that could impact during boost phase provided they were stationed nearby (e.g. in SK).
These missiles don’t force decisions about counterattack to be made within the short window before striking since the major powers can still counterstrike with missles housed safely on nuclear subs, hidden in silos in their vast empty fields and scrambled to wait in the air. Using hypersonic weapons as second strike weapons ensures that a relatively small number of nukes scattered on subs, scrambled into the air or placed in a few of our minutemen silos provide an effective MAD style deterrence against great powers.
The fact that hypersonic missiles potentially render aircraft carriers and other capital ships useless isn’t all bad. China inevitably will develop its own aircraft carriers if they remain useful meaning both countries will spend massive amounts of money to remain on par. Far better if we remained on par without the capital ships given that whenever we need to project airpower against distant weaker states (e.g. UN approved bombings etc..) we can use the hypersonic missiles to project power. It potentially harms our strategic position re: russia but it’s not totally obvious to me if it’s a net harm or benefit.
At War The new weapons – which could travel at more than 15 times the speed of sound with terrifying accuracy – threaten to change the nature of warfare. A Mach 14 Waverider glide vehicle, which takes its name from its ability to generate high lift and ride on its own shock waves.
Shouldn't Harvard Believe In Educating Misbehaving Children?
Harvard’s recent decision to rescind it’s offer of admission to Kyle Kashuv really bothers me for a number of reasons. The fact that adolescent boys will egg each other on to do stupid shit shouldn’t surprise anyone. Indeed, any guy who tells you that they are sure they wouldn’t have done something equally offensive (though perhaps not online) at that age in the right circumstances (deliberately being extreme in what was foolishly assumed to be a private context) isn’t telling the truth. The admissions department at Harvard knows this and deliberately chose to put headlines over their supposed goal of educating admitted students. There isn’t any actual evidence this student is racist. Just someone who showed bad judgement like other adolescents. Harvard is willing to admit confessed violent criminals so the idea that this conduct was just too extreme is absurd.
No, he isn’t being sent to prison and his life is surely not ruined because he has to go to state school but it is a serious consequence and even if it wasn’t that just changes the extent of the damage and isn’t a justification for Harvard’s actions. Though, I’ll grant that if Harvard came back around after the controversy died down and offered to let him into the next year’s class that might make for an overall sound response. But I doubt they will do that.
Second, this further contributes to the troubling social narrative that not getting caught using bad words and otherwise signalling a certain kind of social virtue is more important than actually being good to other people. Yes, racist words can be quite hurtful but compare using the n-word in this context to making fun of a socially awkward classmate or even cheating on your significant other. If Harvard wants to condition admission on being a good person how about they start by kicking out students who were mean to their fellow classmates or their significant others. If the worst that kids do in highschool is use racist/sexist/whatever language in a context they believe won’t be seen by anyone likely to be offended that would be an infinitely better world than the one we live in now.
Third, one can reasonably infer that this past conduct surfaced as a result of Kyle’s public political positions. Using someone’s own words to counter their public arguments is certainly justified but the net effect of punishing kids for engaging in political advocacy. The exact opposite of the position that Harvard seemingly advocates. Moreover, one has to wonder if these documents would have come out (and if Harvard would have reacted as it did) if he wasn’t publicly known as the Parkland survivor with a conservative viewpoint. Moreover, the absence of any similar stories about the other contributors to that google doc having their admission to college rescinded suggests that either other schools don’t see things the same way Harvard does or raises questions of selective enforcement based on public visibility.
Fourth, it suggests that Harvard really does see it’s own admissions system as a kind of prize to be doled out for good behavior rather than a scarce resource that is allocated based on perceived benefit. If Harvard was interested in taking the best, brightest and likely future influencers and molding them for the benefit of the country this is the last thing they should do. Yes, make it clear this behavior is bad but then admit the student and mold him into a better person. Rescinding the admission just engenders bitterness and the kind of ugly emotions that led to Trump’s election.
Victims of Monopolies Don't Ask For Anti-Trust Protection
So today brings yet another editorial from the journalism world bemoaning the fact that the internet has rendered traditional journalistic outlets unprofitable. And I’m sympathetic to all the people who planned their lives around this profession and are now struggling. It’s always tough when technological progress renders a bunch of jobs obsolete. And we always see the same calls for governmental protection to protect the existing jobs and businesses. The calls for regulation always have some justification but rarely does it involve this level of absurdity. I mean really? You’re going to blame monopolistic practices by Facebook and Google and ask for an exemption from antitrust laws in the same breadth.
If the problem was really some kind of monopolistic pressure from Google and Facebook I’d expect the demand to be to enforce anti-trust law against these companies? The reason that this isn’t the demand is obvious. Companies in the news business aren’t losing money because they must comply with the whims of monopolistic services. They wouldn’t be doing any better if there were 10 popular social networks and 10 major search engines. They are losing money for the simple reason that there are too many companies producing journalistic content online. The internet reduced the transaction costs to access newspaper articles to nearly zero and as long as dozens or hundreds of papers republish the same content people won’t pay for it.
I mean the complaints in the linked editorial aren’t those of a small business being squeezed by a monopolist. They are those of an industry forced to compete for customers. Neither Google or Facebook threatens these news outlets to give them a cut of their online revenue or use their ad-platforms on pain of not being featured on their sites. Indeed, the complaint here is literally the opposite: Google and Facebook are helping people find whatever news sources they want. The ad revenue Google and Facebook generate is a direct consequence of the economic (one can debate the social value) value they bring in terms of search or social networking.
Now one might worry that there will be a social cost if we cut back on the number of news outlets. That’s another discussion but even if so I’m quite wary of letting the news media suck at the government’s teat. I mean if the news industry sees it’s survival as dependent on anti-trust exemptions that makes it dangerously dependent on the continued good will of the government.
As I’ve said before I don’t actually think there is much to worry about. Eventually, the duplicated effort will be cut out of the news industry and we will see a stronger, better kind of investigative reporting rise from the ashes.
Over the past decade, the news business has endured a bloodbath, with tens of thousands of journalists losing their jobs amid mass layoffs. The irony is, more people than ever are consuming news. There’s never been a greater need for factual reporting, from the White House down to the local school board.
I like the idea of this oped series and I’m glad genetic modification is becoming a more mainstream topic. However, I’m very disappointed that the author took the easy (but usually inaccurate) path of projecting our current fears onto future tech rather than carefully trying to work out the novel new effects good and bad (tho the dystopian predictions never seem to get it right).
Indeed, we can already dismiss some of the core presumptions of the oped as implausible. Like computer tech biotech has economies of scale and continual cost reductions so let’s try not to repeat the mistakes we made worrying about the digital divide rather than what will happen when everyone’s online. Maybe only the rich will get customized babies but once we learn how to perform the procedure the marginal cost will drop very quickly (indeed I’d guess the IVF treatment will be the major cost hurdle but not out of reach of most Americans). An oped that looked into the potential effects of conformity as a result of mass produced genetic packages would have been much more interesting. As would discussion of the potential implications of parents having the option of changing their babies apparent race.
Second, by hypothesis being genetically engineered is a huge benefit to earnings but merely because of employer reaction rather than true talent. But you can’t BOTH claim that’s true, gene modification is the cause of growing caste divides and the public gene enhancement project didn’t raise salaries since either the elites must really have some extra ability or employers are just using gene enhancement as an excuse to hire the children of elites (so it’s not the gene editing that’s driving inequality). Moreover, if private gene editing offers these great economic benefits there should be plenty of financing opportunities along the lines of the education loans that take a fraction of future earnings.
Finally, either the IQ enhancement really works or it doesn’t. If it creates substantial IQ boosts we know based on what we see now that this makes huge differences in people’s ability to do various jobs and tasks. You’re not likely to see a research mathematician or physicist with an IQ below 120 and these careers have pretty objective measures of success. So people would simply be able to go check if all the major new theorems and breakthroughs in the sciences are all from genetically enhanced or not (whether it’s IQ or the result of better motivation).
If so that means society is much better off (richer, more capable more medical tech) even as a result of elites getting these modifications. Also it makes it more implausible prices haven’t dropped. In terms of changes to society the likely effects of turning one Einstein or Feynman (or even Sergey Brin and Larry Page) every 50 years into 10 a year would pretty seismic. On the other hand if you don’t see this actually making a difference in these objectively measurable fields it will eventually start to dawn on people it’s not really working at all.
This is only the most obvious and easiest to think of positive effect. Personally, I’m a big fan of the fact that it could finally bring about an end to traditional racism. The fact that parents can choose a race for their children turns race into a matter of fashion rather than a matter of ancestry. Of course, parents will often want their children to look like them but this mere possibility puts a limit on how bad the discrimination can be since if it’s bad enough you don’t put your kid through it. Moreover, once we start editing the genome I’d be shocked if we didn’t work out pretty quickly how to couple melanin production to some other uncommon nutrient or add a hook which allows it to be suppressed giving people a choice about how to present themselves. Once people can change their skin color for aesthetic effect or for a concert it will fundamentally end traditional racism.
While a homogenous army of tall men with blue eyes and firm handshakes might seem undesirable consider the benefits of a little more homogeneity in looks. Just tweaking people so the bottom 20% of the looks bracket no longer exists (i.e. now looks better) will make a huge difference in people’s welfare and it will encourage people to focus more on things besides looks once everyone has decent looks. There are so many interesting angles for fiction on this subject to cover so why must it all retread the same ground?
A Moral Imperative
Ultimately, I’d argue that we have a moral imperative to make enhancement available as soon as possible. Yes, the intelligence boosts too but the most important reason is all the unnecessary suffering that eliminating predisposition to depression or back trouble or whatever else. After antibiotics I expect that to be the next great human health advance and putting this off because we feel uncomfortable is like denying a child a vaccine because the idea of them getting artificial chemicals injected into them creeps you out.
We aren’t ready to start o humans yet but for us to get there we need to start a focused effort on learning how to manage safe and effective genetic enhancement of lower animals, primates and ultimately humans. Even if you disagree with me on the desirability of this technology you’ve got no choice. It’s inevitable and the question the world needs to answer is whether they prefer it done by third-world doctors in back rooms or safely researched by the world’s best scientists and offered in our best facilities. I don’t plan to have children but if I was and I knew I could give them an advantage by having some illegal gene editing done in some clinic I’d give it a serious thought and there are lots of people who would take it way farther even with the risks (think beauty pageant moms). So let’s get cracking.
DNA tweaks won’t fix our problems. By Ted Chiang Mr. Chiang is an award-winning science fiction writer and the author of “Exhalation.” Editors’ note: This is the first installment in a new series, “Op-Eds From the Future,” in which science fiction authors, futurists, philosophers and scientists write op-eds that they imagine we might read 10, 20 or even 100 years in the future.
Is this right? Only 2 of the democratic candidates for president have come out in favor of carbon taxes? Only Delany seems to have made it a key platform. I’ve never been a big climate change hawk before but, while I’d really love to have many of the social programs the dems are proposing, we’ve got to deal with global warming sometime and, unlike all the other priorities, this one gets much more expensive the longer we wait.
So waiting on global warming means less money in the future to fund the social programs we want and harms that might offset them. A carbon tax now means revenue that we could spend on desired social programs.
Yes, I know other candidates have supported funds for R&D, renewables etc.. but, c’mon, that’s just a gesture. The government doesn’t have the money, absent a huge tax hike in which case just tax carbon, to subsidize renewables enough to make fossil fuels more expensive across the board given their superior energy density and existing infrastructure.
When I see articles like this one I’m puzzled as to why people think it will be such a big deal. For a damn long time we managed without photo or video evidence at all and it’s even easier to fake text than it is to fake photos or videos. Yes, it will take time to get used to it but once people realize that there are videos out there showing absolutely everything they’ll stop believing things just because they saw a video of it.
I mean, I do see that a video has a stronger emotional impact but I don’t see why people won’t adapt.
Last week, Mona Lisa smiled. A big, wide smile, followed by what appeared to be a laugh and the silent mouthing of words that could only be an answer to the mystery that had beguiled her viewers for centuries. A great many people were unnerved.
I believe it’s time we stopped treating the people who dispense your prescriptions as medical professional. We should revoke the discretion given to pharmacists not to fill facially valid scripts (certainly electronic scripts) unless the computer flags a dangerous drug interaction, the pmp flags doctor shopping or the script seems to clearly contain a mistake1. The involvement of the medication dispenser as more than a glorified clerk and pill counter in filling prescriptions is a holdover from the days when the pharmacist functioned as something of a hybrid between a nurse-practitioner and sole clearinghouse for all a patient’s medications.
None of these roles for a pharmacist make sense anymore. Patients now fill prescriptions at whatever pharmacy is most convenient with no guarantee that any one pharmacy chain let alone pharmacist will process all their prescriptions2. Yes, pharmacists can access your other prescriptions via prescription monitoring programs (PMPs) but so can your doctors making your doctors, with their greater information about you, in a better position to check for dangerous interactions. Any advantage possessed by the pharmacist as a result of their narrow focus on drugs combined with the breadth of the drugs they are familiar with has been undercut by software that can automatically flag potentially dangerous interactions.
While having a second set of eyes glance over the prescription is valuable (especially running software that flags interactions with the other prescriptions listed in the patient’s PMP record) pharmacists aren’t the best way to implement such a system3. However, even if inertia means we keep employing the pharmacist in this capacity that doesn’t justify giving they discretion to refuse to fill valid prescriptions absent some indication of outright physician mistake or dangerous drug interaction unknown to them. Given this kind of discretion to pharmacists offers no benefits I can see and imposes substantial costs.
For instance, this discretion frequently ends up with pharmacists refusing to fill prescriptions explicitly because the patient is uninsured patients (happened to my father just this week) and I suspect it happens for more frequently without being explicitly acknowledged. I’ve also seen just how much more difficult this discretion makes it for acquaintances who look poor or non-white to get their prescriptions filled. Furthermore, while not quite as bad as the situation with Plan B some pharmacists judgmentally decide they disapprove of certain kinds of prescriptions, e.g. opiate maintenance therapy, and make it particularly difficult to get such prescriptions filled. One might think pharmacists might at least need a good reason to refuse to fill a prescription but apparently the law says they can do so for any reason at all.
One might think this kind of discretion is necessary to reduce prescription forgery and attempts to circumvent doctor shopping prohibitions. However, the former problem is quickly being rendered obsolete with electronic prescriptions and even when we are talking about paper prescriptions refusing to fill facially valid prescriptions just sends the prescription forger out looking for a pharmacy that doesn’t care or tacitly accepts the practice to make more money. Refusing to fill the prescription covers that pharmacist’s ass or makes them feel good but doesn’t stop the drug seeking patient from filling their script. Likely, a much bigger dent in prescription forgery and related activities would be made if reputable pharmacies filled facially valid scripts after carefully checking IDs but, when suspicious, reached out to contact that patient’s prescribing physicians.
While the drug addicts will always find some pharmacy which will fill a valid script4 the same can’t be said about patients in genuine need of their medications. Poor working parents don’t have the free time or money to drive all over town trying to get their prescription filled and they don’t have the drug abuser’s contacts letting them know where they should go nor the desperate driving need of the addict.
Horribly, despite the fact that exercising this discretion seems to be primarily a harm it appears that pharmacists can refuse to dispense controlled substances for any reason. Though if the patient is disabled (as many chronic pain patients are) this may create a cause of action.
And if when asked the customer, taken as their word, indicates the doctor knew it was unusual in that way they still have to dispense ↩
For instance, when I get a prescription from a doctor I usually just fill it at whatever pharmacy is next door to that doctor so I don’t have to call an additional Lyft. ↩
Have the prescribing physician run the software to flag interactions using the same PMP data the pharmacist would use plus information from the patient’s records. Rather than having pharmacists be the second pair of eyes to look at the prescription require that each prescription also be run past someone with nurse or pharmacist training by the doctor (via an online service if they lack office staff). ↩
Among addicts there are standard percentages of the prescription given in exchange for lending money to spring it from the pharmacy prescription or driving them around to pharmacies to get it filled) ↩