Bignick
New member
This essay is frankly and entirely one-sided. I have no interest in remarks like "On the one hand this may be true but on the other hand that may be true and then again, who knows, maybe everybody is right." I don't like this wishy-washy approach. Better to be flat out wrong and even irritating than to be indecisive and maddeningly bland.
I will state right at the outset that I believe all condemnation of steroid drugs is a terrible mistake. I am so far to the left of even my most liberal friends that I will even defend so-called cheating, not merely the idea that the use of steroids should be made legal. However, this is a side issue for me, and not terribly important. What is important is that I will DEFEND three views:
1. Whether the use of steroids is unhealthful or not, people do not have the right to deprive those who wish to run the risks access to these drugs. Steroid use should be legal and, at the very least, decriminalized.
2. The medical evidence is not clear but the best indicators are that the dangers of steroid use are exaggerated.
3. The argument that steroid users have an unfair competitive advantage over nonusers turns out to be superficial and false.
I lead off right away with the main part - a defense of drug use, regardless of whether or not the use of drugs is safe. Some portions of the discussion are a bit hard going but I think the patient reader will be glad he waded through it all.
Most physicians are very ignorant even of the medical literature that researches steroids, and readers should know that. Most physicians merely pose as experts when they are simply mouthing the orthodox slogans of the profession. Quite simply, this is not a nice thing to do.
Several persons have been very helpful to me in one way or another and I acknowledge their assistance. Foremost, perhaps, is Mark Holowchak, a former philosophy colleague of mine, an outstanding powerlifter and staunch opponent of steroids. I have made liberal use of Mark's ideas as a backdrop for my own. Almost as important as Mark in helping me shape my ideas was Rick Collins, a New York attorney who is probably the most knowledge able lawyer in America on the subject of steroids and the law. Rick maintains a website on which he shares his vast knowledge with whoever wants to know more. Rick kindly read a version of the Gendin/Holowchak debate and offered enlightened commentary. Third, there are at least a half dozen bodybuilding experts who maintain websites on the pharmacology of steroids. Most of these persons are self-taught experts but, for all that, they know more about the medical aspects of steroids and related compounds than 95% of all physicians - and that's a conservative estimate.
II - A SHORT PRELIMINARY
Mark McGuire's admission in the summer of 1998 that he uses androstenedione created an uproar in the press and on TV. More importantly it provided an opportunity for us to think hard about drug use. We should not treat his admission as just one more occasion for a chorus of glib condemnation.
I will consider the two fundamental reasons why the use of performance-enhancing drugs is frowned upon. One reason is that the use of anabolic steroids is harmful to the user: the health risks far outweigh the potential benefits. The other reason is that those who use them gain an unfair advantage over those who don't. The arguments given for these positions are profoundly flawed and I hold that the use of all performance-enhancing drugs should be legal. (As a shorthand expression, I sometimes use the word "steroid" even when I mean to include all performance-enhancing drugs. Performance-enhancing drugs is a mouthful.)
So much that is usually said on the subject is utterly banal and repeated so often that any fourteen-year-old sports fan can trot out the cliches and deliver them with the fluency with which he pledges allegiance to the United States. It is not easy to make headway against a view so well entrenched. In going against the grain I realize I deal with a prejudice that reason alone may not be able to overcome. Moreover, the philosopher's way is not always so direct as one might wish. I will develop analogies and examine presuppositions and concepts that may make impatient readers grow weary. (For example, my distinction between habits and addictions.) Still, I believe patient readers will be rewarded. They will encounter interesting arguments and will never have their intelligence insulted. A final preliminary. I am no respecter of authority. The reader may be surprised at the vehemence of my hostility toward the medical industry. In any case, forewarned is forearmed. I hope the reader will not be "turned off" but actually come to share some of my disdain for those who think of themselves as "our betters".
III -THE PATERNALISTIC OUTLOOK
Before I turn to the claim that the use of steroids is dangerous I must first address the general philosophy that lies behind this worry. This general philosophy goes by the name of "Paternalism" and it is the doctrine that certain groups - typically medical, legal, governmental - have the right or duty to look after the best interests of the general citizenry. The name is taken, obviously, from the term "paternal" which means "fatherly". It is generally conceded, (and I make that concession myself), that parents should look out for their children's best interests. In other words, a father should be paternal. However, we may differ about the age at which children gain "majority" - the right to decide matters for themselves. Most of us hold that this is a sliding matter. Thus, with respect to what books to read, children are their own masters fairly early. Whether to smoke or not requires them to defer to the authority of their parents for a couple more years. What makes the argument for parental control easy is that parents generally love their children. Parental control usually has as its motive the genuine concern of parent for child and is hardly ever motivated by a lust for control or power. Moreover, parents happily relinquish control gradually. Rational, loving parents are pleased to note the progressive maturity of the child. Their aim is to help make the child an autonomous person whose decisions are entirely his own, even though those decisions may be contrary to the personal philosophies of the parents.
Governmental paternalism and medical paternalism are in another boat. First, they are impersonal forces, unlike our parents. They promise to improve our lives but demand complete control over us - control that is never relinquished. Medicine never ceases to remind us how much freer we are from disease, how much longer we live, and even how much taller we are than our great grandparents were. It wants our undying admiration. Government never stops telling us that we are more civilized, freer from censorship, our economy is stronger, and we are better in this way and better in that way. It, too, does all it can to ensure us that its heart is pure. The truth, however, is that paternalism, whether in medicine or government, is never benign. It can never escape the suspicion that more is wanted than just the good of those over whom it exercises power. Even when he starts out with the best intentions the paternalist eventually goes astray. Thus, the celebrated remark of the great nineteenth century philosopher and political theorist, Lord Acton:
"Power tends to corrupt and absolute power corrupts absolutely."
In a telecast in March 1999, Henry Kissinger called power a sweet addiction. Each of us has borne witness to this insight hundreds of times. People campaign for public office on a promise of limited terms in Congress but eventually surrender to the joys of power and remain in office until carried off to senior retirement communities - still barking orders at nurses' aides.
James Madison, the father of our Constitution, wrote in THE FEDERALIST, number 63, that attention to the judgment of others is important because, independently of its merits, any government plan must have the appearance of being wise and honorable. Indeed, appearance may be more important than merits. When Ramsey Clark was appointed Attorney General of the U.S. his father, Tom Clark, resigned from the Supreme Court. That Tom Clark could have continued to do his job admirably without prejudice is something I strongly believe. Unfortunately, that too many others would have been suspicious is even more certain. Thus Tom Clark did the right thing.
A good leader does not impose his will on his subjects but leads them by reason. He shows them respect and, in turn, they willingly agree to his recommendations, or they reject those recommendations. It doesn't matter. The leader's role is to be wise, not to be forceful. A good leader understands that the people may be wrong to reject his proposals but he understands, too, that they have that right. Paternalists fail to understand this basic principle of democracy. They are compulsively driven to make sure their subjects (or patients) do the right thing.
I believe in liberty. Indeed, I am passionate about it. Supreme Court Justice Oliver Wendell Holmes once said the freedom of speech he wants to preserve is the freedom to say what the rest of us find hateful. Similarly, I believe that the liberty to do only what is safe and good is no liberty at all. This does not mean that anything goes. I believe in free speech but not calumny. I even believe in the right to suicide but not the right to throw yourself off the roof of a high building, possibly killing others and, in any case, surely making a terrible mess. For reasons I will give later, I believe in the banning of heroin and cocaine but not marijuana or steroids.
This nation was founded upon the importance of individual liberties. Today we look back on our history with some shame when we contemplate how long it took for black persons to have their chains removed. We look back with shame on how long it took to realize that depriving women of the right to vote was not merely depriving them of a civil right but treating them as less than human. In all corners of life we find, if only we look hard enough and with an open mind, other groups that are not taken seriously. Not all of these, of course, have the importance of those I have just mentioned, but a minority doesn't lose significance because it is of small size or because its civil right is not a matter of life or death. Indeed, precisely because a minority is very small and its problems not earth-shattering, it may expect neglect and even derision.
One such minority is the anabolic steroid-using community. Possibly numbering one hundred thousand persons, possibly more but probably fewer, we don't take it seriously. Battered by public opinion, steroid users are not visible as are blacks and women. Treated simply as cheaters and fools they exist as an underclass whose exact numbers no one can ascertain. The best they hope for is to find ways to circumvent the rules without being caught and it hardly occurs to them to lobby for revision of laws. I regard this as a great pity and an injustice.
In 1859 the English philosopher, John Stuart Mill, published his brief essay, ON LIBERTY. To this day it remains the very model of good sense on what the purpose of government should be. Early in his essay, Mill writes a paragraph that has been deservedly reprinted hundreds of times. It goes approximately as follows:
The object of this essay is to assert that the sole end for which mankind is warranted in interfering with the liberty of action of any their number is self-protection. Power may be rightfully exercised over a person, against his will, only to prevent harm to others. His own good, physical or moral, is not a sufficient warrant. Over matters concerning only himself, every person is sovereign.
In the body of the essay Mill argues for two things.
(A) He offers reasons for believing that normal persons are the best judges of their own best interests. He shows that those who set themselves up as our paternalistic benefactors are neither virtuous enough nor smart enough to be entrusted with the responsibilities they so eagerly assume. He offers sensible and powerful reasons for thinking society is better off as a whole by permitting its members to run their own lives.
(B) Mill also argues that liberty is a good thing in itself, regardless of its effects. I recall that some years ago there was a television commercial in which someone said, "Mother, I'd rather do it myself". It was said with some exasperation, the implication being that the person would rather do it her way even at the cost of blundering than have her mother do the task for her and get it right. It is a feeling all of us have experienced. Even when you are willing to have a job done for you, it is YOU who does the relinquishing of control. You do not want it snapped up from you. Others should help you only when you have consented to their help. What is especially precious is the liberty not to have to conform to the values of others. So long as each of us, in the course of going our own way, is no wrongful hindrance to others going their own ways, no one may rightfully bend us to his will. What makes a true democracy great is not the simple right of each of us to participate in the political process but to have certain of our rights immune to the political process. We now understand better than our ancestors did that we may vote on whether to build a certain road but we cannot rightfully vote one way or the other on whether to enslave certain people to build that road. Democracy is two-pronged: the right to equal participation in decision-making processes and the right to be immune from certain decision-making processes. What we must do is apply this democratic principle thoroughly and consistently. That is not so easy as we could wish.
Paternalists think that Mill's presumption that people generally know what is best for them is just plain false. They say that the average adult admits his dependency, even his inferiority, to physicians. In a thousand ways we are bombarded every day with messages that remind us of our inability to think for ourselves. A certain product is ballyhooed on television and finishes with the warning: "Only your doctor can say whether X is right for you." even when using or not using the product is just a matter of simple common sense. We think about changing to a new toothbrush and are advised to "Check with your dentist first." yet no dentist would ever admit he has not the slightest training in the "field" of toothbrushes. Physicians prefer to substitute "Tylenol" for "acetaminophen" and "Motrin" and "Advil" for "Ibuprofen" when they instruct their patients. They use the word "Metamucil" for every brand of psyllium fiber. Unfortunately, we do tend to accept this diminishment of our understanding unquestioningly. We take for granted that a dermatologist has expertise in shampoos and unembarrassedly tell our friends: "My dermatologist recommends Head and Shoulders over Inositol." An honest dermatologist would send you to a hairdresser, who has hundreds of times more experience. He would confess not one word was spoken about shampoos in his six years of medical training.
Unhappily, people do thrive on authoritarianism. We do not bristle when we hear someone say he is doing such and such "on doctor's orders". Comfortably, we say "My doctor insists that I must..." rather than "My physician advises me to..." All this is WRONG! We are not children. We should not abdicate the right to be in charge of our lives, however foolishly we lead them (and we probably won't). Let us agree never to use such cliches again as:
"You don't have to be a brain surgeon to know that..."
or
"You don't have to be a rocket scientist to know that..."
These slogans only reinforce the built-in arrogance that is part and parcel of these professions. Except for their specialized knowledge of brain surgery or rockets these people have no claims to being gurus. I was appalled when I read a letter in the New York Times that went something like this:
"As a cardiologist with more than twenty years experience, I am utterly baffled about American policy in Bosnia."
He went on to say why he was baffled. Most of us would read this without a second thought. Surely if we had read the following we would have been startled:
"As a master plumber with more than twenty years experience in sewer lines, I am utterly baffled about American policy in Bosnia."
So thoroughly brainwashed are we, that we can be amused or startled by the second while being oblivious of the arrogance of the first.
Our awe of persons with "advanced" degrees is misplaced. Awe should be reserved for God. Look, I have a doctorate degree in philosophy. I have been studying philosophy for forty-eight years - longer than most physicians have been alive. I am not being unduly modest when I say there is not much I know. I know something about a small specialty called philosophy of law, but not so much as you might think. What I have learned is how to think critically; I know how to retrieve information and utilize it. Intelligence is not a matter of having accumulated a vast storehouse of information. The same is true of lawyers, medical practitioners and rocket scientists. But what absolutely nobody knows is how other people ought to live their lives. If I want to know how to blow up a bank I may consult a demolitions expert but I wouldn't ask him whether I should do it. I am depressed when I see a TV show on abortion which has a dialogue between a woman who had an abortion and a physician. Why the physician? After all, the abortion issue is a moral problem, not a technical know-how question. The physician is merely like the demolitions expert. He knows the "how", not the "whether". He may know the physical risks but beyond that he has nothing to contribute over and above what the master plumber with twenty years experience in sewers can contribute to the abortion issue. It is paternalism rearing its ugly head. When it comes to steroids, paternalists have found a cause that makes them exceedingly self-righteous. Consider the following example.
The American Academy of Orthopedic Surgeons released a "Position Statement". After grudgingly conceding that steroids can be useful it said "their use can cause serious harmful physiological, pathological, and psychological effects". What's that? Psychological effects? Was that discovered in the course of fusing two spinal discs together? The Academy Position Statement continued: "When feasible, the relevant sports medicine bodies should implement aggressive drug testing programs to detect their use and impose harsh penalties..." Harsh, did I hear? Did the Academy send its members to a law symposium where legal theorists debated sentencing hypotheses and did these orthopedists then come back fully "expertised"? Why should we think that because the orthopedist knows the dangers of steroids (if he does) he also knows what penalties to impose for their use? Consider the following imaginary Position Statement by the Association of Master Plumbers:
"It has come to our attention that America's sewers are being contaminated. Among the dangers are...[A list is given.] We believe in very harsh punishment for the offenders. As master plumbers we believe fifteen years of hard labor is more appropriate than the currently imposed schedule of fines."
Ridiculous, is it not? We hardly notice the analogous nonsense of the orthopedists.
Paternalism is rooted in the desire for control and power. It is fueled by the belief that ordinary people don't know what is best for them and it zealously promotes only what is puritanical. The paternalists always want to preserve ultra-conservative ideals.
Paternalists are most comfortable treating us like children. If we submit meekly in one area we develop an inclination to submit in others. If you accept your state legislature's demanding that you wear seat belts it will be easy for the legislature to move on to shoulder harnesses. Later come crash helmets and eventually fire repellent asbestos suits. Actually, none of these strikes me as a bad idea but there is a much better way: give advice, not orders; try to persuade, not to demand; live and let live.
I will state right at the outset that I believe all condemnation of steroid drugs is a terrible mistake. I am so far to the left of even my most liberal friends that I will even defend so-called cheating, not merely the idea that the use of steroids should be made legal. However, this is a side issue for me, and not terribly important. What is important is that I will DEFEND three views:
1. Whether the use of steroids is unhealthful or not, people do not have the right to deprive those who wish to run the risks access to these drugs. Steroid use should be legal and, at the very least, decriminalized.
2. The medical evidence is not clear but the best indicators are that the dangers of steroid use are exaggerated.
3. The argument that steroid users have an unfair competitive advantage over nonusers turns out to be superficial and false.
I lead off right away with the main part - a defense of drug use, regardless of whether or not the use of drugs is safe. Some portions of the discussion are a bit hard going but I think the patient reader will be glad he waded through it all.
Most physicians are very ignorant even of the medical literature that researches steroids, and readers should know that. Most physicians merely pose as experts when they are simply mouthing the orthodox slogans of the profession. Quite simply, this is not a nice thing to do.
Several persons have been very helpful to me in one way or another and I acknowledge their assistance. Foremost, perhaps, is Mark Holowchak, a former philosophy colleague of mine, an outstanding powerlifter and staunch opponent of steroids. I have made liberal use of Mark's ideas as a backdrop for my own. Almost as important as Mark in helping me shape my ideas was Rick Collins, a New York attorney who is probably the most knowledge able lawyer in America on the subject of steroids and the law. Rick maintains a website on which he shares his vast knowledge with whoever wants to know more. Rick kindly read a version of the Gendin/Holowchak debate and offered enlightened commentary. Third, there are at least a half dozen bodybuilding experts who maintain websites on the pharmacology of steroids. Most of these persons are self-taught experts but, for all that, they know more about the medical aspects of steroids and related compounds than 95% of all physicians - and that's a conservative estimate.
II - A SHORT PRELIMINARY
Mark McGuire's admission in the summer of 1998 that he uses androstenedione created an uproar in the press and on TV. More importantly it provided an opportunity for us to think hard about drug use. We should not treat his admission as just one more occasion for a chorus of glib condemnation.
I will consider the two fundamental reasons why the use of performance-enhancing drugs is frowned upon. One reason is that the use of anabolic steroids is harmful to the user: the health risks far outweigh the potential benefits. The other reason is that those who use them gain an unfair advantage over those who don't. The arguments given for these positions are profoundly flawed and I hold that the use of all performance-enhancing drugs should be legal. (As a shorthand expression, I sometimes use the word "steroid" even when I mean to include all performance-enhancing drugs. Performance-enhancing drugs is a mouthful.)
So much that is usually said on the subject is utterly banal and repeated so often that any fourteen-year-old sports fan can trot out the cliches and deliver them with the fluency with which he pledges allegiance to the United States. It is not easy to make headway against a view so well entrenched. In going against the grain I realize I deal with a prejudice that reason alone may not be able to overcome. Moreover, the philosopher's way is not always so direct as one might wish. I will develop analogies and examine presuppositions and concepts that may make impatient readers grow weary. (For example, my distinction between habits and addictions.) Still, I believe patient readers will be rewarded. They will encounter interesting arguments and will never have their intelligence insulted. A final preliminary. I am no respecter of authority. The reader may be surprised at the vehemence of my hostility toward the medical industry. In any case, forewarned is forearmed. I hope the reader will not be "turned off" but actually come to share some of my disdain for those who think of themselves as "our betters".
III -THE PATERNALISTIC OUTLOOK
Before I turn to the claim that the use of steroids is dangerous I must first address the general philosophy that lies behind this worry. This general philosophy goes by the name of "Paternalism" and it is the doctrine that certain groups - typically medical, legal, governmental - have the right or duty to look after the best interests of the general citizenry. The name is taken, obviously, from the term "paternal" which means "fatherly". It is generally conceded, (and I make that concession myself), that parents should look out for their children's best interests. In other words, a father should be paternal. However, we may differ about the age at which children gain "majority" - the right to decide matters for themselves. Most of us hold that this is a sliding matter. Thus, with respect to what books to read, children are their own masters fairly early. Whether to smoke or not requires them to defer to the authority of their parents for a couple more years. What makes the argument for parental control easy is that parents generally love their children. Parental control usually has as its motive the genuine concern of parent for child and is hardly ever motivated by a lust for control or power. Moreover, parents happily relinquish control gradually. Rational, loving parents are pleased to note the progressive maturity of the child. Their aim is to help make the child an autonomous person whose decisions are entirely his own, even though those decisions may be contrary to the personal philosophies of the parents.
Governmental paternalism and medical paternalism are in another boat. First, they are impersonal forces, unlike our parents. They promise to improve our lives but demand complete control over us - control that is never relinquished. Medicine never ceases to remind us how much freer we are from disease, how much longer we live, and even how much taller we are than our great grandparents were. It wants our undying admiration. Government never stops telling us that we are more civilized, freer from censorship, our economy is stronger, and we are better in this way and better in that way. It, too, does all it can to ensure us that its heart is pure. The truth, however, is that paternalism, whether in medicine or government, is never benign. It can never escape the suspicion that more is wanted than just the good of those over whom it exercises power. Even when he starts out with the best intentions the paternalist eventually goes astray. Thus, the celebrated remark of the great nineteenth century philosopher and political theorist, Lord Acton:
"Power tends to corrupt and absolute power corrupts absolutely."
In a telecast in March 1999, Henry Kissinger called power a sweet addiction. Each of us has borne witness to this insight hundreds of times. People campaign for public office on a promise of limited terms in Congress but eventually surrender to the joys of power and remain in office until carried off to senior retirement communities - still barking orders at nurses' aides.
James Madison, the father of our Constitution, wrote in THE FEDERALIST, number 63, that attention to the judgment of others is important because, independently of its merits, any government plan must have the appearance of being wise and honorable. Indeed, appearance may be more important than merits. When Ramsey Clark was appointed Attorney General of the U.S. his father, Tom Clark, resigned from the Supreme Court. That Tom Clark could have continued to do his job admirably without prejudice is something I strongly believe. Unfortunately, that too many others would have been suspicious is even more certain. Thus Tom Clark did the right thing.
A good leader does not impose his will on his subjects but leads them by reason. He shows them respect and, in turn, they willingly agree to his recommendations, or they reject those recommendations. It doesn't matter. The leader's role is to be wise, not to be forceful. A good leader understands that the people may be wrong to reject his proposals but he understands, too, that they have that right. Paternalists fail to understand this basic principle of democracy. They are compulsively driven to make sure their subjects (or patients) do the right thing.
I believe in liberty. Indeed, I am passionate about it. Supreme Court Justice Oliver Wendell Holmes once said the freedom of speech he wants to preserve is the freedom to say what the rest of us find hateful. Similarly, I believe that the liberty to do only what is safe and good is no liberty at all. This does not mean that anything goes. I believe in free speech but not calumny. I even believe in the right to suicide but not the right to throw yourself off the roof of a high building, possibly killing others and, in any case, surely making a terrible mess. For reasons I will give later, I believe in the banning of heroin and cocaine but not marijuana or steroids.
This nation was founded upon the importance of individual liberties. Today we look back on our history with some shame when we contemplate how long it took for black persons to have their chains removed. We look back with shame on how long it took to realize that depriving women of the right to vote was not merely depriving them of a civil right but treating them as less than human. In all corners of life we find, if only we look hard enough and with an open mind, other groups that are not taken seriously. Not all of these, of course, have the importance of those I have just mentioned, but a minority doesn't lose significance because it is of small size or because its civil right is not a matter of life or death. Indeed, precisely because a minority is very small and its problems not earth-shattering, it may expect neglect and even derision.
One such minority is the anabolic steroid-using community. Possibly numbering one hundred thousand persons, possibly more but probably fewer, we don't take it seriously. Battered by public opinion, steroid users are not visible as are blacks and women. Treated simply as cheaters and fools they exist as an underclass whose exact numbers no one can ascertain. The best they hope for is to find ways to circumvent the rules without being caught and it hardly occurs to them to lobby for revision of laws. I regard this as a great pity and an injustice.
In 1859 the English philosopher, John Stuart Mill, published his brief essay, ON LIBERTY. To this day it remains the very model of good sense on what the purpose of government should be. Early in his essay, Mill writes a paragraph that has been deservedly reprinted hundreds of times. It goes approximately as follows:
The object of this essay is to assert that the sole end for which mankind is warranted in interfering with the liberty of action of any their number is self-protection. Power may be rightfully exercised over a person, against his will, only to prevent harm to others. His own good, physical or moral, is not a sufficient warrant. Over matters concerning only himself, every person is sovereign.
In the body of the essay Mill argues for two things.
(A) He offers reasons for believing that normal persons are the best judges of their own best interests. He shows that those who set themselves up as our paternalistic benefactors are neither virtuous enough nor smart enough to be entrusted with the responsibilities they so eagerly assume. He offers sensible and powerful reasons for thinking society is better off as a whole by permitting its members to run their own lives.
(B) Mill also argues that liberty is a good thing in itself, regardless of its effects. I recall that some years ago there was a television commercial in which someone said, "Mother, I'd rather do it myself". It was said with some exasperation, the implication being that the person would rather do it her way even at the cost of blundering than have her mother do the task for her and get it right. It is a feeling all of us have experienced. Even when you are willing to have a job done for you, it is YOU who does the relinquishing of control. You do not want it snapped up from you. Others should help you only when you have consented to their help. What is especially precious is the liberty not to have to conform to the values of others. So long as each of us, in the course of going our own way, is no wrongful hindrance to others going their own ways, no one may rightfully bend us to his will. What makes a true democracy great is not the simple right of each of us to participate in the political process but to have certain of our rights immune to the political process. We now understand better than our ancestors did that we may vote on whether to build a certain road but we cannot rightfully vote one way or the other on whether to enslave certain people to build that road. Democracy is two-pronged: the right to equal participation in decision-making processes and the right to be immune from certain decision-making processes. What we must do is apply this democratic principle thoroughly and consistently. That is not so easy as we could wish.
Paternalists think that Mill's presumption that people generally know what is best for them is just plain false. They say that the average adult admits his dependency, even his inferiority, to physicians. In a thousand ways we are bombarded every day with messages that remind us of our inability to think for ourselves. A certain product is ballyhooed on television and finishes with the warning: "Only your doctor can say whether X is right for you." even when using or not using the product is just a matter of simple common sense. We think about changing to a new toothbrush and are advised to "Check with your dentist first." yet no dentist would ever admit he has not the slightest training in the "field" of toothbrushes. Physicians prefer to substitute "Tylenol" for "acetaminophen" and "Motrin" and "Advil" for "Ibuprofen" when they instruct their patients. They use the word "Metamucil" for every brand of psyllium fiber. Unfortunately, we do tend to accept this diminishment of our understanding unquestioningly. We take for granted that a dermatologist has expertise in shampoos and unembarrassedly tell our friends: "My dermatologist recommends Head and Shoulders over Inositol." An honest dermatologist would send you to a hairdresser, who has hundreds of times more experience. He would confess not one word was spoken about shampoos in his six years of medical training.
Unhappily, people do thrive on authoritarianism. We do not bristle when we hear someone say he is doing such and such "on doctor's orders". Comfortably, we say "My doctor insists that I must..." rather than "My physician advises me to..." All this is WRONG! We are not children. We should not abdicate the right to be in charge of our lives, however foolishly we lead them (and we probably won't). Let us agree never to use such cliches again as:
"You don't have to be a brain surgeon to know that..."
or
"You don't have to be a rocket scientist to know that..."
These slogans only reinforce the built-in arrogance that is part and parcel of these professions. Except for their specialized knowledge of brain surgery or rockets these people have no claims to being gurus. I was appalled when I read a letter in the New York Times that went something like this:
"As a cardiologist with more than twenty years experience, I am utterly baffled about American policy in Bosnia."
He went on to say why he was baffled. Most of us would read this without a second thought. Surely if we had read the following we would have been startled:
"As a master plumber with more than twenty years experience in sewer lines, I am utterly baffled about American policy in Bosnia."
So thoroughly brainwashed are we, that we can be amused or startled by the second while being oblivious of the arrogance of the first.
Our awe of persons with "advanced" degrees is misplaced. Awe should be reserved for God. Look, I have a doctorate degree in philosophy. I have been studying philosophy for forty-eight years - longer than most physicians have been alive. I am not being unduly modest when I say there is not much I know. I know something about a small specialty called philosophy of law, but not so much as you might think. What I have learned is how to think critically; I know how to retrieve information and utilize it. Intelligence is not a matter of having accumulated a vast storehouse of information. The same is true of lawyers, medical practitioners and rocket scientists. But what absolutely nobody knows is how other people ought to live their lives. If I want to know how to blow up a bank I may consult a demolitions expert but I wouldn't ask him whether I should do it. I am depressed when I see a TV show on abortion which has a dialogue between a woman who had an abortion and a physician. Why the physician? After all, the abortion issue is a moral problem, not a technical know-how question. The physician is merely like the demolitions expert. He knows the "how", not the "whether". He may know the physical risks but beyond that he has nothing to contribute over and above what the master plumber with twenty years experience in sewers can contribute to the abortion issue. It is paternalism rearing its ugly head. When it comes to steroids, paternalists have found a cause that makes them exceedingly self-righteous. Consider the following example.
The American Academy of Orthopedic Surgeons released a "Position Statement". After grudgingly conceding that steroids can be useful it said "their use can cause serious harmful physiological, pathological, and psychological effects". What's that? Psychological effects? Was that discovered in the course of fusing two spinal discs together? The Academy Position Statement continued: "When feasible, the relevant sports medicine bodies should implement aggressive drug testing programs to detect their use and impose harsh penalties..." Harsh, did I hear? Did the Academy send its members to a law symposium where legal theorists debated sentencing hypotheses and did these orthopedists then come back fully "expertised"? Why should we think that because the orthopedist knows the dangers of steroids (if he does) he also knows what penalties to impose for their use? Consider the following imaginary Position Statement by the Association of Master Plumbers:
"It has come to our attention that America's sewers are being contaminated. Among the dangers are...[A list is given.] We believe in very harsh punishment for the offenders. As master plumbers we believe fifteen years of hard labor is more appropriate than the currently imposed schedule of fines."
Ridiculous, is it not? We hardly notice the analogous nonsense of the orthopedists.
Paternalism is rooted in the desire for control and power. It is fueled by the belief that ordinary people don't know what is best for them and it zealously promotes only what is puritanical. The paternalists always want to preserve ultra-conservative ideals.
Paternalists are most comfortable treating us like children. If we submit meekly in one area we develop an inclination to submit in others. If you accept your state legislature's demanding that you wear seat belts it will be easy for the legislature to move on to shoulder harnesses. Later come crash helmets and eventually fire repellent asbestos suits. Actually, none of these strikes me as a bad idea but there is a much better way: give advice, not orders; try to persuade, not to demand; live and let live.
