Opinion The scientization of public policy and politics: A new approach to conceptualizing and identifying the phenomenon, 2023, Roberts

[Dolphin]

This sounds like it's annoying but I suppose it's possible there are other interpretations?

Source: Politics & Policy Preprint Date: August 19, 2023
URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/polp.12548

The scientization of public policy and politics: A new approach to conceptualizing and identifying the phenomenon
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Alex N. Roberts

Abstract

We know that deep scientization (DS)—the misrepresentation of political issues as technical/scientific ones best handled by experts — can unduly limit public deliberation and lead to policy misdesign.

Yet, tools for investigating DS remain lacking.

This article develops a new approach to diagnosing DS that works by identifying where experts have used their discretion to construct policy claims that contravene existing, shared epistemic standards.

This approach's value is demonstrated through a case study of U.S. chronic fatigue syndrome (CFS) policy.

The study shows that, whereas government experts originally developed CFS as a research construct, they have since used their discretionary power to recast CFS as a serious disease requiring new policy interventions.

This epistemically unjustified transformation of CFS has limited public discussion of important value-laden policy questions and arguably yielded poor policy outcomes.

The approach developed here can also be used to uncover DS in other policy areas.

 

[Ash]

I’d like to read the whole paper. But failing that who is this person what’s their background do you know?
I think I remember some of the other papers listed underneath by title but not more.

 

[Hoopoe]

I wonder how the author determined that scientization, and not research, is the reason CFS is now seen as serious disease.

To be honest the abstract makes him look like one of those people who read something about CFS decades ago, decided it was nonsense, and have not mande any effort to read more about it since then

 

[Ash]

Yeah

 

[EndME]

Is part two going to be "scientization of public policy and politics: How people that practised research wanted to make us believe that the earth is round and how this technical/scientific misrepresentation of a political topic wanted to create incentives for us to sail around it"?

 

[Andy]

By the same author, The biopsychosocial model: Its use and abuse 2023 Roberts

 

[cfsandmore]

Is this a historical paper?

 

[SNT Gatchaman]

Drawing on a wide range of policy and medical documents, I find that “CFS” appears to have served as a vehicle for DS [Deep Scientization]. “CFS” was originally created as a research construct by the CDC in 1988. It has since been misrepresented as a disease through repeated misuses of techno-scientific discretion. In the process, important unresolved political questions—for example, should we invest public resources in “CFS” research and drug development? Should “CFS” be a basis for public assistance?—have been given what appear to be pseudo-scientific answers and thereby removed from the public sphere.

In the domain of health care, there are two important epistemic standards (or rules) that govern the use of illness constructs, which will be the focus of this article's case study. The first rule is that an illness construct—for example, “fibromyalgia”— should not be treated as an objectively existing disease unless it has been validated by some unique biological finding, such as a disease cause or mechanism, that identifies the candidate disease and distinguishes it from other illnesses. Without such a rule, potentially anything could be medicalized and turned into “a disease.” The second rule is: causal statements must refer to identifiable entities. That is, if it is argued that “Disease X causes joint pain,” then there should be some known biological agent or process that could be substituted for the term “Disease X” to make the statement a (potentially) legitimate causal explanation. Without this rule, medicine would risk becoming a mystical enterprise and would cease being an empirical science.

The Institute of Medicine has called CFS “a serious, chronic, complex, and systemic disease that frequently and dramatically limits the activities of affected patients,” adding “It is ‘real’”. According to CDC researchers, “CFS” causes at least $37 billion in economic losses annually.

Given these developments, one would expect that it had actually been demonstrated that there is a serious disease called “CFS.” Yet, this is not the case. As the CDC (2019) and Institute of Medicine (2015) themselves have acknowledged, no characteristic biological abnormalities in patients meeting the diagnostic criteria for “CFS” have been identified. Moreover, substantially different definitions of “CFS” are currently proposed and in use (FDA, 2014; Institute of Medicine, 2015), meaning researchers have not even agreed on what “CFS” is. Thus, the premise of current “CFS” policy—namely, that “CFS” is a disease that causes serious societal damage— cannot possibly be based on medical inferences.

Drawing on the concepts developed above, I argue in this section that the claims made about “CFS” are largely products of ontological confusion. Various policy and medical actors have used their techno-scientific discretion to construct a disease called “CFS” as a means of legitimizing favored policies and courses of action.

 

[SNT Gatchaman]

We can better understand the nature of “CFS” if we appreciate the context in which it emerged. During the early 1980s, physicians in several U.S. states began receiving patients complaining of severe fatigue and other problems. The apparent new illness was mysterious. Patients reported unusually diverse combinations of problems, including different levels of tiredness, migraine, heart palpitations, sensitivity to light, new allergies, inebriation after consuming a few sips of wine, and many other problems.

And so, in 1988, the CDC published “Chronic Fatigue Syndrome: A Working Case Definition” in the Annals of Internal Medicine. The CDC's article notes the disconfirmation of an EBV connection. Hence, it proposes the new label “chronic fatigue syndrome.”

The authors are quite clear about what “CFS” is not. They acknowledge the “remarkable absence of objective physical or laboratory abnormalities in patients and the variable, “nonspecific” nature of their symptoms. Thus, the authors emphasize that “CFS” should not be regarded as a disease. Rather, “CFS” was developed as a construct, “an operational concept designed for research purposes”. [...] Thus, “CFS” began as a research construct the CDC created in response to a Congressional mandate. How, then, did it come to be seen as a disease? Partly, the answer is that the CDC used its techno- scientific discretion to imply that “CFS” is a disease, even as it explicitly denied this view.

However, as noted above, current “CFS” policy is based on the explicit premise that “CFS” is a serious disease causing billions in economic damage annually. How has that image of “CFS” been constructed? Part of the answer is that medical researchers have extended the CDC's discretion-based transformation of “CFS.” They have used the self-sufficient and opaque nature of the case definition to impute to “CFS” an even more naturalistic origin, such that it is now openly called “a disease”— despite the absence of evidence to support that claim.

 

[SNT Gatchaman]

The reification of “CFS” as a disease has also obscured another important policy question: Should “CFS” be a basis for disability benefit coverage? From one point of view, the answer is clearly no. “CFS” is not a validated disease diagnosable with objective evidence, which are criteria for benefit eligibility

That said, unless we assume that “CFS” patients are malingering— a hypothesis for which I have seen no evidence—then it might well make sense to grant them benefits on practical/humanitarian grounds. However, the appropriate way to do that would arguably be by establishing a policy for dealing with all symptoms like “CFS,” and not by declaring “CFS” per se eligible by fiat.

 

[SNT Gatchaman]

It might be tempting to assume that all of these developments are good for patients, even if they are not epistemically justified. Is it not helpful to treat “CFS” as a disease if it brings attention and support to patients? Not necessarily. While being supportive is good, proceeding from the unsubstantiated premise that fatigued patients have a disease called “CFS” may well be counterproductive. The misrepresentation of “CFS” as a validated disease might have harmed patients.

The whole point of creating the “CFS” construct, recall, was to help researchers home in on the actual causes of patients' symptoms, such that they could be understood and treated. For “CFS” to play this role, the CDC emphasized, the construct would have to be continually revised in light of emerging empirical findings, or perhaps rejected as invalid. Yet, the “CFS” construct has been revised relatively minimally over time in light of its weak empirical support. It is difficult to see how the reification of “CFS” as a disease could not have contributed to this inertia.

Meanwhile, the reification of the “CFS” construct as an organic disease may well have diverted research and treatment from more fruitful paths. For example, from the earliest CDC surveys on, researchers have observed that many “CFS” patients also meet criteria for depression and other psychiatric disorders (and vice versa). This has led to an ongoing preoccupation with developing “more precise” diagnostic criteria for “CFS,” to help “provide adequate treatment for these patients as well as to prevent erroneously labeling them as having a psychiatric condition” (Institute of Medicine, 2015, p. 183). But why is “CFS” not depression or some other psychiatric malady?

It is accepted that psychiatric disorders can manifest in both mental and bodily symptoms. “CFS” patients exhibit these symptoms. Psychological treatments have also been shown to help “CFS” patients (Klineberg et al., 2014). Why, then, should psychiatric diagnoses be ruled out a priori?

 

[SNT Gatchaman]

Alex N. Roberts is an incoming Assistant Professor of Political Science at the University of South Dakota in the United States. His research focuses on the mechanisms of scientization and medicalization. His work has appeared in Public Performance and Management Review and Medicine, Health Care and Philosophy and is forthcoming in The Journal of Medicine and Philosophy.

Unsurprisingly, I can't find any biological papers in the references list from the last 10 years.

 

[Hoopoe]

You see, he's only trying to discredit the illness to help patients and is really concerned about their mental health.

(sarcasm)

 

[Charles B.]

This guy is a visiting Professor at a nondescript school. I wouldn’t put too much stock into his recycling of CFS = depression ramblings

 

[boolybooly]

the reification of the “CFS” construct as an organic disease may well have diverted research and treatment from more fruitful paths ... why is “CFS” not depression or some other psychiatric malady? ... It is accepted that psychiatric disorders can manifest in both mental and bodily symptoms. “CFS” patients exhibit these symptoms. Psychological treatments have also been shown to help “CFS” patients (Klineberg et al., 2014). Why, then, should psychiatric diagnoses be ruled out a priori?

Why does he complain about reification of CFS and diversity of criteria, then proceed to reify CFS himself and then attribute it to psychiatric condition based on symptoms?

That seems hypocritical and lacks intellectual consistency. The author seems unaware of the history of harms which have been done to ME CFS patients by treating them as if they had a psychiatric condition.

Which psychological treatments is he talking about?

Is this the Klineberg ref?
https://pubmed.ncbi.nlm.nih.gov/24944088/
"Adolescent chronic fatigue syndrome and somatoform disorders: a prospective clinical study."

Conclusions: Improvement in adolescent physical and psychosocial functioning over time suggests that a multidisciplinary treatment model may be effective for varied complex medico-psychosocial presentations, irrespective of diagnosis and illness precipitant. Illness precipitant may have a greater influence on treatment outcome than diagnostic category.

If so it is thoroughly biased by BPS assumption.

I feel what I have read of this "analysis" does not make a useful point and is just more typical handwavey BPS "beelzebub's tales to his grandson", chasing its tail in ever decreasing circles and trying to sell the reader on believing in psychiatric explanations for CFS. I wonder who is paying for it?

 

[EndME]

Did I understand this correctly?

According to his line of thought a disease starts to become a disease once a clear biological biomarker exists. This of course means that the early victims that died of HIV/AIDS didn’t die of a disease, because the objective biomarker was only found later, the same of course applies to decades of people dying of MS. Furthermore this can be expanded throughout the whole human history, since biological biomarkers are a new phenomenon we can thus say diseases didn’t exist throughout humanity and roughly only started occurring after the industrial revolution. In fact just dispose or stop the use of MRI machines for certain patients, and we don't have to deal with MS anymore, as markers become absent. Was it even possible to break ones bones before advanced imaging techniques existed?


"Schrödingers disease hypothesis: Diseases stop existing if we stop looking, all we have to do is close our eyes."


This means diseases are not biomedical conditions and problems, but instead financial investment topics.

 

[Hoopoe]

To think in terms of "real diseases with biomarkers" and "not real diseases without biomarkers" is flawed thinking. Reality is more nuanced than that. In his world view, psychiatric disorders also seem to be a third category which are real but not a disease (due to lack of biomarkers).

There are also other medical conditions that don't have a biomarker but are still accepted as real diseases.

It is accepted that psychiatric disorders can manifest in both mental and bodily symptoms. “CFS” patients exhibit these symptoms.

How insightful and deep of an analysis . If he had spent more time reading the IOM report he might have learned that "CFS" patients have symptoms that don't fit psychiatric disorders.