Thursday, January 27, 2005

The misdiagnosis trope

In a recent article libertarian congressman Ron Paul has aptly compared the decision to undertake the Iraq war to a medical misdiagnosis. It is not unlike those cases one sometimes hears about where a patient goes into the hospital for treatment of cancer in one part of the body, only to find that his chart has been switched with that of someone else and a different part of the body has been operated on.

On the world's body the cancer is Osama bin Laden, and this malignancy is located on the Afghan-Pakistan border. That is the area that needed decisive surgical intervention. Instead, we operated 800 miles away, ignoring the al-Qaeda metathesis, and in fact helping to spread the malignancy. Formerly in remission, Iraq is now a critical zone.

In the medical field itself, diagnostic displacement has a considerable history. A notorious example stems from a hundred years ago, from the practice of a shady Berlin doctor, Wilhelm Fliess. For a time guru to no less than Sigmund Freud. Fliess believed that the etiological locus of sexual malfunction lay in the nose! He would then operate to extract a bone there that he thought was the problem.

In all likelihood this ectopic treatment reflects a persistent folk belief, which in the 18th century acquired the status of an urban legend. In this view one can estimate the size of a man's penis from the size of his nose. I believe that there is a letter by Alexander Hamilton supporting this belief, which is occasionally found even today.

To be sure, sometimes particular effects derive from seemingly remote causes. However, such claims must be demonstrated,not just assumed. In my view they emphatically were not established in Iraq--at least not until our catastrophic intervention made them possible