Once upon a time, there was a young heart surgeon named David who had just finished his medical training, (including 4 years of college, 4 years of medical school, 6 years of general surgery residency, and 3 years of cardiothoracic surgery subspecialty fellowship training). He had just started practicing in his hometown as a heart surgeon, and his practice was thriving due to a combination of his excellent technical skills and his compassionate bedside manner. David enjoyed his work immensely, and took pride in his ability to improve his patients’ health based on application of reason and science to their medical problems. As a conscientious surgeon, he believed that preventative medicine was an important part of his therapeutic arsenal, so he was also an active advocate of a healthy lifestyle, counseling his patients on the need for good nutrition, regular exercise, etc., in order to prevent cardiac disease. Because of his friendly and effective communication style, David quickly became a popular and regular speaker on local TV and radio talk shows.

One day out of the blue, David was contacted by one of his medical school classmates, Bill. Bill said that he had been impressed by David’s work as a health care advocate and wanted to know if David would be interested in joining his organization. Their discussion follows:

Bill: I’m the head of the local chapter of the Organization of Health Practitioners or OHP. Everyone in our group is health practitioner of some sort, and our goal is to promote health in our patients. Based on your work, we think you’d be an excellent candidate and we’d love for you to join our organization.

David: Oh, really? So what kind of health practitioners are in the OHP and what do they believe in? Is it an organization of MDs?

Bill: Oh, no, we’re much more broad-minded than that. The OHP consists of a variety of health practitioners, including some MDs as well as practitioners of fields such as reflexology (people who believe that massaging zones of the foot can cure diseases in other parts of the body like the liver or spleen), iridology (people who believe they can diagnose diseases from the color patterns in the iris of the eye), homeopathy (people who believe that administering ultra-dilute solutions of toxic compounds can cure disease), etc. We even have a few faith-healers who believe that guided prayer can cure disease without the need for medicine or surgery. But what unites us is that we are all advocates of good “Health” in our patients. In fact, one can’t join the OHP unless you take the OHP Oath stating that you will practice your craft in order to better the Health of your patients.

David: I don’t see that I have anything in common with your group. My advocacy of good health practices is based on a solid grounding in sciences like biology, chemistry, physiology, and anatomy. I think that any advocacy of health is impossible without a firm basis in the biological sciences. Does your organization believe in the need for a scientific basis for health?

Bill: Sure, we do – at least most of us do. Of course, we don’t always agree on the underlying scientific theories behind our views of health. Some of us MDs believe similarly to you. Others believe that the key to Health is massaging special pressure zones in your feet to align the life-energy flows within your internal “meridians”. Still other believe that the key to health is giving chemicals to bind your circulating internal blood toxins. Others believe that the key to health is giving a special dilute preparation of toxins to cancel the illness caused by too many other toxins. I admit that OHP also includes a few faith-healers that reject the need for any scientific theory at all and believe that faith alone is sufficient, but these folks are in the minority.

David: So you don’t believe that you need to agree on a single scientific theory in order to be a member of OHP?

Bill: Of course not! We’re a health advocacy organization, not a scientific organization. Since there are many ways to advocate patient health, we don’t exclude people on the basis of mere disagreements on underlying science. We’re very proud of the fact that we’re scientifically tolerant at OHP, and in fact the constant internal debates between the various subgroups at OHP keeps things interesting and lively. But what unites us all is our concern for Health, so even the faith-healers are welcome at OHP as long as they take the OHP Oath to promote patient Health.

David: But that’s the very problem! By its very nature, the OHP rejects science whether you recognize it or not. First of all, the OHP is willing to include under its banner faith-healers that explicitly reject the need for any scientific basis for their methods. Second, even within the rest of the OHP which claims some sort of “scientific” basis for its practices, the various alleged scientific bases are a hodge-podge of mutually inconsistent theories, which inevitably leads to an incoherent approach to health advocacy.

The “scientific tolerance” that you’re so proud of is basically a refusal to make the judgments necessary to distinguish between genuine science and junk science. If you’re willing to acknowledge all of those incompatible theories as valid “science” and as legitimate grounds for advocating good health, then you’re rejecting the genuine concept of “science”. Even if you privately believe that some of those theories are wrong, but remaining willing to embrace those practitioners as genuine allies and advocates of “Health”, you’re essentially saying that science is unimportant to your goal of promoting “Health”, and hence once again rejecting science whether you acknowledge it or not.

This nebulous goal of “Health” is an indication of this fact. The practitioners at OHP may all superficially sound like they’re advocating the same thing, but in reality they don’t agree on what “Health” is (whether it be a balance of “toxins”, the proper flow of “chi” along the body’s “meridians” or whatever) or how to promote it. I don’t want to promote your vague notion of “Health”, I want to promote genuine, scientifically-based medical care that leads to biological flourishing and a long active, productive life.

In fact, you even went to the same medical school as me, so you should know better. I don’t blame the reflexologists or the faith-healers that much for wanting join the OHP, hoping to gain some legitimacy in the eyes of the public as genuine advocates of “Health”. I can understand their incentives – they benefit from an intellectual package-deal in which the concept of “Health Practitioner” includes them as well as genuine MDs. But I do blame you and the other MDs who are helping them gain this unearned legitimacy, and I want nothing to do with you!

Bill: Come, now – you don’t have to be so dogmatic! I can see that you won’t join us. But would you be willing to come to speak to us at our next OHP meeting? You can speak on any topic you want, even it’s to attack our approach and defend your own approach based on your concept of science. Last year, one of our old medical school professors came and gave a talk to the OHP explaining why the concept of Health could only be based on rational scientific grounds, which he then proceeded to spell out. The follow-up debate was quite spirited, and we believe that debate and discussion is the heart of our intellectual growth.

David: Absolutely not. Even by giving a public talk at the OHP, I’d be granting it an unearned legitimacy as a place where genuine health advocacy takes place, and that’s precisely the one thing I don’t wish to grant. It’s not that I’m unwilling to debate reflexologists or iridologists – I’ve done so before in neutral online discussion groups. But I won’t do so under the banner of the OHP. Even if there are some better, more reasonable people at the OHP that I could reach, I can reach them in other venues, like the local medical society meetings or through my appearances on the local TV and radio talk shows. And hence, I think that our former medical school professor did a grave disservice to legitimate practitioners of medical care by appearing in front of the OHP.

The OHP has nothing of value to offer me, and for me to join or even speak at the OHP would undercut everything that I’ve worked for these many years – namely, the practice and promotion of medical care grounded in genuine rational science.

Bill: Well, I’m very disappointed in you. I guess we won’t be seeing much of you.

David: That’s what I’ve been trying to tell you all along…

FINIS

This little fable is obviously an analogy for the issue of why as an Objectivist I don’t support libertarian organizations. Lest some of the readers think I’m exaggerating, I’d like to cite some real-life data. A few years ago, I attended some Libertarian Party functions in order to learn first-hand if the criticisms made of the LP by Objectivists were true. One of the things I did was ask LP members and officials what they believed, and why.

In particular, I was interested in their answer to the following questions:

(1) What are your political beliefs, and the political beliefs of the LP?
(2) What moral foundation do you hold for your political views?
(3) Do you believe that others in the LP share your moral views?
(4) Do you believe that it’s important for the other LP members to share the same moral views or not?

The nearly universal responses were as follows:

(1) The LP party and LP members believed in promoting something they called “Liberty”. Some of it was couched in the language of rights, but the only ideological condition for membership in the LP was taking their Oath of Non-initiation of Force.

(2) The LP members I met had a variety of moral foundations for their political views, some better and some worse. A few were explicitly subjectivist, such as the woman who told me, “Since there is no objective right and wrong, it would be wrong for the government to tell us what to do”. The obvious internal contradiction was so blatant that it was almost funny. Besides the subjectivists, I learned that there were Christian Libertarians who believed that rights came from God, atheist Libertarians who believed that rights were part of human nature, utilitarians who didn’t believe in rights but advocated the “Non-initiation of force” principle because it maximized “social utility”, Hayekians, Milton Friedman fans, Rothbardians, some supporters of Ayn Rand, some people who were actively hostile to the ideas of Ayn Rand, some single-issue advocates who liked what the LP said on one topic or another (such as drugs or guns or foreign intervention) but disagreed or had little interest in other topics, etc.

(3) They all agreed that there was not anything even remotely resembling agreement on the moral foundations of their varied defenses of Liberty.

(4) They all agreed that it was not important for the members of the LP to agree on the moral foundations of Liberty. In fact, the common refrain I heard was, “We’re a political organization, not a philosophical organization. We don’t need to agree on the correct moral philosophy in order to advocate our political views.” In fact, many of the LP members were quite proud of their philosophical tolerance and considered it a strength rather than a weakness.

Besides their disagreement on moral foundations, there were quite a few disagreements on what Liberty meant in theory and in practice. I learned that there were minimal-government Libertarians who believed that government was essential for protecting individual rights, anarchist Libertarians who believed that any government at all was automatically a violation of individual rights, pro-choice Libertarians who believed that women had an inviolable right to abort their fetuses, pro-life Libertarians who believed that abortion was a violation of the fetus’ rights, Libertarians who believed that spanking a child was a violation of it’s rights, Libertarians who believed that outlawing spanking was a violation of the parents’ rights, etc.

All claimed that their views were consistent with their Oath of Non-initiation of Force. But since they held such different moral theories, this led to different opinions of what constituted “force”, and hence (sometimes radically) different opinions on who should or should not be sent to jail for the use of such “force”.

Yet all were embraced as Libertarians. Sure they might have vigorous internal debates, but they all considered themselves allies in the overall cause of Liberty.

The more I saw, the less I liked.

In contrast, I’d like to make my own views explicit so that there’s no confusion. The analogies with the above fable should be pretty clear:

(1) Advocacy of the proper political philosophy can proceed only from the proper objective moral foundation.

(2) Political advocacy groups like the LP that embrace members with a hodge-podge of philosophic foundations for their politics are in essence embracing subjectivism. Sometimes the subjectivism is explicit (as in the case of the recent appalling events with the Libertarian Party of Colorado as documented by Ari Armstrong in this essay), and sometimes it’s slightly more indirect (as in the case of tolerating multiple, inconsistent, ill-grounded notions of “Liberty” as compatible with a genuine advocacy of individual rights). But in either case, the subjectivism is present, and is in fact the core of the LP philosophy.

(3) An Objectivist has no value to gain from joining or speaking to the LP. To do so would merely grant legitimacy to its underlying subjectivism, and thereby undercut his own rational advocacy of individual rights and proper government. If one wants to reach the better people in the LP, there are other means that don’t sanction the subjectivism inherent in the LP. Similarly, if one wants to debate the mistaken Libertarians, there are other forums in which to do so that again avoid conferring any sanction of subjectivism. And although I’ve focused primarily on the LP, this analysis applies equally to any other libertarian organization that adopts a similar subjectivist “tolerant” or pluralistic defense of Liberty.

It took me a while to come to these conclusions, and I don’t expect automatic or immediate agreement with my views. But I hope my short fable helps illuminate my reasons for holding them. As a physician, I found that by translating these abstract philosophical issues into a more concrete medical context the issues became much clearer to me, and I hope they will for you, too.

– Paul S. Hsieh, MD

Footnote:

Those who want to read more about the specific alternative “health” practices I’ve described above can find more information at the following:

Reflexology (treating disease by massaging zones of the foot)
http://www.ofesite.com/health/reflex/chart/index.htm

Iridology (diagnosing disease from color patterns in the iris)
http://www.kevala.co.uk/iridology/

Homeopathy (treating disease by giving dilute “toxins”)
http://www.quackwatch.org/01QuackeryRelatedTopics/homeo.html

Chelation Therapy (treating disease by removing “toxins”)
http://www.quackwatch.org/01QuackeryRelatedTopics/chelation.html