Dec 12 2019

Crowd Funding Quackery

A recently published ethics paper addresses the issue of whether or not it is proper for crowdfunding sites, like GoFundMe, to allow campaigns to fund dubious medical treatments. This question is also part of a more general issue – how tech companies have replaced traditional industries and institutions thereby bypassing existing mechanisms of safety, justice, and quality control. On the medical issue, the authors write:

Recent studies have shown that many individuals are using crowdfunding to finance access to scientifically unsupported medical treatments. Recently, GoFundMe prohibited campaigns for antivaccination groups on the grounds that they “promote misinformation about vaccines” and for treatment at a German clinic offering unproven cancer treatments due to “the need to make sure people are equipped to make well‐informed decisions.” GoFundMe has not taken any additional actions to regulate the much larger presence of campaigns seeking to fund unproven medical interventions on the platform. In this article, we make the ethical case for intervention by GoFundMe and other crowdfunding platforms.

The basic principle is that tech companies still retain an ethical and legal responsibility for how their platforms and technology are used. Most applications and social media outlets begin as an unregulated peer-to-peer environment, just facilitating an individual exchange between two private citizens. In a way this is a Libertarian nirvana. However, as such applications scale up the downsides that have already had to be dealt with in the traditional industries they are supplanting begin to resurface.

We can take any such app as an example, such as Uber. The Uber app, which I use, is very convenient. They have definitely made a better mousetrap. But as Uber has grown huge, we begin to question what responsibility they have to their drivers and riders. How much do they have to vet drivers to protect riders? What kinds of protections and benefits should they offer drivers? Did they just replace a regulated industry with an unregulated one? The same questions have arisen with Air bnb, which critics warn is being used to simply create de facto hotels that skirt regulations.

There are two principles here. The first has to do with the role of regulations in general to protect the public from exploitation of various sorts. I don’t want to go down that rabbit hole entirely, but just summarize my position as this. I support carefully considered and monitored regulation to keep society functioning optimally and prevent exploitation, externalizing costs, unfair competition, and the like. The only truly free market is a regulated one, because an unregulated market will become increasingly distorted over time as the powerful use their power to obtain more power (rather than play fairly).  At the same time we have to be humble regarding unintended consequences, which is why regulations need to be minimalistic and monitored for their effects. If you buy some version of this basic premise, and are not an anti-regulation purist, then it should be concerning that effective regulations are being nullified by an app. This is happening without any elected representatives of the people making any decisions – without any public representation. In the extreme this can evolve into a tech oligarchy.

The second principle is fairness. If one industry that is regulated is competing with another that is unregulated, that gives an unfair advantage to the unregulated one (regardless of what you think about regulations in general).

Another angle to the this question is that any crowdsourced system we establish has to account for the full range of human personality. We cannot naively assume that everyone will play nice. By some estimates, about 1% of the general population display significant psychopathic personality traits. This is more of a spectrum than a dichotomy, and so the number will depend on where you draw the line, but this estimate is a reasonable guideline. That means any social platform we create will also be creating a playground for the world’s psychopaths. In fact, research shows that internet trolls are more likely to display features of psychopathy and sadism. Along those lines, any market must account for frauds and con-artists, otherwise you are simply given them free reign to prey on the public.

Social media and smartphone apps make exploitation easy, because of anonymity and the low barrier for entry.

Now lets apply all of this to the question at hand – should GoFundMe ban medically dubious treatments from their platform. I think the answer is a clear yes, and as noted above they are already doing so. To anticipate a common objection, some will say that if a private exchange is legal, then tech companies have no business imposing further regulations or censorship. But the “technically legal” threshold does not make sense on close inspection. We have to recognize that criminal law is only one form of protection of the public from harm, and it has a high threshold (arguably the highest). There are many other layers of protection, however. In medicine, professionals are licensed, and that license comes with various mechanisms to ensure competence and ethical behavior.  Hospitals have their own vetting process before granting privileges. Insurance companies (whether private or government) have criteria for what treatments they will pay for, and who is qualified to receive payment for medical services. In short, there are many regulatory and civil mechanisms of public protection far below the criminal threshold. So being “legal” is not always sufficient.

It is all these civil and regulatory protections that apps like GoFundMe are bypassing. This is a con-artist’s dream.

Further, even if you think that individuals have the right to use their own resources to purchase dubious medical treatments from whomever they want, that does not necessarily translate into a right to use a public platform to solicit funds from the general public using emotional appeals. Really the legitimate question is – where do you set the threshold. Companies like GoFundMe, who certainly have the funds, can simply employ medical experts and ethicists to develop guidelines and algorithms and make individual decisions to protect their users from medical harm or fraud using their platform.

One final point – another possible response might be that individual users can vet claims for themselves. Again, let the marketplace of ideas sort it out. This doesn’t work for a couple of reasons, primarily because many such decisions would require high levels of specialized knowledge most members of the public do not possess. This also relates to a broader point. As our civilization gets more and more complex, the cognitive load required to navigate through the world and make day-to-day decisions is getting overwhelming. One major reason for the regulatory state is that, without it, citizens could simply not function.

Think about it – imagine if you had to take personal responsibility for the engineering of your car, the safety of every building you enter or bridge you drive over, reviewing the research for every drug you take, food you eat, or for all the substances that make up the various industries in our technological world. It is simply not possible.

Instead we pool our resources, have educated and vetted experts transparently review the evidence for us, conduct inspections, and provide for at least a minimum safety net. It’s an imperfect system, and requires tweaking in places, overhauling in others. But it’s better than the wild west. Also consider this reality – going through even a typical day, you may encounter hundreds of items and services subject to regulatory protections. In a wild west scenario you would have to expend your limited resources vetting all this. Meanwhile, a con-artist or psychopath can focus incredible amounts of time and energy on their one scam. The asymmetry is overwhelming. That’s not a world I want to live in.

No responses yet