Kevin Patterson is a Canadian novelist and internist
The U.S. Senate report on torture reaches two important conclusions: the government-sanctioned interrogation techniques used after the 9/11 attacks were ethically disastrous and they did not work. Indignant words are being written about the first of these and for a few days will feature prominently in the news cycle. It might be more useful to concentrate on the lack of usefulness of torture. The power of ethical arguments at this moment, to us, is clearly weaker than are the winds of circumstance and emotion.
For the moral outrage of Americans to have meaning, the torturers would have to have been arrested by now. If the revulsion of America's allies meant anything, our leaders would have insisted by now that the torturers be held accountable. They haven't and so we are complicit. And: we have had our own trafficking with torturers, and thus our condemnation would have to begin with our own acts, which is always less stimulating.
A purely pragmatic and less fraught conversation about what works and what doesn't may help us steer clear of such situations in the future. There is a model for this, in medicine. The Role 3 Combat Trauma Hospital at Kandahar Airfield is just metres from the detention cells in the Special Forces' compound. Graeme Smith quotes Canadian Special Forces as calling the place 'Camp Slappy.' In the hospital, in 2007, the doctors and nurses constantly discussed the evidence for the various approaches we took with shattered civilians and soldiers. Early feeding versus delayed, tight control of glucose with insulin infusions, antibiotic choice – every decision was viewed through the lens of outcome data.
Until about 20 years ago, this was not at all usual. It was normal to guide one's practice by personal experience, colleagues' anecdotes and the recommendations of experts. This approach led physicians widely astray. We prescribed estrogen millions of times to lower the risk of heart disease when it turned out that it doesn't. We transfused blood aggressively into anemic ICU patients; SSRI antidepressessants have been prescribed for mild to moderate depression to 15 per cent of American adults; the most commonly performed operation became arthroscopy for arthritic knee joints – none of these work better than placebo.
Doctors have concluded that intuitive approaches based on our always incomplete understanding of pathologies are not reliable. The Evidence Based Medicine movement has upended the discipline, and done more to wring quackery from it than any number of exams and regulatory measures. What it says is, 'nevermind what you think should work, look at the objective data.'
One might have thought physicians would have done that long ago. But we clung – we still cling sometimes, that arthroscopy data only emerged a year ago – to a process that begins with an understanding of a problem and proceeds to its solution through that understanding. Women with falling estrogen levels have increasing risk for heart attacks. Replace the estrogen and reduce the risk, it only makes sense. Except that it isn't so. We flatter ourselves in imagining that our understanding of the body is complete enough for this to work reliably.
And we flatter ourselves when we make decisions about the use of violence on people who frighten us based on our interior senses of appropriateness and justice. Clearly, Western leaders can talk themselves into anything. Hanging naked men by chains until they freeze to death. Rectal feeding. Take a few seconds and imagine what that means.
Let's strip our flawed and empty morality from the decision making process and make the coldest and least emotional decisions possible about the use of violence. Let's rival Henry Kissinger at the peak of his bloodless realpolitik and embrace undiluted pragmatism. The data have been collected, the studies have been done.
Torture does not work. Invading and occupying Afghanistan did not work. Invading and occupying Iraq did not work. Bombing Libya did not work. Never mind the empty anguish of liberals and the reflexive aggression of the right: these strategies fail. Wrong or not, they are a waste of effort. Of money, even.
Brutality, as an instrument of national policy, has intoxicated the West for more than a decade. The drug needs to be pulled from the shelves.