In the early 1980s, transit officials in Washington couldn't figure out why traffic on the Beltway would grind to a near halt every day around the exact same time. The usual explanations didn't fit.
Then it was discovered that a single driver was to blame. Every day on his drive to work, this commuter would plant himself in the left lane and set his cruise control to 55 mph, the posted speed limit, forcing those behind him to merge right, and you can imagine the effects.
To his credit, this driver came forward in a letter to the editor of the Washington Post. The man's name was John O. Nestor. He explained that the left lane was great; less traffic, less merging -- why not ride it into work every day? Besides, he wrote, "Why should I inconvenience myself for someone who wants to speed?"
He achieved immortality by being transformed into a Dickensian-sounding verb: "Nestoring," defined as an absolute adherence to the rules, regardless of the larger consequences.
Fittingly, Nestor was a regulator at the U.S. Food and Drug Administration. Virtually no drug was worth the risk, according to Nestor. The FDA transferred him out of the cardio-renal-pulmonary unit to some bureaucratic backwater because he "had approved no new chemical entities ... from 1968 to 1972, an experience that contrasted with the experience of every other medical [sic] modern nation and with the experience of other divisions of the FDA."
Of course, that made him a hero to activists like Ralph Nader, whose organization praised Nestor's "unassailable record of protecting the public from harmful drugs." (The Naderites helped Nestor in his lawsuit to get reinstated.)
And it's true: If you approve zero drugs, it's 100 percent guaranteed you will approve no harmful drugs. You'll also approve no helpful drugs. As we learn more and more about the human genome, it's become more clear that what is a lifesaver for many might be a death sentence for a few. Most people can eat peanuts; a relative few of us cannot. The Nestor approach would be to ban peanuts for everyone to prevent anyone from being harmed.
That argument works better for peanuts than it does for new medicines. After all, peanuts rarely save anyone's life. Drugs, on the other hand, have the potential to work miracles for some patients. Nestor's tale has gained wide currency as an allegory about the shortcomings of the FDA and the drug industry. But I keep thinking about it in the context of the gun debate in the wake of the Newtown, Conn., massacre.
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