I appreciate your perspective. To address some of your points:

1) "The simple fact of the matter is that the FDA, like any regulatory agency in a democratic country with a free press, gets pushed from all sides. Sometimes criticism of the FDA takes the form that it is too slow to approve drugs or medical devices that are already approved in other countries. Simultaneously there is criticism that the FDA approves some drugs or medical devices without full information from the companies that make them."

I think these are good points, and I'm aware that drugs lose their FDA approval or get pulled off the market from time to time. This is generally good. My issue is that a lot of drugs that get approved do so on really shoddy science. I've documented this extensively in previous posts, but some of the highlights:

- To get approved, you generally only need to show that a drug is safe and effective for one indication for six weeks or so. There generally isn't any requirement to show that drugs are safe or effective for longterm use, even if they are generally marketed and prescribed for longterm use. A good example of this is with various psychiatric drugs, as Robert Whitaker documents in his book Anatomy of an Epidemic.

- There have been many, many cases of pharma companies faking their research data, hiding bad results, bribing doctors to prescribe certain drugs, etc. And the most these pharma companies ever get is a slap on the wrist, usually a fine much less than the profits they have made over the years.

- There is currently to mechanism is place to get FDA approval for non patentable drugs. The number of non patentable drugs that make it into the marketplace is effectively zero, even though there are many non patentable drugs that are potentially more safe and effective than drugs that can be patented.

- Many of the new drugs approved are simply evergreened versions of existing drugs, designed solely to extend the patents of pharma companies. I wouldn't have a problem with this if these drugs were genuinely better, but usually they aren't. The FDA generally goes out of its way to allow drug companies to market their evergreens as being more effective or having less side effects, even if there isn't nearly enough research (or no research at all) to believe that these things are though.

- Many of the epistemological assumptions behind the current paradigms of pharmacology are highly dubious. (Again, I have made my case for this many times elsewhere so it would be largely a waste of everyones time for me to go into this again here.)

My attitude toward the FDA isn't that it should be abolished. I firmly believe that government regulation is needed, I just think the FDA is doing a really bad job currently.

2) "...medical practice in general is ineffective."

I generally try to be careful not to make statements to that effect, even though I am critical of the medical system in the vast majority of my posts. Basically in order to say that you would need to know:

- What percent of the time are doctors able to make a diagnosis? What percentage of the time are patients diagnosed correctly?

- What percent of the time do they get the appropriate treatment for their condition?

- What percent of the time are patients better off as a result of going through the medical system?

If you have better research I'd love to see it, but the best and most current information on this I've been able to find is as follows:

"Perhaps the most striking revelation to emerge from this review is the surprisingly small amount of systematic knowledge available on the quality of health care delivered in the United States. Even though health care is a huge industry that affects the lives of most Americans, we have only snapshots of information about particular conditions, types of surgery, and locations of care.

The dominant finding of our review is that there are large gaps between the care people should receive and the care they do receive. This is true for all three types of care&mdash;preventive, acute, and chronic&mdash;whether one goes for a check-up, a sore throat, or diabetic care. It is true whether one looks at overuse or underuse. It is true in different types of health care facilities and for different types of health insurance. It is true for all age groups, from children to the elderly. And it is true whether one is looking at the whole country or a single city."

[...]

"A simple average of the findings of the preventive care studies shows that about 50 percent of people received recommended care. (None of the studies reported a percentage of people receiving contraindicated preventive care.) An average of 70 percent of patients received recom- mended acute care, and 30 percent received contraindicated acute care. For chronic conditions, 60 percent received recommended care and 20 percent received contraindicated care. These values do not indicate exact levels of quality in the United States, but they do provide a quantitative sense of how much could be done in all areas to identify and eliminate overuse and underuse of care. [...]

The United States cannot afford to let this situation continue. A systematic strategy for routine monitoring and reporting on quality, as well as the information systems needed to support such activities, will be essential if we are to preserve the best of the American health care system while striving to improve the efficiency with which high-quality services are provided." Source: http://www.innovationlabs.com/summit/summit3/readings/Schust... (How good is the quality of health care in the United States?)

I have a lot more research notes on various things related to the healthcare system and the state of health in the US, two very different but related things, and I'm going to publish those notes at some point as sort of a citation vault. (I'll send you note now though with some stuff for you to peruse.)

3) "because street drugs that have had no rigorous studies of safety and effectiveness (and are known to put people into hospital emergency rooms from time to time with deadly symptoms) are sometimes championed by you in other posts, while prescription drugs that have been carefully studied in that regarded are doubted in most of your posts."

I think this is a mistaken belief on your behalf. Almost all of the commonly used street drugs have more research on them than all but the most well studied prescription drugs. And all of the most studied drugs in general are the so-called recreational drugs. For example there are over 20,000 studies on marijuana and cannabinoids alone. Similarly, you'd be hard pressed to find any antidepressant with more research done on it than LSD and Psilocybin. There are many books that sum up the scientific research about specific drugs. For example, the book Marijuana Myths, Marijuana Facts has a good summary of marijuana, although it's about ten years out of date. The book Marijuana Is Safer also has a good summary of the research, although it doesn't cover every single point. There is a good podcast with an RN about some specific medical benefits that I often link to, which you can see here: http://www.matrixmasters.net/salon/?p=258

I actually have some Squidoo pages with extensive collections of research on marijuana and psychedelics, although HN does not let you link to Squidoo pages. (But you can probably find them via Google or through the internal site search engine, and then find the rest via my profile.)

I do occasionally advocate illegal drugs for certain specific issues, but more generally I'm an advocate of more sensible drug laws. I generally believe that virtually all drugs should be legal, the government should regulate the purity and quality, and there should be some sort of drivers license type system in order to get certified to use different clases of drugs. (E.g. there would be a certification for psychedelics, a certification for opiates, etc, as well as certification for different delivery methods.) And if you're not certified then you could still use various drugs under a doctors supervision, either on an inpatient or outpatient basis depending on the drug/dose/delivery method.

Also, as a general rule of thumb there aren't really any safe or unsafe drugs, just safe and unsafe use patterns. Unfortunately I think the government is larger pushing people away from safer drugs / usage patterns and toward more dangerous practices. The book Marijuana Is Safer makes a good case for this for marijuana, but really marijuana is just one drug in a much larger argument.

Hopefully this explains at least a little better about the bigger picture of what I believe and why.