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Friday, July 06, 2018

Medicine is increasingly dominated by collectivist ideology.

This commentary title is an truncated and slightly altered version  of the following quote from the brilliant essay by Dr. Michel Accad. "Medicine today is dominated by the collectivist ideology" . See here for the reference to his 2009 contribution. 

This is a theme I have thought and fretted about far too much.Many of the thoughts I have mulled over and occasionally expressed in this blog are far better expressed in Dr. Accad's essay. Here is a sample;

"In the broadest sense, medical collectivism is the belief that medicine cannot be left to voluntary and unrestricted transactions between individual patients and individual healers but must be improved, directly or indirectly, by the hand of government."

and another.

" Individuals and populations ,patients and society are conveniently conflated as a matter of fact."

And here is the real money quote.

"..hoodwinking physicians into practicing population medicine is of course the essential means to confuse practitioners into thoughtlessly carry out sweeping interventions whose primary benefit is the profit of third parties."

Docs who were trained in my era ( I know that was a long time now-MD-64) learned that the principle ethical precept was do what was right for the patient and there was ,with few exception.s no other obligations.  What was definitely not on the table was the notion that physicians had an obligation to conserve the nation's medical resources. Social justice was not on the table.


I believe the metaphor of the Bootlegger and the Baptist captures an important aspect of what is happening in  medical practice in the United States.

I do not envision a wide spread plot or conspiracy of third party payers and academic physicians and leaders of major medical professional organizations meeting regularly to further their long term dream of finally taming the physicians and disabusing them of their traditional role as a fiduciary of their patients. However, the third party payers certainty welcome the efforts of the academic medical elite in that regard and some times welcome them into their ranks .

The Baptists in this conception are those physicians who sincerely believe that in the age old conflict between the interests of the individual and those of society as a whole that the trump card would be held by society.The Bootleggers are the third party payers whose bottom line increases in proportion to the acceptance of those views.

2 comments:

Nicolas Martin said...

I won’t disagree that medicine is increasingly collectivist, but that's not surprising given the collectivist roots of modern American medicine.

State licensure was the nail in the coffin of individualist medical practice, and that process began in the late 1800s with the enthusiastic support of doctors. It was intended to eliminate competition and complicate entry into the field, and in those respects it has worked wonderfully. Prescription drug laws, the socialization of drugs, was the decisive nail in the coffin of free market medicine, and physicians were also thrilled at that development. Since the early 1900s medicine has moved inexorably toward a more thoroughgoing collectivism, and even ostensibly free market organizations like the American Association of Physicians and Surgeons defend the statist quo when it benefits its members.

To quote the great libertarian opponent of medical collectivism, Thomas Szasz, “Physicians, especially psychiatrists, have been waging war on autonomy for more than 200 years."

james gaulte said...

Amen. From very early on, physicians have not been reluctant to glob on to the power of the state for their own nest feathering activities.ALso The distinction between Baptist and Bootleggers sometime gets blurred.


James Gaule