“And it belongs to…the medical art to produce health, not to make money. Nevertheless, some men turn every art into a means of money-making, as if this is the end.”
Aristotle, Politics
The state of medical practice in our country and in the world has been brought before our eyes in a dramatic way in the last year. There is much to ponder.
Let me immediately give a caveat. I am not going to make concrete assertions about the Covid crisis: its nature, its true extent, the response to it, its politicization, or its dramatic effects in the economy, in social life, in education, in religion, etc. Rather, this seems a fitting moment to reflect on a rather dramatic assertion—I think an insight—of Aristotle’s regarding the art of medicine.
The assertion, which is simple but profound, applies to any art. An art is a know-how, usually practiced, developed, and handed on over many generations, about how to reach certain ends by specific means. Some arts have a deep and perennial connection to human life—such as the arts of agriculture, home-making, woodworking, and of course, medicine, to name a few.
Aristotle explains that the end or goal of an art is to produce something with excellence. The art of woodworking is about producing beautiful and useful things of wood. The procedures and standards of the art are determined in view of this end. The art of medicine seeks to bring about health. Every aspect of the art should be judged in view of the greater health of human persons.
But Aristotle observed that something bad can happen, sometimes very subtlely. A worker deserves compensation and reasonably seeks it. Yet what if the worker puts his attention more on the compensation than on the product that is worthy of compensation? The art itself can be twisted, again subtlely but significantly, away from its real nature and end. The standards of woodworking can shift: from real quality of the product to the money-making power of the product. And the ‘art’ becomes a different thing—different in its procedures and standards, and different as something that should complete and give joy to its practitioner.
Aristotle himself choose medicine as an example of this problem. I find this remarkable. Perhaps prophetic.
Allow me to be clear regarding this complex matter. Individual practitioners of an art can be of good intention—for instance truly wanting to work for the health of people—even while the art itself as a whole degenerates, turning away from its true calling, and taking on methods and means that are inappropriate.
I am suggesting that even while there are many, many noble, well-intentioned and deeply competent men and women in the medical profession, we would all do well—including those in the profession—to consider with care Aristotle’s point. Has the practice of medicine, particularly as it has become a massive industry, in significant ways allowed its money-making side to overrun its deeper call and nature? And if this is the case, what does it mean for us?
I suggest just two things we might do. First of all, while always retaining a fitting respect and even piety towards those who have committed their lives to medicine, we reasonably have a certain skepticism regarding the pronouncements, or purported announcements, of the medical industry and experts. I don’t say this lightly, and I don’t mean we all pretend to be experts. But a rational agent has to take reasonable precautions in view of the reality in which we find ourselves. This puts a heavy burden on all of us, especially parents and others who have care of children. We must with diligence, courage, and humility go about trying to discover what is best for our children, for we are the ones who are responsible for them. So, seeking out what we judge to be the most reliable sources (yes, a very difficult thing) we make our best judgement.
Second, we can recommit ourselves to taking more responsibility for the day to day aspects of living a healthy lifestyle—the very things that the true art of medicine has always brought to our attention, things that can require real sacrifice. Eating well—itself very challenging. Sleeping well. Exercising regularly. Fresh air, clean water. Avoiding toxins of many sorts—in our foods, in our cleaners, in many miscellaneous products, in the byproducts of our countless technologies, and also in toxic thought patterns. We can work on our attitudes, keeping a hopeful and positive outlook, and maintaining an inner silence and peace, interacting with others in charity.
The true art of medicine has been practiced and developed by countless men and women through the ages. It is never beyond redemption. But its renovation will require all of us to be intentional and courageous, beginning in our own lives at home.
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Doc,
Well put! I appreciate your reflections and encourage you to continue posting them!
Semper Idem,
Andrew H. Watson
Lincoln, Nebraska
Andrew, I really appreciate your kind encouragement. I hope all is well in Nebraska.
your Wednesday Quote and Reflection has enriched my life and generated some good conversations with friends. I look forward to your ICC course this year on Philosophy. Enrollment opens tomorrow!
Thank you very much, Sue. I’m looking forward to the ICC Intro to Philosophy course too!
Thank you for a very relavent topic that has certainly deteriorated in many ways and throughout the world. It seems like today many see the invisible dollar sign on the foreheads of human beings rather than the person. Let us invoke all the saints patrons of medicine and the Holy Spirit, the Healer to transform hearts in this art. The practice of medicine in Canada is not always artful, I can assure you.
Clara, in Toronto Canada
Clara, You are very welcome. Yes we do have much to pray for. In any case we can keep encouraging each other…
It was some twenty years ago when I learned that Big Pharma was, at that point, the second largest contributor to political campaigns on both left and right in the American political scene.
I do not know what the data on their contributions says since March 23, 2010–ten years later–but one would do well to know at least a bit of Organic Chemistry before having any prescriptions filled.
“Ars longa, vita brevis, occasio praeceps, experimentum periculosum, iudicium difficile.” Hippocrates
“The art is in the making.” paraphrase of Étienne Gilson
Well said, well said.
Dr. Cuddeback, I have greatly enjoyed your Wednesday quotes and I look forward to them every week. Today’s topic stood out to me, as it is one of the very few topics you have mentioned that I know well as I work in the medical field and grew up around it.
First, I agree very much that, like all good things, medicine can and is abused. So I don’t want to reiterate all that you have said that I agree with. I want to just point out some not so obvious things regarding money jn medicine that may give you at the least, a better insight or understanding into it.
Firstly, it may not be very apparent if unfamiliar with the industry but to a large extent, physicians do not have a complete say in their compensation. In fact, in my field, radiation oncology, one small example
is that there is not only a maximum but a minimum charge for just a basic consult that the physician can not legally charge less than, even if he wanted to. There are many more examples of things like this and there are many things that affect this.
Secondly, medical school has begun to steer away from the old model of encouraging new doctors to go out on their own, hang their own sign, so to speak and work for themselves. In the old days, doctors reputation were important because thats how they stayed in business. They could charge more or less what they wanted as well. The preferred model now is of a glorified shift worker. Meaning many doctors now have set shifts that they work like a factory, and they work for a hospital most often instead of opening their own practice. The hospital tells them how much they will make based on certain criteria that the doctor must meet. Once again it all goes back to the money for the bigger players. By adopting this model, the government is slowly consolidating the power in healthcare to fewer and fewer organizations.
Thirdly, insurance and lawyers are a huge reason medicine cost so much and thus there is so much money in healthcare. Physicians have to pay an astronomical amount of money every month just for malpractice insurance in case they make a single mistake and someone wants to sue them.
Also, at least in radiation oncology, the FDA, and other government agencies, oversee the use of radioactive isotopes and other uses of ionizing radiation and have set prices for various procedures that are more or less universal standards. They vary some depending on states but overall, physicians can’t change what they are set at. It is far worst in socialized healthcare like England or Canada but that is a totally different discussion.
Anyway, I just wanted to shed some light on the this topic from a different perspective. You absolutely right that many people go into medicine for the wrong reason and it is sad. I guess that is just part of human nature.
Thank you again for all the work you put into this website, Xochtil and I, as well as Seth and his wife have really enjoyed it as well as your courses. Take care and God bless,
William
Dear William, I am very grateful that you have shared all this. It is very informative. It makes me ponder all the more how medicine has become an industry, and it is in many ways more and more removed from individual practitioners who could exercise a concrete prudence in the particular context of the place of their work and the needs of the individuals they treat.
I also just want to be very clear (not that you have said otherwise) that I did not intend to in any way criticize the many great people today who enter the medical field in an endeavor to serve people in this very important way! God bless all those in the medical field!
I send my very best wishes you and Xochtil and Seth and his wife!