Washington DC
"Just ask your doctor.” It’s a refrain heard by the hour on television these days. Doctors and celebrities bombard us with health fears, old and new, contrived and real, designed to build markets for their employers’ latest miracle potions. It also vividly underscores the concerns raised by Dr. Nortin Hadler in The Last Well Person when he says that, “Medicalization imposes a scientific idiom of distress on common sense.” (p.5)
It is also precisely how minor, age-old distresses become debilitating larger-than-life “branded” diseases in the form of, say, Restless Leg Syndrome (RLS) or Acid Reflux Disease (ARD). How different is this, really, from the successful efforts by Republican pollster Frank Luntz to rebrand “global warming” as “climate change”? In one case, the strategy is to create urgency where little exists, as is sometimes the case with medicalization. With global warming, however, the strategy is most decidedly to mute the urgency born of manmade shifting climate and weather patterns. In both cases, truth suffers at the hands of power.
Hadler’s thesis about corporate medicine is a more credible, thoughtful consideration of contemporary capitalism than Lynn’s approach in The End of the Line (2005). Hadler uses his personal credibility as a medical doctor – reflecting practical experience, understanding of the social consequences of illness, and a commitment to rigorous science – as well as reasonable analysis of specific phenomena in a manner that eluded Lynn’s more sweeping generalizations. In doing so, however, Hadler makes more persuasive arguments about capitalism as applied to his view of the medical establishment and the rights and responsibilities of educated consumers. Indeed, if Eisenhower were leaving the Presidency today he might just as well have warned us about the excesses of the “medical industrial complex” that encourages us to “just ask your doctor” when, in fact, that doctor is often very difficult to see and spends very little time with us, anyway.
It’s also interesting to note that Lynn’s concerns about globalization and “industrial interdependence with other nations” (p.5) seems to find less saliency in the American medical industry described by Hadler, which is relatively closed to the wisdom of other industrialized nations that already provide their citizens with national health-care systems. How far does market meritocracy really extend and how much of Adam Smith’s sense of “fellow feeling” are we truly serving when 45 million Americans go without health insurance?
We are a nation that frequently speaks to unconstrained, utopian logic at the self-actualized summit of Maslow’s hierarchy of needs while, at the same time, ignoring the many Americans who struggle to become or remain well at the most basic level of Maslovian survival. Indeed, it would be interesting to ask Fareed Zakaria (2004) if he would include basic health care as a requisite liberty for truly democratic societies.
We are all medical consumers as we are political consumers. Our right and responsibility is to ask questions of the elite, within reason, for we do not necessarily share their agenda. Informed inquiry separates us from fairly recent days of snake-oil salesmen and purveyors of magical elixirs. That’s why it’s difficult to reflect on Hadler’s work without immediately considering Thomas Sowell’s approach in A Conflict of Visions (2002). After all, there is something of an ideological framework to medicalization, or at least a pretension about it, suggesting that we should trust elites to put our needs first and to give us the right answers.
At the level of rhetoric, at least, medicalization seems to resemble Sowell’s unconstrained vision in its reliance on the proposed intentionality of creating social benefit and the role of experts in impartially guiding us toward that benefit. These can seem to represent in Condorcet’s unconstrained terms, as well, “The progress of the human mind.” (Sowell, p.18)
Once again, however, and as has been a consistent theme throughout these reflections, such superficially unconstrained notions are far more at home with Sowell’s constrained vision and arguably reflect a much more Hobbesian world view of the darker nature of humankind. Sure, medicalization often aspirin-coats itself as being generous and unconstrained. However, a more constrained vision resonates powerfully throughout today’s medical industry, necessitating educated decisions made by consumers and communities about the trade-offs imposed by both the disease and its cure.
Yes, some unpronounceable drug may purport to alleviate the symptoms of Restless Leg Syndrome, but as Hadler demonstrates in other settings, that same drug can have a mind-numbing array of possible, deleterious side effects. This can be the case, too, in legislative processes where policies born of narrow commercial or political interests are positioned as “reforms” and turn out to be, in reality, worse than the original afflictions. Rousseau-like idealism about health and wellness are not primary considerations for the medical industry as a whole, notwithstanding the caring work of so many wonderful doctors, nurses and medical technicians.
But is our doctor really supposed to adjudicate the many medical and commercial trade-offs for us? Do we really trust such elites to perform this task? In The Future of Freedom, Zakaria laments the passing of the old guard of elites, perhaps including the trusted community doctor who still made house calls with black bag in hand. Ironically, it seems that some doctors today and all of corporate medicine are every bit the new, moneyed elite that rightfully worries Zakaria. Of course, the responsibility for effectively assessing medical, political and all other claims and making prudent trade-offs ultimately belongs to each of us as individuals and as part of a society capable of understanding, questioning and deciding in the public interest.
Education & Survival
Public education is essential for medical consumers to survive and even thrive. Indeed, Hadler calls education the “handmaiden” of socioeconomic status, which he says is a definitive measure separating advantaged or educated medical consumers from disadvantaged ones. He says that the disadvantaged or ill-informed consumers of medicine often “live under clouds of persistent pain and pervasive work incapacity. Their life is shorter and less sweet.” (p.12)
Given the velocity of change today born largely of technology, education through the constant reconstruction of experience becomes essential for discerning among incessant medical claims and counterclaims of varying veracity. At the societal level, this constant reconstruction of experience is central to Sowell’s constrained vision that finds the best decisions are often made through “systemic processes that mobilize and coordinate knowledge scattered by the many?” (p.45) Indeed, collective wisdom about medicine and, more important, about misguided medical claims, has long been passed intergenerationally and can serve the purpose of warding off age-old charlatans and false remedies. It’s no wonder that virtually everyone I know scoffs at the “Just ask your doctor” imperative, but a great many of us are still asking, right?
So what does this say about the relationship between elites purporting to protect us against terrorism or Acid Reflux Disease and our ability and willingness to resist them when they are wrong or, at minimum, misleading? Zakaria rightly tells us that democracy requires the development of an educated business class separate and apart from the state or the church. But what of an educated consumer class, as well, with sufficient critical-thinking skills to resist the worst of that business class? Hayek, Friedman and the laissez-faire thinkers long maintained that so-called free markets restore integrity to the process by exposing the charlatans. Regrettably, this is not always true. American consumers, hospital patients and citizens are daily fed all manner of promotion designed to incite our emotions, mobilize our fears, and shape our behaviors. Much of it is simply not in our interests. It’s a horrible thought, but one occasionally wonders whether a consumer class must remain relatively uninformed for markets and political campaigns to maximize profit and power.
At its best, education embodies the processes of constant, iterative reconstruction of both individuals and societies. Enter Dewey (1916) who believed that the less informed the populace, the more subject it is to deception and the diminution of choices – in candidates or cures! In Jeffersonian terms, Dewey believed that education is the bulwark of democracy. He would readily embrace Hadler’s efforts to encourage each of us to become more knowledgeable, despite the latter’s warning that, “Teaching the well how to approach the act of medical treatment critically is something of a heresy.” (p.7)
In Hadler’s case, we the people become more discerning – as he did – through the combination of 1) practical experience, 2) an understanding of social consequences by, about and beyond us, and 3) research and rigorous empiricism. We learn explicitly in a manner that appeals to our cognition while also learning implicitly through our behaviors and actions. We evolve over time because explicit and implicit learning work together to increase our knowledge, which was another of Dewey’s fundamental tenets. Dewey believed that it was essential to integrate book learning with hands-on experience in the constant reinvention of self and society.
In the context of Hadler’s compelling and undoubtedly controversial work, it also powerfully underscores the essential role of holistic, integrated lifelong learning in any effort to take back our medicine as well as our politics. Just ask your doctor, for he or she is just as likely to feel trapped by this system, too.
Warning: You may not read this essay if you are a biped, breath air or happen to be a man, woman or child. Do not consume this work if you are or have ever been sick, grown hair, eaten food, drank water or read a newspaper. Don't touch this under any circumstance if you are pregnant, want to be pregnant or have ever thought of pregnancy. Hey, just ask your doctor.
References
Dewey, J. (1916). Democracy and Education: An Introduction to the Philosophy of Education, New York: Cosimo Publications.
Lynn, B. (2005). The End of the Line: The Rise and Fall of the Global Corporation, New York: Doubleday.
Sowell, T. (2002). A Conflict of Visions: Ideological Origins of Political Struggles, New York: Basic Books.
Zakaria, F. (2004). The Future of Freedom: New York, New York: W.W. Norton.
"Just ask your doctor.” It’s a refrain heard by the hour on television these days. Doctors and celebrities bombard us with health fears, old and new, contrived and real, designed to build markets for their employers’ latest miracle potions. It also vividly underscores the concerns raised by Dr. Nortin Hadler in The Last Well Person when he says that, “Medicalization imposes a scientific idiom of distress on common sense.” (p.5)
It is also precisely how minor, age-old distresses become debilitating larger-than-life “branded” diseases in the form of, say, Restless Leg Syndrome (RLS) or Acid Reflux Disease (ARD). How different is this, really, from the successful efforts by Republican pollster Frank Luntz to rebrand “global warming” as “climate change”? In one case, the strategy is to create urgency where little exists, as is sometimes the case with medicalization. With global warming, however, the strategy is most decidedly to mute the urgency born of manmade shifting climate and weather patterns. In both cases, truth suffers at the hands of power.
Hadler’s thesis about corporate medicine is a more credible, thoughtful consideration of contemporary capitalism than Lynn’s approach in The End of the Line (2005). Hadler uses his personal credibility as a medical doctor – reflecting practical experience, understanding of the social consequences of illness, and a commitment to rigorous science – as well as reasonable analysis of specific phenomena in a manner that eluded Lynn’s more sweeping generalizations. In doing so, however, Hadler makes more persuasive arguments about capitalism as applied to his view of the medical establishment and the rights and responsibilities of educated consumers. Indeed, if Eisenhower were leaving the Presidency today he might just as well have warned us about the excesses of the “medical industrial complex” that encourages us to “just ask your doctor” when, in fact, that doctor is often very difficult to see and spends very little time with us, anyway.
It’s also interesting to note that Lynn’s concerns about globalization and “industrial interdependence with other nations” (p.5) seems to find less saliency in the American medical industry described by Hadler, which is relatively closed to the wisdom of other industrialized nations that already provide their citizens with national health-care systems. How far does market meritocracy really extend and how much of Adam Smith’s sense of “fellow feeling” are we truly serving when 45 million Americans go without health insurance?
We are a nation that frequently speaks to unconstrained, utopian logic at the self-actualized summit of Maslow’s hierarchy of needs while, at the same time, ignoring the many Americans who struggle to become or remain well at the most basic level of Maslovian survival. Indeed, it would be interesting to ask Fareed Zakaria (2004) if he would include basic health care as a requisite liberty for truly democratic societies.
We are all medical consumers as we are political consumers. Our right and responsibility is to ask questions of the elite, within reason, for we do not necessarily share their agenda. Informed inquiry separates us from fairly recent days of snake-oil salesmen and purveyors of magical elixirs. That’s why it’s difficult to reflect on Hadler’s work without immediately considering Thomas Sowell’s approach in A Conflict of Visions (2002). After all, there is something of an ideological framework to medicalization, or at least a pretension about it, suggesting that we should trust elites to put our needs first and to give us the right answers.
At the level of rhetoric, at least, medicalization seems to resemble Sowell’s unconstrained vision in its reliance on the proposed intentionality of creating social benefit and the role of experts in impartially guiding us toward that benefit. These can seem to represent in Condorcet’s unconstrained terms, as well, “The progress of the human mind.” (Sowell, p.18)
Once again, however, and as has been a consistent theme throughout these reflections, such superficially unconstrained notions are far more at home with Sowell’s constrained vision and arguably reflect a much more Hobbesian world view of the darker nature of humankind. Sure, medicalization often aspirin-coats itself as being generous and unconstrained. However, a more constrained vision resonates powerfully throughout today’s medical industry, necessitating educated decisions made by consumers and communities about the trade-offs imposed by both the disease and its cure.
Yes, some unpronounceable drug may purport to alleviate the symptoms of Restless Leg Syndrome, but as Hadler demonstrates in other settings, that same drug can have a mind-numbing array of possible, deleterious side effects. This can be the case, too, in legislative processes where policies born of narrow commercial or political interests are positioned as “reforms” and turn out to be, in reality, worse than the original afflictions. Rousseau-like idealism about health and wellness are not primary considerations for the medical industry as a whole, notwithstanding the caring work of so many wonderful doctors, nurses and medical technicians.
But is our doctor really supposed to adjudicate the many medical and commercial trade-offs for us? Do we really trust such elites to perform this task? In The Future of Freedom, Zakaria laments the passing of the old guard of elites, perhaps including the trusted community doctor who still made house calls with black bag in hand. Ironically, it seems that some doctors today and all of corporate medicine are every bit the new, moneyed elite that rightfully worries Zakaria. Of course, the responsibility for effectively assessing medical, political and all other claims and making prudent trade-offs ultimately belongs to each of us as individuals and as part of a society capable of understanding, questioning and deciding in the public interest.
Education & Survival
Public education is essential for medical consumers to survive and even thrive. Indeed, Hadler calls education the “handmaiden” of socioeconomic status, which he says is a definitive measure separating advantaged or educated medical consumers from disadvantaged ones. He says that the disadvantaged or ill-informed consumers of medicine often “live under clouds of persistent pain and pervasive work incapacity. Their life is shorter and less sweet.” (p.12)
Given the velocity of change today born largely of technology, education through the constant reconstruction of experience becomes essential for discerning among incessant medical claims and counterclaims of varying veracity. At the societal level, this constant reconstruction of experience is central to Sowell’s constrained vision that finds the best decisions are often made through “systemic processes that mobilize and coordinate knowledge scattered by the many?” (p.45) Indeed, collective wisdom about medicine and, more important, about misguided medical claims, has long been passed intergenerationally and can serve the purpose of warding off age-old charlatans and false remedies. It’s no wonder that virtually everyone I know scoffs at the “Just ask your doctor” imperative, but a great many of us are still asking, right?
So what does this say about the relationship between elites purporting to protect us against terrorism or Acid Reflux Disease and our ability and willingness to resist them when they are wrong or, at minimum, misleading? Zakaria rightly tells us that democracy requires the development of an educated business class separate and apart from the state or the church. But what of an educated consumer class, as well, with sufficient critical-thinking skills to resist the worst of that business class? Hayek, Friedman and the laissez-faire thinkers long maintained that so-called free markets restore integrity to the process by exposing the charlatans. Regrettably, this is not always true. American consumers, hospital patients and citizens are daily fed all manner of promotion designed to incite our emotions, mobilize our fears, and shape our behaviors. Much of it is simply not in our interests. It’s a horrible thought, but one occasionally wonders whether a consumer class must remain relatively uninformed for markets and political campaigns to maximize profit and power.
At its best, education embodies the processes of constant, iterative reconstruction of both individuals and societies. Enter Dewey (1916) who believed that the less informed the populace, the more subject it is to deception and the diminution of choices – in candidates or cures! In Jeffersonian terms, Dewey believed that education is the bulwark of democracy. He would readily embrace Hadler’s efforts to encourage each of us to become more knowledgeable, despite the latter’s warning that, “Teaching the well how to approach the act of medical treatment critically is something of a heresy.” (p.7)
In Hadler’s case, we the people become more discerning – as he did – through the combination of 1) practical experience, 2) an understanding of social consequences by, about and beyond us, and 3) research and rigorous empiricism. We learn explicitly in a manner that appeals to our cognition while also learning implicitly through our behaviors and actions. We evolve over time because explicit and implicit learning work together to increase our knowledge, which was another of Dewey’s fundamental tenets. Dewey believed that it was essential to integrate book learning with hands-on experience in the constant reinvention of self and society.
In the context of Hadler’s compelling and undoubtedly controversial work, it also powerfully underscores the essential role of holistic, integrated lifelong learning in any effort to take back our medicine as well as our politics. Just ask your doctor, for he or she is just as likely to feel trapped by this system, too.
Warning: You may not read this essay if you are a biped, breath air or happen to be a man, woman or child. Do not consume this work if you are or have ever been sick, grown hair, eaten food, drank water or read a newspaper. Don't touch this under any circumstance if you are pregnant, want to be pregnant or have ever thought of pregnancy. Hey, just ask your doctor.
References
Dewey, J. (1916). Democracy and Education: An Introduction to the Philosophy of Education, New York: Cosimo Publications.
Lynn, B. (2005). The End of the Line: The Rise and Fall of the Global Corporation, New York: Doubleday.
Sowell, T. (2002). A Conflict of Visions: Ideological Origins of Political Struggles, New York: Basic Books.
Zakaria, F. (2004). The Future of Freedom: New York, New York: W.W. Norton.