Health
neither begins nor ends with the doctor. The
doctor’s role is somewhere
in the middle. And still crucial. If doctors
weren’t important, the
Church of Modern Medicine could never have gained
the power it has.
This simultaneous process of destroying Medicine
and rebuilding
Medicine is, by nature, a political process. At
all levels, the Medical
Revolution involves the participant in politics:
If you keep your
children out of public school to avoid immunizing
them, that is a
political act. If you have your baby at home when
state laws discourage
it or health insurance refuses to pay for it,
that’s a political act.
If you decide to have another baby, that’s a
political act. While we
turn our backs on the Inquisition, we turn towards
and embrace the New
Medicine as we need to in order to survive and
prosper. That is going
to require action which is explicity political,
too.
As John McKnight has said in his essay, “The
Medicalization of
Politics,” “Politics is the act of citizens
pooling their intelligence
to achieve the maximum human good. Medicalized
politics is the
disavowal of that common intelligence. Politics is
the art of the
possible -- a process that recognizes limits and
grapples with the
questions of equity imposed by those limits.
Medicalized politics is
the art of the impossible -- the process by which
an unlimited promise
is substituted for justice. Politics is the art of
reallocating power.
Medicalized politics mystifies control so that
power is no longer an
issue. The central political issue becomes the
right to more control.
Politics is the act of citizens. Medicalized
politics is the control of
clients. Only the hands of citizens can cure
medicine. Medicine cannot
cure itself because its prescriptions came from
its own system of
values.”
If your community is considering fluoridating the
water -- or if it
already has fluoridated water -- you may have to
fight it. You may take
political action and work against the enactment of
national health
insurance, or work for the inclusion of
“revolutionary clauses” which
will prevent the Inquisition from getting a death
grip on our society.
You may work politically for laws which will
effectively remove poisons
from our air, food and water. Or for changes in
the Social Security and
tax laws that will favor keeping families together
and strong.
I recently was asked by a group of Latin-American
mothers in Chicago to
help promote breastfeeding among the members of
their organization for
better child raising. They knew their biggest
problem was that the
community hospitals these women were using
sanctioned the use of
formula. The mothers decided to do something with
their organization.
They visited the heads of the hospitals and tried
to persuade them to
stop encouraging bottlefeeding by handing out free
sixpacks of formula
and special “supplementary feeding packs” to
mothers who already were
breastfeeding. They said that if the hospital
heads did not respond to
their requests, they were going to picket the
hospitals.
It seems to me that the New Doctor has to be in
the front lines of
these struggles. He or she will have to be
involved politically if only
in response to his patients’ needs. He or she will
be visible through
the newspapers and other media when these issues
come to the fore. And
if they don’t come there, he’ll make sure they do.
This is one of the major differences between the
ethics of Modern
Medicine and those of the New Medicine. Modern
Medicine tells doctors
to stay out of politics. Of course, this is merely
to hide the fact
that doctors are already into politics in an
immensely powerful way.
The Church likes the status quo, since it is in
control, so it wants to
be able to scare away potential troublemakers and
blacken the
reputations of those who can’t be scared away, by
labeling them
“politicians.”
The New Medicine says that the doctor is not a
monastic priest sitting
in his monastery, but is a participant in the life
of the community.
Doctors will be community leaders active in
politics because concern
for the health of the community demands it. When
the water company
wants to fluoridate the public water, the New
Doctor will be right
there to make sure people know the biological
consequences. When the
power company wants to build a nuclear power
plant, the New Doctor will
not stand by and let the health of the community
be threatened. Rather
than allow political issues to become medicalized
and thus defused --
the New Doctor will acknowledge the need for
political power to be
applied to matters of health and disease. He or
she will not shrink
from identifying “bad” politics as factors in
disease.
Community involvement of this nature implies a
certain type of doctor
with the sensitivities, skills, and motivation to
help build the New
Medicine. Any collection of ideas-for-action can
be subverted by the
people who do the acting.
The New Doctor is comfortable with people from all
walks of life -- not
only in the doctor-patient relationship, but in
social relationships as
well. The New Doctor considers his or her service
as an agent of social
improvement, so he or she will need to understand
and be aware of the
social and ethical foundations of medicine.
The New Doctor will be conversant not only in the
language of science,
but in the language of people as well. He or she
is going to be
constantly informing patients: informing them of
the risks and benefits
of prospective treatments, informing them of the
ways they can stay
healthy, informing them of how certain activities
and circumstances
affect health. The doctor-patient relationship is
democratic in the
sense that both doctor and patient share
information equally. But that
“democracy” must necessarily break down when the
doctor has to exercise
his or her authority. The “perfect” example of
this is when the patient
is unconscious. Obviously, under those
circumstances the doctor must
accept responsibility and make choices in the best
interests of the
patient -- without the patient’s consent. When the
patient is
conscious, however, the doctor must still
recognize that there might be
a point at which the patient’s knowledge ends and
the doctor’s keeps
going. That’s why the patient is seeing the
doctor, after all, to
depend -- however much -- on that knowledge and
training. I don’t care
whether the doctor wears blue jeans or a
three-piece suit, whether his
or her hair is short or long, whether he works out
of a brand- new
clinic or a used van -- the patient is there for
the benefit of the
doctor’s knowledge. The doctor must inform the
patient of how the
patient’s choices will affect him, but he or she
must not shrink from
making a judgment based on his or her knowledge
and talents. That’s
what the patient is paying for.
When the New Doctor is faced with a patient who
has just had a baby,
that patient is going to be informed of what her
alternatives are for
feeding and caring for that baby. The New Doctor
is going to tell her
that bottle feeding is not as safe or healthy as
breastfeeding and that
the difference in benefit and risk is great enough
so that if she
chooses to bottle feed, she is going to have to
find another doctor.
The New Doctor is not afraid to act on evidence
that’s available today.
He or she has enough confidence in his or her
knowledge, training, and
instincts to avoid the cop out: “We
don’t know enough. All the evidence isn t in. We
need more research.”
Because the New Doctor admits up front that these
choices are
necessary, he or she must be aware and responsive
to the ethics of the
doctor-patient relationship. To what extent do
people have stewardship
over life, death, and health? How far can medicine
increase our control
over life and death? What issues are involved in
the choices to use
artificial organs, transplanted organs, and
artificial life-extending
machinery? It’s not enough for the New Doctor to
know how to do things,
but why. Just because something can be done, does
that mean it should
be done? The ethic that will permeate the New
Doctor’s practice and
training is regard for the rights and dignity of
human beings.
As maker of health, the New Doctor is aware that
the patient and nature
are the ingredients, not merely the medium for the
expression of
technique. Aware of the limits of human
competence, the New Doctor
knows when to intervene in natural processes, when
to encourage natural
processes, and when to let natural processes run
their course. Implied
in this knowledge is awareness of the harm that
can be done by doctors.
“The
art
of medicine,” accordlng to a colleague and good
frlend of mine, Leo
I. Jacobs, M.D., Medical Director of Forest
Hospital, Des Plalnes,
Illinois, “flows
from
the physician’s ability to be introspective and to
understand the
patient as a human being with certain feelings,
thoughts, attitudes,
interpersonal relationships, aspirations, and
expectations rather than
a mere symptom carrier. Such a physician tends to
see the patient, and
not himself, as the primary person responsible for
maintaining health,
by leading a meaningful life in which proper
nutrition, exercise, and
stress management combine with an appropriate
balance of love, play,
and work within a harmonious family. Such a
physician will resort to
drugs or surgery only after his understanding of
the patient’s
predicament has ruled out non-invasive or
educational, psychological,
or social approaches.”
The New Doctor acknowledges nature as the prime
healer, and so regards
natural supports of health, such as the family, as
having supreme
importance in the healing process. The family is
the unit of health and
disease, so the New Doctor treats the whole person
in the context of
family as well as religion and social system. The
New Doctor makes
house calls and meets the family on its own turf.
He or she disregards
professional language and advice that tends to
split families into
warring factions. Proper avoidance of
hospitalization will be a key
goal, so the New Doctor delivers babies at home
and scorns the idea
that people must come into and leave this world
under conditions of
intensive care.
The New Doctor is a lifeguard. He or she stands by
ready to intervene
in life-threatening situations. At the beginning
of life he lets the
mother deliver the baby and stands by for the tiny
percentage of cases
in which he is needed.
As soon as we assign the role of lifeguard to the
doctor, we define
what he does and does not do throughout his
career. He or she does not
play the central role. The central roles are
played by the individual,
the family, and the community.
And in “guarding”
the
health of his patients, the New Doctor establishes
priorities
according to their promise of safety and
effectiveness. The Hippocratic
order of treatment placed regimen before medicine
and surgery. So will
the New Doctor. What a patient does every day with
and to the body and
soul have a greater effect on health than what the
doctor can do in a
small fraction of that time. The New Doctor must
teach the patient what
to do during the mass of time he is living his
life on his own, away
from the doctor, to maintain and maximize health.
The one rule I give to all my medical students is
that I don’t care
what you do to the patient as long as he or she
feels better when
leaving the office than when coming in. The New
Doctor heals with
himself. If the doctor has enthusiasm and hope,
and can communicate
this to the patient then the patient is going to
feel better. A healer
is a healer no matter what techniques he uses.
Conscious of this, the
New Doctor prescribes “himself”
in generous doses, meaning he or she uses whatever
resources of personality and human caring
possible.
The New Doctor still will be a priest in the sense
that he or she will
officiate or mediate at the absolution or
cleansing of the patient’s “sins.”
You’ll still have to confess to the New Doctor, in
the sense that you will give your “history”
and
the doctor wlll identify what is health-producing
and
health-destroying in your life. The New Doctor
doesn’t presume you’re
never going to do anything unhealthy, but he’s
going to make sure
you’re aware of it when you do. We know that the
body has its own
powers of absolution in its incredible ability to
adapt and make up for “mistakes.”
You
still have to do penance, but there’s a
difference. The New Doctor
doesn’t sprinkle you with holy water and pronounce
you saved if you
take this drug or let him mutilate you. The New
Doctor doesn’t
sacrifice you to any vengeful gods. Your penance
is biological, it’s
the price you have to pay to get back in balance.
You have to
overcompensate for a while to make up for going
too far.
Naturally, the New Doctor tries to motivate people
to avoid disease,
too. I believe guilt is one of the strongest
motives for changing one’s
behavior. The New Doctor, being concerned with
causes of disease rather
than superficial symptoms, is going to ascribe
guilt in a more rational
and ethical fashion than Modern Medicine. The
guilt will be personal,
but not exclusively personal, and it will be
relieveable through
action, not symbolic rituals. In the case of lead
poisoning, the guilt
will be ascribed to whoever is responsible for the
lack of food in the
refrigerator, whoever is responsible for the lead
in the air, in infant
formula, and in food. If a woman opts for
analgesia and anesthesia
during childbirth, she deserves some guilt because
these things are not
good for the baby. If a mother tells the New
Doctor she’s planning to
bottle feed her baby, the New Doctor is going to
tell her she’s
threatening the baby’s health. New Doctors will
try to make people feel
guilty about eating refined sugar and flour and
over-processed foods,
about smoking and about not exercising.
The New Doctor’s use of guilt will motivate people
to healthy habits
rather than frustration and fear because there
won’t be any
double-think involved. Something is either good
for you or bad for you
and the New Doctor will make sure you know the
difference. That
difference will be determined biologically rather
than politically or
religiously. If bottle feeding is wrong, it’s
wrong because it exposes
mother and baby to a number of unhealthy
conditions, such as
gastroenteritis, allergies, infections, and
inadequate bonding between
mother and child. The New Doctor may believe that
a woman’s body is her
own; but biologically he or she knows that
abortion causes a higher
rate of sterility and other complications that a
properly informed
woman would not choose to expose herself to. A
doctor should tell a
women that an abortion will increase the chances
of her delivering a
premature infant in the future by fifty percent.
He should tell her
about the Israeli study of more than 11,000
pregnancies in which women
who had previous induced abortions “were
subsequently
less likely to have a normal delivery. In the
births
following induced abortions, the relative risk of
early neonatal death
was doubled, while late neonatal deaths showed a
three- to four-fold
increase. There was a significant increase in the
frequency of low
birthweight, compared to births in which there was
no history of
previous abortion. There were increases in major
and minor congenital
malformations.” (American
Journal of Epidemiology, September, 1975)
The New Doctor’s honesty will extend to denying
Modern Medicine’s
mythical claim that everything can be cured, that
no matter how you
mess yourself up the skills of the doctor can put
you back together.
The New Doctor informs his or her patients that
real cures are hard to
come by and that even miracle cures fade fast.
Patients are thus
cautioned against straying too far away from the
balance that will
insure them a long and healthy life.
The New Doctor will be skeptical of the promised
benefits of drugs and
surgery. One of his or her major areas of
responsibility is to protect
people against the excesses of surgeons and drug
companies in foisting
off their wares. Nevertheless, the New Doctor does
not abandon useful
technology, but rather discriminates between
useful machinery and
machinery for-the-sake-of-machinery. He’s trained
in the use of
scientific equipment, but he’s also taught the
risks and the
deficiencies of it. Most of all, the New Doctor
doesn’t rely on
machinery unless absolutely necessary. He’s aware
of the dangers of
letting technology rule over common sense and
instinct.
Since he will reject much of Modern Medicine’s
machinery the New Doctor
is knowledgeable in unorthodox methods of treating
disease, including
nutritional therapy, acupuncture, kinesiology,
chiropractic,
homeopathy, and others.
One of the primary activities of the New Doctor is
to protect patients
against the excesses of specialists. New Doctors
will be antagonists to
the specialists: they’ll make their patients feel
guilty about going to
a specialist and endangering themselves without
justification. Instead
of viewing the patient as a collection of symptoms
localized in a
single spot, the New Doctor will see the whole
person as the context
and possible cause for disease.
Eventually, in the light of ethics, iatrogenic
considerations and
exposure, and generalist education of doctors, the
specialties will
largely disappear. If the hospital addiction can
be licked early in
life -- at birth -- it will not become a habit
later in life. Home
delivery of babies will cause the disappearance of
ninety-five percent
of obstetrics and gynecology. As the failure of
psychiatric
chemotherapy, psycho-surgery, electroshock
therapy, analysis, and most
counseling is exposed -- in favor of strong
familial, friendship,
self-esteem support networks -- most of psychiatry
will disappear.
Internal medicine will go under with its highly
lucrative recruiting
practices: annual exams, screening for
hypertension, and drug therapies
for diseases that can be treated naturally.
Surgery will mostly
disappear as people learn to refuse to let doctors
mutilate them for no
particularlv good reason -- and. as they are able
to find more and more
New Doctors who will treat them without surgery.
The entire field of
orthodox oncology will disappear as chemotherapy,
surgery, and
radiation for cancer are revealed as fundamentally
irrational and
scientifically unsupportable. Pediatrics. of
course, will disappear as
more and more mothers are encouraged to breastfeed
their babies.
The New Doctor is committed not only to putting
the specialists out of
business, but to putting himself out of business
as well. Doctors used
to say they were in business to put themselves out
of business, but it
was only a slogan. Now you don t even hear them
saying it anymore. But
the New Doctor will back up his commitment with
action. He or she will
teach people how to keep themselves healthy and
how to restore health
and balance without the aid of a professional.
While the New Doctor
knows there will always be a need for doctors, the
doctor’s role in the
person’s health will diminish to the point where
it might not be a bad
idea if doctors had another way to earn a living
besides practicing
medicine. One thing is certain, if every doctor
were a New Doctor, we
would need far fewer doctors and medical care
would not be the outsized
behemoth in people’s lives that it is today.
The New Doctor must be prepared for courageous
behavior, which means
doing what has to be done even though it means
giving up the wealth,
power, and status associated with being a
conventional physician. I
don’t think we’ll have any trouble instilling
courage in New Doctors.
The ones I’ve met -- as both doctors and
doctors-to-be -- seem to come
equipped with both courage and the cunning to
defend themselves. I met
a young doctor recently who had quit his formal
medical education as
soon as he was eligible for a license --
immediately after his
internship. I asked him where he was licensed, and
he told me in five
states. He said he anticipated having trouble with
the medical
establishment, so he’s prepared if they start
taking his license away.
Smartest fellow I’ve met in a long time. The New
Doctor knows what he
has to do to survive long enough to work himself
out of business.
Obviously, the New Doctor exists despite his or
her medical education
rather than because of it. With this in mind, I
and a number of my
colleagues have created a blueprint for the New
Medical School, which
is now actively seeking state approval and looking
forward to taking on
its first class of New Doctors-to-be.
The education of the New Doctor will include not
only medical and
clinical sciences but ethics and literature as
well. All students in
the New Medical School will be shown how human
behavior relates to
health and disease. New Doctors will be trained to
comnunicate by means
of the written as well as the spoken word. They
also will learn the
basic techniques and social implications of other
media, such as
television. New Doctors must not only be able to
communicate
effectively with the community, but they must be
aware of the processes
by which they and their patients are influenced.
Since legal procedures
are important not only to the doctor’s protection
of his practice but
to the protection of his patients as well, New
Doctors will learn to
deal with lawyers and the law.
The New Medical School will have a Department of
Ethics and Justice. A
community’s concept of justice determines the
health of its members in
terms of life expectancy, infant mortality,
morbidity statistics, and
quality of medical care. Theoretical economic
structures are
irrelevant. A free enterprise system saturated
with justice can provide
good medical care, while a socialized medical
system devoid of justice
can provide deadly medical care. An immoral
society that sets arbitrary
limits on technological achievements can be
harmful, while a moral
society that strives for the best that technology
has to offer can
produce healthy people. In our Department of
Ethics, the traditional
medical disciplines will be required to expose
their material to the
fight of various ethical systems: Jewish,
Christian, Hindu, Islamic,
utilitarian, situational, etc.
The New Medical School will have a very strong
Department of Iatrogenic
Disease. In this department all medical
disciplines and specialties
will be required to demonstrate how their methods
can produce disease
and disability. Doctors and professors will be
paid to find out how
medical care does more harm than good, and how
proposed new treatments
might prove harmful.
Instead of the New Medical School providing the
same specialist-
encouraging instruction and role models that
conventional schools do,
it will stress generalism. The New Medical School
will be an open form
of ideas on healing. Students will be taught not
only by medical
doctors, but by osteopaths and chiropractors and
naturopaths and
nutritionists. We don’t want the New Doctors to
learn about these ideas
and practices as if they were abstract academic
principles. We want
them to see them practiced firsthand.
The New Doctor will be educated in methods and
principles that do not
become obsolete every few years. Once the
fifty-to-ninety percent of
what is now being taught is rejected as either
wrong, outdated or
irrelevant, we will have enough time to teach what
has to be taught,
such as fundamentals of diagnosis and prognosis.
The New Medical School will begin producing New
Doctors by selecting a
different kind of person to be a student. Students
who score highly on
traditional medical school entrance exams tend to
be too compulsively
achivement- oriented. They lose contact with the
genuine goals of
medicine and become wrapped up in competition and
in the application of
technology to subdue rather than restore the
balance of Nature. The New
Medical School will downplay quantitative tests
and look for people who
are comfortable being with people rather than
doing something for or to
them. We don’t want insecure people with so little
self-esteem that
they always need to be proving themselves by
challenging their peers
and defending their status. Such characters are
unhealthy to those
around them as well as to themselves.
To help avoid the social pathology that seems to
affect physicians as a
group, the New Medical School will concern itself
with supporting and
strengthening the family life of each New Doctor.
We will encourage
students to marry and have families, because we
want them to experience
their profession from both sides, as real people.
The New Doctor will
also have strong roots in the community, since the
local culture of a
people is always a factor in health and disease.
I remember some years back I was asked to give the
speech to incoming
medical students at a medical school. The title of
my talk was “How
to
Survive Medical School.” I gave them a number of
rules, one of which
was to stay close to your farmily and to people
you knew before medical
school. Stay close to people who are not doctors
and not studying to be
doctors. Don’t work too hard. Dont’ try for A’s.
It’s almost impossible
to get kicked out of medical school, so you might
as well just slide
through. Make a major investment in your
education, but not an
exclusive one. Not an investment to the exclusion
of the rest of your
life.
After I finished, the dean of the school got up
and said he agreed with
everything I said, but that the students should
always remember that
when you enter medicine you are entering a new
life!
Students at the New Medical school will be taught
in a different
manner, too. Their relationship to the faculty
will be as graduate
students actively involved in the shudy of a
discipline rather than as
passive recipients of trade school training. The
New Medical School
will not be a research institution or a hospital.
It will be a school.
Students will be assigned to teachers, not to
hospitals. The teaching
format will be by preceptorship or professional
apprenticeship.
Students will take responsibility for their own
education.
When those young men and women are graduated you
won’t have any trouble
distinguishing them from the rest of the pack. For
in preparing the
state application form for our New Medical School,
we visited a number
of other medical schools. One of them was a new
school in a small
community in southern Illinois. After they had
finished showing us all
they had accomplished, we asked the directors one
question: If you were
to mix your graduates with a bunch of Harvard
Medical School graduates,
would you be able to tell them apart? The answer
was “No,
you wouldn’t, because our students are
indistinguishable from those at Harvard.”
We then decided that we wanted nothing further to
do with that school. Our students are going to be
easily identifiable:
Their first rule is going to be First, Do No Harm.
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