THE TRAGIC FAILURE OF ORGANIZED MEDICINE
His profession has a great record of scientific achievement says this well-known doctor. But in social progress it’s still in horse-and-buggy days. It’s time doctors stopped dragging their heels on health plans and treating medicine like any other business.
HARRY PAIKIN M.D.
Dr. Hurry Puik in lias hern in general practice sime IVJI in Hamilton. where lie's a member of the Hoard of Education and the Hoard of Health anil a former chairman of both bodies.
He's also vice-president of the Ontario Urban and Rural School Trustees Association and a member of the American Academy of Dermatology and Syphilology.
Science divorced from society is to be compared to a spirited wild horse, roaming free on the plains. It is beholden to no man. Its great strength is either husbanded slothfully, or dissipated in aimless meanderings. But when science occupies its true and proper position as the servant-mentor of society, the wild horse is transformed into a centaur, a modern Chiron, acting as guide and preceptor to a herculean society.
Not only does this hold true for the physical and biological sciences in general, but it holds true for medical science in particular. During the past few decades, medicine has made tremendous technological advances. But what of its sociological gains? Scientific medicine and sociological medicine — can we boast of them, equally, with the same pride of achievement? A celebrated University of Toronto biologist. Dr. A. F. Coventry, said in 1924: "In our sociological progress, we are some three hundred years behind our technological developments.”
That comment was made at the beginning of the period of the greatest accomplishments in medical history. At that time, after a long slumber in the doldrums of the post-Pasteur era. the world was still atingle with the electrifying discovery of insulin, that marvelous juice manufactured by the islands of Langerhans in the pancreas. With the advent of insulin, sufferers from diabetes could expect a mitigation of their symptoms, and a lengthening of their days. Not only did insulin reduce suffering and prolong life, but it acted as a stimulus to the scientific spirit, lighting the way to broad new' fields of research and a host of further discoveries.
At first, insulin was scarce and difficult to produce. Had it fallen into private hands, it would undoubtedly have been exploited as a lucrative source of profit. But • the University of Toronto, recognizing its superlative benefits, decided to make it available through the C onnaught Laboratories — inexpensively to those who could pay, and, in co-operation with the Government of Ontario, free to those who could not pay. In doing so. the University of Toronto and the Government of Ontario donned seven-league sociological boots.
What part did organized medicine play in the insulin drama? At best, a passive one. Looking with little enthusiasm on free medicine and medical treatment, organized medicine held itself aloof from participation in government-sponsored medical schemes. That the boon of a new medical discovery in any era should be the heritage of the people of that era as a historical and democratic right did not seem to make an imprint upon the deliberations of organized medical groups. Thus, organized medicine of that day, because of its lack of philosophic maturity, missed the great opportunity of joining with the university-government team to form a scientific-sociologic triumvirate that could have catapulted medical progress forward. The genie of science was stirring within the lamp of society, but the medical Aladdin, a neophyte, did not know how' to bring it forth.
Most highly developed of the members of the medical profession, philosophically, are not the practicing
doctors who form the ranks of organized medicine, but the dedicated scientists, teachers, professors, and laboratory workers, the "lab rats” as they call themselves, who have decided to devote their lives not to the pursuit of the dollar, but to the pursuit of knowledge and scientific truth. It is they who have made the great advances and discoveries in medicine. Freely they have given to the world the fruits of their researches. No dollar - dedicated doctor has ever produced anything worthwhile. Scientists such as Drs. Banting, Fleming, and Salk, with whom 1 have spoken, did not seek rapid riches from their discoveries. But numerous medical walruses and carpenters have been only too eager to gorge themselves on the scientific oysters.
Six years after the discovery of insulin. Minot and Murphy in Boston lit another beacon on the untrodden highways of medicine with the announcement that liver cured pernicious anæmia. The price of the lowly liver in the butcher shops jumped, and people paid for liver shots to keep themselves alive. Each new' discovery strengthened the hand, and increased the therapeutic skill, of the doctor. More, better, and newer methods of diagnosis evolved, better and faster-acting drugs w'ere produced, and safer, smoother techniques wære created. Medical progress bounded forward, and medical costs leaped ahead in unison. Organized medicine blinked, took note, scratched its head, and decided that there was no use in disturbing the sun and the moon in the firmament.
While pygmies grew, Buddha sat entranced
Came the antibiotic era. the day of the sulfas, penicillin, and the mycins. The pygmy doctors of the Thirties, with their little black bags containing a limited pharmacopoeia of morphine, aspirin, digitalis and vegetable laxative tablets, became the powerful giants of the Forties, armed with an arsenal of sulfa, penicillin. aureomycin. and thiouracil. And medical costs? They shot up to the sky. Organized medicine sat like a Buddha contemplating his navel. The scientific fruits were good, but their price was high. What to do about it? Aladdin had still not learned how to rub the lamp.
In spite of the many highly developed surgical techniques and specific medicines, there are thousands of people walking the streets today who suffer for lack of medical treatment simply because they cannot afford it. people with bunions and hammer toes, club feet, varicose veins, hernias, low back pain, chronic arthritis and bursitis, prolapsed wombs, haemorrhoids, genitourinary detects, unsightly skin tumors, varying degrees of deafness, visual impairment, and nasal obstruction, and the myriad of unfortunates who put up with dental defects and indigestion. Add to these the many untreated cases of metabolic disease, anæmia. respiratory infections, psycho-neuroses, allergies, and chronic skin conditions, and an appalling panorama of medical neglect begins to unfold.
Let us face the truth honestly and squarely as the people of Britain faced it. It costs a lot of money to keep healthy, more than the continued on page 34
continued on page 34
The tragic failure of organized medicine
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“If health reforms are not properly the business of organized medicine, whose business are they?”
average man, plagued by periods of unemployment and lack of security and struggling with the burdens of raising a family and keeping a home together in a semblance of decency, can afford. If, like the majority of people, he belongs to the ranks of honest men, he may have to sell his soul to a finance company to meet his bills. Many never get out of debt, for sickness has a way of striking not once but often.
Never raising its voice in protest against the inequities in society, inequities that directly contributed to the increase in the incidence of disease, organized medicine sat back in detached and unperturbed fashion, while labor and political groups carried on the fight for legislation that would abolish disease-ridden slums, build badly needed houses, increase workmen's compensation, welfare, and old-age-pension payments, combat unemployment, create, freer educational opportunities, and establish hospital and health insurance. Organized medicine knew that poor nutrition and poor living conditions bred such diseases as tuberculosis and the dysenteries, fostered rickets, scurvy, anæmia, and dental caries, but organized medicine said nothing, did nothing. Organized medicine knew that there was a shortage of doctors in the country, that many large rural areas had no doctors at all, but organized medicine conducted no surveys, laid no plans, had
no solutions to offer. Organized medicine knew that medical education was costly and that not enough students were entering medical courses, but organized medicine offered no scholarships or bursaries, gave no encouragement.
But these things are not properly the business of organized medicine, some will declare. Then whose business are they? Should doctors show no concern for the living conditions of the people? Is not the least that might be expected of them, as individuals and members of organized groups, a desire to give advice, help and co-operation to a government that would seek to create a plan of total war against disease? That which the anti - socialist Economist said of the Tories who opposed the British Labor Government's health scheme might well be applied as a criticism of organized medical groups who oppose a government health scheme in our country today: “Instead of standing forth as the champions of wise and vigorous government, they have allowed themselves, by talking in generalities about abstract principles, such as ‘freedom’ and ‘enterprise’, to be represented as the captious remnant of a bygone social order.”
Reacting to the hypnotic effects of a scientific-commercial schizophrenia, organized medicine in Canada maintains categorically that medicine is a business, the business of every privately practicing doctor, and that neither government nor
citizenry nor the angels may dare interfere in its operations. Third parties beware!
But surely it is time that Canadian organized medicine recognized an incontrovertible fact — we have reached a point in our sociological development at which we can no longer continue to regard health as a business, but must acknowledge that it is a service to the people, a service that, like education, must be the democratic right of every citizen.
Exemplifying to a startled. Englishspeaking world the feasibility of a government-sponsored national health plan, the free-to-all National Health Service was inaugurated in the British Isles in the late forties. Its critics were legion, its proponents in the ranks of medicine woefully few. But, nevertheless, it was in to stay. With the somewhat truculent remark that he did not care about the doc-
tors, dentists, or optometrists, but that he cared only about the British people, Aneurin Bevan, acting for the Labor government, put the plan in. and after the Labor government's subsequent defeat, the victorious Conservative government left the plan in. It is still in today, a British institution which the average Briton regards as his heritage and his right. One might venture to state that one might have more success in closing the pubs in Great Britain today than in abolishing the National Health Service. The doctors are working under it, accepting it, and for the most part liking it. Of course, there is much room for improvement. But then, that is England, and the English move slowly—until they are aroused, that is.
The National Health Service, as it operates today, is in the main a boon and a blessing to the people of England. But it has certain shortcomings, which could
have been prevented or corrected by the British Medical Association. A proper blueprint for co-operation with and guidance of the plan at its inception would have served the British people far better than the fatuous and intransigent opposition which the British Medical Association manifested. As a result, the plan as it stands today precludes attendance by any general practitioner upon his patient in hospital. Once a patient is sent to a hospital, he is turned over to one or more of a staff of specialists (for the most part salaried) who look after him from then
on. Thus, to the British general practitioner in Britain today, all hospitals are virtually closed.
Aneurin Bevan was anxious to set up a plan of health coverage for the people of Britain that would guarantee them protection against the costs of medical, surgical, and obstetrical needs, of tooth repair, dentures, eyeglasses, trusses, braces. wigs, and hospital confinement. He realized that no insurance company could undertake to supply these things in so all-inclusive and unrestricted a fashion, and that any private insurance company
attempting to offer even a limited coverage must do so by charging a high premium. Only a government imbued with vision and endowed with a lofty purpose could offer to the people, on such a grand scale, a plan of relief from the back-breaking costs of disease.
Aneurin Bevan. of course, is not a doctor, in his enthusiasm and determination to inaugurate a national health plan for the people, he did not see that he was doing so at the sacrifice of one of their most fundamental democratic rights, namely, the right of each patient to be
attended by the doctor of his choice, not only in the doctor’s office, or in his own home, but also and particularly when he is confined to the strange and often terrifying environment of a hospital.
A National Health Plan in Canada will be different. It should be different. Circumstances, the conditions of politics, economics, culture, and society, are different. The doctors in Canada should offer their co-operation to the government in evolving a plan that will be best for the people and best for themselves.
A National Health Plan in Canada must not make the mistake that was made in Britain. It must guarantee that all hospitals, including the exclusive university teaching hospitals, become open hospitals in w'hich every patient shall have the right to be attended by the doctor of his choice, and in which every practitioner, general as well as specialist, shall have the right to attend and treat his patient. This presupposes the abolition of outmoded charity wards and out - patient departments, a step that is long overdue.
Many are the arguments offered against a national health plan by its critics. It w'ill destroy the doctor’s initiative; it w'ill create a welfare state; it will be costly; it w'ill foster neuroses and malingering; it w'ill be exploited by the unscrupulous. Such arguments are specious, claim its advocates. Is initiative, then, to be equated with profit-making? Has the free public educational system created a welfare state? Will not the costs, in comparison with the benefits, be exceedingly cheap? Will not removal of fear over the high price of sickness reduce neuroses rather than engender them? Will not ready accessibility to medical care diminish malingering rather than increase it? And. as a corollary, the more people who can obtain medical care, the more freely and easily they can get medical advice, the earlier they can seek out their doctors. the sooner will they be cured, and the less sickness will there be in the country. Further, freed of the need to pay for doctoring, they will have more money for better food and the ordinary requisites of life. A National Health Plan is bound to produce a healthier, happier, more vigorous, longer-lived nation.
Bevan, himself, who first became fired with zeal to establish a National Health Plan because of the suffering he saw around him as a young miner in Wales, had ready answers for his critics. To those who averred that the British health plan lent itself readily to political opportunism, he demonstrated that the personnel of hospital boards had remained virtually the same after the plan as before. To those who claimed it would be exploited by hypochondriacs, he pointed out that the new escalators in the London subways had caused some to go riding up and down for a while, but they soon tired of it. And to those who warned that the British citizens were selling their birthright of freedom for a mess of pottage. he replied that Britons could eat tastier, tougher fare than pottage, now that they had got new false teeth from the health service.
Like the fish evolving to the mammal stage, medicine has many gills to lose. We have not yet arrived at the Chiron stage in medical progress. Our medicine is far from being a scientific-sociologic centaur. We have a long distance still to travel along the road of philosophic and socio-economic progress before we will have attained to the truly dignified position of social man. erect on his feet, with back unbowed by discriminatory burdens, with head held high in self-respect and eyes fixed on the stars, -fc