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MEDICINE FOR SALE
95
When Feynman was asked to join the commission of inquiry into the Challenger shuttle disaster, his first reaction was not to go anywhere near Washington ("screw the Government") and to continue doing his physics for as long as his abdominal cancer would allow him. When he finally accepted he became a legend overnight when, in front of TV cameras, he dropped a piece of a rubber ring (which was to seal the booster rocket but did not) into ice-water and
demonstrated how the rubber lost its resilience. In his
minority report, published, after attempts to stall it failed, as an appendix F to the main report, Feynman accused NASA of playing Russian roulette with the lives of the crew, and concluded that "a successful technology must take precedence over public relations, for Nature cannot be fooled". The bulk of the second memoir is an inimitable Feynman’s own investigations into the cause and the background of the catastrophe. account of
Feynman’s scientific credo was encapsulated in two public lectures-on Cargo Cult Science and on the Value of Science. This belies the "powerful sense of social irresponsibility" of which Feynman liked to boast. Pseudoscience (in which Feynman includes educational theories, parapsychology, and much of medicine) is like cargo-cult rituals in the South Seas. During the war the islanders had seen aeroplanes landing with lots of goods and they imagined that, if they built airstrips, lit fires along them, and sat a man in a hut, as a controller, with two pieces of wood for headphones and some bamboo sticks for aerials, planes would bring cargoes of goodies again. The form is the same but it does not work-no planes land. There is nothing easier than fooling ourselves and others. Schools provide no courses in self-defence against wishful thinking. Feynman insisted on scrupulous honesty in presenting all data from experiments, on bending over backwards to show we may have been wrong-this he saw as the scientist’s main responsibility. Above all he defended the need for complete freedom of inquiry. "In order to progress we must recognise our ignorance and leave room for doubt... our freedom to doubt was born out of a struggle against authority... permit us to question, to doubt, not to be sure ... Herein lies a responsibility to society ... It is our responsibility as scientists, knowing the great progress which comes from a satisfactory philosophy of ignorance, the great progress which is the fruits of freedom of thought, to proclaim the value of this freedom, to teach how doubt is not to be feared but welcomed and discussed, and to demand this freedom as our duty to all coming generations."
Amidst the aggravating madness of this absurd world, these words give a glimmer of hope. I even feel proud of being human because Feynman existed. Every teacher and every student should read these two books: the teachers to examine their consciences and to reflect on how they have been enslaving young minds; the students to learn how to recover their natural subversiveness and to rediscover the joy of free inquiry.
MEDICINE FOR SALE As the British National Health Service moves closer to US styles of health care, the experience of American physicians deserves careful analysis. Much has been written of the burdensome regulations that interfere with
professional decision-making regarding hospital admission, laboratory tests, procedures, and so on. Some of the patients, too, are less than happy. 37 million Americans are not insured, and an equal number beyond this are only partly covered or not covered throughout the year, and are only marginally solvent. In a poll comparing US, Canadian, and UK medical care, 13% of the respondents reported that they had failed to obtain medical services during the past 12 months. Of these, 58% attributed it to "lack of money/insurance; couldn’t afford it". Only 5 % of British respondents reported they had failed to obtain needed care in that period, and of those, only 2% (one person) said that the cause was lack of money. Even some of those who can afford good insurance are disturbed by the influence of financial matters on the doctor-patient relationship. Fee schedules may be exploited by charging for each element instead of by an inclusive fee. Some doctors have investments in laboratories to which they refer their patients: are all their referrals necessary? A newspaper relates the story of a physician-owned laboratory that earned dividends averaging 5000-7000% for its investors. It is now charged with fraud and paying "kickbacks" to the doctors. The doctors bitterly claim that they were only following the precepts of the Reagan administration, to make medicine more competitive and entrepreneuria1,2 The Health Letter reports the cynical action of a pharmaceutical manufacturer who utilises the airline
promotion gimmick-the frequent-flyer bonus programme increase market share of a prescription drug. If a physician prescribes this particular drug, and especially if it replaces another drug, he or she may win a free airline ticket anywhere in the continental United States. What doesthis convey to the American public about the ethics of doctors-or about industry’s perception of their ethics? Is it that physicians will order a medication, necessary or not, change a patient’s medication, for the sake of a free plane trip? Do physicians have to be bribed to use a better or safer
-to
effective medication? Such news items carry the message the public that "important decisions concerning their health and lives can be bought and sold...".3 Health Letter quotes a surgeon: "The majority of doctors who work hard, care, and are doing their best completely aboveboard, are being hurt by those who are out to make their millions as fast and as long as society will permit. Abuse of the system by a greedy minority is eating away at our marvelous profession, and we will have only ourselves to blame if we continue to put up with it." or more
to
Institution for Social and Policy Yale University, New Haven, Connecticut 06520, USA
Studies,
GEORGE A. SILVER, Emeritus Professor of Public Health
1.Blendon
RJ.HMQ survey: comparing three systems. Health Management Q. First Quarter 1989; ii, no 1. 2.Cooper KJ.Some doctors profit by referral to their own labs.Miami Herald, Feb 19,
Department of Community Health, Trinity College, Dublin, Ireland
Health Watch
PETR SKRABANEK
1989. 3.Outrage of the month.Health Letter
1989; 5, no 5: 12.
When Feynman was asked to join the commission of inquiry into the Challenger shuttle disaster, his first reaction was not to go anywhere near Washington ("screw the Government") and to continue doing his physics for as long as his abdominal cancer would allow him. When he finally accepted he became a legend overnight when, in front of TV cameras, he dropped a piece of a rubber ring (which was to seal the booster rocket but did not) into ice-water and
demonstrated how the rubber lost its resilience. In his
minority report, published, after attempts to stall it failed, as an appendix F to the main report, Feynman accused NASA of playing Russian roulette with the lives of the crew, and concluded that "a successful technology must take precedence over public relations, for Nature cannot be fooled". The bulk of the second memoir is an inimitable Feynman’s own investigations into the cause and the background of the catastrophe. account of
Feynman’s scientific credo was encapsulated in two public lectures-on Cargo Cult Science and on the Value of Science. This belies the "powerful sense of social irresponsibility" of which Feynman liked to boast. Pseudoscience (in which Feynman includes educational theories, parapsychology, and much of medicine) is like cargo-cult rituals in the South Seas. During the war the islanders had seen aeroplanes landing with lots of goods and they imagined that, if they built airstrips, lit fires along them, and sat a man in a hut, as a controller, with two pieces of wood for headphones and some bamboo sticks for aerials, planes would bring cargoes of goodies again. The form is the same but it does not work-no planes land. There is nothing easier than fooling ourselves and others. Schools provide no courses in self-defence against wishful thinking. Feynman insisted on scrupulous honesty in presenting all data from experiments, on bending over backwards to show we may have been wrong-this he saw as the scientist’s main responsibility. Above all he defended the need for complete freedom of inquiry. "In order to progress we must recognise our ignorance and leave room for doubt... our freedom to doubt was born out of a struggle against authority... permit us to question, to doubt, not to be sure ... Herein lies a responsibility to society ... It is our responsibility as scientists, knowing the great progress which comes from a satisfactory philosophy of ignorance, the great progress which is the fruits of freedom of thought, to proclaim the value of this freedom, to teach how doubt is not to be feared but welcomed and discussed, and to demand this freedom as our duty to all coming generations."
Amidst the aggravating madness of this absurd world, these words give a glimmer of hope. I even feel proud of being human because Feynman existed. Every teacher and every student should read these two books: the teachers to examine their consciences and to reflect on how they have been enslaving young minds; the students to learn how to recover their natural subversiveness and to rediscover the joy of free inquiry.
MEDICINE FOR SALE As the British National Health Service moves closer to US styles of health care, the experience of American physicians deserves careful analysis. Much has been written of the burdensome regulations that interfere with
professional decision-making regarding hospital admission, laboratory tests, procedures, and so on. Some of the patients, too, are less than happy. 37 million Americans are not insured, and an equal number beyond this are only partly covered or not covered throughout the year, and are only marginally solvent. In a poll comparing US, Canadian, and UK medical care, 13% of the respondents reported that they had failed to obtain medical services during the past 12 months. Of these, 58% attributed it to "lack of money/insurance; couldn’t afford it". Only 5 % of British respondents reported they had failed to obtain needed care in that period, and of those, only 2% (one person) said that the cause was lack of money. Even some of those who can afford good insurance are disturbed by the influence of financial matters on the doctor-patient relationship. Fee schedules may be exploited by charging for each element instead of by an inclusive fee. Some doctors have investments in laboratories to which they refer their patients: are all their referrals necessary? A newspaper relates the story of a physician-owned laboratory that earned dividends averaging 5000-7000% for its investors. It is now charged with fraud and paying "kickbacks" to the doctors. The doctors bitterly claim that they were only following the precepts of the Reagan administration, to make medicine more competitive and entrepreneuria1,2 The Health Letter reports the cynical action of a pharmaceutical manufacturer who utilises the airline
promotion gimmick-the frequent-flyer bonus programme increase market share of a prescription drug. If a physician prescribes this particular drug, and especially if it replaces another drug, he or she may win a free airline ticket anywhere in the continental United States. What doesthis convey to the American public about the ethics of doctors-or about industry’s perception of their ethics? Is it that physicians will order a medication, necessary or not, change a patient’s medication, for the sake of a free plane trip? Do physicians have to be bribed to use a better or safer
-to
effective medication? Such news items carry the message the public that "important decisions concerning their health and lives can be bought and sold...".3 Health Letter quotes a surgeon: "The majority of doctors who work hard, care, and are doing their best completely aboveboard, are being hurt by those who are out to make their millions as fast and as long as society will permit. Abuse of the system by a greedy minority is eating away at our marvelous profession, and we will have only ourselves to blame if we continue to put up with it." or more
to
Institution for Social and Policy Yale University, New Haven, Connecticut 06520, USA
Studies,
GEORGE A. SILVER, Emeritus Professor of Public Health
1.Blendon
RJ.HMQ survey: comparing three systems. Health Management Q. First Quarter 1989; ii, no 1. 2.Cooper KJ.Some doctors profit by referral to their own labs.Miami Herald, Feb 19,
Department of Community Health, Trinity College, Dublin, Ireland
Health Watch
PETR SKRABANEK
1989. 3.Outrage of the month.Health Letter
1989; 5, no 5: 12.