Medical Art and Science: Is One a Chicken and the Other an Egg?
FDA and Congress vs. Your Medical Care
Medicine: Art or Science or Both?
If you think the FDA is only giving doctors, hospitals, and drug companies a hard time, think about this recent note in The Wall Street Journal: "The Food and Drug Administration recently argued in the D.C. Court of Appeals that it has the power to ban meat and vegetables without violating anyone's fundamental rights."
In other words, FDA agents also want to give you a hard time in the grocery store; they could claim to know what food is best for you, regardless of what you might think, smell, or taste.
This is like the Marx brothers asking, "Who you gonna believe, me or your own eyes?"
Politicians of all stripes are giving everybody a hard and expensive runaround trying to tell you what health insurance you should or should not buy.
These political machinations remind me of the "experience machine" described by Robert Nozick in his 1971 book "Anarchy, State, and Utopia."
Nozick says, "Suppose there was an experience machine that would give you any experience you desired. Superduper neuropsychologists could stimulate your brain so that you would think and feel you were writing a great novel, or making a friend, or reading an interesting book. All the time you would be floating in a tank, with electrodes attached to your brain. Should you plug into this machine for life, preprogramming your life's desires? . . . Of course, while in the tank you won't know that you're there; you'll think it's all actually happening."
Whether or not you would like to be plugged into this machine, even for an hour or a week of virtual joyriding around the solar system, would you plug your children into such a machine, from the moment of their birth, so they wouldn't have to experience any of life's travails? Most people recoil in horror at the thought.
Nozick's experience machine comes across as a nightmarish fantasy.
Yet the fantasy of simplifying everybody's health insurance needs with a superduper health insurance machine lives on in the dreams of many government officials.
The underlying idea seems to be that the practice of medicine is simply an applied biological science, open to scientific conclusions and solutions. But this idea just doesn't compute.
If medicine was only applied biology or science, we wouldn't often need medical care beyond guides in handbooks, computers or on the internet. Occasionally, we'd have to go to a medical technician for lab tests, diagnostic imagery or surgery.
Several guides to medical self-care are available and immensely valuable, such as the series written by James F. Fries, M.D., of Stanford Medical School. But Dr. Fries as well as the other medical writers often recommend seeking a physician rather than just a scientific technician.
Dr. Philip Overby, a pediatric neurologist at the Albert Einstein College of Medicine, asks in "The New Atlantis" magazine, "are the goals of modern medicine the same as modern science? Are physicians the same as scientists? The obvious answer to this last question is no: physicians treat patients. They aim to heal the afflicted, not simply to discover the truths of nature."
He's also concerned about the "transformation of doctoring in the image of science." ". . . the close relationship between modern medicine and modern science has made many doctors think and act like scientists."
There is much more to medical care than science alone. Simply considering the patient's own goals and desires in life requires a human response, not just a scientific calculation.
Overby's vision contrasts with the common political assumption that some government experts (like the programmers of Nozick's experience machine) should know how to manage your life better than you do.
These are radically different premises.
The modern political premise implicitly held by many politicians is that the government owns you, or at least knows what's best for you. This logic requires that the government tell you what you can and should do with your life, such as not costing the government too much for your medical care.
At the logical extreme, government officials could — and should — force you to sacrifice your very life for a greater good.
The other premise is that you own yourself, such as articulated in our Declaration of Independence, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed."
In this vision, human beings have rights prior to government; government is a tool of the governed, not the other way around.
Most people want their doctors to use good judgement, not just scientific acumen and monetary or fiscal calculation. I doubt that even Sen. Ted Kennedy tells his doctors, "Do the best you can for me, doc, of course within the federal budget limits on medical spending I voted for."
Medical science should be a tool of the art of medicine, not a tool of government policy.
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