The Goose and the Golden Eggs
by Carl Reich, M.D. F.R.C.P.The current century will be looked upon as the period in which man made his greatest progress, utilizing science to make advances in every aspect of his existence, from metalurgy to the plastics industry and from the fields of education and communication to health care. In this latter instance, when I first began the study of medicine in 1938, the trend then, already was to interject science into the art of medicine. The leaders in medicine then, who were my teachers, did so willingly with the prediction and with the promise of great advances, especially in the development of scientific diagnostic methods and in the development of new drug therapies.
In this latter area of drug therapy, one cannot question that the then infant pharmaceutical industry recognised that it could best advance the main reason for it's existence, which was increasing investor's profits and the expansion of the industry by the introduction of new drug therapies. Thus, this industry did with the approval of the profession. by supporting the scientific research of disease, especially that which would lend to the profession's acceptance of a new drug therapy. Almost of necessity, this inroad of science involved a disregard of clinical medicine, which in essence is a study of the association of physical and functional alterations of the body. All emphasis, instead, was directed towards making a scientific diagnosis and to applying a scientific therapy of a synthesized drug. This influence reached such proportions that for decades very many research projects conducted in Canada's medical schools were financed entirely or at least in part, by the pharmaceutical industry and reflected an emphasis on scientific methods.
A highly specialized group of representatives of the various pharmaceutical industries, especially trained to promote research on new drugs fronted this attack on the profession. These men brought promises of grants in aid of research to the heads of the various departments of medical schools, such as to the professors and the associate professors of internal medicine, paediatrics, obstetrics, surgery et cetera. if these physicans would research a therapy which involved the use of a drug which had been created and patented by the drug company.
No less vigorous in the assault on the medical schools were the representatives of companies manufacturing scientific laboratory equipment. designed to provide exact and indisputable scientific diagnosis of disease. The net result of such a scientific assault was that functional improvement, such as the relief of distress or suffering, was disregarded as an inexact index of the efficiency of a therapy, for it could not be measured in linear mass or volumetric fashion. Moreover, since all emphasis was made on scientific patented therapies, and since elements of good nutrition could not be patented, the effect of nutrition on health was steadfastly and purposely avoided.
Just as it became the accepted attitude of the public towards science, to adopt scientific things and accomplishments as being vastly superior to all that pre-existed the scientific era, so it became equally acceptable to the leaders of the profession to adopt these offerings of these two massive industries. The amalgamation of these industries, and of medicine, therefore, proceeded to such a degree that over the past five decades, medicine has largely been fashioned to become an instrument to utilize the services of these industries.
Indeed the modern physician now only represents an extension of these industries into the public. (Emphasis ours.)
Modern medicine therefore has been greatly altered by the profession, but only as the profession acted in response to or was guided by the pharmaceutical and diagnostic laboratory equipment industries. Under such care or guidance, medicine has now become fashioned into the proverbial goose that lays golden eggs for these industries! In this instance, the golden eggs are either a new drug therapy or a new scientific laboratory test, which therapy or test were first tested and approved by the medical profession within the industries and within the medical science centres of universities, and then used on the public by the profession at large.
There are those who will object to this viewpoint, saying that such an obvious creation could not be produced and would not endure if it were not in keeping with better health care and that if it were otherwise it would soon be found out by the profession or the public, to soon be discarded. Such surveillance of this creation however, is not possible for, as this influence of science grew, so was its control of the special area of scientific medical investigation removing it from the marketplace of medical practice. Such control naturally largely meant the control of government and of private funding of medical research. Such control was neatly and effectively introduced, and ever since firmly maintained, by the introduction by this elite of the dictum, that no medical research project was worth the paper it was written on unless it was proven either by scientific blind study, or preferably, by ultra-scientific double-blind, study. Also such study should be concerned with objective findings which could be measured either by linear volumetric or mass measurement. The net result ofthe enforcement of these criteria on medical research was that statements of functional improvement which resulted from a particular therapy, such as degrees of relief in the suffering of chronic asthma. were rejected and scientific data was insisted upon. The reasons given for such rejection was that such functional modalities were subject to misinterpretation both by the patient and by the physician and therefore of necessity, were inexact and non-scientific. Such insistance on scientific guidelines has, therefore, firmly placed all medical research into the hands of the scientific elite and therefore under the influence of the pharamaceutical industry.
Another influence stabilizing the encroachment of science into the field of medicine has been the method of administration of the self-regulatory medical profession which includes "peer group review without appeal". By this mechanism, physicians who dared deviate from the accepted transition or conversion of the art of medicine. into a science by performing clinical research in their practices on the effect of good nutrition on health and on the effect of therapy of disease with vitamins, frequently saw their constitutional rights of practice removed from them by their peers. Despite the fact that this disaster happened only occasionally within the profession in Canada, its rare occurrence was still very adequate to emphatically remind the rank and file of the profession, that it would only profit them to forsake clinical medicine and instead to pursue the sacred cow of science.
"WHO WOULD KILL THE GOOSE"
If I were an artist and were to caricaturize this analogy I would depict two individuals looking at a goose labelled "Medical Profession", in a padlocked cage labelled "The Medical Establishment". There are three golden eggs in the cage, two labelled "Drug Therapy" and one "Scientific Diagnostic Tests". The eggs are held in a container labelled "Professional Approval". A lock, identical with the lock on the cage also locks this container. The goose is eating from a small trough. It, or the food it contains is labelled, "Grants in aid of scientific research".
One of the individual viewing the cage is labelled, "The Pharmaceutical Industry". Smiling and unconcerned he holds a key in one hand. The key is labelled "M.R.C.". which is an abbreviation for Medical Research Council. In his other hand he holds a container of food. It or the food it contains is labelled, "grants in aid of scientific research".
The other individual labelled, "Joe Public", with a worried and concerned look on his face holds an axe in one hand labelled, "Revolutionary Reform", and in the other hand holds a food container labelled, "Non-monetary Based Incentives for Research".
This caricature represents a pharmaceutical industry which is unconcerned for it is confident that it has so nurtured and guided the evolution of the profession that the scientific oriented medicine, which it now provides the public is inviolate from any intrusion. The public is represented as being concerned because the profession initially designed to protect its health, no longer produces advances in medicine of benefit to the public, but instead its end product is largely of benefit to the pharmaceutical and scientific diagnostic equipment industries. (Emphasis ours.)
The caricature also represents the public as being concerned for it knows that while it cannot do without the profession, it does not know how to nurture it back to its previous state, providing advances in medicine which are in keeping with national health.
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