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May 14, 2008
Social Reform
I need to start a book review section, but short of figuring out what that means, I need to make a few comments about The Medical Profession and Social Reform, 1885-1945. It is great study of the transformation of medicine "in the 'spirit' of Johns Hopkins and the atmosphere of Massachusetts General Hospital." (Cabot's phrases)
Flexner said in his report, "the physician's role is fast becoming social and preventative, rather than individual and curative." Flexner is, of course, the fellow who wrote the report recommending that medical schools across the US be forced to follow the Hopkins/MGH model of education, standardizing education, making the physician an academic doctor (requiring a bachelor, usually BS, prior to matriculation and imbuing the principles of "scientific medicine." This was a conscious shift in emphasis. It has been accepted without question that this was a good and necessary shift. It has not been without its negative consequences though, as is true for many social changes that appear to be well-motivated.
It does seem that many of the social reforms, such as rural health initiatives, STD clinics and industrial medicine, were necessary and helpful. There is no question that conditions were bad. As appealing as an agrarian community solution would be to these three problems, that is not the direction in which God has taken the world. Thomas Chalmers' solutions to the social problems of over-crowded Glasgow did not include the unlikely possibility of undoing the clearances and industrialization, but rather accepted the general circumstances and found solutions within that framework. (Chalmers' solutions flowed out of the work of the church, rather than medicine becoming the agent of reform.)
It has been my contention through many of the posts here that the scientific emphasis in medicine has failed us. The wrong questions are asked and this leads to the false impression of success. This is as true of CABG and stents as of industrial medicine or STD's.
Another significant negative consequence to this shift is the dissatisfaction of doctors. Most doctors have some altruistic motivation. But the conflict between being social reformer and caring for individuals frustrates even the most compassionate. Add to that frustration the government control that is the inevitable end of such a social reform model. ("End" in two senses: Such a social reform model must have a controlling power and the institution that sucks all power to itself when there is no restraint is the modern State. Also, though, this will be the end of medicine as we know it, as the State has repeatedly through history proven itself incapable of practicing medicine.)
I should note that I thought that I recalled Starr referencing Taylor in his acclaimed study The Social Transformation of American Medicine. Maybe I just thought that he should have done so. His thesis builds on Taylor's pretty closely.
| By Robert Maddox | 10:50 AM