Heroes and Villains

In his latest opinion piece George Friedman paints a pretty bleak portrait of the medical establishment:

t is the medical system that was charged with protecting us from this disease. No institution can possibly be infallible, and each is limited by its knowledge and culture. The medical research establishment did not understand the nature of the disease. It still is uncertain whether catching the disease provides immunity or whether we will spend our lives in endless recurrence. It has at the moment no treatment that might mitigate the disease nor any that might prevent it. The culture that medical research has presented and projected to the world is that it is intensely at work, but that its work cannot be time-sensitive. It cannot be hurried, but its process must take its course.

This is not an unreasonable standpoint, but it has consequences. The only solution the medical system had was to prevent the spread of the disease by sequestration, the separation of individuals from each other. This may have had some mitigating effect on the disease, but it is having a disastrous effect on society. It is not hyperbolic to say that we are heading for a depression. The best available medical solution reduced the available labor force, reduced consumption and in many countries forced extravagant government infusions of money, infusions for which we will pay later. A depression is a disease in its own right. Poverty and despair cause their own deaths, but it is the loss of expectations and hopes that is the highest cost. I say we seem to be heading toward depression, not that we are there. Still, the danger is there and it is not trivial.

The mitigation of the spread of the disease has, apart from the social pressures of sequestration, generated a significant economic crisis. The response has been myriad decisions based not on certainty but on calculated risk. The government does not know that the trillions of dollars to stabilize the economy will abort a depression, but it does know that the cost of a depression justifies taking a risk and racking up debt. Each of us, in some small or large way, has engaged in calculated risk.

The moral foundation of medicine is that it must, first of all, do no harm. By “harm” it means that no action of the physician or the researcher should harm the patient. This imposes a meticulous discipline on medicine. No drug is released until it is certain that it will do no harm. This requires meticulous testing and evaluation, and that takes time. Part of the medical research process is imposed by the complexity and mystery of the subject. Part of it is due to the moral aversion to risk. And that aversion to risk can turn a virtue into a vice.

The medical profession cannot eliminate risk, but doing no harm makes it a moral imperative. Other systems operate not on a zero-risk principle but on the principle of calculated risk.

That’s an interesting point and explains why physicians should not be making public policy. The focus of the physician is properly on his or her patient. Would it be unethical for a physician to advocate a course of action that would benefit society at large or humanity at the expense of her or his patients? I think it would be. Conversely, it would not be unethical for a physician to advocate a course of action good for her or his patients but deleterious for the society at large. Different callings properly have different ethical obligations.