Medical economics (1947)

From the December 1947 issue of the Socialist Standard

The religious racket has, been exploded by Socialists since the days of Marx; but the more scientific racket, the medical “business” has received little attention, in spite of the fact that it is now generally recognised as the strongest and most militant trade (or professional) union in the country.

Millions of pounds are daily spent on therapeutics (curing disease) but scarcely anything is spent in comparison on prophylactics (preventing disease), for the simple economic reason that it is far more profitable to pursue, therapeutics. If too much attention was devoted to prophylactics it might render therapeutics redundant by “killing the goose that laid the golden eggs.” Doctors and hospitals must have sick people, and millions of them, or go out of business.

The workings of the medical profession provide a wonderful example of the economic factor in determining events and culture. Perhaps in this respect it is even more clearly demonstrable than in the case of the spiritual counterpart in religion. In this country there are more doctors and hospitals per head of population than in most countries, and strange to say, there is also a vast and increasing number of sick or ailing people. The same is the case with dentists; in spite of the fact that they are to be seen everywhere, and in spite of the widespread use of the tooth brush and dentifrice, the state of the teeth of the average English person is appalling, when compared to those of many primitive tribes who have no dentists, no tooth brushes and no dentifrice. In fact it would appear superficially that the more dentists, and care of the teeth, the worse is the final result.

Strange to relate with all the efforts of the medical profession and all their scientific research, Cancer, Diabetes, Heart Disease, Nephritis, Rheumatism. Nervous Diseases, Occupational Neurosis, and a host of other complaints, continue to increase yearly, which clearly indicates that something is radically wrong somewhere.

Capitalism regulates, the channel in which medical money goes, and stipulates broadly how it shall be spent; “for the hand that pays the piper, calls the tune.” Surgeons who can get, (or extract from the patient), 100 guineas for a certain operation, are always lurking for possible clients ; and why not, for their success depends very largely upon how many they find. Would anybody pay a surgeon for saving them from an operation? They certainly would not be prepared to pay the same fees.

Drug manufacturers, and patent medicine vendors, make enormous profits on certain chemical preparations, and do not fail to take full advantage of the power of advertising through the medium of those who handle and prescribe the drugs. Only too often quite worthless and harmful drugs are applauded as having health-giving properties, and statements made about them which could never be justified.

The late Lord Trent (formerly Sir Jesse Boot), owner and controller of about 1,000 chemists shops which hears his name, was bed ridden with Rheumatism, and had to be wheeled about in a bath-chair for many years of his life before he died, whilst his shops sold dozens of different chemical preparations for alleviating rheumatism.

A lady who is quite a public figure, owns or used to own, a once much advertised slimming product, and yet she herself regularly tipped the scales at 18 stone. Just imagine this 18 stone of beautiful womanhood ; what about a shovelful of her own slimming mixture for breakfast? But business is business, especially in anything connected with medicine and health, so why worry?

Today certain drugs are making fortunes for the companies behind the medical profession. Just think of the amount of advertising the B.B.C. gives to Penicillin, Streptomycin and Pheno-barbitone. Almost every day the B.B.C. has to announce that some doctor has carelessly mislaid quantities of the latter, thus giving further free advertising to these drugs, incidentally, who says the B.B.C. don’t advertise?

Blood squirting (hypodermic injections of serum), is popular today because apart from their simplicity, and certain medical reasons, these, practises, are enormously profitable, both to doctors and the companies responsible for the serum preparation. An old horse, of little use for its traction power, might fetch about £10 in the cats’ meat market (although horse flesh has many other uses than for cats’ meat). If the horse is deliberately given a dose of a disease resembling smallpox or diphtheria, it can be made capable of producing many times its cats’ meat value by producing suitable serum, at wholesale prices.

The enormous amount of injections done during the war on soldiers—where the men lined up before the doctor who did one after the other just like shelling peas, till the needle got blunt and was thrown away— was not done for nothing, nor even without profit. Manufacturing chemists were reaping thousands out of it.

Medical research under capitalism has got itself into an absurd scientific entanglement. Shaw’s “Doctor’s Dilemma,” and Cronin’s “Citadel,” only touch on aspects of this contradictory muddle. After millions of pounds had been spent on Cancer research (and the figures for cancer mortality steadily rising), the medical profession were instrumental in causing the government to pass the Cancer Laws of 1939, to prevent anybody except a qualified medical man from treating cancer. It would appear that the large amount of criticism they were receiving at this, time had to be silenced, and freedom of action as well as freedom of criticism was debarred to the public.

It is not always those who have the biggest purses who receive the best treatment. Sometimes the more money you have the more operations and specialists’ fees, and subsequently a quicker route to the grave. This was the trouble with the one-time world famous film idol, Rudolph Valentino, who wasted his money on medical attention to no purpose. Doctors are specialists in the art of knowing how to bleed (financially) those who have too much (pecuniary) blood. Kings and presidents, Lords and business magnates have to watch their step where doctors are concerned, as do also the working class. Even Karl Marx was helped to an untimely grave before his life work was completed through advertised chemical dope. Engels observed when Marx was obviously dying, that his body was literally full of patent medicines.

It is regrettable that so many workers have little real interest in health matters, and consequently become such easy victims to medical frauds, and tyranny. Doctors thrive through the advertisements for medicines, cigarettes, alcoholic drinks, doped foods and the health-destroying habits that follow their use. Why should the medical profession endeavour to educate the workers on these topics, and lose them as potential clients as a result? Is there any wonder why the doctors and specialists confine their nomenclature to technical terms derived mostly from the. Latin: or Greek, and pharmaceutical abbreviations that few can understand. It is not easy either to climb into the profession nor to understand its workings; those in it see to that.

“It’s your blood they’re after.” The recent blood transfusion campaign, coming at a time when it is extremely difficult to obtain blood-making foods of the right nature, quality and quantity, is enough to make us sit back and do some thinking. Every day appeals are made on the radio that blood donors are urgently needed, and thousands have responded, to what they consider a humane cause.

At one time in capitalism’s youth, we were told that disease was due to too much blood. When the public were convinced of this doctrine a new line of business was established in removing this surplus. The barber-surgeons were brought into existence for the purpose of taking a pint of blood from all comers who were sick (plus of course a fee for services rendered). The fact that many people treated by these methods were suffering from anaemia and afterwards died, and many others through lack of antiseptic precautions became infected and succumbed, did not worry the barber-surgeons much. Today we can get our blood taken for nothing, and by the latest scientific methods. Tomorrow we might be paid for giving it, but that all depends on how many “blood blacklegs” there are, and also the degree of health consciousness of the masses. No longer is the theory held, “let us take some of your surplus blood and you will get health,” but rather, “let us give you some more blood and you will gain health, or have your life saved.” A curious biological reverse !

Of course there are thousands of street and industrial accidents today that need immediate supplies of blood. But this is not the whole story, there are also many hospital accidents, for modern surgeons, with the aid of anti-septic surgery and anaesthetics, regularly take risks that but a few decades ago they could, or would, never have taken. There is more surgery today than ever before, and there is going to be more tomorrow, especially if a third world war occurs. Consequently a blood donor campaign becomes necessary to capitalist society. Surgery is a very profitable department of science and those that are in it intend that it shall remain so. These strange changes in doctrine become practical politics to the high priests of the medical profession.

Capitalism has long ago converted the cow into a milk producing machine, and the hen into an egg producing apparatus; it now seeks to convert the worker into a blood producing factory, and this has got to be done on a restricted diet.

Horace Jarvis

A Pill For The Public (1938)

Book Review from the July 1938 issue of the Socialist Standard

“ Patent Medicines,” by Professor A. J. Clark (Fact, May, 1938).

The select committee set up by H.M. Government in 1914 to "consider and enquire into the question of the sale of patent and proprietary medicines” expressed the hope that the National Insurance Act would curtail the business in secret remedies. Their optimism has been far from justified, and the N.H.I. Act, having failed to put an end to illness, fanned the belief, already widespread, that health could be obtained from a bottle. A number of capitalists, more perspicacious than H.M. Commissioners, were well aware of this. They sank money in the production of patent medicines, and by one device or another encouraged the belief. The sick public, uninformed and receptive, swallowed thousands of panaceas from almost plain water to poisonous drugs, and paid well for the privilege. The proprietors, on the other hand, waxed prosperous.

Prof. A. J. Clark has set out the details in the Fact for May. Let us say here that the monograph is not written from a working-class angle, and that this entails a certain criticism, to which we shall allude later. But, subject to these limits, practically every aspect is covered in a simple and straightforward manner. We think that Prof. Clark might have detailed some of the huge profits made in the trade—for instance, Beecham’s Pills, Ltd., which markets many well-known proprietaries, such as Germolene, Iron Jelloids, Veno’s, Amami shampoos and the like, and has a capital of about two and a half million pounds, declared this year a profit of over £600,000 and a dividend of 85 per cent.

All sections of the community take patent medicines (the expression “Patent Medicine” only strictly applies to those registered under letters patent, of which there are actually very few). The volume of retail trade is, therefore, very large — possibly between £20 and £30 millions annually. The Government takes a rake-off in the shape of medicine stamp duty, which amounted in 1928-9 to one and one-third million pounds, since when it has declined by 44 per cent. Manufacturers found that by slightly altering the composition and printing on the package a pseudo-scientific formula, meaningless to the man in the street, they were legally exempt from paying the duty and pocketed the difference. We know of no case in which the price to the public was afterwards reduced. The law relating to patent medicines is, in fact, a confused jumble of statutes and regulations dating from 1787. It is still possible to use bogus testimonials from fictitious physicians, and perhaps even real physicians! There is a law of the most severe character against the supply of abortifacients; but under cover of wording which is well understood a loophole exists for the business to go on, a business for the most part in either useless or dangerous and always expensive drugs.

Various committees of enquiry have been set up, notably that of 1914, referred to above. Their report was devastating in its revelations and indictment of the patent medicine trade. “Naturally, however, it attracted no attention whatever at the time of its appearance and was allowed rapidly to pass out of print and is now very difficult to obtain. The reasons for its rapid disappearance are unknown” (page 29). The publications of certain analyses carried out by the British Medical Association vanished in an equally mysterious manner. The interests concerned were quite averse to anything being done, and it was pot until 1920 that a “Proprietary Measures Bill" based on the 1914 report, was introduced into the Lords, but “was allowed to perish for lack of Parliamentary facilities.” There' were further Acts in 1931 and 1936, both of which failed to become law. In 1936, however, the Government became alarmed at the decline in revenue, and a committee was set up to. consider this aspect alone. Their report, published in 1937, suggested a much wider basis of taxation, and “a Bill was promptly prepared in accordance with the recommendations of the select committee of 1937; it did not attempt any reform of the secret remedies fraud, but was simply designed to increase revenue by extending the scope of the incidence of the Medicine Duties. . . . The Bill perished chiefly because it proposed to tax cosmetics, a reasonable but highly unpopular proposal” (page 2$). As a matter of fact, there was much internal opposition to the bill, in particular from chemists, who would have lost certain privileges by its provisions and been placed on the same footing as grocers and other traders. No attempt whatever was made to protect the consumer at any stage.

Patent medicine proprietors are able to exercise a considerable pull over the Press, as the biggest single group of advertisers. One firm stated that it spent one-quarter million pounds in 1937 on publicity, largely in the Press. One of the effects of this expenditure is a virtual censorship of anything likely to endanger the patent medicine interests. Millions of people every year, who from malnutrition, bad housing, and overwork fall ill, succumb readily to the clever propaganda of the big advertising, often handled by firms which specialise in this work. And the more readily since the occasional exposures of danger and fraud rarely creep into the popular Press. These dangers and fraud are very real. A certain check is provided by recent poison regulations, but only this year 73 people in the U.S.A. were killed by a preparation before supplies were stopped. And there would have been no legal restriction on its sale in Great Britain. There is no account, of course, of those drugs which only kill if taken in time, or of the false inducement of security and hope. It is also certain that many workers afford patent remedies by cutting the purchase of vital necessities.

Prof. Clark suggests measures for dealing with the problem. It may be that for a variety of reasons a Government will one day be persuaded to frame new laws. They may even be operated. But the real trouble is that people are ill, and the problem one of preventing it—an impossibility while capitalism lasts. The patent medicine proprietors are in business for profit and indifferent to the harm and suffering they may inflict. Capitalist governments have already had 24 years since the first commission’s report to demonstrate their care for the working class. And the last Bill presented to the House was an attempt to increase revenue from the industry! Is it unlikely that any advantage to the workers from future enactments will only be incidental? There can be few grosser instances of the evil workings of the profit system than the patent medicine industry.

Kilner.

The Lady with the Lamp (1944)

From the March 1944 issue of the Socialist Standard

Nursing as it is To-day

That nursing is a vocation in the religious sense is an assertion surprisingly still made to-day, as witness the film “The Lamp Still Burns,” about which something will be said later. Nurses, like Nuns, are supposed to take up their work in response to a mysterious call, but many relinquish its mixed joys on closer acquaintance.

In early times, before the dissolution of the monasteries, the care of the sick was in the hands of the religious houses, remnants of which became the first voluntary hospitals. The Elizabethan Poor Law was the basis of what is now the municipal hospital, first under the Parish overseer, then the Board of Guardians, and lastly the Ministry of Health.

Of nurses and nursing in this country we know little before the nineteenth century, and training was unknown. In military hospitals there were no female nurses, and mortality was high. The lack of organisation went unnoticed until a major war occurred nearer the scale of modern war. War to the general public seemed far away when only a standing army was affected.

In the early nineteenth century there were voluntary hospitals and workhouse infirmaries for the sick poor, looked after by nurses who, if for nothing else, were known for their drunkenness. This was excused on the ground that hospital conditions were so terrible that some stimulant was necessary to enable nurses to carry on. Beds were packed close together, fresh air was practically nil, and surgical cases often died of the dreaded hospital gangrene. The rich were cared for in their own homes, by women of whom Dickens’ Sarah Gamp seems to have been a fair prototype; but at least they were not exposed to the infection of a hospital ward. Any poor ignorant woman who was fitted for nothing else could be a nurse. They worked long hours, did all the domestic work, and usually lived in the hospital, often in the wards themselves.

In the mid and late nineteenth century great reforms came about, mainly through the establishment of training centres, notably Florence Nightingale’s school of nursing and St.Thomas’s Hospital in 1860. Florence Nightingale may be called the founder of modern nursing. Though known sentimentally as the “Lady with the Lamp,” she instituted modern hospital planning and hygiene, and spread much knowledge of sanitation. It is interesting to notice a little of her career. Being of the propertied class, her wish to be a nurse was resisted by her parents on the ground that a gentlewoman could not associate on equal terms with working women, often drunken and immoral, and, even if chaste, still working women. After much resistance she obtained what training she could at Kaiserworth in Germany in 1851 and with the Sisters of Charity in Paris in 1853.

In 1853 the Crimean War commenced, and in this major campaign great perturbation was caused by the deaths of the wounded British from negligence. Nearly 50 per cent. died. People became incensed as they learned that preparations and precautions were practically nil. The French ally, by contrast, had reasonably well organised medical services, and had taken 50 Sisters of Charity to act as nurses.

Florence Nightingale was asked by the Government to take a party of nurses to remedy matters. We have seen that the British Army had no female nurses, and this intrusion was energetically resisted by many of the medical officers, who saw in it criticism of themselves. The medical profession to-day likewise resists any apparent encroachment on their privileges. We know by Florence Nightingale’s reorganisation of the hospitals at Scutari and in the Crimea that she did not lack energy and initiative.

Following the Crimean War, strenuous efforts were made to reorganise hospitals in this country, and trainees of Florence Nightingale started nursing schools at many hospitals, and the status of nursing became raised.

Just before the turn of the century, great improvement were made in this and other Western countries. Efforts were made to check infectious diseases by isolating and notifying. Great strides in medicine, such as the technique of antiseptic surgery, introduction of anaesthetics, discoveries of the causes of hitherto baffling diseases were made. County councils with medical officers of health were set up, and sanitation at last received some attention.

Florence Nightingale’s reforms in nursing had their way because all this was in the air. The discoveries in medicine made the more intelligent nursing of the sick essential. It was not something which just happened out of the blue by the goodness of one woman, but because at this time it became necessary to transform the Sarah Gamp into a trained knowledgeable worker in the art of nursing, into a woman who could carry out important observations, and many special treatments—in a word, to change the unskilled into the skilled worker.

In 1902 the Midwives Act was passed—”an Act secure the better training of midwives.” Efforts were made to secure as nurses girls of better education, at least secondary school standard. But the shortage of suitable recruits has usually been acute except at the best teaching hospitals —e.g., the London voluntary Hospitals. Girls of better education have wanted better rewards than nursing can give. The lure of the vocation, the life of satisfying work for suffering humanity, etc., ad nauseum, have all been tried. The bait has never been good conditions, reasonable hours and adequate pay for an efficient worker. But the dope has never been completely successful. The municipal hospitals and smaller voluntary hospitals have had to recruit from the elementary schools. This makes it difficult for the recruit, who has probably left school at 14 years and worked in a shop, office or factory, to go back to school again at 18 years. Particularly is this the case now that many high schools run pre-nursing courses, thus relieving the student nurse of much study in her first difficult year of hospital life.

A student has much to learn of a scientific character, and a knowledge of chemistry and mathematics is a great help to the prospective nurse. As always, the good background of education makes all the difference between taking a job in one’s stride or making it a very hard grind. Many fall by the wayside and never become State registered. They then become the assistant nurses, or, shall we say, the labourers of the present nursing world.

What has been the reward for the hard grind ? Until the Rushcliffe scale of salaries was introduced recently, the best salary paid to a student nurse was £20 in the first year, £30 in the second, and £40 in the third, together with board and lodging. The answer to complaints on this score has always been that training was being given free during this period, whilst other trainees—e.g. doctors, teachers, architects, etc.—have to pay for theirs. Such students, however, do not have to work 10-12 hours day or night, often at an exhausting pace, and then attend lectures afterwards. In the writer's experience of commencing training only 11 years ago night duty commenced at 7.30 p.m. and finished at 8 a.m. Often the entire night was worked without a break even for a meal, and then lectures had to be attended at either 9 a.m. or 6 p.m. At 9 a.m. the lecturer received scant attention. A hard school, indeed, and the one night off per week was often spent in sleeping the clock round. The Horder Committee report on nursing reconstruction, recently published, recommends that the nurse should be a student paying for her training, and not an hospital employee responsible for the work of the hospital. They suggest she should be helped by Government grants.

Conditions, however, are improving, in order to attract recruits of what are termed the better kind. Parents are not willing to allow their daughters to undergo an interesting but vigorous training at the cost of their health. “Hard work never killed anyone,” still say some members of the old school. Perhaps not, but health may be impaired, and vitality and energy for outside interests may be completely sapped. We do not, generally speaking, find nurses interested in political questions and world affairs. Why? Because the hospital is its own little world in which one may work and take no notice of the greater world. This may be thought a good thing. Florence Nightingale would have considered that completely absorbing work in the service of others was so. Facts belie it. A nurse so living becomes narrow and harsh, and finally is quite unable to understand the youngest recruits. Certain hospitals in this country now allow their trained staff to live out. This has, on the whole, been extremely successful, and these hospitals have had less difficulty in obtaining staff.

What are the nurse’s expectations when finally she is trained, passes her exams, and can put those long-coveted letters S.R.N. behind her name? She may remain in a general hospital as a staff nurse to do surgical or medical nursing, and after a few years of experience become a Sister and direct the ward. She may take further training in some other branch of. nursing—e.g., midwifery, fevers, children, district, public health or industrial nursing. Many fields of interest are now open to the trained nurse. The latest of these is that of industrial nursing.

The Government has recommended that factories employ a trained nurse and establish a first-aid and welfare department. This department was not established out of the kindness of the employer’s heart. Absenteeism through sickness is considerably reduced: prompt treatment of accidents saves weeks of disability, and reduces compensation;—the worker with a wound has his dressing done by the factory nurse, thus preventing him taking a day off to visit his local hospital or his panel doctor.

Public health and district work is popular, as here the nurse works with greater freedom than her hospital colleague, and she lives out. These nurses regard their work as important and socially useful; their hours are reasonable, and their scale of salary has just been raised through the recommendations of the Rushcliffe Committee. It is not, however, princely, as the maximum salary for a superintendent of health visitors, a post only reached after years of experience, is £55O per year.

The Rushcliffe yearly salaries for the trained nurse are £90, for the ward sister £130, and for a sister tutor £200 rising to £350. These are exclusive of emoluments. The student nurse is to be paid at the rate of £10 first year. £45 second year, £50 third year, and £60 fourth year. These are mentioned in detail as they were supposed to constitute a wonderful improvement.

Previous to the war nurses who married were expected to leave. Since the war they have been permitted—nay, implored—to remain. Florence Nightingale was harsh with nurses who married; she considered that they should devote their whole lives to their work.

The clock cannot be put back despite frantic efforts to do so. The production at this time of the film “The Lamp Still Burns” shows a desire to do so. The heroine, Hilary, foregoes her private life to serve her calling. Few would be willing to make such an unnatural sacrifice Why should such an anachronism be expected? Under modern conditions the nurse may work, for example, for eight hours efficiently and then leave hospital, district or clinic for her home or her own interests and relaxation. The nurse in training may live in for convenience, but should have her lectures in her “on duty” time.

Reorganisation is required and had to some small extent been carried out in England before the war, but more widely in America. Under better conditions nursing could be a most satisfying kind of work. Indeed, it provides an answer to those who state that workers must have bosses. Many nurses, working without supervision, voluntarily exceed their hours of duty for their patients’ welfare.

Efforts are required by nurses themselves to improve their conditions. Hitherto they have been too exhausted to do much in that direction, plus, of course, the play on the vocational side.

The nurse has now become a skilled worker, but do not whisper this to her, as she is taught to regard herself as belonging to the professional class, whom it would appear are a race apart. This snobbery has been a bar to trade-union activity, which has, generally speaking, been resisted by hospital matrons.

Apart from the apathetic state of nurses, three main obstructions to progress exist : The attitude of the working class, who ignorantly look on her as an angel of mercy or despise her as part of what they regard as the racket of medicine; the medical profession, who wish the nurse to be the Cinderella to their own great glory; lastly, from those who as nurses wish the vocational idea to continue.

Many of the diseases and accidents which can be directly traced to the needless hazards of industry or to the poverty of the workers, as well as the more dramatic casualties of war, will die with the death of capitalism. Only under a form of society in which the health and happiness of people, rather than the production of commodities, is the aim can nursing come into its own, with its infinite possibilities of satisfying work.

W. P.

The Rise and Fall of Modern Medicine (2000)

Book Review from the September 2000 issue of the Socialist Standard

The Rise and Fall of Modern Medicine by James Le Fanu. Abacus, 2000.

This intriguingly titled book makes fascinating reading. Le Fanu argues that in the forty or so years following the end of the Second World War the achievements of medicine were prodigious, but that by the beginning of the 1980s “the age of optimism had ended”. The first half of the book, which charts the rise of modern medicine, Le Fanu associates with a series of spectacular discoveries and developments, and particularly with “twelve defining moments”—including the discovery of penicillin and cortisone, smoking being identified as the cause of lung cancer, tuberculosis being cured with streptomycin etc, the development of intensive care, open-heart surgery, hip replacement, the prevention of strokes, the cure of childhood cancer. The second half, the fall, he associates with the “blind alleys” of “Social Theory” and “The New Genetics”.

It is instructive to note that most of the favourable reviews which are quoted at the beginning of the paperback edition, are especially generous when writing about the first part of the book. And it is easy to see why. Le Fanu juggles his story marvellously, mixing medical history, reflections about the scientific method and enthralling anecdote, skilfully and entertainingly. The first part of the story is essentially descriptive—discussing the combined impact of drug therapy and technological developments in combating disease. In contrast the second part is more polemical, and this more contentious, and reviewers in, for example, the Daily Telegraph and the Financial Times, are generally much happier with exposition than argument. This is especially the case when the argument reveals that the public can be persuaded to believe the most fanciful nonsense, if it is offered by supposedly credible authority figures.

But why the fall? Why did the great advances of the years following 1945 come to an end? First, says Le Fanu, because the rate of introduction of new drugs fell in the 1970s, as the discovery of new biologically important chemicals ended. And, second, because new technological innovations seemed only able “needlessly to prolong the process of dying”.

Into the vacuum two new specialities have emerged: genetics and epidemiology. However, says Le Fanu, since genetics is not a particularly significant factor in human disease its impact is limited. But if the author has little faith in the efficacy of genetics, he reserves his most devastating criticisms for epidemiology and the Social Theory that it spawned.

Social Theory seeks to provide not only an explanation for disease, but also to suggest ways of engineering its prevention. For example, if smoking can be shown to be associated with lung cancer, causing people not to smoke will reduce the incidence of the disease. Health promotion (or what Le Fanu calls social engineering) thus becomes associated with changes in lifestyle and diet, and can be seen as the modern-day equivalent of the great sanitary reforms of the late 19th century, which were based on massive civil engineering projects.

Unfortunately much of the so-called evidence which informs current Social Theory is specious. Le Fanu has much fun setting out the way in which eminent scientists, health administrators and politicians have become involved in some of the fictions of the last 20 years, especially those associated with supposed “Diseases of Affluence”—various cancers, strokes, heart disease etc. Thus it turns out that there is no evidence to sustain the supposed link between eating large quantities of meat and dairy products and cancer, even though in the last five years the population of the USA has been spending $3 billion a year on cholesterol-lowering drugs, on the basis of just such a connection. “Together the drug companies and Social Theorists had triumphed.”

And there is more, much more. Le Fanu offers convincingly evidence to show that most of the claims that associate diet with disease are at best tendentious half-truths. And whilst he doesn’t suggest a conspiracy uniting the leaders of the medical profession, with drug manufacturers and politicians, there is no doubt that the nostrums which underpin Social Theory are consistent with the interests of all three groups, if clearly not with the public-at-large. Socialists will find this unsurprising. Professionals with reputations to preserve frequently find themselves allied to capitalists who want to make money, and politicians anxious to save it. Every politicians knows that prevention is cheaper than cure, especially when the former is paid for by the individual and the latter by the state.

On reviewer reports that “this excellent book” has changed his opinions about modern medicine. It has certainly changed mine.

Michael Gill

Material World: TCM – Cheaper and Nastier (2017)

The Material World column from the February 2017 issue of the Socialist Standard

Many practitioners of ‘complementary and alternative medicine’ such as homeopathy claim and seek that the state should support those treatments financially. One such unorthodox medical model was in fact sponsored by a government, not due to a proven track record but inspired by political necessity. Mao Zedong explained his support for Traditional Chinese Medicine (TCM) in a 1950 speech:

  ‘Our nation’s health work teams are large. They have to concern themselves with over 500 million people [including the] young, old, and ill. … At present, doctors of Western medicine are few, and thus the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine’ (From Kim Taylor’s Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution).

Of course, this improvised health service was not suffice for the Chinese Communist Party leadership, themselves.

‘Even though I believe we should promote Chinese medicine. I personally do not believe in it. I don’t take Chinese medicine.’ Mao is quoted as saying. (In the Private Life of Chairman Mao by Li Zhisui, one of Mao’s personal physicians)

Inconsistent texts and idiosyncratic practices had to be standardised. Textbooks were written that portrayed Chinese medicine as a theoretical and practical whole, and they were taught in newly founded academies of so-called ‘Traditional Chinese Medicine.’ Needless to say, the academies were anything but traditional, striving valiantly to ‘scientify’ the teachings of the accepted ‘wisdom’ that often contradicted one another and themselves. The belief running through all aspects of TCM is the notion of qi, an energy life-force that flows through everything. Science-based medicine does not recognise qi energy because there is no convincing empirical evidence that such a thing exists. Nor is there any evidence for the alleged meridians or channels in the body where qi flows that can become blocked and which can be unblocked through acupuncture to allow qi to flow freely and restore health.

TCM advocates point to the thousands of herbs and plants used in treatments and it has never been disputed that a great number of these do have health benefits. However what is surprising from those proponents of TCM in the West is the silence about the use of animal parts. Throughout Asia, thousands of bears are kept in tiny cages their entire lives so that their gall bladders can be tapped for bile. Bear bile has always been a popular ingredient in TCM and is used for many ailments from haemorrhoids to hepatitis. Because only small amounts of bile are used in TCM, there is now a surplus of bear bile so bear farmers have also begun producing shampoo, wine, tea, and throat lozenges containing bile.

Extraction of a bear’s bile is done in a process called ‘milking,’ which is performed twice daily. A catheter is surgically implanted into the bear’s abdomen. Veterinarians rarely perform this surgery, which results in roughly half of the bears dying from infections or other complications. Bile is then drained from the catheter and collected by the farmer. Milking begins at age three, and continues for a minimum of five to ten years. Some bears who have been rescued were found in cages producing bile for twenty years or more. The Chinese government banned the use of the catheter method of bile collection in favour of the ‘free drip’ method which involves surgery to create an open hole in the bear’s abdomen through which bile freely drips out. This was touted as more humane, yet is as inhumane for bile often leaks into the bear’s abdomen, which increases rates of infection and mortality. Farmers have trouble keeping the hole open. This results in more painful surgery, and often the implantation of a small catheter to keep the hole permanently open. The filthy conditions on most farms lead the bears to suffer from further infections, worms, and other parasites. The bears’ muscles atrophy from confinement in such small cages for the duration of their lives. They are also extremely malnourished from a diet of grain mash or porridge, and their teeth and claws are often removed to prevent injuries to the farmers.

Overall, the worldwide trade in bear parts, including bile, is estimated to be a $2 billion industry. Research from 2007 shows its profitability: while the wholesale price of bile powder is around US$410 per kg in China, the retail price increases exponentially to 25 to 50 fold in South Korea, and to 80 fold in Japan. The demand for animal products continues to grow as the worldwide interest in ‘alternative’ medicine grows. The impact of TCM goes well beyond bears and as we know affects tigers and rhinos, amongst many other animal species.

Alan Johnstone

Drugs . . . drugs . . . (1988)

Book Review from the January 1988 issue of the Socialist Standard

Cured to Death by Arabella Melville & Colin Johnson. (New English Library, £2.50).

The authors' aim in this well referenced book is to show that "Western medicine has made a fundamental error in allowing itself to become reliant on the universal use of drug therapy" (p.3).

The authors present a comprehensive analysis of the effects, on individuals and society, of prescription drugs and the factors involved in their use. "Drugs are manufactured by commercial organisations for the same reason as any other product: to make a profit" (p.4). The methods employed to increase these profits include high pressure sales techniques (for the so-called ethical products), falsification of test results, the dumping of drugs with proven dangerous side effects onto countries with less effective, or more corrupt, control procedures after they have been withdrawn from sale in other countries. The drugs industry have created unnecessary cases for treatment, promoted new diseases to meet the need for "cures" already discovered and moved towards mass medication in the name of disease prevention.

Also included in this analysis are the political power of the drugs industry, the inherent danger of all drugs and inadequacy of testing procedures, the difficulties of identifying side effects, the pressure on doctors, the conditioned attitudes of doctors, patients and the medical establishment and some harrowing case histories of victims of drug side effects.

Owing to the difficulty of identifying side effects in individual patients and the understandable reluctance of many doctors to consider the possibility that treatment prescribed by them may have caused harm, the only statistics available to indicate the extent of the harm caused by the mass use of drugs are those suggested by interpreting the results of epidemiological studies. The best estimates of drug induced disease in the population of Britain lead to a constant prevalence of two per cent, or over one million people. According to the authors the probable figure for drug-induced deaths in Britain is between 10,000 and 15,000 in an unexceptional year, at the current rate of prescribing (p. 108).

This book provides yet more evidence — if any were needed — of how the insatiable drive for profits, which is fundamental to capitalist society, damages health and destroys lives.

Grant Dixon

Doctors are Wage Slaves (1945)

From the December 1945 issue of the Socialist Standard

Many of Marx’s statements appear more strikingly true to-day than they did in his lifetime; the greater development of the capitalist mode of production has seen to that. In the Communist Manifesto Marx stated:— 

  “The bourgeoisie has stripped of its halo every occupation hitherto honoured and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage labourers.”

The effects on the man of science are readily seen by reflections on the atom bomb; on the priest, in the churches' justification of the recent war; and on the physician in his increased employment in the military and industrial forces of the capitalist countries. The use of the physician in war and peace has been found by the capitalist class to be a very profitable proposition. It has at the same time occurred to many workers now to view the doctor in industry in the role of an employer’s man.

The correctness of this is well illustrated in a recent copy of The Lancet (October 6th, 1945) by the very materialistic approach given to new aspects of disease by the medical profession.. Three papers in this issue are devoted to the exposition and treatment of lumbago. This condition has hitherto been regarded as a rheumatic manifestation; now it is being realised that strain may cause a displacement of part of the spine and bring about the characteristic signs of lumbago. In The Lancet editorial this discovery is related to industry and the Services, and the comments of two American doctors employed by an insurance company dealing with workmen’s compensation are given. These medical men point out that strain is now regarded as a causal agent and may occur during working hours; the onus of responsibility may be thrown on the employer.

Medical discoveries have now ceased to be of primary interest to the sufferer and are considered mainly from a monetary aspect with the doctor eager to serve his employer, as anyone unfortunate enough to have beheld the undignified spectacle of conflicting medical witnesses in compensation cases will realise.

The function of the doctor in the Services and in industry is well summed up by the editorial when it states: “The factory physician or the unit medical officer is mainly concerned with palliation and return to duty. . . .'

However earnestly the young doctor may start out after qualifying, he soon comes to grips with the system under which he must practise in order to live. He may be loath to recognise it and may make various vain endeavours to put back the clock such as his resistance to salaried service like the National Health Service, where the State would pay the doctor on the basis of work done.

As capitalism operates through commodity production, service becomes a commodity, whether it be banking or medical attention, and is purchasable. The employer of the industrial medical officer purchases the doctor’s labour-power. The doctor gives the service of medical attention and the employer sees to it that the attention shall serve the employer’s interest.

Thus we see that all who must sell their labour-power in order to live do so at the dictates of capitalism, though men and women in many professions imagine they are exempt. Capitalism is a levelling force, and makes the interest of all workers one. The sooner that workers, be their tools the stethoscope or the carpenter’s saw, the test-tube or the power-driven tools of the factory, realise their common interest and strive together to overthrow their common enemy, the sooner will men of science and medicine not have to prostitute their knowledge. Only under Socialism will their knowledge be used for the benefit of mankind as a whole, unhampered by monetary considerations.

W. P.

The Specialist Disease (1937)

From the August 1937 issue of the Socialist Standard

A novel written by Dr. A. J. Cronin which criticises the medical specialist has caused some comment in the papers lately. A writer in the Evening Standard gave the instance of a friend of his who, after having had a fall from a horse which brought on a form of rheumatism, went to his family doctor and was told that time and rest was the cure for his complaint. Not satisfied with this his friend came to London and spent a hundred pounds or so visiting specialists who did him no good. Finally he had to adopt the rest cure, and after some months was quite all right.

At the invitation of the News Chronicle, Dr. Harry Roberts gave his views in that paper (July 22nd, 1937).

In the course of his article Dr. Roberts makes the following remarks: —

   I have known men who, with no special training and no special qualifications, having failed in general practice, have staked their last few hundred pounds on a room or a share of a room in the Harley Street area, offering themselves to the public as a throat and nose specialist, a skin specialist, or a psycho-therapeutist. . . .
  Numerically, men of this kind constitute a fairly large proportion of the imputation of the fashionable medical area.

One or two ideas are suggested by the above statements. The first one is that people outside the medical profession are groping in the dark when they go to a specialist. They may be led to a competent man and they may be led to an incompetent. Even the competent is likely to be under the influence of his speciality. The man, for example, who is a cancer specialist is likely to twist, quite unintentionally, the symptoms of the patients who go to him into symptoms of cancer. There have been many instances of that kind of thing.

Why is it so difficult to find out the incompetent in the medical profession and why do unqualified people set up as specialists? The reason is quite clear to the Socialist.

The medical profession contains a proportion of competent and incompetent, just the same as any other trade. In the ordinary trades, however, there are men (foremen, managers, etc.) who are paid by the employers to find out and remove the incompetent. The medical profession, however, is one great trade union in which each doctor stands by the other and, so far, they have been able to resist any serious alteration of their methods. They are helped by the large body of wealthy people who are prepared to pay for the attention of doctors. Many of their complaints are due to high living, but quite a lot are purely imaginary.

The doctor, like the engine driver or the clerk, has to get a living. The getting a living (unless he has a private income) overrides all other considerations. If this can be accomplished by a brass plate with a fictitious specialised knowledge then the supporters of the present system cannot complain if the young doctor without patients gains them that way.

As long as a price is put upon knowledge and activity fraudulent methods will flourish. The only way to abolish them is by securing to everyone the satisfaction of his needs. The Socialist is working for this end.

When a man or a woman can devote their whole time and energy to becoming competent in whatever form of activity they may take up, without the haunting fear of being unable to obtain the elementary comforts of life, then there will be some security in going for advice to those who specialise in one way or another.

Gilmac.

Pathfinders: Down on the Pharma (2012)

The Pathfinders Column from the October 2012 issue of the Socialist Standard

The flu season is upon us again and readers will be delighted to hear that swine flu has not been idle. Tests have been taking place after a woman died last month from swine flu contracted at a country fair in Ohio, and three more cases were reported from Minnesota. The flu strain, H1N2, is derived from the 2009 H1N1 virus, is air-borne and carries the pandemic M gene. All victims had prolonged contact with pigs, however a different strain, H3N2, has caused 296 infections across 10 US states since July this year (Link). The message at present is that people at high risk should stay away from pigs, state fairs or Korea, where the H1N2 strain is said to be a ‘triple reassortant’ virus in that it is a mix of avian, swine and human flu (Link).

Scientists are being cautious, obviously. Nobody is going to cry wolf this time, after they got the blame for the huge panic in 2009. Although there was a swine flu pandemic on that occasion it was nothing like the civilisation-ending apocalypse the excitable media had led everyone to believe.

The Centre for Disease Control in Atlanta, which publishes regular information on pandemic threats, is part of a global body of research institutions which, for obvious reasons, would be required almost exactly as-is in a socialist society. Nobody can possibly question the value of what such institutions do. Even creationists, who claim not to believe in evolution, rush fast enough for their annual vaccinations and understand well enough the need for them. We humans are locked in an arms race with microbes and only the most vigilant monitoring stands between us and some disaster of truly biblical proportions.

Other threats, however, are more debatable. Many of the scientists working on the H1N1 virus in 2009 objected to the research being published, for fear that terrorists could use the work to create a synthetic weapon. After 9/11 and a brief wave of anthrax letter-bombs the USA took this threat very seriously, and set up the Biowatch programme, which consisted of networks of sensors in urban areas including underground stations, designed to spot attempts to poison the public (New Scientist, 15 September). Ten years on and Biowatch has produced a null result, which ‘proves’ to its supporters that it has worked. This is like the old joke that an elephant-repellent spray must be working if you can’t see any elephants. Detractors however point to the billion dollar bill and the fact that in the same decade there has not been a single biological terrorism attack anywhere in the world. Given the clumsy, low-tech efforts of many would-be bombers in the past, perhaps the threat of such people managing to develop a bioweapon has indeed been overstated.

But what is one to make of the fact that a very real and present threat, one which everybody knows about, is actually being increasingly ignored? Hospitals are riddled with MRSA and c. Diff. so that it can be more dangerous to go to hospital than stay at home. 60 percent of infectious disease specialists report encountering infections untreatable by any antibiotic. Just when antibiotic resistance is becoming a world-wide problem, it turns out that drug companies are pulling out of antibiotic research (‘NIH superbug outbreak highlights lack of new antibiotics’, WashingtonPost, 25 August). Why? The answer is revealing.

In the first place, the antibiotic honeymoon is over. Like peak oil, we’ve hit peak bio, after which every development is harder and more expensive. It is all about the return on investment. When the field lay wide open in the 1940s and there was plenty of claim to stake and patents to be had, it was a bonanza. Now the well is dry, but unlike oil there is no way to wean humans off the need for antibiotics without seeing a return of the bubonic plague and other horrors. But drug companies are businesses which worry about profit, not plagues, so they are doing the sensible thing and pulling the plug on antibiotic research. You can’t argue the logic when you can make more money out of an erectile dysfunction drug than out of antibiotics. Of the 12 largest pharmaceutical companies only 4 are still doing any research.The largest, Pfizer, has laid off 1200 workers and closed its antibiotic research centre in Connecticut and moved to Shanghai and out of antibiotic research altogether.

Alternatives to antibiotics are, like alternatives to oil, scarcely credible at present. The widely-mooted idea of engineering viruses to eat bacterial pathogens is still some way off, with the first clinical trial in Western Europe only taking place in 2009. Bacteriophages are hard to make, because unlike antibiotics they are not one-size-fits-all. Each pathogen strain requires a different phage, and when a pandemic may present multiple strains simultaneously this is an obvious disadvantage. They are also hard to store, and of course each one has to go through independent regulatory hurdles before being approved for use. Given the increased expense of development plus the tightly restricted potential for patent exploitation, this is likely to make phage research even more unattractive to big pharma than antibiotics. In the event of a pandemic, phage research and production may very well be too slow and cumbersome to respond.

Antibiotics too are facing even more severe regulatory hurdles because of the scare surrounding the antibiotic Ketek, which led to a number of deaths in 2006. With lawyers circling hungrily, no drug regulator is taking any chances. At a time when new drugs are becoming ever more vital, regulators are stamping on the brakes.

‘It’s a case of evolution outrunning capitalism,’ says the Washington Post report. But it’s not a case of capitalism somehow failing to keep up with evolution, as if the two are locked in mortal combat. While the money was in antibiotics, capitalism delivered. Now it isn’t, capitalism has simply lost interest in the matter. The fact that the human race could potentially be decimated doesn’t enter into it.

This is one of the worst indictments of capitalism that it’s possible to make, its absolute defiance of common sense and the interests of the human species it supposedly serves. When science, logic and self-preservation all indicate one road, and money indicates the other, capitalism doesn’t think twice. People who congratulate capitalism for its competitive drive to produce innovation should reflect on the fact that no matter how much ingenuity it inspires in humans desperate to pay their rent, it stands capable at any moment of making the wrong decision just when the consequences could be fatal.

Paddy Shannon