I not at all surprised that the long tale ending in CAT scanning of a possible tumour
was the launch of several hares, or should I say 'pale herrings'?
Firstly an apology: I used a tale within medicine for particular reasons - I know its
innards well; there is a perception of "Medicine" as being an epitome of domination by
experts; it was an attempt to bring something home - & illness is very much at home
with all of us regrettably. But perhaps in retrospect it would have better to be less
specific.
In any case I do not especially want this strand to drag on, but I will respond to
some remarks. I will try to be brief:
i) Gar claims that: "There is no 'anti-expertise" position. The question is "rule by
expertise".
REPLY: I certainly am in agreement with this, & it is what I have tried to point out.
(Albeit perhaps badly!). But, the point I was making is that there is _definitely_ a
strand of "anti-expertise" in some of the simplistic tones of some comments passed on
this question [Gasp, Horror ! - on THIS erudite list!]. In contrast, Melvin used the
term "red experts" - & I think he captured what was needed in the discussion, though
the originator of this strand (jks) no doubt disagrees. The debate in Russia under
Lenin and then subsequently was exactly over this question of 'Red experts', and it
was tending to be re-phrased by ultra-leftists as a
question of "bourgeois experts or _no experts_". This led to Lenin & others fighting
against the "Communist Academy's ultra-leftism. The real questions were - maintained
Lenin - "whose experts? & what socialist controls over experts should be maintained?"
ii) Gar says: "people have the right to make their own decision and not have them
imposed by experts."
Now, WHO on this list has contested that? I think that not even those who have called
themselves "bourgeois liberals" have - unless I missed that??? Certainly in the field
of medicine - now this is a mantra in the West. It is possibly more a mantra in words
than in the enacting, but even the most reactionary physicians will utter pleasantries
along these lines.
iii) I am not sure how this following "red herring" got introduced as a reply to my
little tale, but let us indeed put the neon light on it: Gar says: "But ultimately, if
the society is a democratic one, that non-experts must weigh this against the need to
fund education , and old age pensions and so forth."
This is entirely a much larger kettle of fish than what I was referring to. But why
stop there Gar? Why not include $ for Helicopters & gun-ships & all that stuff? Indeed
ONE of the big problems of the Oregon legislation that asked the population to attempt
to "trade-off" health care financial decision-making process - was that the military
and other Big-Business-Capitalist agendas were left off the list. But to my mind, this
larger dimension is certainly part of what I was trying to say - you will note that
the end of my little tale states: " I view it as not the central matter anyway, the
central matter is the control of power. In a capitalist
system, this is unlikely to favour the masses." Was it not neon-lit enough to see?
iii) Gar says: "Doctors should not be micro-managed. But neither should carpteners or
street sweepers. It is simply that in general expertise should not translate into
authority - the right to control others."
What is there to disagree with here? The interesting question is surely HOW? In an
earlier posting in regards to medicine I suggested that it was possible - even under
capitalist conditions - to use the bourgeois media to shine a spotlight on
inconvenient litmus-test questions (the e.g. I used was the Bristol scandals in the UK
on paediatric cardiac surgery).
iv) And the same with Devine's comment: "One thing we should do is to make sure that
the experts don't restrict the supply of education in order to shore up their status
as experts."
One does not disagree.
iv) As Joanne notes the AMA has certainly tried to introduce an element of
'supply-shortage' to raaise prices that drs can command. The Royal College of
Physicians in Canada has done hte smae. But, it should be noted that there is a very
influential strand of progressive health-care economiats (look up Greg Stoddard &
M.Barer) that have been instrumental in assisting this thinking - at least in Canada.
Thse argued that there are too many drs, that we don't need drs. that health care
advances are societal and not related to medical advance (which is expensive &
enriches drs). Their arguments shut the doors of Canda very firmly in the face of
students wishing to enter med school & foreign docs.
v) re the AMA: en passant, the AMA is one reactionary thing (Paul Starr's book is very
good on this) - but it should be noted that the academic societies have been in fact
'progressive' (I use the '' notation to indicate that they are not as yet raving
Marxist-Leninists - at least to my knowledge) - and have been persistently calling for
a nationalised health care programme. I am especially familiar with the American
Pediatric Society - which has not been at all backward.
Hari Kumar - sent on Saturday (For some reason that neither Michale nor myself have
figured out, my mails either don't come or are rather delayed).
