6 Comments

Interesting post. But, you left out one important factor. Since the 19th century, MDs, through the main organizing group, the AMA, have put physician income above everything else. I know this is easily forgotten, but it is factual. From driving out women to take over birthing babies, to use of licensing requirements to limit other types of medical practitioners, to limiting the size of medical schools and until WW2 to limit women or non-white folks from medical school, medical practice has been a controlled endeavor that attempts to keep other groups from acceptance. There is plenty of literature that talks about the intentional destruction of any and all groups that might offer alternative ways of doing or thinking medicine. The main tools have been propaganda and political coercion, even jail terms for the heretics. So while I won't disagree with you on the overall depth of success of modern industrial medicine, I will note that none of the alternative thinking, either within medical industrial complex or outside of it, has been given a chance to compete in the world of ideas. When mistakes are made (not just by doctors but by pharma too), they are either covered up (Thalidomide, Over prescribing of opiates, antibiotics), normalized (cesarian sections, TV ads for a variety of prescription drugs), lied about (LSD,Marijuana, psilocybin, etc.), and/or used as social control (ritalin, adderall, electroshock therapy, prozac, Zoloft, etc.) (I must add that in a small amount of cases all these modalities of treatment can be beneficial, but the large amount of usage is the result of forces that have nothing to do with helping people). All these ideas are well documented at this point and point to people more interested in prestige and income, than in any search for the best way to help people.

Cynical? Yes. But truthful.

Expand full comment

Your ideas are rich, complex, and meaningful.

A sizeable portion of institutionalists are more comfortable parroting fluff social issues de jour rather than working through your complex questions.

The government sets the agenda by dangling massive amounts of dollars and encouraging funding dependence and accreditation dependence (exhibit 1: TJC and ACGME requiring DEI (*insert gagging here*) programs likely in perpetuity).

Expand full comment

Exactly. Given you're in California, I hope you marry a lawyer.

Expand full comment

The more elite the institution, the more demoralized it is: https://yuribezmenov.substack.com/p/how-to-get-into-harvard-part-2

Expand full comment

So we learn that progress builds on a steady improvement of knowledge. In the marketplace of ideas, some disappear when found incorrect. In facing a new challenge we often revert to tactics that have worked in the past, building on knowledge. In recent years logic and building on past success has fallen through contamination of ideology. Ideology has no real correct/incorrect boundary but is more situational and uncertain. We wrestle with Plato's Republic forever.

Institutions likely become more corrupt over time and require refresh when their policies become harmful. If contaminated by ideology, the corruption becomes complete. When they can't admit error they have arrived at the time for reset and refresh. Hope it doesn't take too long, the need is great.

Expand full comment

I feel at the end Prasad is just trying his hardest to get cancelled here, 'They only fooled you because they bet on Tom Brady. He had a higher winning percentage. But even he can't keep it up forever.'

Expand full comment