Medical Paternalism And Me

The Death of an Ancient Dogma

Mount Vernon, Virginia

December 12th, 1799

Cold air proclaims winter's arrival at George Washington's Mount Vernon estate. The President returns home drenched in the late afternoon, his hair covered in snow after having supervised farming activities since morning.

He ignores his secretary Tobias Lear's advice to change clothes and attends dinner soaked, true to his punctuality. The American hero wakes up with a sore throat at dawn but decides to continue the labor anyways, marking trees meant for cutting on the east side of the Mansion.

His physical state deteriorates throughout the day.

“’You know I never take anything for a cold. Let it go as it came.” Washington tells worried Lear.

He wakes up in severe discomfort that night. Half of his blood gets drained under the supervision of three prominent physicians over the next eight hours, he also gargles a butter-vinegar concoction, receives an enema and swallows an emetic to induce vomiting.

None of these "appropriate" treatments are beneficial, and the founding President of the United States dies sometime around eleven that evening.

" I am just going! Have me decently buried, and do not let my body be put into the vault less than three days after I am dead. Do you understand me? Tis well! "

The death of George Washington marked the last breaths of a dark medical era rooted in the times of Galen of Pergamon, the court physician of Roman emperor Marcus Aurelius.

Galen paved the way to a dozen of medical fields such as anatomy and neurology, but his philosophy also included bodily humor and the now discredited practice of bleeding patients. He built upon the foundations laid by Hippocrates who instituted the notion of medical paternalism, this inherent superiority of doctors over their patients.

Galenism would remain unchallenged for sixteen centuries, protected by the paternalistic status of medicine.

2017

Dr. Eric Topol and collaborator Robert F. Graboyes paint an accurate picture of this old and detrimental dogma in a publication titled Anatomy and Atrophy of Medical Paternalism from the Mercatus Research Center of the George Mason University in Virginia.

" Hippocrates assumed physicians possessed information intrinsically superior to that of their patients. He also believed that this superiority warranted institutional measures to ensure the supremacy of doctor over the patient. In other words, Hippocrates insisted that physicians’ superior knowledge ought to be self-reinforcing because patients’ experience was inferior. Medical institutions should strive to keep patients in the dark, ignorant of their conditions and the ingredients of their medicines. "

The combination of governmental powers and private entities along with social conventions enforces and preserves this 2,500-year-old practice.

"Medical standards are to be dictated and regulated by an elite cadre, " explain Graboyes and Topol.

Asymmetric information between patient and physician justified this paternalistic practice. Keeping up with the massive rush of medical knowledge during the 20th century was costly, difficult, and sometimes impossible for the laypeople and physicians outside of the primary learning centers. Medical schools also struggled to keep up with the changes, which meant the general population would be incapable of following suit.

Physicians had access to knowledge unknown to the public and would, therefore, make better decisions for their health, acting as an "enlightened agent."

The irony is that medical practice most likely caused more harm than good from the antiquity until the early 20th century, according to the authors.


Medical Paternalism And Me.

Innovation is reshaping the healthcare landscape faster than regulator's capacity to maintain their power. Medical paternalism fades as technologies ranging from telemetry to smartphones, peripheral devices, and cloud-based databases allow patients to perform tasks once controlled by doctors and other experts.

Potential ear infections, a typical reason for clinic visits, can now be diagnosed from home with a phone attachment and cloud-based algorithmic interpretation, for instance.

The Internet allows users to access information and mold educated patients, balancing the asymmetry that once justified medical paternalism. 

The chronic disease epidemic affects half of the American adult population, driving the country's healthcare debt beyond the trillions of dollars, an unfortunate trend experienced globally.

The planet is sick. Someone you love is bound to suffer from a chronic condition if you are not already. Doctors and patients must let go of old beliefs and evolve as a team within this new healthcare occasion for the species to thrive, long and prosper.

What a time to be alive!


Reading List

Anatomy and Atrophy of Medical Paternalism 

The death of George Washington

The death of Geroge Washington 2

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Alex Bernier
Alex Bernier

Pieces of myself through facts and fiction - A fallible human of the digital era. I bought the ticket, missed the ride, then tripped down the rabbit hole and woke up stranded with you in this strange matrix.


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