Walter Reed Army Medical Center (WRAMC) has several divisions, one of which is Walter Reed Army Institute of Research (WRAIR). Entering the Army as a Captain in the late 1960’s, I was assigned to WRAIR as a Research Psychiatrist.
Instead of being stationed at “The Main Section” in D.C., I was stationed at “The Annex” in Silver Spring, Maryland. The facility had been a girls’ school expropriated by the Army during WWII. Dedicated to research, unlike at The Main Section, the atmosphere among officers and enlisted men was relatively cordial and informal.
One afternoon, I stood chatting with Gerry, a draftee assigned to the Department of Psychiatry, one part of the Division of Neuropsychiatry. The young man obviously was quite intelligent and well-educated. We’d been chatting about nothing in particular when the conversation drifted to our respective, future plans.
“What are yours when you leave?” he asked.
“Academia,” I replied. “Continue my research . . . UCLA, in fact. Yours?”
“Harvard School of Public Health.”
“Really? Why not medical school?”
“I can see that you can’t.”
“Can’t see? Can’t see what?”
“The future! It’s right in front of you. In fact, it’s already begun . . . Medicare and Medicaid. I’m here to tell you, Doctor, that, someday soon, the federal government is going to control you guys, and I’m going to be one of the controllers. You’ll be saluting me, so to speak.”
“Yeah, right!” I replied, dismissing his prediction.
“That is right. Guys like me will be controlling guys like you . . . physicians, I mean . . . and all the rest in medicine, as well. I’ll be one of the experts doing the controlling. Who knows? Maybe, I’ll even be in Congress. With all due respect, you’ll be doing exactly what I tell you to do . . . Sir.”
His arrogance notwithstanding, I wandered to my office wondering if Gerry could be right. Some years later, I learned how right he was.
How did it happen? How did self-styled, bureaucratic “experts”, few with any medical training, become the controllers and physicians the controlled?
The causes have been multi-dimensional. One was via the manipulation of language. Words became politicians and bureaucrats’ weapons against physicians and patients. Words have power. Words can kill.
In his classic novel, 1984, George Orwell eloquently described how governments simplify language and pervert it to fulfill their own, tyrannical goals. He called it “newspeak”. Those in the federal government have borrowed a page from Mr. Orwell’s book and applied his ominous depiction to all four cornerstones of American society . . . government itself, law, education, and medicine.
Prior to Medicare/Medicaid, the federal politicians exerted little control over physicians. Medicine was a “cottage-industry” with hundreds of thousands of independent offices. These independent physicians collectively held too much power over too large a segment of the economy to suit the politicians. Smashing that power became a top priority for vote-hungry politicians; make voters dependent upon politicians not physicians for medical care. One element of their strategy would be through words . . . propaganda. Through words, reduce the prestige of physicians; thereby, reducing their power. How? Lump physicians together with everyone else in medicine from nurses and technicians then include outright charlatans such as chiropractors.(1) Instead of physicians practicing medicine, medical doctors would be merely one category of “providers” among many delivering “healthcare”. The strategy succeeded.
Ask yourself the following, three questions: 1)What comprises “healthcare”? In Webster’s New Collegiate Dictionary (1977), the term, healthcare or health care, doesn’t appear even. Whence came it? 2) How does “healthcare” differ from medicine? 3) Does the distinction matter?
1) As the term denotes, “healthcare” refers to caring for one’s health. It’s amorphous, is largely a personal responsibility, and includes everything from washing your hair to brushing your teeth to cutting your toenails. Accordingly, a “healthcare-provider” includes anyone or everyone who promotes himself or herself as rendering advice, assistance, or instruction in the care of one’s own health. Simply put, “healthcare” is not medicine.
2) In contrast, medicine is the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat are known as patients. Traditionally but not currently, physicians must have gained a Doctor of Medicine and be licensed as such in the state in which they practice. Traditionally, para-medical personnel included nurses, technicians, and certain classes of therapists. Medicine was among the learned professions. At its best, for its practitioners it was to be more a calling than a business . . . something akin to the priesthood. The sole obligation of the physician was to the patient not to a third-party such as the government or a “healthcare plan” or even society as a whole. Communication between physician and patient was to be sacred and kept confidential except in cases of malpractice litigation.
3) The distinction is not mere semantics. If not coined by them, the term, healthcare, was seized by politicians, bureaucrats, and profiteers to concoct a deliberately confusing, inconsistent system of medical delivery that they themselves could control for their own respective, pecuniary benefits. The consequence has been that, instead of becoming scientifically-based and scientifically-driven, the medical system has become politically-motivated and politically-manipulated with money and power as the controlling variables. The nightmare of ObamaCare represents Gerry’s dream come true. It brings with it a new host of euphemisms guaranteed to confuse. As I described in the non-fictional Healthcare Reform D.O.A. (now out-of-print; 1994)* and more recently in the fictional/non-fictional Inescapable Consequences (2009), there is a better way.
So, in any discussion of medical services, let us force the politicians and bureaucrats to define their terms. Let us remember always . . . words can kill; and, in this case, you, the patients, are the victims.
* Nominated for two national awards by The American Risk & Insurance Association.
1. Theoretically, the underlying principles of chiropractic are nonsensical. Operationally, chiropractors injure 30% of their customers, on average (See, for example, Hurwitz, EL, et al: “Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.” Spine 30:1477, 2005.). Worse, some of these injuries are fatal; chiropractic “manipulation” has been documented to cause death from dissection of the vertebral artery (See, for example, Chen, WL, et al: “Vertebral artery dissection and cerebellar infarction following chiropractic manipulation”. Emergency Medicine Journal 23: e1, 2006.). Re-labeled “chiropractic physicians”, these “healthcare providers” receive the same governmentally-mandated prestige as genuine medical doctors.