In Part I we talked about a new managerial revolution that is taking place in medicine today.
Aaron Kheriaty, writing in The Epoch Times, tells us the managerialist ideology consists of several core tenets, according to Washington-based writer and analyst N.S. Lyons. The first is technocratic scientism, or the belief that everything, including society and human nature, can and should be fully understood and controlled through materialist scientific and technical means, and that those with superior scientific and technical knowledge are therefore best placed to govern society.
This ideology manifests itself in medicine through the metastatic proliferation of top-down “guidelines,” imposed on physicians to dictate the management of various illnesses. These come not just from professional medical societies but also state and federal regulatory authorities and public health agencies.
“Guidelines” is in fact a euphemism designed to obscure their actual function: They control physicians’ behavior by dictating payments and reimbursement based on hitting certain metrics. In 1990, the number of available guidelines was 70; by 2012, there were more than 7,500. In this metastatic managerial regime, the physician’s clinical discretion goes out the window, sacrificed on the altar of unthinking checklists. As every physician knows from clinical experience, each patient is sui generis, unrepeatably unique.
Dr. Kheriaty says, “Real patients cannot be adequately managed by a diagnostic-based algorithm or treated by an iPad. Checklists are useful only once the problem has been understood. For the practitioner to be able to make sense of problems in the first place requires intuition and imagination—both attributes in which humans still have the edge over the computer. Problem-solving in a complex environment involves cognitive processes analogous to creative endeavors, but medical education as currently configured does not cultivate these capabilities.”
Technocratic scientism has likewise driven the campaign for so-called “evidence-based medicine” (EBM)—the application of rationalized expert knowledge, gleaned typically from controlled clinical trials, to individual clinical cases. At first glance, evidence-based medicine seems hard to argue with—after all, shouldn’t medical interventions be based on the best available evidence? But this model has serious flaws, which have been exploited by Big Pharma. Studies yield statistical averages, which apply to populations but say nothing about individuals. No two human bodies are exactly alike, but technocratic scientism treats bodies as fungible and interchangeable.
By this way of thinking, treating patients might just as easily be done by robots – plug in the symptoms, out comes a diagnosis and treatment. No need for any human intervention. I’m sure there are those who would agree with this approach, but doctors know better. Medicine is both science and art – a unique blend of scientific knowledge and human experience that only can be applied by humans.
EBM proponents claim we should only use the “best available evidence” to make clinical judgments. But this sleight-of-hand is deceptive and wrong: We should use all available evidence, not just that deemed “best” by self-appointed “experts.” The term “evidence-based” functions to smuggle in the claim that double-blinded, randomized, placebo-controlled trials (RCTs) are the best form of evidence and therefore the gold standard for medical knowledge.
Dr. Kheriaty says, “This results in, among other things, the scrapping of the entire discipline of epidemiology. EBM’s criteria constitute Big Pharma propaganda masquerading as the “best” expert scientific and technical knowledge.”
(Note: More on managerial ideology and its impact on medicine next post.)
