{"id":48282,"date":"2020-08-11T17:02:41","date_gmt":"2020-08-11T16:02:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48282"},"modified":"2020-09-14T17:06:48","modified_gmt":"2020-09-14T16:06:48","slug":"richard-smith-the-faults-and-dangers-of-an-iatrocracy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/11\/richard-smith-the-faults-and-dangers-of-an-iatrocracy\/","title":{"rendered":"Richard Smith: The faults and dangers of an iatrocracy"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The first thing that struck Bernard-Henri L\u00e9vy, arguably France\u2019s leading public intellectual, about the covid-19 pandemic was the rise of \u201cmedical power.\u201d In his short, enjoyable, and provocative book <\/span><i><span style=\"font-weight: 400\">The Virus in the Age of Madness<\/span><\/i><span style=\"font-weight: 400\"> he explains why such power is both undeserved and dangerous.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Now aged 71, L\u00e9vy is one of the <\/span><i><span style=\"font-weight: 400\">Nouveaux Philosophes<\/span><\/i><span style=\"font-weight: 400\"> inspired by among others Michel Foucault, and he reminds us that Foucault observed that governments have learnt as much from the hospital as the prison. In <\/span><i><span style=\"font-weight: 400\">The Birth of the Clinic<\/span><\/i><span style=\"font-weight: 400\"> Foucault described the management of outbreaks of plague in the 18<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> century: in L\u00e9vy\u2019s words, \u201cexile to an island or a ghetto on the outskirts of the city, as was the practice with lepers and the insane, gave way to confinement of entire cities, where all citizens were under house arrest and neighborhood watch patrols wrote up holdouts. Once night fell, everyone was out on their balcony, not to applaud the caregivers but to enable the sanitary authorities to tally up the dead, the dying, and the living.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cBut,\u201d observes L\u00e9vy, \u201cuntil now, never had things gone quite this far.\u201d He emphasises the uniqueness of how we have responded to this latest in a long line of pandemics, including to the \u201cHong Kong Flu\u201d of 1968 that killed a million people. \u201cNever had we seen, as we did in Europe, heads of state surrounding themselves with scientific councils before daring to speak.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">After praising the health professionals who put themselves at risk by treating those sick with covid-19, L\u00e9vy writes \u201cbut to make physicians into supermen and superwomen and to endow them with extraordinary powers requires a leap that can be taken only with the help of several misconceptions.\u201d He then explains those misconceptions.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Firstly, doctors and scientists do not always know more than others. L\u00e9vy, who is equally comfortable quoting Plato and <\/span><span style=\"font-weight: 400\">Youtube<\/span><span style=\"font-weight: 400\">, tells us that the French philosopher Gaston Bachelard observed that \u201cscientific truth\u201d is never more than a \u201ccorrected mistake.\u201d The British philosopher of science Karl Popper also argued that the only \u201ctruth\u201d in science is the hypothesis that has not yet been falsified, with the implication that one day it may well be falsified. L\u00e9vy supports his argument by quoting just some of the many doctors who have made statements like the<\/span> <span style=\"font-weight: 400\">\u201ccoronavirus is way less serious than influenza\u201d that have proved badly wrong.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Secondly, doctors and scientists do not speak with one voice, as even the most casual reader of <em>The<\/em> <\/span><i><span style=\"font-weight: 400\">BMJ<\/span><\/i><span style=\"font-weight: 400\"> knows well. Having been \u201cfortunate enough to have arrived at philosophy through the door of epistemology,\u201d L\u00e9vy notes that \u201cthe \u2018community\u2019 of scholars is no more communitarian than any other\u2026is riven with fault lines, divergent sensibilities and interests, petty jealousies, esoteric disputes, and, of course, fundamental differences. I know that the research world is a <\/span><i><span style=\"font-weight: 400\">Kampfplatz<\/span><\/i><span style=\"font-weight: 400\">, a battlefield, a free-for-all no less messy than the one Immanuel Kant bemoaned in metaphysics.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cThe emperor has no clothes, even if he is a physician,\u201d concludes L\u00e9vy<\/span><span style=\"font-weight: 400\">. \u201c<\/span><i><span style=\"font-weight: 400\">Especially<\/span><\/i><span style=\"font-weight: 400\"> [his emphasis],\u201d he continues, \u201cif he is a physician. The renowned doctor, the big shot, however formidable and learned he may be, is naked under his white coat. And in that he reconnects with and shares the fate of the rest of humanity.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">L\u00e9vy\u2019s third anxiety is the most worrying. He warns against what he calls \u201chygienics.\u201d He defines it thus: \u201chealth becomes an obsession; all social and political problems are reduced to infections that must be treated; and the will to cure becomes the paradigm of political action.\u201d We all know, he writes, where such a doctrine can lead, arguing unphilosophically it seems to me that one example will suffice. He tells the story of eugenics, which gripped France and other countries in the 1930s before being taken to its hideous extreme in Nazi Germany.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019ve heard several philosophers say that the history of philosophy is essentially a matter of understanding Plato, and L\u00e9vy describes how in his dialogue <\/span><i><span style=\"font-weight: 400\">The Statesman<\/span><\/i><span style=\"font-weight: 400\"> Plato considers a country run by physicians. After advancing several reasons in favour of an iatrocracy, Plato abandons the idea: in L\u00e9vy\u2019s words, \u201cPolitics, he says, is an art that, since the retreat of the gods, deals with a chaotic, changing world, swept by storms and rudderless. But, in a storm, what is the point of a Hippocratic nosology of \u2018cases\u2019? Do not<\/span> <span style=\"font-weight: 400\">the difficult times call instead for citizen-guardians possessing the audacity and strength to think through, carve into stone, and proclaim legal \u2018codes\u2019?\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Doctors have important roles to play in a pandemic\u2014primarily in treating the sick and advising on prevention\u2014but they cannot become rulers, and politicians cannot hide behind them. And we, the people, must never succumb to the idea that a world run by doctors would be a better world.<\/span><\/p>\n<p><em style=\"font-size: 1rem\"><strong>Richard Smith<\/strong>\u00a0was the editor of The BMJ until 2004.<\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Competing interests: <\/strong>None declared.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The first thing that struck Bernard-Henri L\u00e9vy, arguably France\u2019s leading public intellectual, about the covid-19 pandemic was the rise of \u201cmedical power.\u201d In his short, enjoyable, and provocative book The [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/11\/richard-smith-the-faults-and-dangers-of-an-iatrocracy\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48283,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-48282","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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