Sophistry in American Medicine? Platonic Reflections on Expertise, Influence and the Public’s Health in the Democratic Context

by Evan V Goldstein

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.

– Hippocrates, Hippocratic Oath


The American medical profession often extols the superiority of American healthcare. Without question, the American medical craft—defined as the physicians, clinicians and healthcare organisations that comprise the American healthcare sector—provides immense value to patients and contributes expertise on matters relevant to the public’s health. As caregivers, clinicians navigate uncertainty over diagnosis and prognosis, make difficult therapeutic choices, and save lives through their treatment decisions. However, several conspicuous realities about the cost and quality of healthcare in America should give the reader pause, particularly when assessing claims about the American medical craft’s wisdom and prudence in matters related to the public’s health.

To examine who should have what authority over matters of public health, this paper invokes the teachings of Plato’s Socrates and explores the claim that the United States has been hampered by less-than-ideal public health decision making. This paper further explores the notion that public health decision making has been adversely impacted by the overextended reach of medical craft expertise, as permitted by the American democratic political system.

A key takeaway? There is no time like the present for reflection— honest reflection beyond what the vogue policy models or power elites posit.  American thought-leaders and policymakers must not forget that the debate over craft skill, deep knowledge, sophistry and who should have what decision-making influence in public affairs is not new. Rather, it is an ancient debate, and now as then, the ancient arguments remain relevant in the democratic context. To Plato’s Socrates, the public’s health, including the equitable appropriation, allocation and distribution of health-related resources, should be the responsibility of the state and its statesmen. Quite the contrary, medical expertise is fallible in matters of governance and policymaking pertaining to the health of society—just as any single trade craft would be.

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