Saturday, January 17, 2009


I recently wrote that civilization spawns and perpetuates enduring falsehoods. Until relatively recent centuries, “traditional morality” posed an almost insuperable barrier to scientific inquiry. “Taboo,” “awkwardness” and “religious condemnation” combined to frustrate attempts to use human sense to understand physical phenomena. Although my last essay dealt with a more specific scientific inquiry (sexuality in the animal kingdom), today I apply the same reasoning to a much broader scientific pursuit: Medicine.

Medicine is a scientific discipline. It aims to repair the “human organism” through direct and chemical interventions. Those interventions, in turn, represent the sum total of scientific observation concerning the human body. To that extent, medicine shows its scientific moorings. Like any scientific pursuit, medicine focuses human observation and deductive reasoning onto a tangible, perceptible object: The human body. There is nothing “metaphysical” about this. Men began assembling medical knowledge by watching sick and injured people. They experimented with various cures. Over the centuries, they saw what treatments worked. Ultimately, they came to understand that the human body is an observable phenomenon. By understanding the body’s physical characteristics, they devised more effective cures. To that end, they began to investigate the body more closely. In short, medicine depends on human reason to observe and analyze human biological processes.

But it has never been easy for scientists to use reason. Throughout history, societies have condemned scientists for candidly making reasonable inquiries into subject matter considered “morally off limits.” This was especially true for physicians working in medieval Europe. Church doctrine forbade tampering with dead bodies because people believed that desecrating a corpse would jeopardize the soul’s chances for salvation. Yet physicians could not carry out their scientific work without actual human specimens upon which to make comprehensive observations. Many early medical scientists risked execution by stealing or buying dead bodies to perform dissections. Until the 17th Century, “traditional moralists” labeled pioneering medical scientists “grave-robbers.” Despite these challenges, early physicians laid the sensory groundwork for later investigators. They risked everything to apply their reason in a world that eschewed reason for superstition.

With the Enlightenment, governments began to see that human reason offered better opportunities for power than religious doctrine. After all, scientists showed that they could invent extremely useful devices—especially weapons—and political leaders liked that. In order to hasten discovery, governments began to allow scientists to freely use reason in scientific pursuits. Nonetheless, medicine lagged behind other scientific disciplines because social taboos concerning the human body remained very strong. Christian theology had a hand in perpetuating these reservations, primarily because Christianity holds the human body in contempt, preferring instead to focus on “otherworldly life.” These ideas died hard; and they frustrated physicians who could not make the observations needed to discover effective treatments.

Governments began easing their grip on medical inquiries. Beginning in Italy and England, new legislation introduced capital offenses punishable by “death and dissection,” explicitly authorizing physicians to take the bodies of hanged criminals for anatomical investigation. See Murder Act of 1752, 1751 Parliament, c. 37. Physicians did not care from whence came the bodies they observed; a human body is a human body. These measures spurred more detailed anatomical insights, as well as more effective treatments. Interestingly, however, mainstream society continued to regard medical science with suspicion. After all, legislatures intended their “death and dissection” penalties to be particularly harsh. They represented the social view that physicians were still disgusting grave-robbers. To an average citizen, the idea that a person would want to receive the body of an executed criminal was morally revolting. At the same time, Parliament believed that criminals would fear postmortem dissection more than mere execution—and thus refrain from murder—because postmortem dissection was somehow sacrilegious and “dirty.” (See Murder Act of 1752, calling postmortem dissection “[S]ome further mark of terror or infamy” upon the punishment for murder; See also William Hogarth’s painting The Reward of Cruelty). Despite the stigma and suspicion, physicians continued their work. And today we are all better for it.

In this historical light, I praise physicians for their perseverance against social prejudice. In recent decades, of course, society has accorded far more respect to the medical profession than ever before. But from a historical perspective, doctors have come a very long way against very long social odds. Like all sciences, medicine had to fight through persistent social myths and stultifying moral norms. Ultimately, medicine assembled the objective knowledge it needed to fully understand how the human body operates. Combining that knowledge with other scientific inquiries on chemistry and physics, doctors learned how to treat injuries and diseases, making life better for all.

None of these things would have been possible if doctors had adhered to “traditional morality.” In a fundamental sense, doctors are scientists. As such, they must reject social prejudice and apply pure reason. They are not afraid to acknowledge that man is an “animal” with body systems that can be understood in the same way that animal body systems can be understood. That may seem obvious, but “traditional morality” recoils from the notion that man is an animal. In fact, western theology draws lofty distinctions between animals and men. In the Old Testament, God gives Man dominion over “every creeping thing that creepeth upon the earth.” Genesis Ch. 1:26. But medicine never could have developed if scientists did not acknowledge that man has living organs, just like any other mammal that “creepeth upon the earth.” Man exhibits the same biological processes as animals: He breathes, he sleeps, he bleeds, he eats, he excretes, he experiences pain, he grows old, he dies. Physicians moved beyond the rhetoric about human superiority. They were not afraid to see that man had a body that could break down and fail. Through reason, they learned how to repair it.

Viewed abstractly, physicians, doctors and surgeons perform useful work. I often criticize modern medical institutions for their obsessive focus on money, but that does not diminish my abiding respect for medicine as a profession. After centuries of scientific inquiry and taboo-busting, physicians learned how to stop influenza, transplant malfunctioning hearts, eradicate the black plague, treat venereal disease and even remove cancerous tumors before they spread to the rest of the body. They discovered medicines that ease pain and improve physical well-being. This is valuable work. In its basic substance, medicine is good: Doctors cure disease, heal wounds, take away pain and provide hope to desperate people confronting desperate physical challenges. Modern insurance practice and financial concerns do not alter that basically good substance. Through reason and scientific inquiry, doctors have created a truly beneficial craft.

I often marvel at medicine, especially when I compare it to other forms of work. When a lawyer goes to work each day, what does he really deliver? At the end of his day, what has he produced? He has shown up at court in a suit, asked the judge for another week to hand in a paper, then gone back to the office to ask solemn questions to an injured person about how they slipped on a sidewalk. Or he may have negotiated a merger deal, making some rich guy even more money. But what does a surgeon do? He gets up early in the morning, puts on his scrubs, goes to the operating room and saws open a little boy’s head to remove a life-threatening brain tumor. Afterward, he takes off his mask and tells the boy’s family that he is resting and should recover. In both cases, “professionals” applied their knowledge to “help” someone.

You tell me which service is more meaningful.

After studying law, I gained more respect for medicine because I compared the substance of both professions. As the above example illustrates, the lawyer delivers “value” by defending another person’s financial interests, while the surgeon delivers “value” by literally saving another person’s life. In my eyes, the surgeon delivers dramatically more value. Life is more valuable than money, no matter what any insurance company says. Surgeons take away pain and save lives. Lawyers argue and bicker to save money. The difference is so striking and so embarrassing that it should make any lawyer reevaluate whether he is actually a “professional.” Still, surgeons have not received respect as a profession until relatively recent times, while lawyers always had a high place in society. Lawyers represent the dominant values of society because law reflects and embodies dominant social values. Those values once condemned surgeons as grave-robbers and butchers. But now look at them. Their “butchery” can save a lawyer’s grandmother from cancer, while all the lawyer can do is seek summary judgment in some esoteric contract dispute and win money.

I praise surgeons for their dedication to the abstract substance of medical science. Through human reason and intrepid determination against social prejudice, modern medical science has come a very long way. I am thankful for that. I must be emphatic, however, in restricting my comments to abstract substance. The current form and practice of modern medical science is an entirely different subject. Modern medicine is a tremendous achievement in human civilization. It saddens me that business concerns, money and class structure impede access to this achievement. I can only hope that, one day, everyone has an opportunity to benefit from them. Is it not sad that, after overcoming social taboos and achieving a respected place in society, medicine may now only be available to the wealthy? What good are science and knowledge if only a few can enjoy them?

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