Free Trade Medicine: Let The Market Decide?

Towards a dangerous anarchy

Once upon a time, the world of US medicine was very different. As recently as the 19th century medical practice was a chaotic quagmire of often bizarre modalities each competing one against the other in a "war of each against all" for unwitting patients. This was a medicine where blood letting, faith healing, herbology, healing elixirs, potent tonics, and homeopathy were among the many choices available for the prospective patient. It was a time of little consensus and even less theoretical agreement among a heterogeneous mass of "practitioners" each plying their wares, spells, and potions to a clueless public. This era in the United States is a reminder of disjointed "pre-enlightenment" periods of other cultures and could be safely described as a form of anarchy. Add to this that none of these practices were evidenced based, and you can get an idea the sorry state of affairs medicine was in.

This was before the dominance of evidence based and scientifically trained physicians, that in the 2oth century revolutionized an aimless and ineffectual medicine into a results oriented proposition that quickly gained the acknowledgement and respect of the general population and won hard earned government support. Since that time, the medical profession has gained a special status and position in large part due to demonstrable effectiveness. This position, however, is being challenged by those who support a "freedom of choice in medicine" arguing that the special societal status of science based medicine impugns this basic right.

Indeed, there is a movement successfully inserting alternative non science based medical practices into science based strong holds such as governmental research projects, hospitals, and even medical schools. It is helpful to get an idea of the 19th century societal environment that was so conducive and fertile to the state of medicine of the time as this provides insight into today's issues.

Social attitudes and historical precedents supporting medical anarchism

A study by K. Patrick Ober on the status of 19th century medicine before the dominance of evidence based medicine provides a unique insight on the mindset of the times. According to Ramey & Rollins:

"...the proliferation of medical modalities was to an extent a reflection of Jacksonian democracy and its bias against special privilege. Legislative favoring of any approach to medicine was seen as limiting choice. Control of medical licensure by state legislatures had almost disappeared by 1850, and the resultant "free trade in medicine" allowed for anyone to practice regardless of qualification or training."

In addition the success of "Adam Smith's theory of laissez-faire economical free enterprise combined with Mills classical liberalism" together created an unrestricted form of free enterprise that shied away from any form of regulation. In other words, the philosophy of "let the market decide" took a firm hold in this societies mindset.

The problem though is, as noble as this idea may be, it has limits as the disastrous and dangerous medical anarchy of the times demonstrated. As Ramey & Rollins suggest, when it came to medicine the stakes were too high. People were not buying or selling goods, they were playing a game of life and death. It became apparent that the benefits of having a reliable knowledge base used by a group of responsible providers far out weighed the attractions of "freedom of choice" in the medical context.

Supported by certain organizational rules and expectations along with dependable funding, the development of modern medicine took hold. The rumblings of "free choice" promulgated today by many in the alternative medicine arena does not take into account the hard lessons learned from this recent past.

The Bottom line is responsibility

As I discussed in a previous post, science based medicine is not without its problems. Every effort should be made to maintain a science based methodology allowing for the examination of new or old practice modalities for effectiveness. To date, a science based approach has allowed for an overall process that sooner or later accepts what works. The bottom line is that the medical community has a basic and foundational responsibility to practice effective medicine. As Ramey & Rollins notes:

" The alternative to establishing science-based practitioners as the socially accepted filters of medical therapies is medical anarchy. However, while such anarchism is in some respects attractive on its face, it is ultimately unacceptable for a variety of reasons. It would leave no rational decision procedure for choosing among competing therapies. Society, on reflection, is unlikely to want such a state of therapeutic anarchism"

I only hope that this optimistic outlook for our societies judgement holds true. It is up to the science based community to share their knowledge and educate the public regarding the importance of evidenced based science so that we may avoid repeating mistakes of the past.

ref: Complementary and Alternative Veterinary Medicine considered. Ramey,D,Rollin,B. Blackwell Pub. Iowa.2004