"Decay of American Culture" and Our Health Care System

Dr. Erich Loewy, physician-ethicist who has written to this blog several times in the past and who is very outspoken in expressing his beliefs has written another commentary which is an analysis of American culture and its consequences including its relation to medical care. Now, within the United States there is debate as to how to change the healthcare system to provide appropriate care to all but especially also to those who find no easy way to obtain and pay for their care. Some may find objections to what Dr. Loewy writes and, if so, their opposing views are certainly welcome on this blog. ..Maurice.

Several issues have been posted on Dr. Bernstein's superb discussion blog. I do believe that there are certain things they have in common. Dr. Bernstein, for example, brought up the problem of Islamic students who refuse to do some things on the grounds of their particular belief system which I do not think reflects the view of most Imams. I have had many students who were Muslim and never in about 40 years of teaching have ever had this type of problem. My best friend Manucher Mavendad unfortunately now dead used to frighten people in the lobby if by chance we came in through opposite door and he would say "you miserable Jew!!" and I would respond with "you filthy Arab"---by now our audience was certain that we would slay one another when we physically met. Instead of it we walked out together laughing. We were medical students--what do you expect.

I have watched over the years a decay in American culture (I fled here from the Nazis at age 11 in late 1938) which is frightening. I am told--I was not in the US than--that there was quite a bit of solidarity at the time of the Depression and people had and needed solidarity and mutual helpfulness. Over the years this country has become more and more obsessed with material values until today we have a lop-sided society.

I totally agree with what other ethicists have said. We who are employed by Universities (not only but perhaps even more so if these institutions are either state or receive state and federal funds) are employed to teach what we today believe the "truth" at the same time as saying that much of what we call "truth" today will probably be found to be wrong tomorrow. That we cannot know and we can only try to do three things: (1) Carefully teach the up-to date state of knowledge; (2) Serious thoughts of what are likely to be found to be problems tomorrow; and (3) Say that skepticism if not carried to a paralyzing extreme is healthy up to the point where it stops us from acting today because we may know better tomorrow.

The curriculum that was the framework of American Medical Education has been severely threatened by a paucity of state or federal funds and substituting for these grants from the Pharmaceutical Industry. In other words Pharma has essentially said "why should we do the research when we can "buy the University." It might have been thinkable if all medical schools for once got together to say to the federal and state governments: "we cannot run what we consider to be an excellent University without your funding us. We will not reduce or accommodate to the Pharmaceutical Industry because we feel quite certain that (for business reasons) they would swallow us. Having Pharma putting what they would have been ready to spend for grants into a common pool with no one knowing what came from where and having a board of people decide who gets what from the pot to me is thinkable.

I think that Capitalist greed (with its insistence of autonomous individualism as the highest good) will eventually undo us. I also think that these various things are made from the same cloth: support of industry; the growing number of poor, the old who throughout life worked hard at a rather menial job with a poor salary and who now (because they were poor their whole life) receives a totally inadequate social security; Medicaid and Medicare which are completely inadequate and co-payments which patients cannot afford and which makes their being insured a farce; a racist society covered by PC and a Democracy which lacks what John Dewey called the necessary underpinnings of political democracy. To whit: (1) Personal democracy; (2) Economic democracy and (3) Educational Democracy to which I would add Roosevelt's freedom from fear and freedom from want. We have in large and small things lost trust in our fellow man. This is a vicious circle: I think you do not trust me and therefore I do not trust you. This nation fails to understand solidarity and its rich possibilities for all of us.

The second paragraph of Jefferson's Declaration of Independence not only tells us in very few words what all people aspire to but also makes it clear that governments are instituted to protect these freedoms. If government fails to do this, the population has every right to get rid of that government which is more likely to preserve these rights and which is our (and not industries) servant. Indeed we not only have a right to do this we have a duty to act this way.

Hopefully such a change will be peaceful but with every day that passes I doubt it more. At the moment the population is too indolent and once they have been hit as individuals they complain but have lost all power. A revolt without knowing just what to put in place after they have succeeded chaos ensues and ultimately the need of the people to no longer live in chaos leads straight to the strong man.

We in medicine will, inevitably, be affected. Our current health-care system is the result for decades of an obstinate AMA which only wished the status quo. That, thank heavens, has changed. As citizens and as physicians we should, I believe, heavily participate in creating a health-care system were all have their needs taken care of.

Dr Erich H. Loewy
Professor of Medicine and Founding Chair of Bioethics (emeritus)
Associate in Philosophy
University of California, Davis