Conclusion: Making and Creating Choices

Abstract

We cannot refine the politics out of medicine. We are not faced with a choice between medicine or politics, but with the inescapable reality of medicine as politics. By this I do not mean that we can simply reduce medicine to politics, to arbitrary power as opposed to rational knowledge. Rather, I mean, as this study has made manifest, that medical rationality is a framework of thought and action interpenetrated by professional and socioeconomic interests and values. My intention is to expose the artificial and unrealistic separation of medical knowledge from its political context, from the social distribution of power.

In examining the effectiveness of alternative systems of medicine a number of specific points must be taken into account. It is not possible simply to embark on this task using the scientific methods that are current in medical science.... The Commission believes that the division between alternative and orthodox medicine is not — or is not principally — of a scientific nature, but owes its origins and its continued existence to both socio-political and scientific factors. This implies that the gap cannot be closed simply by making scientific recommendations.

The Secretary for the Commission for Alternative

Systems of Medicine, The Hague, 1981

(The Commission for Alternative Systems of Medicine, 1981)

Some political leaders and medical spokesmen have misled the public as to what they will and can do. ... [T]he FDA does not always enforce regulations equitably. In the area of anti-cancer drugs, the FDA has approved drugs for commercial distribution, and physicians have used these drugs, for types of cancer for which these drugs have no demonstrable benefit, and yet these are among the most toxic drugs on the market. These facts are obvious to ordinary people, and they wonder quite appropriately what, if anything, the FDA seal of approval means.

The quality of health care that people receive is rightly subject to political control, for the people who use it pay for it. The body politic usually delegates its power to define standards to expert groups, but there is no a priori reason why it cannot set and abide by its own standards. When the public perceives that the government or its experts (in this case the medical establishment) have failed to enforce standards of quality, it is reasonable for it to withdraw its mandate and revise it or cancel it entirely.

Robert S. K. Young, Division of Oncology, Food and Drug Administration (Young, 1987).