BEHIND THE CURRENT DEBATE over national health insurance, the government's rhetoric about pregnant teen-agers and smoking, the country's mania for jogging and vitamins, and medicine's multi-billion-dollar price tag -- this book tells us what health care in the United States is really all about: Since the turn of the century, American medicine has been and is now designed to further the political and economic interests of upper-class corporate America.
Now this is not the conventional view. We'd all like to think that the prime objective of medicine is to keep people well and heal the sick. So this book won't be put out on the coffee table in the doctor's office, nor will it draw applause in the board room of the American Medical Association.
But no one can or should ignore this book. It's an eloquent, well-documented damning appraisal of the historical marriage between medicine and capitalism and its impact on shaping the kind of health-care system we have today.
These are distrubing times for health. A number of anti-medical-establishment writers have attacked the system for rising costs, ineffectiveness, wastefulness, imcompetence, and illegal and unethical behavior. But here author E. Richard Brown goes one step further: He exposes the basic motive of the system.
Brown traces the development of American medicine the way a political economist would look at the commodities market. Who profits the most? The inescapable conclusion is a new twist on an old line: what's good for business is good for medicine -- and the combination has got to be best for Americans.
To exhume the roots of today's medical-industrial power base, Brown searched through old records and letters focusing on the Rockefeller empire. During the formative period of medicine from 1900 to 1930, corporate foundations funneled more than $300 million to medical schools and hospitals. Rockefeller wealth became the single largest source of capital for medical science and public health in the United States.
Brown uses records to show that, with the dawing of the age of philanthropy, the prime objective was actually the preservation of the new status quo of the capitalist elite. Science became the tool by which medical elitism was forged; the health-care system itself became the stage. To the public, however, all this translated into a major reform of American medicine.
For example, "a core of professionals developed who were more dedicated than ever to seeing medicine as science displace medicine as art. These medical scientists' interests and identification were bound up solely with medical schools and not with private practice." So it is not surprising that the then "predominant type of medical school, owned by the faculty and existing on student fees," lost out when foundation money was being handed around. With the emphasis on new equipment and costly research -- and both of these being the drawing card for students -- the older institutions no longer seemed deserving, in circular fashion, of either students or funds.
The results were dramatic. The number of medical schools dropped from a high of 166 in 1904 to 76 in 1929. All three women's medical colleges and five of the seven black schools colsed. "Scientific medicine solved two broad problems the medical profession faced in the late nineteenth century: lack of public confidence in the effectiveness of their service and competition withing the medical profession," Brown writes. Scientific medicine also brought about the emergence of hospitals as the base of medical care. Again with massive funding from corporate institutions, the number of hospitals jumped from 178 in 1873 to 4,359 by 1909.
Even the concept of disease was shaped by the corporate view: Disease, it appeared, did not come from unequal distribution of wealth, wretched living and working conditions, miserable and alienating work, or economic insecurity. As Frederick T. Gates, a Baptist minister from Minneapolis who became the guiding force of the Rockefeller medical philanthropy, proclaimed: "Disease is the supreme source of almost all other human ills, poverty, crime, ignorance, vice, inefficiency, hereditary taint, and many other evils." According to the corporate gospel, disease was the cause of the misery commonly attributed to poverty, for "misery is a technical not a social problem."
As for public health programs, again the very concept of medical care was shaped by corporate interests. Health was defined as the capacity to work. Said C. W. Hopkins, chief surgeon for the Chicago and Northwestern Railway in 1915: "It is now a well-recognized fact among the managements of the railroads that it is just as important to care for sick and injured [workers] as it is to maintain a certain standard of efficiency or perfection of their rolling stock and road bed."
Meanwhile, doctors got into the country club. "It was clear to all physicians that producing a lot of doctors would lower rather than raise the status and income of the profession as a whole." The poor, blacks and women were weeded from the ranks. Doctors' average income went from less than $4,000 in 1929 -- comparable to a mechanical engineer -- to more than $60,000 today. Health care is now the country's third largest industry, involving construction firms, banks, drug companies, medical supply houses, insurance empires and flower shops.
Rockefeller Medicine Men is a sensational expose of the formative period of American medicine. However, there's no question that Brown's view is a skewed as that of the corporate establishment. But when Marting Luther nailed his theses to the door, no one expected him to be openminded. Besides, in competition with such reassuring symbols as Marcus Welby, radical visions about health care don't get much sustained attention from the general public.
Bron's book falls short of exposing the corporate dominance which exists in today's more complex health system, but he does arm us with the right questions to ask. None of the current plans for national health insurance, for example, would change the basic corporate structure of medicine: It's still tied to expensive technology. Brown also shows how the federal government has taken up where the foundations left off.
We ought to be getting a little suspicious. With so much money devoted to scientific medicine, why is it that so little research has gone into the environmental causes of disease? Is it the ghost of Reverend Gates? What about black-lung disease? Or kepone poisoning? The problems of occupational health hazards are now well known.
Looming on the horizon is perhaps the most ominous development yet. As Brown points out, it's the blame-the-victim trend: disease as a product of life style -- smoking, drinking, overeating, sexual depravity and the rest. Under this new medical fascism, health is not a social right but the individual's own responsibility.
For Brown and many others, health is part of the larger social arena. "It is possible to make a health care system that effectively serves the health needs of the majority classes rather than the economic and political interests of its providers and the upper classes," he concludes. "The struggle for that new health system may contribute to the larger struggle for a new, more just economic and social order."