When God was in Heaven, our images of the Divine split between Justice and Mercy – the Shock and Awe figure of the Last Judgement or someone more like Portia letting us know the quality of mercy is not strained, that it droppeth as the gentle rain from Heaven upon the place beneath. A person with the love of a Mother for her child.
Through to the 1750 or so, the Monarch stood in for God. Hierarchy means rule by the sacred (Hieros) or the sacred’s anointed – it does not mean rule by the powerful one. The monarch’s role was to dispense Justice and Beneficence, aimed at securing the people – the flock, Good Shepherd like (even if some monarchs took their flock to war). An important function was to protect the people against corporations (guilds or powerful cities with vested interests like London). In 1542, for instance, Henry VIII passed an Act to curb an emerging medical monopoly – Original and Translation.
When we started decapitating our own monarchs, rather than other peoples’, we had to find a new way to ensure Justice and Beneficence. We turned to constitutions and procedures and ultimately insurance and welfare states. Those doing so saw themselves as progressive.
The progressives seemed to have history on their side because this move coincided with the rise of science, which led to material prosperity and later better health. It seemed that thinking for ourselves and claiming our rights rather than carrying out our duties worked.
Exit from Eden
Our exit from Eden into the Modern World came with an Original Default. The default was to procedure. Mercy or Care are, or can seem, arbitrary. Justice cannot be, or even appear to be, arbitrary. It requires procedures and adherence to procedures – to bureaucracy.
The problem is its difficult to place a limit on procedures. Once you start down a procedural route, how do you justify a procedure-free space? But a world in which the head always rules over the heart, to put it in first millennium language, is an inhuman one.
This is an age-old dilemma. Aristotle grappled with it and likely others before him. David Hume did too just before modern procedures began to take hold. Max Weber, 2300 years after Aristotle, was greatly troubled by it. In 1920 he saw procedures crowding in on all sides. He worried we would trap ourselves in an Iron Cage of procedure – his worries were intense enough for some like Zygmunt Bauman to think he all but foresaw the Holocaust.
I Consume therefore I Am
A hundred years after the death of Weber from the Spanish flu, the last great pendemic, our subjugation by the knee of procedure pressing down on our throats has reached the George Floyd 9-minute level.
Procedures lend themselves to algorithms and operationalism, both of which focus on doing rather than thinking or making judgement calls. In our day, Descartes ‘I think therefore I am’, which replaced Luther’s ‘I believe therefore I am’, has become I do therefore I am.
In the last two decades this has been internalised in the form of I shop therefore I am, where the shopping or consuming extends to medical procedures and even death.
We transited from being subjects with duties to citizens with rights and now to being consumers at the mercy of fashions. In the words of Herbert Marcuse, we became one-dimensional. This happened as much in medicine, if not more so there, as in any other walk of life.
What were once political or philosophical matters in the world around us have migrated into us to be sorted by consuming some medical procedure.
Operationalising Ethics
With the medical breakthroughs of the 1940s and 1950s, a bunch of theologians spotted that, besides the nuclear bomb, the bulk of the ethical action in our new world was happening in medicine. There were new and huge issues to rival the bomb from organ transplants and a trade in organs for transplanting to brain death to possible modifications of our genes and ultimately perhaps a capacity to engineer humans.
While we had dumped monarchs 150 years before and science had become the dominant driving force in history, engagement with ethical issues still took place in theology or philosophy departments. It was theologians who initially drew attention to the new dilemmas we were facing. By virtue of their background, they did so with what was viewed in the 1960s as an opening to the transcendent. It might work better now to reframe this as an openness to something greater than our individual selves.
This openness quickly closed. In the 1960s and 1970s, operationalism, which had begun in the 1930s and gained traction in the 1940s because it meshed with the needs of the US military, triumphed.
In the 1960s doctors, rather than engaging with the problems we brought them, began to measure our blood pressures, or glucose levels, or moods with rating scales. This medical operationalism began to give us problems, where before we had brought ‘our’ problems to doctors.
This was an era, when in psychiatry we thought it made sense to bridge the divide between different visions of mental illness with operational criteria (DSM-III).
An era when we thought it made sense to bridge the divide between capitalism and socialism with an operation – manage the money supply, initially called monetarism and later called neo-liberalism.
When it came to the big ethical questions in medicine, philosophy and theology got operationalized and became bioethics. Like figures and tick boxes for blood pressure or mood scales, the big ethical questions were reduced to tick boxes.
- Does the person have capacity? If they do, they meet the principle of autonomy over their self and have rights to do whatever they decide for themselves.
- Is the procedure being proposed something that offers what for this person is a good – if so it meets the principle of beneficence.
- Is the procedure being proposing not unduly likely to do more harm than good – if so it meets the principle of non-maleficence.
- Does the procedure meet the requirements of justice? No bioethicist feels comfortable denying something on the basis that there might be a bunch of poor people who can’t afford a procedure.
Somewhere in the midst of this, the progressive dream slipped off the rails. We had fought for rights to access abortion, gender reassignment and medical assistance in death but rather than having gained ground from which we can survey the advances made, these have now become consumer items and we seem diminished.
Boxes get ticked – yes we have capacity, and we regard these things as a good and don’t see a problem. The procedures go ahead. What we don’t have any more is an opening to question what we are doing to ourselves.
Pretty well everyone who was given an antidepressant had capacity. Who dares say then that we might now have a public health crisis with 15+% of the population on them and mostly unable to get off them? Where is even the white supremacist to ask why is it primarily white people on them and why are white birth rates falling? Where are the anti-abortionists to ask why are so many women of child-bearing years on these drugs that cause miscarriages and are linked to increased rates of terminations and birth defects?
If these guys can’t spot a problem, its no surprise our doctors can’t either – especially given that its all good for business.
Everything has become a matter of bureaucracy and procedure. This was partly what Weber foresaw. It was us, the people, socialists mostly, who fought for rights but in order to hold what we had gained we wanted them enshrined in procedures – not realising that once this happens that those the deepest pockets and the most power can always make our procedures work for them.
We fought pharmaceutical companies for the rights of people in the developing world to access Triple Therapy for AIDs and are now tone-deaf to the fact that pharmaceutical companies love our continuing fight for access to costly medicines which leads to a polypharmacy that seems likely to be contributing to reductions in our life expectancies.
The Health of Drugs
The most ghoulish aspect of all is seen most clearly in drug wrecks.
We no longer operate on the rule of an eye for an eye, or on the basis of honour. We have agreed to trade these for due process. If a grieving parent now seeks to bring some good out of the death of a child at the hands of a drug that has destroyed his or her mind or a parent seeks to make sense when someone on an inexplicable manic killing spree shoots their child, they will find themselves up against what can only laughingly be called ‘due process’.
Their obvious truth is pitted against a ghost-written and fraudulent literature that Courts psychotically designate as science. At the very top of government and the top of the legal system, there is an awareness that when it comes to drugs the system will always find people to blame and will never blame the drug.
Pharmacovigilance which began life in the 1950s aimed at alerting us to risks of the poisons we took is now more concerned with the health of medicines – ensuring the sacramental status of our medicines is maintained (a sacrament is something from which only good can come). The powers that be go into overdrive to ensure that no Adverse Drug Reactions are accepted as credible.
Not a Drop of Blood
When it comes to a crunch in the Merchant of Venice, Portia invites Shylock to take his pound of flesh, noting the agreement does not specify an entitlement to a single drop of blood.
When it comes to a crunch, Justice hinges on people not procedures. In Court, it is the story a person tells, or those who are witnesses on her behalf, and whether the story holds up under cross-examination that counts.
All the expert testimony in the world saying this drug never caused anyone to commit suicide or homicide or lose the ability to make love is worthless if 12 people listening to the story figure there is no other way to explain what happened except that this drug caused or played a huge part in that event.
They have to be brave people, as they will likely have to accept that in coming to this verdict they acknowledge that pretty well the entire medical literature on these drugs is ghost-written and there is no access to the clinical trial data and FDA or whichever medicines regulator they have is more concerned about the health of a drug than their health.
You can’t fool all of the people all of the time, especially when you collect them together in a jury or citizen’s assembly. Especially when these are drugs their sons and daughters are taking in ever increasing amounts, and they see marriages being laid waste to, pregnancies compromised and lives lost. Something will give.
Magic is from Venus offers a view on what might make a difference
Coda
This Algorithm is from Mars post has been delayed because it grew and grew and will be revisited in posts to come. To my surprise there have been previous similar posts – see
Something Happened to Science and to Us
Something Happened Neo-Medicalism
Perseverance, nicknamed Percy, is a car -sized Mars rover designed to explore the crater Jezero on Mars as part of NASA ‘s Mars 2020 mission.
Patrick D Hahn Retweeted
Scott jenkins @Sc0ttJenkins
If I knew that I would be lying on the bed suffering the consequences of medication that I took as prescribed 2 decades ago, I never would have taken it in the first place. I was 17 when a dr prescribed me Seroxat and diazepam, the initial diagnosis was a chemical imbalance.
I continued to take medication for 2 decades until my body couldn’t take it any more. Now the chemical imbalance “theory” is no longer supported by rpsych The makers of Seroxat were fined 3 billion for hiding the fact that their drug caused children to commit suicide.
And now diazepam ( benzodiazepine) has just recently recieved a black box label after 50 years. So excuse me if I don’t have much faith in pharmaceutical companies.
Yay science!
Yay science!
The Progressive Dream of the Percy’s went off the rails when Shelley Jofre ‘Laid Bare’ and nobody took a blind bit of notice so Venus is Rising has a lot going for it…
It never ceases to amaze me that in the real world, in the here-and-now, we fight for the same things. We fight for the people we love, and for the strangers near and far who we know are just as worthy of love, against the forces that see them as nothing more than sources of profit. And fond as we are of the beasts of the field, we consider ourselves — all of us — just a wee bit more than cattle.
Sometimes we have the nerve to dream that we have “rights.” Perhaps we are even humans, with “human rights.” God forgive us, sometimes we even imagine ourselves to be not subjects or serfs, but citizens! We begin to feel that it might not be a sin after all, to raise our tiny voices and speak our piece as to what sort of world we should live in. Maybe we could even do it together. It might make for a better world in a tiny sort of way.
At any rate, the death of any one of us for the sake of someone else’s wealth and power strikes the rest of us as a tragedy, and a moral question that actually matters. We are not ashamed of feeling that way; we’re actually kind of proud of it. Thoughts and feelings like that, we figure, give our dumb little lives some meaning, as long as we act on them.
99% of the time, David, I could swear you feel the same way.
And yet over and over again you mourn for the days of feudalism, of the serf and the slave and the divine right of kings. But whatever moral system our rulers had in those (not so) good old days, it wasn’t motherly! If there were any covenant between man and God, only the most miniscule fraction of humanity — those of royal blood, the propertied and titled (and mainly the male ones) — were in on it. The rest of us were mere objects. And if those exalted beings thought of anything as having Transcendent Value, it sure as hell was not us. We could be slaughtered on a whim, for convenience’s sake, out of habit.
Our deaths did not even rise to the level of being a moral question, really. Possibly, to a few monastic scholars, it was a moral question (if a tiny one) where George Floyd would spend eternity. But in this life? Whether he could breathe or was crushed to death was of little importance to his “betters.” As long as he died in a state of grace — as long as the Church bureaucrats could tick their boxes — all was right with the world. George’s duty and ours was to die patiently. First for the kings, then for the bosses.
So no, I don’t miss the “justice and beneficence” of the monarchs. Nor do I miss the days when I was the chattel of my father or brother, when it was not only their right but their sacred duty to slit my throat if I “disgraced the family name” by copping the wrong attitude or speaking to the wrong boy. And when they too could be disemboweled or drawn and quartered for a single disrespectful word to the lordly lords whose divine right it was to rape me on my wedding day.
Mind you, I don’t want to be lorded over by the drug companies or their bio-ethicists either. But I don’t think their problem is the “original sin” of trying to dream up systems and procedures. OK, clearly those four “principles” of modern bioethics won’t solve all our problems, cranking out right answers like a machine. And yeah, probably it is arrogant to think they could.
But the real problem is not the bioethicists’ Sin of Pride in drawing up formulas. It is that those bioethicists are bought and paid for — literally selling “ethical clearance” on a contract basis to the highest bidder. They are bound to the corporations as surely as the priests before them were bound to King and Church. They can’t begin to ask whether the products we are offered are actually “a good for this person,” or whether they do “more harm than good.” And they can’t begin to offer us a “right to decide” while tying a blindfold on us. So they have reduced their own “principles” to garbage from the start.
If Remdesivir (or Lexapro) actually did save lives, it might be a “moral dilemma” whether to buy some and save a few dozen people from Covid, or spend that money on clean drinking water for the kids in Flint, Michigan. But if Remdesivir doesn’t save anyone, and probably harms quite a few people, then handing that money over to Gilead is simply a crime–both against the kid in Flint AND her daddy in the ICU. And we’d be naive to think of it as an abstract philosophical crime. It’s a straight-up financial one.
Antidepressants:
“Who dares say then that we might now have a public health crisis with 15+% of the population on them and mostly unable to get off them”?
This implies that, – – (unless unknown policies dictate otherwise) – – perhaps ??? a significant percentage of armed police officers might (hypothetically) have been given antidepressants.
If so, might the resultant, potential, disinhibition and risk of akathisia impact upon their decision making?
It is of course possible that operational policy and procedures ensure that this could not take place.
“it is no part of the College’s function to ‘police’ such debate”
Such gross ethical transgressions are unique for psychiatry; they are not even possible in other specialties. If a cardiologist loses an academic discussion, or his colleague has exposed his fraud, it won’t help him to suddenly claim that his opponent got a heart attack.
By
Peter C. Gøtzsche, MD
April 26, 2021
False information on withdrawal from UK psychiatrists
https://www.madinamerica.com/2021/04/mental-health-survival-kit-chapter-2-part-8/
What this illustrates is: We already knew that drug companies don’t care about patient safety if it could harm sales.4,51 We now know that psychiatric leaders also don’t care about patient safety if it could threaten their own reputation, the guild they represent, or the flow of money they receive from drug companies. This corruption of a whole medical specialty also permeates our authorities, which rely heavily on specialists when issuing guidelines.
Tom Jefferson: The UK turns to Witty, Vallance, and Van Tam for leadership: revolving doors?
December 6, 2017
https://blogs.bmj.com/bmj/2017/12/06/tom-jefferson-the-uk-turns-to-witty-vallance-and-van-tam-for-leadership-revolving-doors/
In my view it is time that the government and the public took a close look at what is going on in the upper echelons of healthcare planning and delivery in this country and considered imposing a substantial time moratorium on hiring workers with close ties to industry. Should such senior appointments not be subject to parliamentary committee scrutiny?
https://study329.org/wp-content/uploads/2015/01/2013-06-14-RIAT-to-GSK.pdf
June 14, 2013
Dear Christopher Gent, Andrew Witty, and Patrick Vallance,
Unpublished trials and misreported trials distort the public medical knowledge base and undermine the basis for rational use of healthcare interventions.
And so it started – the Data Wars…
TO CANADIANS
David Carmichael writes: If COVID cooperates, I’m going to be starting a KNOW YOUR DRUGS Cross-Canada Tour on July 1 (Canada Day) in Halifax that will end in Victoria on November 6 (Know Your Drugs Day); the 7th anniversary of Vanessa’s Law (Protecting Canadians from Unsafe Drugs Act) becoming a federal law.
During the tour, I’ll be facilitating public discussions about prescription drug safety. At each event, I’ll also be promoting KnowYourDrugs.org and delivering a presentation to help prevent SSRI antidepressant-induced suicides, which could increase significantly as Canadians deal with the economic fallout triggered by the pandemic by visiting their doctors and being falsely told they are depressed because of a chemical imbalance in their brain, and that Prozac, Zoloft, Paxil or another SSRI will correct it.
If you live between Halifax and Victoria and might be interested in helping me organize/promote a public discussion about prescription drug safety in your community, please join the KNOW YOUR DRUGS TOUR private Facebook group, or send me a private message. Thank you.
Know Your Drugs Tour
Volte-face …
Chair – Sir Patrick Vallance
Preparedness Partnership Member – Sir Andrew Witty
No10 convenes panel of top scientists chaired by Sir Patrick Vallance in hope of slashing time it takes to create and deploy vaccines to fight Covid variants to just 100 days
https://www.dailymail.co.uk/news/article-9489321/Experts-meet-cut-vaccine-development-time-face-new-pandemics.html
Who are the pandemic preparedness partnership (PPP) members?
Sir Patrick Vallance (chair) – UK Government Chief Scientific Adviser
Sir Andrew Witty – CEO, United Health Group
Sir John Bell — Regius Professor of Medicine, University of Oxford and member of the Bill & Melinda Gates Foundation Scientific Advisory Committee
Martin Landray — Professor of Emerging Infectious Diseases and Global Health at the University of Oxford
Dame Anne Johnson — Professor of Infectious Disease Epidemiology UCL
Lord Jim O’Neill — Former Chairman of Goldman Sachs Asset Management & Former Commercial Secretary to the Treasury
Baroness Minouche Shafik — Director LSE and former Deputy Governor of the Bank of England
Aurelia Nguyen — Managing Director Office of the COVAX Facility, Gavi
Sir Jeremy Farrar — Director Wellcome Trust & Chair of the Scientific Advisory Group of the WHO R&D Blueprint.
John-Arne Rottingen — Co-chair ACT-A, member of the G20 High Level Independent Panel (HLIP) on financing for pandemic preparedness and response & ambassador for Global Health, Norwegian Ministry of Foreign Affairs.
Peter Sands — Executive Director – Global Fund
Richard Hatchett — Chief Executive Officer CEPI
Sergio Carmona — Acting Chief Executive Officer and Chief Medical Officer FIND
Soumya Swaminathan — Chief Scientist WHO
John Tsai — Head of Global Drug Development and Chief Medical Officer, Novartis
Sir Mene Pangalos — Executive Vice President Biopharmaceuticals R&D, AstraZeneca
Mikael Dolsten — Chief Scientific Officer, Pfizer
Paul Stoffells — Vice Chairman and Chief Scientific Officer, J&J
Roger Connor — President Global Vaccines, GSK
June Raine — Chief Executive, MHRA
“The 100,000 people who work for GSK are just like you, right? I’m sure everybody who reads the BMJ has friends who work for drug companies. They’re normal people… Many of them are doctors”. Sir Andrew Witty
No Mars – Bar …
The Mayan Indians thought that Venus represented Evil. I suppose it depends who you ask ?
https://youtu.be/6TI1M3abAM8
I’m a bit confused about who is the best Priest there needs to be some sort of Priest league table that gets published. I’m just reading Bill Brysons The Body and that is very good, it is tricky to decide who is best at Priesting.
https://youtu.be/TBrKxF3bnUY