Slings and Arrows; J. Wilke

JOAN WILKE INGS o,rt<1.ARROWS Any legal system that awards material compensation for the incidents and accidents of "outrageous fortune" produces an outrageous society. THE PRACTICE OF MEDICINE is in a legal bind that is costing countless lives and creating untold misery. While bureaucratic blockages continue in the :Food and Drug Ad ministration, . some p.eople find it necessary to. leave the country for the mediciries they need to stay alive. In hospitals across the coun try, the simplest procedures to avoid pain and complications are prohibitively delayed to accommo date procedures necessary to pro tect doctors against possible law suits. The red tape takes time and time can be a killer. A number of things have con tributed to this situation. For one thing, in this welfare world, people are psychologically attuned to believing nothing should go wrong -and if it does, they should be paid for it. If they lose Miss Wilke is an advertising writer.

their jobs for any reason, doesn't their employer have to pay com pensation? Of course - even if they're fired for incompetence or simply quit out of discontent. In recent news stories, a woman brought suit for $130,000 for not being hired as a volunteer fireman. Another person is bringing a mil lion dollar suit against the city for an auto accident in which a family member was killed. A bus company is being sued for a mugging that took place on its property. And a frostbitten hiker rescued from a mountain top in a winter storm is suing the rescuers for not reach ing him faster. Generally speaking, every time a person makes a welfare claim he also is bringing suit for food, shelter; wages or other benefits. He sues his friends, neighbors, everyone for his misfortune. It's certainly no more absurd to fix re sponsibility for ill health and acci1975 SLINGS AND ARROWS 395 dent than for unemployment or in sufficient income.

While it is astonishing that peo ple will "bite the hand that feeds them," it is so well established in the prevalent hostility toward en terprise and industry that we shouldn't be shocked when people also slap the hand that helps them medically. The attitude that nothing should go wrong in life and all reverses should be materially compensated is carefully cultivated by the false assurances of our omnipresent government controls. Supposedly when government controls every thing, everything is supposed to be all right. Actually, it only prevents anything from going right when it diverges from its peacekeeping function. Certainly progress has been slowed by the findings, delays, re versals, uncertainties, new find ings and political mach inations of the FDA. But the FDA is not bad because it's slow, confused or wrong. It's bad because it exists. There's simply no way it can ever be right.

Across-the-board medical deci sions are impossible to make. The vast physiological differences in people make it a certainty that what is right for one person will be wrong for another. Individual error is a. fact of life - something we all have to Iive with. But error that becomes insti tutionalized through government controls is something we shouldn't have to tolerate. We shouldn't give power to other people's mistakes. Controls Have Consequences By the sheer threat of its im placable presence, the government has stifled advances in medicine, not allowing the free market to work its wonders. For one thing, the FDA holds that anything is harmful if it is harmful in large quantities. If universally applied, that would certainly make everything harm ful. As a political body, however, the FDA is characteristically se lective in its applications. Its rulings never apply to city governments that continue to pour fluoride into our drinking water although it causes pitting in the teeth of adults and is poisonous in large quantities. Youngsters' fluo ride needs are ~ore safely pro vided by the market in toothpaste products.

Meanwhile, milk advertising is attacked on the basis that milk is not good for everyone - such as those with an allergy to it. Medicines are assailed for hav ing "ine·ffective ingredients," whereas Mary Poppins and every good marketing person knows it takes "a little bit of sugar to make the medicine go down."

396 THE FREEMAN July How to Stop Progress If consistently applied, govern ment "protection" could wipe out all the medical advances since the discovery of anesthesia. And inci dentally, anesthesia is harmful to some, and to anyone in large quan tities. While bureaucrats fuss over their decisions, people are suffer ing and dying. How could two bureaucrats ever agree anyway? Doctors and scien tists don't agree among themselves in many cases. And of course there's nothing that couldn't be harmful to someone, somewhere, under some circumstances. While that elusiveone-in-a-mil lion person is protected in one way (harmed in others) by government action, hundreds and thousands are denied the benefits of needed ministrations. The government also fosters a false sense of security~ through licensing. And here again, govern ment controls keep unavailable the services which could be helpful to many people.

In spite of the frequent benefits of acupuncture, for example, try to find a practitioner in your tele phone book. If we are protected from these helpful people, the standards of acceptance for licens ing must be exceedingly high, right? Wrong. A spokesman for the AMA re cently stated that "the inept must be ferreted out of the organiza tion." Then what could be clearer than the fact that licensing has not performed any safeguarding function. Secrecy Maintained The government and the AMA have built secrecy around the med ical profession that shouldn't exist. This cliquishness is reminiscent of the awesome aura and sacrosanct position of the medicine man in primitive tribes. His monopoly had the approval of the chief. Today's doctors and medicines have the· ap proval of the government. And that's about all we know about them. In many cases, people go to a doctor with nothing more than the chance recommendation of a friend or acquaintance. They know very little about him. It was different when people lived in the same town all their lives. But in our mobile society, newcomers have no infor mation on which to base a decision.

In fact, it's not allowed. Any doctor who· makes new~ with some exciting ideas or treat ments is in danger of losing his position. It's something of a crime for a doctor to get publicity. It's unethical. It's awful! But why? When you choose a doctor you could be making a life and death decision. Certainly you should have as much information as possible 1975 SLINGS AND ARROWS 397 on which to base your decision. This is someone you should want to know quite a bit about. Let the facts Be Known I believe it is unethical for doc tors not to get publicity and I think advertising by doctors would be very helpful. With information available, you could make your de cision on the basis of the doctor's background, his experience, any approach he uses that is diffe~ent from others in his field, and so on. And you'd also know who else is available and their backgrounds. To me, this is a lot safer than get ting a recommendation from a hairdresser or picking a name that sounds nice out of the yellow pages.

After choosing the doctor you think you can put the most faith in and soliciting his aid, it would be nothing but barbarian to bring charges against him, even in the case of error. The only basis for a legal. case against a doctor should be misrepresentation as to his background, education or experi ence. Public information about doc tors, more than anything else, would act as a safeguard. Public declarations have to be truthful. They're legally assailable, but bas ically they're truthful in order to fulfill their function. Falsehood makes its way in politics, but in the market place it's quickly dis covered. As for medicines, the-personal opinion of a doctor in the case of an individual patient is obviously safer than the judgment of a bu reaucrat thousands of miles away trying to determine what's right for crowds of numbers averaged into statistical lumps. Government controls standard ize mistakes, disrupt efficiency, de lay progress and prolong suffering.

And they are generally demoraliz ing. At a time when we need more, not fewer doctors~ malpractice suits and insurance costs are add ing to the disruption of the med ical field already suffering govern ment manipulation through infla tion, welfare programs, education practices and limited entry. * Legal suits and insurance re quirements are discouraging peo ple from becoming doctors and driving others out of practice ... threatening the future of all medi cal care. Some doctors are avoid ing specializations where risks are high, such as brain surgery. Others are relocating geographically to are-as where insurance is less costly. * For an authoritative explanation of how government has created doctor short ages, overlong hours on duty and the like, see "The Medical Market Place" by A. R. Pruit, M.D., THE FREEMAN, February, 1971.

398 THE FREEMAN July Only a free market in medicine' can get the health field back in the pink. Without government block ages, the're would be more doctors, more levels of practice, more levels of prices, more general care avail able, more discovery and progress. Would there be more negligence in hospitals without the threat of malpractice? On the contrary, it is that costly threat that is now para lyzing medical practice, extending risks, delaying action and costing lives. In summary, malpractice should be included among the other gov ernment controls such as the FDA and licensing, which are curtailing medical activity and' threatening the nation's health. Malpractice suits are a psychological spin-off of the welfare system where mis fortunes are not to occur without compensation. These suits are costly to everyone, not ~only' in dol lars but in pain. There should be no legal basis for any malpractice suit against a doctor because: 1) all·· life is uncertain and human error is a fact of life; 2) patients are physiologi cally different, making medi cal practice unpredictable; 3) qualified doctors will differ and vary in recommended pro cedures, each acting in his own best judgment; 4) those seeking a doctor's services voluntarily must know they are taking a necessary risk. Any medical treatment is risky. If they don't want to take that risk, let them cure themselves. Or sue themselves.

As things stand, doctors are re garded as more than human - and everyone else less .than human. Doctors should be regarded as hu man and capable of error. And pa tients should act more human by bearing the responsibility for their d~cisions. Information should be available on which to base those decisions. Actually, it's a wonder no one has sued a doctor for bringing him into this risky old world in the first place. That is the underlying basis for every compensatory claim. It is a complaint against life itself. We are born into an un certain world. There is nothing certain about a job, or an opera tion - or walking down the street. Shakespeare wrapped the whole issue up in that tidy phrase, "to be or not to be." It is a question that few in history have had the opportunity to ask themselves as we in America have. We answer it affirma tively whenever we act re sponsibly on our own.

We can only be by making our own informed decisions freely in an open market and then honoring those decisions in our relation ships with each other. , on RECESSION, I submit, is the un wanted offspring of inflation. In flation is of course the all too fam iliar problem of too much money (demand) chasing too few goods (supply) , with the upshot of prices and expectations everywhere tend ing to rise higher and higher .. How should business managers cope with inflation? This paper seeks answers to that question. To do so we should define our terms. What is management? What is business? And what is at stake in the onslaught of inflation? A reading of Pete'r Drucker's new book, Management: Tasks, Responsibilities, Practices, leads me to the following in answer to the question, What is manage ment? The answer is manifold. ManWilliam H. Peterson is the John David Camp bell Professor of American Business, American Graduate School of International Management, Glendale, Arizona.