Paging Doctor Marx?

Nothing is so foolish that some philosopher has not said it, and no idea has been so discredited that it has not continued to be touted. Intellectuals are particularly unsusceptible to refutation by experience, because they much prefer complex rationalisations to the patently obvious — which is a threat to their livelihood, for the patently obvious needs no priestly class (or caste) of interpreters. There is no experience that they cannot rationalise away.

It is hardly surprising, then, that intellectuals who claim not only to be rationalists but rational are often drawn to gnostic doctrines that claim to reveal the hidden meaning not just of something, but of everything about human existence. Marxism, Freudianism, and, in its most recent form, Darwinism are examples such doctrines. For many, they held, or hold, the key to reality as Mrs. Mary Baker Eddy held the key to the Scriptures.

In a way, then, it came as little surprise to read an editorial in The Lancet, one of the two or three most important general medical journals in the world, that extolled the contributions of Karl Marx to medicine. Written by its editor Richard Horton, it did not go quite so far as to claim that Marx was a great medical scientist but it did claim that a Marxist outlook could bring many benefits to medicine:

First, Marx offers a critique of society, a method of analysis, that enables explication of disquieting trends in modern medicine and public health—privatised health economies, the power of conservative professional elites, the growth of techno-optimism, philanthrocapitalism, the importance of political determinants of health, global health’s neoimperialist tendencies, product-driven definitions of disease, and the exclusion of stigmatised communities from our societies. These aspects of 21st-century health care are all better investigated and interpreted through a Marxist lens. Second, Marxism defends a set of values. The free self-determination of the individual, an equitable society, the end of exploitation, deepening possibilities for public participation in shaping collective choices, refusing to accept the fixity of human nature and believing in our capacity to change, and keeping a sense of the interdependence and indivisibility of our common humanity. Finally, Marxism is a call to engage, an invitation to join the struggle to protect the values we share.

If one were training students in the dark arts of suggestio falsi and suppressio veri, this would serve as an excellent text: not, alas, that I think the editor is conscious of his intellectual legerdemain. Anyone familiar with the editor’s stances on almost everything will know that he is more Savonarola than Talleyrand. A full Vesalian dissection of this passage’s evasions, errors, half-truths and platitudes would take a book-length essay, which it hardly merits.

It is true, of course, that Marx offers a critique of society, but then so does the average barfly and Hitler. It is true also that Marx ‘enables explication of’ various trends, but the question is not whether he enables explication, but whether the explication he enables is true. Not every critique of society is justified and not every explication is true just because there are still problems in the world and people continue to behave corruptly, unjustly, cruelly and so forth. And Marxism, in so far as it has a theory that can be tested against reality, has proved about as useful and veridical as the miasmal theory of plague, cholera or malaria.

One of the more interesting phenomena in the list that the author claims can be explained by Marxism is the product-driven definitions of disease: in other words, pharmaceutical companies develop a drug and then invent or promote a category of disease that it allegedly treats. But while this may well have happened, it has done so at the margins of medical endeavour; it is certainly not central to it. And in so far as it has happened, one does not need an entire philosophical system or gigantic theory to explain it, only a very slight knowledge of human nature (the reality of which Marxism disastrously denies, though the editor of the Lancet finds it one of its attractions).

Companies that have expended billions on research, or rather the executives who run those companies, naturally enough want to see some return on their company’s investment, and if they are desperate or intellectually dishonest enough, may proceed to invent, or encourage others to invent, bogus conditions which their new drugs supposedly treat. Of course, they cannot do this without the corrupt collusion or mental torpor of doctors. But no one ever suggested that capitalism was the primrose path to universal virtue, let alone happiness.

Marx’s relations to ethical values and morality were far from straightforward to say the least, and in practice — that is to say, when Marxists have attained power — have been nothing short of catastrophic. Marx poured unrelenting scorn on those who promoted socialism for ethical reasons and by the use of ethical methods. There is no doubt that he himself had deep moral feelings, but they almost always involved profound and visceral hatred of others, which was also usually, though perhaps not quite always, the case with his followers.

However, being a man of a quite remarkable and almost heroic lack of self-knowledge, he denied that his views were other than scientific in the hardest of hard-nosed ways. But it is not surprising that those, as did Marx, who have a theory of knowledge, including of moral knowledge, that claims that men think what it is in their class interests to think – this not as a psychological or sociological generalisation, but as an epistemological necessity – should end up slaughtering millions, somewhat contrary to the public health that, according to the editor of the Lancet, ‘was the midwife of Marxism.’

‘Finally,’ says the author in one of his characteristic flights of rhetoric than never seem to get off the ground, ‘Marxism is a call to engage, an invitation to join the struggle to protect the values we share.’ But what are these values, and who are the ‘we’ of this extraordinary, though very dull, exhortation? I expect the second person plural pronoun is used in its le tout Paris sense, that is to say all those decent people who think exactly like the editor of the Lancet, by whom no doubt he had made sure that he is surrounded.

The extraordinary thing about this editorial is not that it was written – in a world of 7 billion people almost everything that can be written will be written – but that it should have been written by a highly educated man, the editor of one of the most important and powerful medical journals in the world, which is owned by Elsevier, one of the largest scientific publishing firms in the world. One is almost tempted to a Marxist interpretation: that political radicalism is now nothing but a market commodity.

Reader Discussion

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on January 22, 2018 at 07:33:11 am

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Paging Doctor Marx? | Top 100 Blog Review
on January 22, 2018 at 12:34:03 pm

Like all things Left these days, Marxism is only a mood. Feeling strongly and letting others know your feelings is considered, by the Left's laity as well as by some of its "social thought" priests, to be the highest moral achievement. It takes years to actually read Marx, and then the first generation of commentators on Marx, and then the second. Even then one is not guaranteed a solid understanding of Marxism. But who, in this Age of TL;DR, even has time for that? The statement Marxism is a call to engage, an invitation to join the struggle to protect the values we share is so incorrect as a matter of fact, so patently incorrect to anyone who has actually read even just a little of Marx, that one expects it to be taught as Marxist orthodoxy in the academy in short order.

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Image of QET
on January 22, 2018 at 12:55:56 pm

The "we" of which he speaks is in fact the first person plural,not the second person plural. Other than that,another brilliant and insightful article by the learned Doctor.

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Image of John Jones
John Jones
on January 22, 2018 at 13:04:42 pm

I suspect that some of the "disquieting trends" in modern medicine are disquieting in the context of imaginary Marxist Utopia and not so much in the daily of lives those who must contend with reality. An example, admittedly anecdotal, is the case of Belinda Stronach.

Ms. Stronach is a former member of the Canadian parliament. Several years ago, she was given the diagnosis of breast cancer and opted to forgo treatment in the Canadian health care system in favor treatment in the United States. Initially, there were official evasions about the location of care, with claims that she had surgery at an "undisclosed Toronto hospital." Eventually however, it was admitted that Ms. Stronach received treatment at UCLA, because this was felt to be the best care for her particular case. One might surmise that a reason this was true because of the "privatized health economy" in the United States, in which much of the medical care, even at public institutions such as UCLA, is paid for by private insurance.

One of the reasons that UCLA may have been an appropriate choice for Ms Stronach's care is that UCLA was instrumental in the development of herceptin, a very efficacious therapy for certain types of breast cancer, and which was unavailable in Canada at the time of Ms. Stronach's crisis. The research that led to development of herceptin as a clinical intervention was funded to a significant degree by....Revlon. This, I will assume, qualifies as "philanthrocapitalism,"one of those "disquieting trends" that harsh the buzz of Marxist fantasy.

It is also worth noting that herceptin is particularly efficacious against a particular type of breast cancer, specifically tumors that are HER2 receptor positive. It makes sense to define HER2 receptor positive breast cancer as a discrete clinical entity because it has discrete treatment options that may not be efficacious for other members of a generalized and heterogeneous class of malignancies. This type of cancer can fairly be termed a disease whose definition is treatment driven, and to the extent that herceptin is a product, product driven. There are a large number of malignancies for which emerging technologies both give hope to patients, (there's your disquieting techo-optimism), and are defined by characteristics that make them susceptible to particular therapies. These include canccers that respond to chimeric antigen receptor T cells, and those with genetic susceptibility to PD-1 checkpoint inhibitors. One also notes that more mundane diseases are defined by available therapies such as MRSA, methicillin resistant staphylococcus aureus., or its flip side, MSSA, methicillin sensitive staph aureus. I am not sure why defining a disease by those antibiotics (products) that will or will not work is "disquieting."

As for "political determinants of health," well perhaps if we could find a few kulaks we could ask their opinion.

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on January 22, 2018 at 14:51:04 pm

There is another (presumably) unintended irony here, regarding the accusation that drug companies invent diseases their drugs will "cure." It has been well said (I can't remember by whom) that Lenin's brilliance consisted in his ability to create the conditions in which his theses were true." Likewise, why were the 30's Show Trials "shows" at all (and not just subterranean kangaroo courts)? Because the Stalin and Co. needed to create the conditions in which their diagnoses and cures were true. Haven't got kulaks, well, let's manufacture some. It take a truly impressive lack of reflection for a Marxist to accuse others of doing what every Marxist government has in fact done, to murderous effect.

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on January 22, 2018 at 17:29:42 pm

"but that it should have been written by a highly educated man"

Hardly, extraordinary, down right common that the "educated strata' are the most gullible.

"The fading of the critical sense is a serious menace to the preservation of our civilization. It makes it easy for quacks to fool the people. It is remarkable that the educated strata are more gullible than the less educated. The most enthusiastic supporters of Marxism, Nazism, and Fascism were the intellectuals, not the boors. The intellectuals were never keen enough to see the manifest contradictions of their creeds. It did not in the least impair the popularity of Fascism that Mussolini in the same speech praised the Italians as the representatives of the oldest Western civilization and as the youngest among the civilized nations. No German nationalist minded it when dark-haired Hitler, corpulent Goering, and lame Goebbels were praised as the shining representatives of the tall, slim, fair-haired, heroic Aryan master race. Is it not amazing that many millions of non-Russians are firmly convinced that the Soviet regime is democratic, even more democratic than America?"

von Mises, Ludwig (1945). Bureaucracy

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JK Brown
on January 22, 2018 at 18:06:32 pm

Now it could also be simply that the intellectuals view this (actually, any SYSTEM) as an opportunity for them to share in their "much deserved" power and influence as, in their minds, it is their DUE based upon their superior intellect and academic achievements, accomplishments not otherwise rewarded in the real world.
They, too, can shine and enjoy the power and influence that is theirs by virtue of their academic prowess.

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Image of gabe
on January 22, 2018 at 19:37:06 pm

Perhaps the good editor can tell us how many new drugs and devices have been invented by Marxist societies. To ask the question is to answer it.

Interesting that an editor of a scientific journal finds truth not in real world data, but his feelings about what is right.

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Image of Chip
on January 23, 2018 at 10:36:41 am

A magisterial response, if I may. Perhaps you should send something like it to The Lancet.

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Image of Chris
on January 23, 2018 at 12:52:56 pm

That is a brilliant comment! Thanks.

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Image of Catanddog
on January 23, 2018 at 14:30:10 pm

Chip, below, say effectively the same thing, where we change reality to fit the theory, so it appears I'm not the only one who read the article this way.

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Image of Aaron
on January 28, 2018 at 12:30:19 pm

Would the editor understand it?

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Image of BC
on February 25, 2018 at 21:02:07 pm

Actually very many. Perhaps you should read on some history?

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Image of foljs
on February 26, 2018 at 06:55:49 am

[…] Appalling: editor of The Lancet extols Marx as a guide to understanding medical science [Theodore Dalrymple, Law and Liberty] […]

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Image of Medical roundup – John Culbreath
Medical roundup – John Culbreath
on March 22, 2018 at 06:25:48 am

prof premraj pushpakaran writes -- 2018 marks the 200th birth year of Karl Heinrich Marx!!!

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prof premraj pushpakaran
on June 23, 2018 at 07:30:08 am

[…] • Theodore Dalrymple, “Paging Dr. Marx?“ […]

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Image of Noteworthies (32) – A Sunday of Liberty
Noteworthies (32) – A Sunday of Liberty
on December 27, 2018 at 06:01:13 am

[…] 1. Paging Doctor Marx, Theodore Dalrymple, January 22, 2018 […]

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