Too often, public health agencies act as if they simply know better than the citizens they supposedly serve.
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.