Krista Douglass: The Corrupting Power of Medicine

 

AP English 12

Mrs. Clark

22 April 2008

 

The Corrupting Power of Medicine 

     A cough, a cold, a broken bone, a rare disease; a call to the doctor is soon to follow.  With such extensive technology and the latest advances in treatments, the limits of medicine have been virtually eliminated.  Medicine has given us the power to improve our health, cure our aliments, and lengthen our lives.         

     In such an age, it seems almost wrong to wonder about the aptitudes of our physicians.  The requirements for a degree in this field are more rigorous than ever.  Medical students must attend both undergraduate and graduate schools, followed by several years of training before actually beginning their practices.  For those that specialize in a certain discipline, this schooling is even longer.  Moreover, all students are expected to follow a standardized system of principles for practicing the art of medicine.           

     As early as the 4^th century B.C., "the father of medicine" set this standard.  Hippocrates is credited with being the first physician to refute the idea of mystical forces causing illnesses, thus separating medicine and religion.  All diseases, he believed, could be traced back to our habits and environment.  The Hippocratic writings focus on prognosis and therapy rather than solely the administration of drugs, a revolutionary practice for the time.  Many of our medical terms and definitions of illnesses can be contributed to his works. 

     Most important, though, was his contribution to ethics: the Hippocratic oath.  The Oath literally "specifies the duties of the pupil…and the pupil's obligations in transmitting medical knowledge", and also "gives a number of rules to be observed in the treatment of diseases" (Edelstein 4).  First and foremost, the physician is to do no harm to the patient, a belief that holds firm today.  It also states the physician should refer the patient to a specialist if the matter is too complicated, inform the patient truthfully of the diagnosis, abide by the patient's wishes, maintain patient confidentiality, and evade inappropriate relationships with patients and their families (Perrin 7-8).  This oath became a set of commandments for early medical students.  As medical technology has progressed, the Oath has been revised and is no longer obligatory, yet still stands as a symbol of the moral responsibilities of a physician.  

     Ethics are intended to prevent misconduct and establish a healthy, trusting relationship between patient and doctor.  This connection is critical for the well being of the patient.  Nevertheless, as long as these rules have existed, there have been those that breach them.  Most notably in our history is Doctor Jack Kevorkian, the physician who challenged our beliefs about euthanasia.  After administering lethal injections into many consenting patients, Kevorkian was charged with second-degree murder.  Although he undoubtedly abided by the patient's wishes, both euthanasia and physician-assisted suicide contradict the Oath's vow to use medicine to benefit human life.  Terry Schiavo's treatment has also become a landmark case due to its conflict between doctor responsibility and family wishes.  However, similar cases, though less publicized, are quite common.  Conflicts regarding autonomy, abortion, stem cell research, and animal and human experimentation have been brought to the forefront, making the emphasis on ethics, now more than ever, a cultural issue.                

     This denunciation of the Oath has always been a widespread issue, equally reflected in the literature of the time.  The most famous example, Frankenstein, demonstrates the tragedy that can befall due to ambition and amoral research, introducing the "mad scientist" complete with the infamous "god complex", as a classic fictional character.  The tendency persists into the 20^th century, as seen in The Fifth Child and Wit, giving insight into the often negligent care of even the most critical of patients.  According to Huxley and Atwood's work, this theme is expected to carry on in the future; the years ahead hold promises of moshka-medicine, soma, as well as radical genetic engineering and a rejection of societal ethics.   The prospect is not as far fetched as we may think.  But will our technology and ethics really separate so far as to allow the cultivation of human lives?

     However, as our culture continually blames physicians for their lack of moral fortitude, we often overlook another important factor.  After all, it is the patients, society in general, who desire new, advanced technologies, demand medications, and create nearly impossible standards for our doctors to uphold.   One of the most important standards is, of course, the Hippocratic Oath.       

     As an aspiring medical student, I have often wondered about the emphasis placed on ethics.  Although extreme malpractice is generally only discussed in literature and films, it does exist in the modern world.  As much as the field of medicine is growing and changing, it is nearly impossible to project the role medicine may have by the time I have begun my practice.  It will be the duty, both of myself and other students of medicine, to recognize and follow these regulations to ensure the best possible treatment for each patient, and to define the relationship between our advancements and ethics. 

     The power of medicine is immeasurable; no other such science has contributed so greatly to the quality and duration of a human life.  Yet, as seen in literature, this power can become an infirmity when distorted.  We alone must distinguish our abilities and our moral obligations. 

Chapter 2: Our Own "Brave New World"

     Had one developed an illness before the institution of modern medicine, treatments would have been vastly different.  In prehistoric cultures, a shaman would have relied on his knowledge of herbs and spirituality for a cure.  Egyptian physicians expanded the knowledge of human anatomy with dissections, leading them to focus on more natural causes and remedies.  In the middle ages, when illnesses were thought to be triggered by an imbalance of the humors, a more hands-on approach was taken, though practices like leeching were not often successful (Trueman 1-2).

     Thankfully, times have changed.  A patient today is taken to a hospital or clinic where he is examined, tested, and then most likely offered a choice between treatments.  Hippocrates' medical guidelines have established a more modern feel to the practice of medicine.

     Yet as times continue to change, technology is advancing our knowledge farther than we could have ever imagined.  Not only can physicians help cure a sickness, but they can prevent it.  Moreover, some procedures have become mere luxuries rather than necessities.  Anyone unhappy with his or her wrinkles, smile, or bone structure has the power to correct it.   These changes have enabled us to prolong and improve the quality of life, or at least ensure our happiness. 

     Frankenstein was one of the first examples of this new technological trend.  Frankenstein's monster was pieced together using what seems to be incredible, and impossible, technology.  Though at the time organ transplants, genetic engineering, and cloning were just hypotheses, Shelley introduced the world to the possibility of such advancements. Now, though, these procedures seem almost routine; "with the miracle that is modern surgery, we use patches and parts…and we stitch them together" (Gaylin 2).   "False teeth…hearing aids…hair grafts, pacemakers…artificial limbs" are all products of the incredible medical technology (Kurtz 6).  Frankenstein is no longer a myth, but a reality.    

     In a world fueled by our scientific discoveries, ethics have often been disregarded.  Beneficence is still stressed, yet now is often overshadowed by the desire for medical advancements.  In his oath, Hippocrates states physicians should "give no deadly medicine", "produce abortion" or divulge secrets (Hippocrates 1).  Yet euthanasia, abortion, and the Electronic Medical Record are all realities.           

     "Criticized as being 'pre-technical', 'simplistic'…and 'irrelevant'" (Guinan 2), the Oath has been modified for most students of medicine, and in some cases even eliminated.  Because of all the possibilities that medicine now presents, ethics have slowly been pushed to the side to meet the demands of the changing times.  In Huxley's Brave New World, test-tube babies are cultivated to regulate castes and eliminate individuality (5-7); Ben is sent to a clinic where he is sedated nearly to the point of death in The Fifth Child (Lessing 82-85); Victor Frankenstein pieces together a monster using human bodies to advance his knowledge (Shelly 38-39).  Though many of the aforementioned practices can certainly be beneficial, in these cases they can be seen as corrupt simply because of their disregard for the principles of ethics.

     As we progress, however, we are moving away from simply improving life to actually designing it.  In Brave New World, genetic engineering becomes the focus of society, eventually replacing conception altogether.  Designer babies are created in a lab, and predestined to become leaders, thinkers, or laborers.  There is no need for parents, no need for personality or thought; human life becomes something merely fabricated.  "What is an individual?" the Director states.  "We can make a new one with the greatest ease—as many as we like” (Brave New World 148). 

     Tales like these, along with advancements that seem to point in the same direction, have brought practices like genetic engineering to the forefront.  The benefits of such developments are obvious.  Engineered stem cells can be used to replace damaged cells that cause debilitating diseases, as well as reverse the effects of infertility, cancer, and other injuries (Kurec 2).  Skepticism still surrounds the process; some scientists fear it is "going to divide human beings into classes that may one day try to destroy one another" (Baard 1).  Yet considering the details described in Frankenstein were once deemed improbable, dystopian novels like Brave New World and Island seem less far-fetched than we once thought.

     Beneficial though they may be, the conflict does involve ethics.  Simply because society demands the right to autonomy does not mean such substantial freedom should be given.  In vitro fertilization, prosthetics, and transplants are all technologies that are moving us towards the likes of Frankenstein's monster.  "We must not try to produce a human machine," Gaylin warns, for "machines rapidly become obsolete" (5).        

     Though the Oath may be somewhat outdated, referencing Roman gods and ancient philosophers, should we completely reject it?  "Human disease and suffering are…inevitable" Guinan states, "and the contemporary emphasis on autonomy…should in no way necessitate diminishing or eliminating the Hippocratic virtues" (3).  Whether in the 4^th century B.C. or in the 21^st century, the desire to improve lives has not been eliminated, and neither should the regulations. 

     With new medical advancements, the possibilities are endless.  Abortion, plastic surgery, and euthanasia were all once the musings of scientists.  Even simple things, like electronic medical records, have made medical care more of a science.  The fact is, "technology has surpassed even its own expectations".  We must advance cautiously, though, for "our freedom is bringing close to disaster" (Gaylin 2, 5).

Chapter 3:  The "God Complex"

     From thermometers and scalpels to X-rays, antibiotics, and vaccines, technology has strengthened medicine immeasurably.  With new advances, we are able to identify illnesses more quickly and cure them with medicine that research has discovered.  Diseases like polio and smallpox are virtually eradicated.  Surgery has become more precise and effective.  We are now living longer than ever, thanks to medicine. 

     Yet with all these advances, it is often easy to forget our humble beginnings.   Not quite two centuries ago, practices like  "leeching" were our most advanced treatments.   What is possible now, though, is often so exciting that we as a society forge these limits, and push on to gain more knowledge and to become more skilled.   It is because of this "sky is the limit" thinking that many patients have come to expect unachievable accomplishments from our doctors, and many doctors have become narcissistic.

     Many physicians today have developed what can only be called the "god complex", excessive arrogance because of their supposed powers.  While the Hippocratic Oath sets firm guidelines to prevent such a mindset, "only 14 percent of modern oaths prohibit euthanasia…8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version" ("The Hippocratic Oath Today" 1).  Often "thanks to medicine" becomes "thanks to us".  Yet surprisingly, our culture has embraced this myth; in fact, it has created it.  There is a reason why some of the highest paying jobs are medical related.   

     Obviously, this kind of thinking has led to a decline in our values.  Though the Oath has been changed to better fit the times, " fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge"  ("The Hippocratic Oath Today" 1).  Whereas before a doctor was a citizen specialized in the science of the body, our advancements began to overstep our guidelines as medicine became, to some extent, a crime of "hubris" and a challenge to God.  A doctor is now "more than a rival to God; he [is] God"  (Gaylin 2).   

     The complex has not only developed because of our technological advances, but has also served to fuel our discoveries.  With the breakthrough in genetics, we are now able to create designer babies, a process that will "improve the quality of life" (Kurec 2).  Technology will give us the power to model our children and create humans with a "higher IQ and superior strength spliced into their DNA" (Baard 2).  Cloning, once restricted to animals, is now possible in humans.   Many of the aspects of creation are no longer reserved for God, but accessible to physicians.  We are on the brink of limitless opportunity.  "We [do] not have to fear God for we [have] replaced Him" (Gaylin 2).

     Literature has long reflected this trend towards the "god complex".  Marlowe's Dr. Faustus takes place in a time where the Renaissance "traditional world order" held precedence in society; a man was expected to stay within the boundaries of his place in the universe.  Yet with Faustus we see dangerous ambition, the beginning of the denial of the Renaissance natural order. 

     Why Faustus hast thou not attained that end? 

     Are not thy bills hung up as monuments

     Whereby whole cities have escaped the plague

     And thousand desperate maladies been cured?

     …Oh what a world of profit and delight,

     Of power, of honor, and omnipotence

     Is promised to the studious artisan!  (Marlowe 4-6).

The desire for knowledge is natural, but Faustus' mind focuses on power.  In Marlowe's legend, we see an example of an extreme thirst for scientific knowledge and of pride.  According to Schummer, "If hubris means comparing or measuring one's own capacities with God's capacities, then…hubris is only one step towards atheism", or our modern "God complex" (9).

     Frankenstein delves deeper into this realm, actually creating life.  "What had been the study and desire of the wisest men since the creation of the world was now within my grasp", Frankenstein claims (Shelley 37).   This power prompts Victor to break from the confines of mortal men and become a "God".  "A new species would bless me as its creator and source", he boasted (38).  It is easy to see Victor's reasoning, as society is often overwhelmed by the desire to discover new techniques and treatments, to become the creators of something incredible.      

     Lessing's The Fifth Child portrays a more modern view of this complex.  Ben, deemed "a troll... a goblin", even a "monster", is sent to an institution where his destructive and dangerous behaviors can be controlled (Lessing 49).  This institution is most nearly an experiment station, where patients are constantly drugged and kept in a state of near-death.  When Harriet rescues Ben, she is told he would not have lasted much longer, a convenient side effect of his medicine (Lessing 85).  Simply because Ben is frightening, he and the other "freaks" are experimented on both illegally and unethically (Lessing 81). 

     Rather than creation, like in Frankenstein, here we see a destruction of life.  According to Hippocrates, this would clearly been seen as an act of "malice"; because we had not created these individuals, it would be wrong to destroy them (Hippocrates).  Yet with more and more advances towards actual human design, are we now more responsible for our lives, and subsequently our deaths?

     On a more realistic level, one can examine the recent explosion of demand for plastic surgery and transplant procedures.  With this technology, we have taken it upon ourselves to change our appearance, thereby changing our original and intended characteristics.  Likewise, while certain advances may prolong life decades, is it ethical to use "animal organs to supply parts for human bodies", or conduct "stem-cell research on fetal tissues"? (Kurtz 1).

     This speculation and examination of the cultural trend towards a God-like physician says nothing at all about the patient, when ironically is the patient that receives the worst from this scenario.  In Wit, Vivian is a cancer patient who, like Ben, is often treated as only an experiment.  "'Rounds' seems to signify darting around the main issue… which I suppose would be the struggle for life…my life…with heated discussions of side effects, other complaints, additional treatments," she explains (Edson 36).  Throughout the play, doctors and nurses give her minimal attention and explanation for her illness, refusing to recognize "all that sentimental stuff…all that meaning-of-life garbage" (77).   During Vivian's death, the doctor shouts, "She's research!" initiating resuscitation contrary to Vivian's wishes (82).

     This behavior, the experimental treatment of humans, can also be seen in Margaret Atwood's The Handmaid's Tale.  In the Republic of Gilead, the use of a certain group of women as "breeders" has become a state-sponsored and culturally accepted practice.  "I used to think of my body as an instrument… there were limits, but my body was nevertheless …one with me", Offred notes (Atwood 73).  Now, though, she and the other women are simply "containers; it's only the inside of our bodies that are important" (96).  In both pieces, a sense of power given by society to the doctors and leaders has led these two "patients" to become merely research.       

     Can we really define life?  Is it right for us to create humans, or to decide when death should occur?  Certainly there are negative effects to the "god complex"; Frankenstein's monster is a perfect example.  Finding his creator terrified of him, an experiment gone wrong, the lonely monster states, "evil thenceforth became my good", and devotes his life to ruining Frankenstein's (Shelley 195).  Again, cases like those involving Dr. Kevorkian demonstrate the danger that can result from our knowledge.  In Brave New World, we see the culmination of a mass of knowledge: a society with medicine at the head, yet devoid of all morals, sentiments, and purpose.      

     Though our medical advances are amazing, this does not necessitate a prideful attitude towards our accomplishments and potential.   As Thomas Merton said, "Our vocation is not simply to be, but to work together with God in the creation of our own life, our own identity, our own destiny" (Quoted in Gaylin 2).  To surpass this is a dangerous leap of hubris.  Until we reach the point of actual creation independent of a God, the "god complex" still exceeds our limits.  Yet try as we might to avoid it, these doctors are what we have made them: a product of our selfish and limitless desires.  They are "gods" because we have made them so.  Egotism merely follows suit.       

     How, then, do we determine the limit of our ever-increasing medical prowess?  According to Gaylin, "the guidelines necessary to test the value of change would be the degree to which those changes encourage or discourage the emergence of the other noble and human qualities" (2).  Should we continue crowning ourselves Gods and medicine our means of creation, we may be headed for a "Brave New World", replacing all ethical morals with our thirst for knowledge and power.    

Chapter 4: Negligence and the Myth of the Corrupt Doctor

     An injury or illness is certainly one of the most terrifying situations for humans.  However minor the wound, the mere prospect of being hurt or in pain can leave one frantic.  Our reassurance comes from the doctors, though, who can prescribe us pills, set our bones, and repair us.  We are able to receive individual treatment, making us feel protected and important. 

     Though to us even minor injuries are our top priority, and we appreciate this personal attention, often physicians are exceptionally busy and cannot give the desired consideration.  However, especially in literature, we sometimes see other motives for this behavior.  Negligence, though not nearly as publicized as criminal behavior by doctors or controversial technological advances, can be just as dangerous.  Like the god complex, malpractice may result from overstepping one's boundaries as a physician or simply not meeting the expectations of the patient.  The possibilities of medicine and trust in our own judgment can claim us as victims of the corrupting power of medicine. 

     By definition, negligence is the "failure to exercise the degree of care required for the protection of other persons that may be injuriously affected by the want of such care".  In the field of medicine, this can include "failure to diagnose, or misdiagnosis of a disease or medical condition", "failure to provide appropriate treatment" or "unreasonable delay in treating a diagnosed medical condition" (Larson 1).  Literature often creates extreme examples of these cases, yet there are real cases that demonstrate more simple effects.  Many long-term patients are found to have developed sores on their backs and legs as a result of improper positioning.  Stories surface quite frequently about anesthesiologists and surgeons "fooling around" in the rooms, taking their role too lightly. 

     The few extreme cases, though, have become famous.   In the 1960s, Willowbrook State School in New York was revealed to have abused its mentally challenged patients with its unethical hepatitis studies.  Between 1932 and 1972, the "Tuskegee Study of Untreated Syphilis in the Negro Male" denied a control group treatment for syphillis, violating the rules of informed consent (Tuskegee Study 1).  The "Baby K" case focused on the treatment of  a futile patient, a baby born without most of its brain, and the mother's fight to continue treatment (Healthcare Ethics 2).  Also famous, of  course, are the cases of  Dr. Kevorkian and Terri Schiavo.

     In literature, however, we are presented with a different perspective; gruesome tales of corrupt doctors performing surgeries without the consent of the patient are portrayed in both films and the ever-popular thriller and suspense novels.  Yet the actual motive is not usually for evil intent.  Though Socrates' thesis on ethics described the conflict as being one between "the beneficial (the 'good') and the harmful (the 'evil')," many doctors simply exhibit misguided judgment in their diagnosis or treatment (Husted 3).  Though the cases of Kevorkian and Willowbrook State School were certainly committed out of evil intent, they are the exception, not the rule. 

     Negligence can have many roots.  It can stem from the god complex, where doctors assume the simplicity of an illness and the cure and, therefore, give it little attention.  According to Ben Jonson, "success produces confidence; confidence relaxes industry, and negligence ruins the reputation which accuracy had raised".  Though the doctor may have encountered this case hundreds of times, it makes it no less terrifying for the one suffering from the condition.

     Heath care professionals possess an undesirable degree  of power over patients.  They may be tempted to take… irrelevant, ritualistic actions.  They often have little concern for the ethical meaning of their actions.  They may see little need for ethical doubt or analysis. (Husted 7). 

Leaving the patient uniformed and without condolence can be traumatic.  This is one of the main reasons that a doctor is encouraged to have a good "bedside manner", so he or she can relate to the patient and explain the diagnosis in simple terms. 

     Negligence can also be caused by doctors' lack of concern for the patient's well being.  After years in a practice, it is likely that many physicians have become disillusioned and have begun to take their profession for granted. Patients can become like "practice" for physicians instead of a life that should be focused on with the utmost attention.  Harriet notes, in Wit, that the doctor "prefers research to humanity" (Edson 58).  "What they have come to think of me is, in fact, just the specimen jar", she observes, "… just the white piece of paper that bears the little black marks" (Edson 53).  Yet according to The Code of Medical Ethics, "Physicians…must put the needs of patients first.  At least since the time of Hippocrates, physicians have cultivated the trust of their patients by placing patient welfare before all other concerns" (105). 

     The doctors in Wit treat Harriet as an experiment, using language she doesn't understand and bringing in students to observe her.  "I want to know what the doctors mean when they…anatomize me," Harriet says (Edson 43).  Jason, the fellow at Harriet's hospital, laments, "I wish they could all get through it [the treatment] at full throttle.  Then we could really have some data" (75).  The most startling scene, however, occurs as Harriet is dying.  Though she is labeled DNR, the attending physician calls a different code.  When things begin to go wrong, he screams, "She's research!" (82).  This not only shows the complete disregard for the patient as a human, but also rather includes Harriet as another hospital experiment.  

     Similarly, in The Fifth Child, Ben's mother, Harriet, comes to rescue him from the institution.  She finds the patients, the "monsters", "drugged out of their minds" (Lessing 81) so the team at the institution will not have to handle them.  "Because he's so strong… he has to have bigger shots," the nurse tells Harriet.  "It kills them." (85). Harriet finds Ben unconscious and covered in excrement, kept in terrible conditions (82).  Instead of searching for a cure or an aid, the center prefers to keep the children in a state of near death for the sake of science. 

     Futility may also play a role in malpractice cases; doctors may suppose that the situation is hopeless and that treatment is unnecessary.  The rules state "physicians are not ethically obligated to deliver care that…will not have a reasonable chance of benefiting their patients" (Code of Medical Ethics 8).  For example, there is very rarely anything that can be done for those with a mental illness.  Ben is sent to an institution because of his crazed fits.  However, with the proper medications, it can be assumed that Ben could have become a normal member of his family.  Psychoanalytical criticisms have suggested that Ben "is not an alien or a throwback as his mother supposes; neither is he demonic or deranged.  Rather, he is a product of his upbringing" (Clark 3).  With uncaring and dismissing parents, "it is no surprise that his development should be abnormal and pathological" (4). 

     Literary interpretations of futility are reflected in many famous ethics cases of our time.  Like the Terri Schiavo case, a case involving Nancy Cruzan, who was part of the "right to die" movement, questioned the right to remove Nancy's feeding tube in her "permanent vegetative state" (Schneiderman 4).  Kevorkian's very argument for his euthanasia experiments centered on this idea of futility; his "Thantron" was used to administer fatal medication to terminally ill patients.  However, the court ruling in the case of Baby K determined that withholding treatment on the basis of futility violated ethics laws and that treatment was not, in fact, "futile or inhumane" (Healthcare Ethics 2).

     However, it is very rarely noted that we may play a part in this vicious cycle.  Of nearly 50,000 medical malpractice suits filed between 1985 and 2000, only 23% of those cases were proven validly negligent (Bartholomew, Dovey, Fryer, Green, Miyoshi, and Phillips Jr. 1).  Could it be that our outrageous demands, our own selfish desires or lofty expectations of these doctors, who are in fact only human, have created this problem? 

     "The past 30 years have witnessed …a rising tide of medical-malpractice litigation… these events, for many physicians, have merged into a single, continually escalating malpractice crisis" (Zuger 71).  Without the power of medicine, we never would have advanced this far, yet it seems now we are at a conflict between the right to autonomy and the obligations of physicians.  Thus we see from literary evidence that it is not the quantity of knowledge gained that is especially essential, but how man chooses to use, or in this case, misuse, that knowledge that has the greatest and most detrimental effects. 

Chapter 5:  Overtreatment and a New "Soma"

     Our culture is one of instant gratification, a world filled with innumerable fast-food chains, high-speed Internet, and instant pain relievers.   This mindset has come to include medical treatment; we believe cures should be quick and pills administered as if through a drive-through.  As more and more pills are being demanded, the pressures on physicians increase as they often look to treat the symptoms and not the disease.     

     Perhaps the most obvious example involves anti-depressants, the use of which has risen significantly over the decades, and most alarmingly, over the past few years.  Once only prescribed by psychiatrists, these pills are now virtually over the counter, administered quite casually by some physicians and to nearly anyone who experiences a sensation of sadness.  Yet it is not just anti-depressants, but many drugs that have become less of a necessity and more of a desire.     

     Many doctors have been criticized for this practice: the over-treating of diseases and a lack of discretion.  Nevertheless, another factor lies within the pressure created by HMOs (Health Maintenance Organizations); most doctors are simply responding to increasing demands from healthcare providers.

     As doctors are compelled to see more patients in less      time and are encouraged to order minimal testing,      there is a pressure to treat patients rather than      understand them. Low potassium level? Give potassium      supplements. Belly hurt? Here's an antacid. Depressed?      Try Prozac. (Shaywitz 1). 

A 2001 study by The New England Journal of Medicine reported that 75% of doctors were unhappy with these pressures, agreeing it has "affected not only the way they practiced medicine but also the medical services available to patients and the quality of health care provided" (Zuger 71).   

     This study holds true in Margaret Edson's Wit, as Vivian is rushed through a grueling treatment with little personal attention from the hospital staff.   "I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home", she states (41).  Even her doctor warns, "There may be some times you'll wish for a lesser dose, due to the side effects.  But we've got to go full force.  The experimental phase has got to have maximum dose to be of any use" (11).  The reader sees Jason, the oncology fellow, being shaped by the pressures of his practice, hurrying to treat the cancer, trying to complete the experiment, yet seldom bothering with the patient herself.          

     This is what Dr. David Loxterkamp calls the "age of managed care", an era in which "the patient and the patient's relationships became something to be diagrammed" (2).  So much emphasis, it seems, is placed on bedside manner, yet in reality the doctors are encouraged to speed treatment and see more patients.   "We have learned to pass patients between specialty pools of preferred providers, to control 'risk' through the use of practice guidelines, and to pursue only those clinical questions that can be answered expeditiously," Loxterkamp notes. "We have a job to do, one that is limited by the clock, the protocol, our role at the bedside" (2).

     The fact is that not all patients are the same, not all sadness means depression, and not all stomachaches are just that.  An article in The New York Times maintains that a man treated with testosterone and an anti-inflammatory for achy joints and a low libido was found nearly two decades later to have hemochromatosis, a treatable, genetic iron-storing disease.  By then, though, it was too late, as he suffered from irreversible damage to his heart and liver and extensive internal bleeding (Shaywitz 1).  Had proper tests been done when the patient was first examined, he would have been treated and been able to recover.  Herein lies the problem with treating the symptoms and not the patient, because, though the symptoms may be the same, all patients are not.      

     More culpable than the doctors and administration, quite ironically, are the patients.  In our society of instant gratification, pain and suffering are unnecessary.  With an abundance of pills available for nearly any problem, there is nearly no waiting for a prescription or an important test result as before; we can take a pill and go on with our day.  Though this sounds progressive and exciting, we have come to demand that our doctors be "pill pushers" (Shaywitz 1), a ready dispenser for our medicines.  Though we often chastise doctors for this practice, we must keep in mind who is demanding the pills to begin with; while some desire a meaningful existence, others see this medical trend existentially, hoping only to make it through the day with the help of medication.   

     This truth is evident in Lessing's The Fifth Child; Harriet, pregnant and in pain, demands strong sedatives for her unborn child, something to "quiet the baby" (Lessing 39).  She even admits the latter part of her pregnancy was better "because of the amount of drugs she took…she was willing them [the drugs] to leave her alone and reach the baby" (42).  Without considering the effect these pills may have on the baby, Harriet insists in them, and the doctor obliges.  Sadly, when Ben becomes uncontrollable, he is labeled a monster, contained in a straight jacket, and sent to an institution, all without proper examination.  

     Of course in this medical horror story, the doctor shares the blame, but Huxley's Island and Brave New World demonstrate more clearly the factor society plays.  In the remote island community of Pala, the citizens have learned to rely on  "the moshka-medicine, the reality revealer, the truth-and-beauty pill" (Island 138), a hallucinogenic drug used to create pleasurable sensations and an enlightening experience.  The inhabitants of Pala constantly use the "medicine" that is prescribed for any symptom.  Though the moshka-medicine is only a hallucinogen, Dr. Robert notes that its effects are mental more than physical: 

     Even if it doesn't refer to anything outside itself,      it's still the most important thing that ever happened      to you…and if you give the experience a chance, if      you're prepared to go along with it, the results are      incomparably more therapeutic and transforming. So      maybe the whole thing does happen inside one's skull.      …The fact remains that the experience can open one's      eyes and make one blessed and transform one's whole      life. (Island 141). 

Although the citizens of Pala see this as progress, society has demanded and thus created a mindless, pleasure-seeking society. 

     Though we often demand our medications like moshka-medicine, the evidence shows many of these pills solely create a psychological cure.  By using placebos, a "fake treatment, made from an inactive substance like sugar, distilled water, or saline solution invoking therapeutic results" (Nordenberg 1), many illnesses can be cured purely through the patient's belief in a cure.  Simply concerning anti-depressants, studies have shown that "up to 75% of the effectiveness of anti-depressant medication is due to the placebo-effect rather than the treatment itself" (Placebo 14).

     Much as in Pala, the society in Brave New World demands the use of soma to alleviate pain and suffering.  Coining phrases like, "One cubic centimeter cures ten gloomy sentiments," and, "When the individual feels, the community reels," the citizens of this society learn to use soma to rid themselves of feelings and to create an almost continual high (Brave New World 6).  Although more of a regulated, state-mandated supply, the Controller admits the reason behind the program is the people;  "They're well off; they're safe; they're never ill; they're not afraid of death; they're blissfully ignorant", he says.  "And if anything should go wrong, there's soma" (220). 

     Certainly if society dictates the desire for anti-depressants and other medications, it is very difficult for the physicians to decline.  However, "the need to look beyond a patient's immediate clinical symptoms and to search intensively for deeper meaning has been and must always remain a defining quality of the medical profession" (Shaywitz 2).  Yet we must not forget our responsibility.  As a society, we must learn to recognize the difference between illness and discomfort, lest we, too, wish to consider the answer to all our problems soma.     

Conclusion

     In an age when medical mystery novels become best sellers and malpractice suits outnumber most others, the medical profession has certainly received a bad reputation.  Yet we still turn to the doctors to cure our coughs, our colds, our broken bones, and our rare diseases. 

     Certainly literature has not been the best example.  Vivian in Wit is treated like a culture in a magnifying glass, while Shelley's Frankenstein does little to dispel the myth of narcissistic doctors.  With the futuristic theories presented in Brave New World,  Island, and The Handmaid's Tale, literature certainly reaffirms our fear of a culture controlled and destroyed by medicine.

     Yet what I have learned from my research is that these novels are quick to place blame on the physicians; after all, they diagnose these problems and administer our drugs.  However, we most often fail to recognize society's role, our role, in this myth.  Our literature often reflects culture's morals and values, its opinion of physicians and their culpability, but not necessarily its truths.         

     As an aspiring medical student, I will certainly see my share of these physicians: the surgeon who believes himself infallible or the resident who delights in experimental treatments.  More frequently, though, I believe I will see students of medicine working hard to improve the quality of human life and struggling to uphold Hippocrates' ethics in a continually changing society. 

     Yes, the power of medicine is immeasurable.  Yet our expectations of doctors and the role of medicine have become immeasurable, too.  As physicians, and as a society, we must strive to compromise our aspirations with our ethics.  If we are to accept that doctors, like ourselves, are simply human, then we must admit that the power of medicine has corrupted not just our physicians, but us as well.  

 

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