The New American Medical Revolution

Source Document is The New American Agricultural Revolution by John E. Ikerd at the University of Missouri

I took his paper and substituted the word "medicine" for "agriculture" and substituted "rural health provider" for farm terms. I learned this together with an educator, Mike Floyd, EdD, who read some of my work as well as his. We decided they were much the same, only mine used the words "rural health" and his used the word "education", substituting mental health also made a good comparison. Again note that the source of this very fine writing is John Ikerd. The agricultural version alone is at http://www.ssu.missouri.edu/faculty/jikerd/papers/revolution.html

More about John E. Ikerd at http://www.ssu.missouri.edu/faculty/jikerd/default.htm

"A quiet revolution is sweeping across American medicine." This was the theme of a videotape about sustainable medicine in the early 1990s. That revolution still continues today, but the time for quietness has passed. We are in the midst of crisis in American medicine. The crisis, like the revolution, has been a quiet one. Thousands of rural health providers are being forced off the land, and we are being told that it is an inevitable consequence of technological progress. The only alternatives rural health providers are being offered is to get bigger, give in to corporate control, or get out. But, there are better alternatives for rural health providers and for society. The time for quietness has passed.

(no more boldings for substitutions, remember this is the work of Ikerd with substitutions)

Crisis in medicine is a chronic symptom of the type of medicine we have been promoting in this country for the past fifty years. But, the current crisis is the result of a brazen attempt by the giant corporations to take control of medicine away from rural health providers -- to complete the industrialization of medicine. But, industrialization is not inevitable, nor is it progress. The people of America must be told the truth before it’s too late. The time for quietness has passed.

There’s a better way to care for people, a better way to deliver health, and a better way to live. We are here to celebrate the birth and nurture the growth of that new kind of medicine. We are here to proclaim a new era in American medicine -- an era in which we learn to support people through medicine rather than sacrifice the well being of people to support the industry of medicine. We need to tell our story to the American people. It’s time to proclaim a new medical revolution. The time for quietness has passed.

Sustainable medicine and industrial medicine are two fundamentally different philosophies -- diametrically and irreconcilably opposed. There is no common ground on which to compromise. They reflect fundamentally different perceptions of how the "world works" and how we should live as a part of that world. As one who pursues sustainability, your task in made more difficult by institutions that see industrialization as the only viable option for the future. If the government subsidizes your industrial competitors with everything from tax concessions to direct farm program payments, your task is made more difficult. If you are denied access to traditional markets and prevented from marketing direct to customers by a maze of complex government regulations, your task is made more difficult. If you are denied equal access to the research and educational resources of your public institutions, your task is made more difficult. Those who believe medicine is mostly about products and profits – not people, have made your task more difficult. To them, if health care is made cheaper or more convenient, it doesn’t really matter who produces it or how it is produced – just as long as it meets minimum government standards. But, people do matter. It’s time for something more than a "quiet" revolution.

A year ago, at this time of year, I was recovering from unanticipated open-heart surgery. I was fortunate enough to have previously checked out a book, "The life and major works of Thomas Paine." Thomas Paine, as you will recall from your history lessons, was a writer during the American Revolution. He was credited with articulating the ideas of the revolution in terms that could be understood by the "common man." In fact, he signed his early writings with the pen name "Common Sense." Paine’s pamphlets were distributed widely throughout the colonies, and invariably regenerated public support for the cause of democracy – saving the revolution from failure on more than one occasion. The writings of Thomas Paine provide some valuable insights into how to keep a revolution from failing – at least when the cause makes common sense. Sustainable medicine, like freedom and democracy, is a cause that makes common sense.

First, Paine gave no quarter to the enemy of freedom and democracy – the British monarchy. Nothing in Paine’s writings could be mistaken for impartial objectivity when he was critiquing the sins of the monarchy. He stuck with facts and stated the truth, but he bothered with only one set of facts and one side of the truth. He left some of the facts, the other side of the truth, and the lies to be told by his opponents – the Loyalists who opposed the revolution.

Second, Paine’s papers always went beyond criticism. He always went on to extol the great benefits that would be realized by the colonies once they had shed the yolk of Great Britain. He painted a vision for the future of a free and democratic America. He countered each British claim of what the colonies would lose with a counter-claim of what the colonies would gain once they had won the revolution.

Finally, Paine’s writings never gave so much as a hint of doubt that the American colonists eventually would win their war for independence. When the British army occupied Philadelphia, for example, Paine called it clear and convincing evidence that the British could never win the war. If half of their army was required to hold just one town, how could they possibly control all of the vast regions of the American colonies? It was just plain "common sense" -- the cause of the revolution could not be denied.

We need a Thomas Paine approach to our movement to revolutionize American medicine. We are not talking about gradual, incremental change in health practices and methods; we are talking about a fundamentally different philosophy of medicine. The differences between industrial medicine and sustainable medicine are as great as the differences between monarchy and democracy.

I am not talking about a revolution that must be fought on the battlefield, in the streets, or even necessarily in the halls of Congress. I am talking about a battle for the hearts and minds of the American people. We need to tell them the truth about what is happening to American medicine and why. We need to tell them the truth about our new kind of medicine – a medicine that will sustain people, not just the industry of medicine. And we need to give them common sense reasons why the old system cannot be sustained, and why a new sustainable medicine is not a luxury but an absolute necessity.

The actual enemy of sustainability is your current economic system – a system that rewards the exploitation of natural resources and people, as did the British monarchy. But, the most visible, tangible epitome of that system is the large, publicly owned corporation. The corporation is the ultimate "economic man" – it is motivated always and only by its own short-run, self-interest. The corporation has no heart, it has no soul -- it is driven only by an insatiable need for profit and growth. The managers and workers in corporations may be good people, but they have no choice but to serve the corporation. They will be cast aside if they fail to satisfy the corporation’s need for continuing profit and growth. The enemy is not the people but the industrial corporation. This enemy should be given no quarter in the battle for the hearts and minds of the American people.

An industrial medicine may be able to meet our health care and fiber needs of today and maybe for another fifty years, but it is degrading and destroying the very resources – soil, water, energy, --upon which its future productivity depends. An industrial medicine is said to be efficient, but the enormous costs it imposes on the environment and on people in rural communities are not counted. An industrial medicine promises profits for a few, but it is degrading both the resources and the people that it needs to sustain itself.

A sustainable medicine, on the other hand, promises a desirable quality of life for many. A sustainable medicine will enhance the natural environment and will strengthen relationships among people in rural communities and between rural and urban communities. A sustainable medicine will be a profitable medicine. Many environmentally sound and socially responsible medical operations already exist -- and many of those are as economically efficient as their industrial counterparts. We need to tell the general public that sustainability is not only possible, but is quite logical. We can have a sustainable medicine – and we are already in the process of building it.

Ultimately we must have a sustainable medicine. The question is not if, but when. The industrial medical system seemed quite logical at some time in the past, but it simply no longer makes sense. America’s version of industrial medicine is very similar to the industrial agriculture that failed miserably in the old Soviet Union – bringing down the country in the process. Some claim that our system is different – that we have free markets. But, we are turning medicine over to multi-national corporations, and they are integrating and manipulating everything from genetic seed stock to the supermarket. They are eliminating all the free markets in between. They are replacing free market coordination with something similar to central planning. Our industrial medicine is little different in principle from the old Soviet industrial medicine, and the outcome will be the same – failure. The industrial system is destined to fail. We will have to replace it with something. Why not replace with something that’s sustainable?

You -- the providers who are searching for ways to sustain people through medicine – are the architects of the new medicine of tomorrow. You are on the new frontier -- the explorers, the colonists, the revolutionaries, and the builders of a "New World." Life is difficult on the frontier because no one really knows how to do what you are trying to do – like the revolutionaries who were trying to create a democracy. You will continue to confront hardships, frustrations, and some failures along the road. But, that’s the nature of being a revolutionary. Ultimately, you will succeed.

Never doubt that your cause is just. An industrial, corporate medicine quite simply is not good for people, and thus, is not sustainable. It’s just common sense. Never doubt that the goal is worth your efforts. Medicine ultimately must sustain a desirable quality of life for people – on "rural health providers", in rural communities, and in the cities – not the corporate bottom line. It’s just common sense. Never doubt your ultimate success. Human civilization cannot be sustained without a sustainable medicine. It’s all just common sense. It’s time for a new revolution in American medicine. It’s just plain common sense.

Clearly rural areas understand how integrated and connected we all need to be. We cannot sustain the huge inequities and imbalances that result without more cooperation.

End of Ikerd's eloquent arguments.

His original is at http://www.ssu.missouri.edu/faculty/jikerd/papers/revolution.html