Do you trust 'your' GP?

A penny for your thoughts, and a dollar for a good argument

Briefly, I wish to highlight a much longer piece by Klaus Dörner that appeared in the Ärzteblatt—the German medical association’s trade publication—back in 2002 (Dtsch Arztebl 2002; 99(38): A-2462 / B-2104 / C-1970).

Entitled ‘The Healthcare System in the Progress Trap’ (orig. Gesundheitssystem: In der Fortschrittsfalle), there is a whole elaboration of why market-first considerations of ‘Health™’ lead into a cul-de-sac (here and in the following, my translation and emphases):

The term ‘health’—if we disregard the World Health Organisation's (WHO) platitudinous phrase about a state of complete well-being—largely defies definition. The very question of it can impair or destroy it, as is the case for similarly sensitive concepts such as trust, love, grace, but also, for example, sleep or satiety. You can do an infinite amount for your health, but this has little or often nothing to do with whether and to what extent you feel healthy—and the latter is what counts. This can lead to a paradox: The more I do for my health, the less healthy I feel. In this sense, health is not feasible, cannot be produced, but rather produces itself [oh what kind of pseudo-Hegelian claptrap]. Health only exists as a state in which people forget that they are healthy. According to Hans-Georg Gadamer, this is the state of ‘self-forgetfulness ... being given away’ to the other or ‘the other’ in private, professional and social life.

Against this background, there is no getting around the logical and depressing realisation that we have been categorically mishandling health with increasing fury for around 200 years—with catastrophic consequences for the development of health as a means of vitality. Since we have freed ourselves from the metaphysical ballast of all transcendence (from aristocracy and the church to God and nature [strange listing; it would be God first, followed by ‘nature’ and mankind]) with secularisation, the Enlightenment, and modernity, and we can now only perceive everything else as an object of appropriation [hi there, comrades Marx and Lenin], we have every reason to rejoice in the grandiose gain in freedom, availability, and wealth of this conquest, availability, and wealth of these campaigns of conquest, in which man is increasingly taking the place of nature, fate or God, we are obviously only gradually gaining a sense of the side effects of this process of progress, for which we would need something like a ‘second Enlightenment’ (Hubert Markl).

There follows a veritable laundry list of problems and things that all point to what economists have long understood as ‘diminishing returns on investment’. It also calls us to question the motive behind ‘the medical establishment’ to, e.g., the following proposition:

With the increasing effectiveness of pain therapy procedures, the number of people suffering from pain is not decreasing, but increasing…

So, what would make certain people—doctors—incentivise to increase the use of prescription painkillers?

Much further below in the piece, there is this revelatory passage:

Competition is forcing the development of new markets. The aim must be to transform all healthy people into sick people, i.e., people who consider themselves to be in need of therapeutic, rehabilitative, and preventative manipulation by experts for as long as possible, both chemically and physically as well as psychologically, in order to be able to ‘live healthily’. This is already quite successful in the area of physical illnesses, but even better in the area of mental disorders, especially as there is no shortage of theories according to which almost all people are not healthy. The analogue transfer of the concept of illness from the physical to the mental is questionable.

And here you have the inescapable logic—and truth—in writing by one Klaus Dörner who, by the way, was born in 1933 († 2022) and wrote the standard textbook of German psychiatry (see his German-language Wikipedia entry).

He wrote the above words in retirement, after having been part of ‘the system’ for his entire professional life. He seemingly had no problems, moral or otherwise, of participating in these shenanigans while active.

These lines do explain, however, a lot that we’ve been observing in recent years, isn’t it?

So, to conclude—please let me ask you this once more:

Do you trust your doctor?

If so, why?