The Dark Corner of Modern Medicine: Corrupted Morality & Unfair Profitability

We all need to make a living. So we provide services to others. Our services must lead to a minimum profit enough to support our living. At the same time, we human are living in a society and we need this society to be harmonious as much as possible. Then there comes morality, which refers to personal or cultural values, codes of conduct or social mores generally accepted in a society.

With morality in mind, when we are making a living, the ‘profit’ we gain should be earned in a right or fair manner.

Morality & Profit From People's Suffering

Is it “moral” to profit from the suffering of others? This is a question raised on Quora.com . A reader with a ID Viorel provided his or her answer:

“That depends on a lot of things ... We know that suffering exists and will keep existing in various forms, no matter what each of us do. So making a profit from a reality of the world is not, in itself, immoral.

“For example, consider the case of a coffin maker: the profit comes from selling coffins to people, which are needed because people die, which causes their loved ones to suffer. You could argue that the coffin maker is profiting from other’s suffering, right? After all, if people wouldn’t die then this person couldn’t make a profit.

“However, there is a reality of our world that people die; not making coffins wouldn’t stop them from dying, nor would it decrease the suffering of their family and friends. You could argue that not making coffins would actually increase their suffering, because they will have to deal with one more problem on top of everything else.

“If, on the other hand, the coffin maker starts killing people to increase their profit - that’s immoral; not because they are making a profit, but because they are CAUSING suffering.

“If they are using the vulnerable mental state of the buyers to pressure them into paying more than they can afford, or if sell an inferior product knowing that the buyer won’t care enough to call them out - that’s immoral; again, not because they’re making a profit, but because they are deceiving their customers.

“So bottom line: making a profit is not an immoral activity in itself; the actions one takes to making profit could be moral or not, just any other actions.”

I agree with Viorel's answer. But I would like to modify Viorel's answer a little bit into:

Making a profit by knowingly killing people or knowingly cause or exacerbate other people's suffering is not moral.

Profit & Medicine

Medicine or health care is a service to alleviate suffering & save life. Doctors, therapists or other clinicians provide this service to make a living by gaining a profit through this service.

In 2023, medical doctor John Orchard, PhD, a Sport and Exercise Medicine Physician published an article in JSAMS Plus which discussed the issues surrounding profit & medicine by introducing three books.

I believe this is a great article for health practitioners to read and think. Deep reading and deep thinking. I cite the key ideas as below.

Wins in Medicine

In medicine you don't have to venture very far to find huge wins: obstetric care, perinatal care, most of cardiology, most of endocrinology, much of oncology, infectious disease etc.

If you work in these areas, you might have very little time for medical scepticism and the opinions of non-doctors who think they know better.

Failures: Medicine's Dark Corner Revealed in Three Great Books

What if there were medical areas where most dogma was actually more harmful than beneficial? If you don't believe that such an area could exist, you need to read Back Up: Why back pain treatments aren't working and the new science offering hope by Liam Mannix.

At Australian newspapers The Age and SMH, Liam Mannix already has a reputation as a terrific journalist with huge respect for both science and medicine, yet his own and his father's experience with back pain has allowed him to write a book of intelligent scepticism.

He intends to reform rather than destroy medicine, in an area where the current scoreboard is dismal. Mannix paints doctors as misguided when it comes to back pain rather than malevolent.

Chiropractors tend to be derided by doctors on the basis that their profession was formed via magical thinking rather than science, yet it would be hard to read Back Up and not conclude that you'd be better off seeing a chiropractor and receive subluxations and reassurance than you would be to see a doctor and receive either a spinal fusion or opiate painkillers (and often they go hand in hand).

Australian doctor-authors Ian Harris (an orthopaedic surgeon) and Rachelle Buchbinder (a rheumatologist) have also recently written books (Surgery: The Ultimate Placebo and Hippocrasy: How doctors are betraying their oath), through the same publisher as Mannix.

Musculoskeletal Medicine: Bad Treatments Continue to Get Funded

They also mount the case that across musculoskeletal medicine there are perhaps more losses (harmful or placebo treatments) than there are actual wins (beneficial treatments like fracture fixation for displaced limb fractures, and disease-modifying treatment for gout and rheumatoid arthritis).

In these great books they explore the paradox that the majority of surgical patients get better; however, at least as many placebo surgery cases get better. Clearly something is going on that isn't the actual surgical technique. Is it pure placebo (the expectation that the ‘best’ treatment will get the result)? Or is it mainly contextual effects of surgery, say, that rehab plans are strictly adhered to when post-surgery but poorly adhered to without surgery?

The title of Hippocrasy makes it clear that Buchbinder and Harris think that individual doctors bear the lion's share of the blame for why ineffective surgeries (and drugs) are still getting used. A highlighted procedure is knee arthroscopy which is clearly either a placebo procedure (on a good day) or a harmful one (on a bad day).

All three books touch on the topic of how doctors are complicit in corrupting the reimbursement system in medicine to make sure that bad treatments continue to get funded.

However, the vilification of whistleblowers who have publicly claimed that Medicare fraud in Australia is commonplace perhaps explains why it is such a difficult topic to approach.

The Profit Motive

It is assumed that medicine being a science will be self-correcting and inevitably move towards a stronger evidence-base, but a competing factor is the profit motive.

The three books reveal that musculoskeletal medicine has many treatments where the desire to offer hope and, also, make a profit is taking precedence over scientific evidence.

The genre of medical scepticism has even further to still run, with the end aim being a health system where evidence-based treatments are funded and ineffective treatments are discarded.

Sadly in musculoskeletal medicine we can't say we are there yet, and fighting against the profit motive will mean it is a long battle.

Final Words

I cite 2 quora.com posters' answers as the final words of this post.

Braxton Anderson III :

What is immoral is causing the misery to create a self-serving profit opportunity.

Sunniel :

A true human is the one who feels pain in other's pain, and gain in other's gain.

References

John Orchard, The fight between medicine and scepticism needs to be resolved by evidence: Book reviews, JSAMS Plus, Volume 2, 2023,

Quora.com , Is it “moral” to profit from the suffering of others? https://www.quora.com/Is-it-moral-to-profit-from-the-suffering-of-othershttps://www.quora.com/Is-it-moral-to-profit-from-the-suffering-of-others