Theodore Dalrymple on Negligence and Unaccountability in Medicine

“The medical establishment has become the major threat to health.” — Ivan Illich

Does an overweight patient deserve more resources from the government on account of his condition?

Buy the book
Organization chart of the American healthcare system

Subscribe Today


Theodore Dalrymple on Negligence and Unaccountability in Medicine

Bob Zadek: Welcome to The Bob Zadek Show. Thank you so much for listening this Sunday.

One of the conceits of the progressive politicians and followers in the United States, if not around the world, is the blind, unyielding faith in the power of experts. They believe there are a cohort of experts in the country and in the world who know better than us how to organize our lives.

That is why progressives always seek to increase the power of government — not because they are hungry for the power per se, but of course they are — but because it is good for all of us, because we are not competent to run our lives.. Therefore, it is good policy to cede power over our lives to those who are more competent than we are.

Omissions and Bad Science

Bob Zadek: You are a retired physician. You have written two dozen books The most recent one is False Positive. What was it that prompted you to conceive of this book? Was there some event that caused you to perk up and get curious about journalism in the New England Journal of Medicine? What caused you concern to write an unusual and extraordinarily important book such as this?

I must say I was surprised at how often I found very simple errors. In addition, the medical journal has a lot of social commentary. One felt, or I felt, after reading this for many weeks or months, that I was reading some kind of orthodoxy which was actually never challenged in the pages of the Journal.

Bob Zadek: You start with a journal that is a technical journal written for a technical audience, for practicing physicians and the like. This journal has achieved a well-deserved stature, and once it achieved this status it gets to a level to where it is presumed to be speaking the truth, or orthodoxy, it then expands and takes advantage of this position in order to lecture us and scold us and opine on matters well beyond their area of expertise. However, it remains cloaked in this aura of authority because of its name. So, they get to be believed somewhat blindly.

And then of course there is the question as to why the origin of this epidemic was not mentioned. And the answer to that seems to be that the journal itself together with the CDC and The Lancet, which is another very important journal, along with the World Health Organization, conspired for quite a long time to prevent it being known that the peacekeeping troops brought cholera to Haiti.

Of course, they didn’t do it deliberately. No one accused them of that. But it was something that they wished to hush up. I’m afraid the New England Journal didn’t cover itself in glory in this episode. So I concluded that actually they didn’t really want anyone to dwell too much on where it came from and why the journal and those other organizations hadn’t mentioned these facts.

Crime and Sociological Determinism

Bob Zadek: I should mention that the book is interesting in that the topics themselves were not topics that you selected because you felt they were important topics. You were driven by the topics which were presented by the articles in the journal as you read them. So the book is an interesting mix of almost independent essays based upon the articles you happen to have read. You spent some time writing persuasively about criminal law and criminal behavior. That is a topic that one would be surprised to see in the New England Journal of Medicine. What interest is it to a general practitioner in the Midwest to see an article on the behavioral sciences and criminal justice? Yet you dedicated a fair amount of time in the book to criminal law.

However, when someone acts criminally, he is said to be suffering from a disease and needs treatment. There is a therapeutic attitude towards criminality which I disagree with. And actually, you haven’t mentioned that I was a doctor for a long time in a prison. A lot of criminals in my view, have adopted this attitude of regarding themselves as ill.

They think of themselves not as agents but as being in the grips of something. So, for example, they might say that they are addicted to stealing cars just because they do it over and over again and find it exciting. They use a medical term, “addiction.” For what they do. They regard themselves as really the vectors of forces rather than people who have agency. It’s a subtle thing because they know in their hearts and between themselves that this is nonsense, but they get rewards for presenting themselves as if this were true. And if you repeat a lie over and over again, it becomes true. So, I was particularly interested in the question of addiction. In the prison in which I worked, heroin addiction was the most prevalent one.

Scientific Orthodoxy versus Personal Responsibility

Bob Zadek: Now there is a somewhat sinister but human reason why the approach of the medical profession to something like drug addiction might be different than the approach of society at large. We call this motivation public choice or sometimes greed.

In England you have to be pretty incompetent or a very frequent burglar to be caught by the police. And he said to me, “Doctor, does burglary have anything to do with my childhood?”

I said, “Absolutely nothing whatsoever.” He was surprised by my response because he has been taught to believe that his behavior is simply a kind of physical response to circumstances. And I said, “It is quite simple. You want things, you are lazy, and you are not very clever.” Instead of being very annoyed, he started laughing as they always did when you went through this conversation. In a way they were quite relieved because they didn’t have to pretend anymore.

Obesity: Illness versus Choice

Bob Zadek: Theodore, another crossover area between medicine and personal responsibility that you comment on is obesity. Tell us briefly what the thesis of the New England Journal of Medicine was on obesity and why you felt that they were spilling over into an area of behavior, rather than a medical issue?

Once society is led to believe that bad behavior is the result of an illness, what happens is that the bad behavior and the cost of fixing that problem, is now absorbed by all of us.The responsibility becomes a collective responsibility rather than an individual responsibility.

So the effect of achieving the labeling of bad behavior as an “illness” is that the responsibility and the cost is transferred from the individual to the collective. And that is fascinating to me because that’s where a discussion of the New England Journal of Medicine spills right over into libertarian concerns.


Related Shows: • host of The Bob Zadek Show on 860AM – The Answer.