Dr. Miguel A. Faria, Jr., who is a consultant neurosurgeon, Adjunct Professor of Medical History (1993-1996) at Mercer University School of Medicine, and editor-in-chief of the Medical Sentinel of the Association of American Physicians and Surgeons, has combined astute political insight with his encyclopedic knowledge of history to create this unique blend of historical perspective and political commentary, with its emphasis on the history of medicine and medical ethics.
The book is divided into the following seven sections: Antiquity, Greece, Rome, Graeco-Roman medicine, Graeco-Roman medical ethics and intimations for the present, Middle Ages, and the Renaissance. The numerous sources he uses include the Edwin Smith Papyrus (the first medical book), the Ebers Papyrus, the Code of Hammurabi; Homer's The Iliad, and the writings of Herodotus, Socrates, Plato, Aristotle, Hippocrates, Celsus, Galen, Maimonides, Paracelsus, Vesalius, Paré, and Harvey.
The author points out that medical ethics dates back to the 8th Century B.C., with descriptions found in Homer's The Iliad, Herodotus' Accounts of the Persian Wars, the Pythagorean Principles, and Hippocrates' Corpus Hippocraticum. The oldest ethical theory is virtue-based and emphasizes the professional individuality of the physician rather than the resolution of every complex ethical dilemma. It takes into account the humanity of both the physician and patient, and the special kind of human relationship which binds the two. This relationship depends largely on the character, trust-worthiness, moral sensitivity, and resources of the physician, with the physician serving beyond self-interest.1
The author then relates how, in recent years, this rich ethical heritage has been lost, as well as our priceless dual legacy of Graeco-Roman humanism and Judeo-Christian culture, so that today, we face many of the same problems that preceded the decline and fall of the Roman Empire. Examples include class warfare (which was an important cause of the civil war in the late Roman Republic), mis-guided economic policies, increased central bureaucracy, numerous government subsidies and entitlements, the use of "practice parameters," to limit treatment for the sake of cost reductions, the indiscriminate collection of "data" to evaluate the cost-effectiveness of care, and the use of dubious clinical outcomes to document patient satisfaction. As the author emphasizes, this data collection will "give the state the power to call doctors 'guilty' whenever it likes," or "satisfy the bureaucrats in search of fulfillment of their government-assigned quotas of provider-victims."2 Especially disconcerting are the government's blacklisting of physicians through the National Practitioners Data Bank, and the unconstitutional use of the "Orwellian" fourth branch of government known as administrative law. Dr. Faria describes the "litigation juggernaut" as an important threat to property, individual liberty, and our constitutional government itself, and points out that if not stopped, it surely will destroy the patient-doctor relationship.3
The author notes medicine today is criticized by health care "experts" who are "statist bureaucrats...[whose] prime motivation is simply camouflaged self-interest...." Also, many of our medical ethicists are not practicing physicians or even medical doctors, yet feel qualified to tell us what is wrong with the practice of medicine.4 In addition, our citizens seek perpetual youth and perfect health without accepting the responsibility for their self-destructive behavior and unhealthy lifestyles, even though the responsibility of the patient to make his own health care decisions dates back to Graeco-Roman times.
Finally, several other problems are discussed with unusual insight, including the Soviet Code of Medical Ethics, the underlying egalitarian ethics of the legal profession, (which has "made fortunes for the litigators, [causing] the erosion of moral values and the corruption of ethics in the legal profession"), and the nuances and decrees of the state socialism found in Cuba, Nicaragua, Great Britain, France, Canada, and the Netherlands.5
The most important reason to study the past is to attempt to foretell the future. Dr. Faria maintains the study of recorded history warns we should reject the "egalitarian socialist ethos of [our] entrenched political establishment" and instead adopt an objective philosophy which embraces enlightened self-interest, private charity, and individual responsibility.6 He suggests that Medical Savings Accounts (MSAs) will empower patients instead of government and third-parties, and are the key to allow correction of our own government-created health care problems without the use of coercion and rationing.
Vandals at the Gates of Medicine is perhaps the most impressive book on health care reform to be published in recent years, a priceless treasure of lessons to be found in our past. A major disadvantage for many readers will be its historical detail. Its unique importance for health care professionals, business executives, politicians, and interested patients, is its emphasis on the development of medical ethics and the importance of ethics in today's health care reform debate.
Reviewed by Jerome C. Arnett, Jr., MD, FCCP, Elkins, West Virginia.
1. Faria MA Jr. Vandals at the Gates of Medicine: Historic Perspectives
on the Battle Over Health Care Reform, Macon, Ga., Hacienda Publishing,
Inc., 1995, p. 214.
2. Ibid., p. 226.
3. Ibid., p. 143.
4. Ibid., p. 222.
5. Ibid., p. 240.
6. Ibid., p. 224.
Reprinted with permission from the Medical Sentinel, Fall 1996 - Vol. 1, No. 3 , pp. 35-36. Copyright © 1996, Association of American Physicians and Surgeons.