Commercialism versus professionalism.

John McArthur, DBA, of the Harvard Business School and Francis Moore, MD, of the Harvard Medical School point out that:

There are two contrasting streams, two distinct cultural traditions, for providing services in the United States: the commercial and the professional. While these two traditions stand in sharp contrast to each other, they have shared a central role in the evolution of our society and its institutions. It is our purpose here to explore threats to the quality and scope of medical care that arise when the tradition of medical professionalism is overtaken (emphasis added) by the commercial ethic and by corporations seeking profit for investors from the clinical care of the sick.(1)

The differences between the cultures of commerce and professionalism is at the heart of the problems disrupting managed care today; and, as shall be shown below, involve the same principles that divide quackery and standard medicine. An editorial in the same issue of JAMA makes our point:

The American Medical Association (AMA) [was] formed in 1847 for the purpose of setting up a code of ethics and distinguishing between physicians and quacks.

Professional medical goals can be protected only if they are well understood.(2)

The Culture of Professionalism. Professionalism is rooted in principles established by Hippocrates, the "father of medical science." Hippocrates coined the term "physician" from physikos, Greek for "nature," to denote that health and disease are natural, not supernatural, processes. The notion that healers possess supernatural powers (eg, faith healing, Therapeutic Touch, animal magnetism) lingers in the minds of many people, and is also seen in the messianic charisma of egomaniacal quacks. Hippocrates told physicians to stop taking credit for their cures, the body has its own inherent healing capabilities; therefore, post hoc ergo propter hoc ("after it, therefore, because of it") was faulty logic. The best that can be done is to aid these, and the worst that can be done is to impede these self-healing processes--primum non nocere, "above all, do no harm." Further, because of the body's inherent healing ability, a physician could not know whether a remedy or nature brought about a cure; therefore, physicians could only learn what remedies do not work when a patient did not recover. The idea of learning mainly from failures also underlies the reality that science is better at finding what does not work than it is at making medical breakthroughs. Hippocrates urged physicians to seek out new remedies, but to be …