> No of course not. The point is the capitalism kills twice over.
I'm sorry; I may be very dense, but I don't quite understand this. How can someone be killed twice?
> Actually what I was trying to illustrate was the transformation of
> skilled labor into devices and proceedures that require less labor,
> and therefore less dependence on that labor---and therefore more
> easily extracted profits or efficiencies by other means, and not
> necessarily less `cost'. All the same sorts of processes and wars of
> advance capitalism are carried out inside the medical world, just as
> they are outside.
Sure, they are. The whole system affects every industry within it. But the tendency you point out is counterbalanced by opposing tendencies, just as tendencies in the whole capitalist system oppose each other. I.e., there are therapies which require more labor, and in fact there is a school of medical thought, which I think is rather commendable, which says that doctors, nurses, etc., need to spend more, rather than less, time with patients. The "barefoot doctor" sort of idea. If the demand for such care rises, that would be such an opposing tendency.
> Again the point was to illustrate various kinds of transformations
> that are installed under progress and efficiencies, but these are
> progress and efficiency in the narrow business sense, rather than in
> the larger social and medical sense. Waste is obviously in the eye of
> the beholder.
Not entirely. For example, what about the stories of unnecessary tests and procedures ordered to provide defenses for possible future malpractice suits, not for medical necessity? Some of these stories are probably myths, but I'm sure that a lot of resources in the medical system could be redirected to treat poor people who aren't getting treated. I would call that waste.
> One thing about advanced
> western medicine is its emphasis on acute conditions and a relatively
> disinterest in the chronic conditions.
Not necessarily true, again. I happen to be a type 2 diabetic, which is a chronic condition which gets a heck of a lot of attention by advanced western medicine.
> This is almost the reverse
> emphasis of various non-western traditional medicine practices which
> tend to treat chronic conditions and more or less flounder on acute
> cases like infections, severe wounds, and so forth.
It floundered with diabetes, too. It didn't have any effective treatment, as far as I know, until western medicine discovered the importance of blood sugar and insulin. Diabetics just got worse and died.
> On the other hand, most of the world would probably be able to provide
> more care for less if they followed older western systems, since these
> are more labor intensive and don't require the high and continuing
> cost of disposables. However a lot these older systems depend on the
> kind of industrialization that many areas lack, so they go immediately
> to imported disposables since they don't have the underlying
> infrastructure to develop and build the older versions. Still it seems
> to me to make more sense to import large autoclaves and other
> equipment than get trapped into buying the more immediately useful
> disposables.
Good idea -- a kind of Illich idea of appropriate technology. It might be that a "socialist" system would provide it better than the capitalist system, which gets under the thumb of the most powerful corporations.
Jon Johanning // jjohanning at igc.org __________________________________ Had I been present at the Creation, I would have given some useful hints for the better ordering of the universe. -- Attr. to Alfonso the Wise, King of Castile