Is Medical Academia repeating Academia’s history? In a recent essay in a small-circulation, specialized periodical, Academic Questions, Prof. John M. Ellis, emeritus Professor of Literature at the University of California, Santa Cruz, recounts the past 4-5 decades of changes in liberal arts departments in US colleges. (How Preferences Have Corrupted Higher Education, Acad Quest, 2008; 21(2):265-274) One modern academic controversy not needing recounting is the takeover of liberal arts departments by post-modernist theology and the partial takeover of universities themselves by radical politics dating from the 1960s. But as recounted by Prof. Ellis, the fifty-year metamorphosis has not only changed universities, but has produced a branching network of intended and unintended consequences.
We have noted before that medicine is both a science and a practice that reflects current social attitudes and mores. (I minimize the aliquot of art, persisting from prior centuries; cultural influences being a more accurate term.) But the changes in universities now reflect in the normative thinking and mores of the modern medical school – at least a nucleus of them. Thus Dr. Ellis’s observations may be a metaphor or template for a medicine of the next several decades.
Medicine’s cultural roots anchor in recent as well as distant history. In the distant past, pre-scientific medicine was based in Greek philosophies and proto-religions with concepts such as miasms, humours, opposites, balances, and ideas of reference and similars. Recent influences include the Soviet –Marxist based Lysenkoist theories that set back Russian genetics for decades, the People’s Republic of China’s politicization of traditional Chinese medicine, and of course the racial theories of the 1930s that justified brutal practices in Axis-occupied Europe. Today’s American pluralistic system of private, group, and public care systems reflects the heterogeneity and conflicts of American political thought. Prof. Ellis now documents a trail of developments in universities, set in motion by a beneficent but planned social movement - racial and ethnic preferential admissions policies to aid social and economic mobility - in the cause of a better society, free and egalitarian.
Yet the trail has left a network of forks and alleyways of consequences. In this segment I want to outline the academic community’s trail as recorded by Dr. Ellis. Readers can use their imaginations in drawing correlations to today’s climates in many medical schools. The two sets are not identical. Different mechanisms and motivations drive the two sets of changes. Overlapping areas are only partial and others may seem unrelated. But there is enough similarity to take away some lessons and to stimulate thought. The main lesson is not to oppose movement toward equality and fairness, but to try to predict consequences and dangers of manipulating normalized social structures.
Dr. Ellis outlines the following steps. Numbering is mine but the sequence is Dr. Ellis’s. Direct quotes are in italics.
1. This story of the series of changes initiated by [admission and hiring by minority] preferences begins in the 1970s, as pressure slowly grew for colleges and universities to admit more minority and women students, and to hire more minority and women faculty.
2. Soon this pressure became intense, and every new faculty appointment was expected to help increase the numbers of minority and women faculty. Many departments began to do what was expected of them, and in the humanities and social sciences almost all did.
3. Implementing the concept of diversity led to use of diversity as the primary selection indicator for applicants.
4. Once a significant or “critical” level of like-thinking faculty was reached, political belief replaced academic curiosity, imagination, and excellence as primary qualification. And so we now have the first major unintended consequence of preferences in faculty hiring: as the number of these new appointees mounted, the entire political complexion of the faculty was slowly tilted, not to the left, but to the radical left.
5.When the nucleus of new faculty feel constrained by policies of their departments, accordingly they soon press for new departments of their own where they will make their own rules—not academic ones. New departments of women’s studies, black studies, ethnic studies, and others like them soon arise.
6. New departments needed additional faculty to staff them, which meant still more political radicals added to the faculty, and ever greater campus influence for radicalism.
7. Even so, they were still very far from a majority, and so one might have expected their influence to be limited, especially since they were out of step with the values of the rest of the academy. But in point of fact that was precisely why they were so effective. Their behavior was so unlike that of academics that administrations and faculty alike were completely unprepared for dealing with them.
8. The unintended consequences of preferences had now developed through the initial stage of simply more radicalism on campus, on to separate radical departments and finally to major radical influence on campus—which meant that something that was completely out of step with the core values of academic life had now gained considerable influence over it.
9. Another major unintended consequence of preferences is a transformation of college administration. If you were to examine any speech made by a university president forty years ago, you would find that the word “Excellence” occurs with great frequency. That concept was the guiding light of the academy. If you made the same examination now, you’d find that the word “Diversity” has taken its place. That change has altered both the relationship between administration and faculty, and the pecking order within the faculty.
10. The obstacle to real educational progress for minorities that now surfaced had its roots in the fact that political radicals don’t look at the past and see accumulated knowledge and wisdom, nor do they look at their society with respect for its institutions and achievements. Their natural instinct is to denigrate society as it is and has been, in order to make the case for the sweeping social change that they think is necessary.
Substitute medical school models for the academic ones and one can see the similarities. Dr. Ellis was not writing about radical politics replacing a dominant political belief system, but of replacing an academic tradition that led to the Enlightenment, political advancement, the rise of reason and science, and evolution of functioning democracy with individual freedom. Now, if a reader were to substitute for “radicals,” terms like “CAM advocates” or “Integrative medicine,” and substitute an intention to change medicine to “more holistic,” to “humanize,” to “become more humanitarian and subjective,” and to “be less removed, cold, unreachable,” it’s like using an overlay map. Perhaps there is less to expand on than I thought might be necessary, because most people will have gotten it. We are in the early to middle phases of a “quiet revolution” leading to a wholesale change of what it means to be a physician, what the practice of medicine is, what evidence and proof are (see Steve Novella’s post of yesterday) and what the roles of rationality and science are.
One can anticipate a clanging of politically-inspired expletives and ad hominem accusations by some who might want to accuse such thinking as right-wingism. Yet the issue is real – is how direct political action in the name of ideological principles have the potential for repelling intellectual and rational advances. Recounting the rise of “CAM” observed through this historical lens will be not only obvious, but I hope enlightening, and a warning.