Complacency in the Medical-Industrial Complex

Science is no longer a game of lab mice and test tubes. 
Long gone are the days of scientists only locked up in labs, secluded from everything but their microscopes and calculators. Now, more than ever, scientists find themselves writing reports and grant proposals, managing jobs, sitting on committees, and delivering lectures.

Scientists work in issues at the forefront of policy, ethics, law, and other areas of society. Though these duties may be as fluid as viscous liquid or as dynamic as biological evolution, scientists and non-scientists alike struggle everyday with understanding science’s role in society.

When Lisa M. Lee, Executive Director for the Study of Bioethical Issues, gave her talk “Handling Obstacles to Ethics in Public Health,” she spoke to an audience of professors, physicians, and other professionals about the current state of affairs in public health ethics and bioethics. She spoke from her background in bioethics, including her work in public health surveillance and privacy. But, as I sat in the front row of the lecture hall, I couldn’t help but wonder, if scientists have expanded their roles in other areas, why was there still such a huge gap between science and policy?

No matter whether you're a physicist or a lawyer, we’ve taught ourselves to be complacent. With the slow death of the liberal arts education and the reduction of college down to a means to manufacture employees, students have anguished over how to get into medical school or make a successful living in the future, but forgotten about the important values of humanism necessary for personal growth. We need to encourage science as a way to seek the truth, of both the economy and virtues. No doubt, science should make money, but it should also teach us values such as wonder, curiosity, and humility in the world.

Dr. Lee suggested requiring ethics training programs for graduate students. I was dubious of this solution because, while it may help students understand ethics, a requirement can only do so much to foster curiosity and humanism before encouraging complacency and discouraging innovation.

Students who aspire to become physicians suffer from this complacency. As pre-medical undergraduates, we have long paths in front of us before becoming a practicing physician. We spend four years taking courses like organic chemistry, physics, and biology while completing the Medical College Admissions Test (MCAT). Our required courses are rigid, standardized, and structured upon what the officials dictate to be important. As we sit in crowded lecture halls, hoping for a good grade or a recommendation letter, our pre-medical overlords teach what's going to be on the exam, nothing more and nothing less. Along the way, we volunteer, shadow, and engage in extracurriculars before entering a four-year medical school program. After that, we have residency and training before becoming a fully-practicing physician. With such a long, stringent path, it’s easy to forget about what’s really important and how to “live in the moment.” Instead, we succumb to utilitarian, consumeristic motives as we value information over wisdom, marketability over authenticity, and dogmatism over free thought. And, when we aren’t prepared for the future, the “Medical-Industrial Complex,” as Dr. Lee puts it, thrives.

Compare the path to becoming a doctor to that of future lawyers, who intern for attorneys as soon as they enter law school. While law students get to see the employable fruits of their efforts almost immediately after college, medical students have to spend much more time preparing before witnessing the value of what they're being taught. It's much more difficult for pre-medical students to truly ponder how their courses will give them benefits in the future, and, especially with stringent and demanding science course-loads, it's easy to lose sight of more valuable goals of methodic inquiry and rationalization in the tense, competitive world of exam scores, GPAs, "informational texts," and oft-repeated "problem-solving skills." And, since most pre-medical students take a large number of science courses, the medical curricula is centered around STEM goals of economic prosperity and political motives.

Pictured: my organic chemistry class.
It might sound absurd to describe the current state of affairs in medicine as a "medical-industrial complex," but it makes much sense in the context of the militarization of education. With the Independent Task Force's "U.S. Education Reform and National Security" in 2012, our education has been structured in the following areas: "economic growth and competitiveness, physical safety, intellectual property, U.S. global awareness, and U.S. unity and cohesion." The highly controversial report has been criticized and praised by professors nationwide, and some, most notably in those in the humanities, have expressed concerns for its methods of re-structuring education. In the report, "What is Education?", Professor of Hebrew and Comparative Literature at Berkeley Robert Alter writes, "Should a teacher’s motives for introducing seventh-graders to science be that she is preparing cadres of future technicians who will be able to design bigger and better defenses against ICBMs?" A future in which students are put in and out of the school-military pipeline is frighteningly grim, and structuring an ethics curriculum would certainly be an effective counter to these woes. And with our war history in Vietnam, Iraq, Afghanistan, and other places, there is a pressing need for us to understand culture, history, language, and other aspects of the human condition in order to address the issues of the future. Sure, we could pump more students into "critical" departments of language and culture based on our political concerns (such as foreign languages of Spanish, Arabic, or Chinese). But, in order to truly address the ethical dilemmas of tomorrow (including political concerns), there must be a change in education that runs much deeper than simply forcing students to take a course in ethics, literature, or history. It must be a change in the way we think about those courses.

In "What is Education?" James Engell, Professor of English and Comparative Literature at Harvard University, writes:
Studies show that in our schools, public or private, student cheating, dishonesty, and plagiarism are on the rise. School administrators in many locations have themselves been caught cheating in order to make the performance of their students look better. Federal and other studies indicate that scientific misconduct and falsification of scientific data are increasing problems. A society without ethical education cannot expect either good government or real security, no matter what shape its laws take or how “reformed” its educational system. The damage done may come slowly but the rot is deeper. The Report says nothing about ethical or moral aspects of education.
Engell continues that these "moral" and "ethical" shortcomings in education have been brought on by a certain "blindness" in accepting results has cost us much in "disease prevention, agricultural production, sustainable resources, and, most troubling, in respect for the procedures and results of science itself." In order to address the ethical issues of tomorrow, we need a fundamental shift in the way we approach our classes to fight the complacency and individual shortcomings that give rise to our blindness. Though Engell isn't a scientist, his concerns for the addressing scientific misconduct come from an appeal to morals and ethics. These moral and ethical considerations come from elements of an education that the humanities emphasize, including the human narrative, critical speculation, heedless skepticism, and empathy. From a more "ethical" look at the world, by emphasizing the education as a humanistic search for truth and justice, we can rise above the typical requirements and capital greed of the militarized education system, whether it's in the sciences or the humanities, and fight the power.

We can only address the ethical issues in science, medicine, and public health through a thorough examination the values we instill in ourselves through education. Those of us who can break from the complacency of everyday life to higher ideals, including courage, justice, and compassion, will be ready to fight the problems of tomorrow.