Michael Senior

SOSC 12200/28 Kareem Rabie

Good news! Its cancer:

The betrayal of core values within the modern healthcare industry
Prompt 4
Freud believed he could cure neurosis, and thus bring a patient back to a
normal condition. How does our model of health or normalcy differ now?
Use Dumit, Fanon, or Butler to critically assess Freuds notions of health
or normalcy and sickness on both the individual and social scales. What
sense or logics are at work?
Beginning in the 1960s, the empowerment of the post-war
pharmaceutical industry caused a dramatic shift within the healthcare
system in America, specifically in the production, marketing and sale of
prescription-only drugs. Freud, a contemporary of this transitional period,
provides significant insight into social opinion towards healthcare as the
shift was unfolding, highlighting the total overhaul of the pre-twentieth
century system which resulted in modern medicinal practice. In tracing
the development of the healthcare system into its current form, we will
uncover significant problems with the dominance of healthcare by a profitdriven industry, and reveal uncomfortable explanations for specific
changes made in the types and targeting of drugs beginning in the late
twentieth century.
Before the twentieth century, the healthcare system was an entirely
corrective institution an individual would report a concerning symptom
or illness to their doctor, and they would (ideally) be prescribed some form
of medication with the ultimate aim of complete cure and a termination of
the treatment process. This idea of total curability, and the identification
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of illnesses as merely temporary interruptions (Dumit, 2012, p.6), is

certainly reflected in Freuds belief that neuroses are in principle curable
(Freud, 1966, p.568) through the unconventional, but nevertheless
corrective, method of psycho-analysis. However, Freud moves away from
the conventional characterisation of humans as inherently healthy
(Dumit, 2012, p.6) - his description of a healthy person as virtually a
neurotic (Freud, 1966, p.568), with those that require treatment simply
people who exhibit to us in a magnified and coarsened form (Freud,
1966, p.420) the repressed thoughts and experiences which stem from a
path of development (Freud, 1966, p.420) identical to that of people
who are normal today (Freud, 1966, p.420), suggests a universal illness
within all humans. Freuds notion of an inherent human illness foresees
the modern shift in focus of medicine from curability to preventability, and
the explosion of treatments that reduce risk (Dumit, 2012, p.7), factors
of which all of us are affected (Dumit, 2012, p.7) by. Freuds particular
notions of health and normalcy, then, reflect the colossal shift in the
basic paradigm of health and disease (Dumit, 2012, p.6) which occurred
in the 1960s concurrently with the release of his 1966 Introductory
Lectures on Psycho-analysis.
In Drugs for Life, Joseph Dumit characterises this historical transition
in the functioning and focus of medicine as a paradigm shift (Dumit,
2012, p.6). First coined by Thomas Kuhn in The Structure of Scientific
Revolutions, originally released just four years before Freuds Introductory
Lectures, the term refers to the total overhaul in the contemporary
worldview in which the entire methodology of a particular community is
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grounded, and occurs when an existing paradigm has ceased to function

adequately (Kuhn, 1970, p.11). The use of this particular terminology by
Dumit emphasises the total incompatibility between the corrective goals
of pre-twentieth century medicine and the profit prioritisation of the
pharmaceutical industry which redirected medicinal production in the
1960s. The transition to preventive medicine during this time period, as I
will discuss later, aligned drug production with the financial goals of
pharmaceutical companies, but also brought about a movement towards a
mass health model (Dumit, 2012, p.8) in which diverse groups of people
are grouped into relative categories (Dumit, 2012, p.13) for the more
efficient and widespread advertisement and distribution of long term
drugs, as opposed to the previously prominent individual health model
(Dumit, 2012, p.8) which relied on prescribed corrective medicine to
counteract individually reported symptoms or illnesses which interrupt
the patients life and drive him or her to the doctor (Dumit, 2012, p.8).
Fundamentally, the post-war pharmaceutical industry inherited dominance
over an economically inefficient product, and significantly adjusted the
healthcare system into one driven by market forces (Dumit, 2012, p.9)
in order to maintain the growth in revenue that shareholders demand
(Dumit, 2012, p.200) prioritising profits over health (Dumit, 2012, p.6)
and sacrificing wellbeing of the patient for that of the investor.
As the title of Joseph Dumits text suggests, the post-war
pharmaceutical industry played a defining role in the redefinition of our
notion of health, losing no time in imagining mass markets for drugs
(Dumit, 2012, p.5) to achieve the ultimate goal of any capitalist
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corporation in the healthcare industry make money by selling

medicines (Dumit, 2012, p.5). In The Condition of Postmodernity, David
Harvey summarises a key goal of an efficient and effective company in a
capitalist market accelerating turnover time in production and
consumption (Harvey, 1990, p.156), and it is clear to see how the
comprehensive paradigm shift which occurred in healthcare in the 1960s
can be attributed to the pharmaceutical companies general desire to
achieve this. The concept of a risk factor was introduced to the general
population, and led to the redefinition of health as a reduction in risk
(Dumit, 2012, p.12) rather than the absence of an actual illness or
disease. The way in which the pharmaceutical industry used clinical trials,
deliberately defined as broadly as possible (Dumit, 2012, p.16), to
support the notion that risks are conditions that must be treated now
with drugs (Dumit, 2012, p.16) was a magnificent way of expanding the
market (Dumit, 2012, p.16) of drug consumers to extend to the entire
American populace treatments that reduce risk ostensibly could be
indicated for all of us since we are all at risk for most diseases (Dumit,
2012, p.7). Furthermore, the desire for instantaneous turnover time
(Harvey, 1990, p.157) led to a focus on chronic treatments (Dumit,
2012, p.5) in order to solidify a repetitive, continuous income stream
through consumers stay[ing] on their medication as long as possible
(Dumit, 2012, p.6), whilst Dumit also notes that there are almost no
studies that help people or their doctors know when to stop taking a drug
(Dumit, 2012, p.10), which undoubtedly contributes to many patients
continuing to take medication for life (Dumit, 2012, p.8) with no
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discernible effect (Dumit, 2012, p.8). In addition, medicinal patents,

which generally last seven to ten years (Dumit, 2012, p.212), mean that
upon expiration a drug goes immediately from being a profit centre for
the company to the companys worst enemy (Dumit, 2012, p.212) the
company must make improvements for the next generation of the drug,
which often results in companies deliberately doing so incrementally,
producing the most ineffective, effective drug (Dumit, 2012, p.207)
possible and regularly resupplying the market with a newer, more
desirable but essentially unchanged version of the original product to
increase consumption. Despite all these tactics being employed solely for
gains in profit, the pharmaceutical industry has been so immensely
successful due to scientific support from clinical trials modern medicine
relies on statistics (Dumit, 2012, p.4), and whilst preventive drugs may
be deliberately withheld from their true potential, their scientific validity
and support is undisputable mass health is both true and absurd at the
same time (Dumit, 2012, p.15).
When it comes to the transaction of drugs between the producer
and the consumer, it must be initiated by the patient an individual must
be fairly confident that they are in need of a drug, and visit their doctor,
before they can gain access to prescribed medicine produced by
pharmaceutical companies. The pharmaceutical industry employs a threefold approach in order to achieve this - in addition to the expansion of the
consumer market and the use of clinical trials as a scientific basis for drug
production, there is a significant amount of direct advertising employed by
pharmaceutical companies that reaffirms the modern health paradigm.
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Usually, these campaigns exploit the anxieties we feel about our health
(Dumit, 2012, p.3) and use fear as a tactic to encourage audience action.
Dumit showcases a particularly striking example of an anxiety based
pharmaceutical advertisement emphasising a particular disease which
has no symptoms (Dumit, 2012, fig.1) and featuring a healthy looking
model which, as Dumit notes, appears to suggest that feeling healthy has
become a sign that you need to be careful and go in for screening
(Dumit, 2012, p.1). Constant streams of information, based on new
scientific findings (Dumit, 2012, p.3), regularly give the audiences a new
risk factor to worry about, and invoke the feeling that a lack of action
would be irresponsible (Dumit, 2012, p.1). Pharmaceutical advertising
and marketing campaigns have been extremely successful in evoking
insecurity within perceived normality, distancing the very definition of
health from what is considered normal, and have achieved rapidly
increasing levels of drug consumption through the advertisement of risk
factors and their associated preventive medications.
Described by Dumit as the gatekeepers to this market [of drugs]
(Dumit, 2012, p.5), it is interesting to discuss how the role of Doctors have
changed throughout this medicinal paradigm shift. It would seem that the
system itself has not directly altered the role of the Doctor, but the
cultural shift in attitudes towards healthcare amongst the general
populace, as a secondary effect of the paradigm shift, has led to the total
disempowerment of the doctor (Dumit, 2012, p.14). The detailed,
informational advertising campaigns employed by the pharmaceutical
industry result in the patient being far more informed upon walking into
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the Doctors office. In the past, a patient would complain of a particular

symptom or illness, and the Doctor would make an assessment and
prescribe the appropriate treatment, however it is now common for
patients to have a specific drug in mind (that, perhaps, they saw
advertised on television) and request it outright. This reduces Doctors to
little more than a box-ticker - the doctor does not even diagnose
(Dumit, 2012, p.13), but merely acts as a cog in the pharmaceutical
machine, functioning as the legaliser of the sale of the specific product to
meet the patients specific demands. Doctors themselves undoubtedly still
act in the interests of patient wellbeing, rather than the economic
interests of the pharmaceutical industry, and would have no ethical
objections to prescribing medication that is, after all, clinically supported.
However, given the immense influence the pharmaceutical industry holds
on society through highly abundant and specific advertising, and
assuming advertisements arent misleading, it is likely that the legal
requirement of the doctors signature during the transaction process is the
only thing preventing his job from becoming utterly redundant.
Much of the problematic nature of modern healthcare arises from its
dominance by a capitalist industry, and therefore economic interests. It
would be amiss not to mention socialised healthcare, as employed in
Canada and many European countries, but unfortunately the problems
remain

unresolved.

Multinational

pharmaceutical

companies

and

modern ease of communication has led to the range of ideas and

images in cultural currency (Dumit, 2012, p.21) transcending borders.
A socialised healthcare system itself certainly sounds like a step away
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from the problematic, capitalist system of administration, but it has

always been the case that research is too expensive for the government
(Dumit, 2012, p.217) and is left to the immensely powerful for-profit
pharmaceutical companies, who ultimately retain their dominance over
drug research, markets and production.
There are certainly remarkable similarities between Freuds notions
of health and normalcy, and those of the contemporary population. Both
parallel normalcy and illness in some form for Freud, a normal human
is inherently ill, having dormant, repressed thoughts and experiences
which only sometimes develop into external symptoms and behaviour. For
contemporary healthcare, the human body is also inherently ill, but this
has been defined by a reformulation of risk factors to be seen as
illnesses themselves. What is more concerning are the differences Freud
is very much a believer in corrective, individualised treatment in order to
cure the patient and terminate treatment, which is totally incompatible
with the modern industrial agenda of pharmaceuticals, which prioritises an
increase in revenue and the prolonging of drug consumption and actively
discourages

any

form

of

corrective

medication

which

ultimately

terminates consumption and companies income streams. Whilst modern

drugs do work, there may well be unexplored, better alternatives which
are ignored because, despite being in the interests of the population, they
are not in the financial interests of the pharmaceutical industry why
would a pharmaceutical company invest in the search for the elusive cure
for cancer, when they can continue to charge patients up to $2000 per
month (Mesothelioma Centre, 2016) for a prolonged course of radiation
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therapy? The findings of Dumit are frightening whilst general opinion

towards the healthcare industry is positive, this is down to an unwarranted
assumption that it still works in the public interest. In reality, the entire
industry is profit-driven, and suppresses the production and distribution of
absolute treatments, like those previously developed for smallpox and
polio, in an entirely unethical fashion which betrays the core values of
what healthcare was built upon - for the healthcare industry, the total
paradigm shift in their mode of operation has ultimately brought about
the loss of their souls (Dumit, 2012, p.210).
Michael Senior
Works and Sources Cited
Dumit, J. Drugs for Life: How Pharmaceutical Companies Define Our
Health. Durham, NC: Duke University Press, 2012. Print.

Freud, S. Introductory Lectures on Psycho-Analysis. New York, NY: Norton,

1966. Print.

Kuhn, T. The Structure of Scientific Revolutions. Chicago, IL: University of

Chicago Press, 1970. Print.

Harvey, D. The Condition of Postmodernity: An Enquiry into the Origins of

Cultural Change. Oxford, England: Blackwell, 1990. Print.

The Mesothelioma Centre. Costs of Chemotherapy & other Mesothelioma

treatments. 2016. Web. <
http://www.asbestos.com/treatment/expenses.php>

Michael Senior

SOSC 12200/28 Kareem Rabie

In science, when human behaviour enters the equation, things go

nonlinear. That's why Physics is easy and Sociology is hard. Neil
deGrasse Tyson

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