The Last Craft Guild
Why the medical profession will change beyond recognition over the next fifty years
One of the lovely things about ignorance is that it permits one to hold incoherent beliefs without suffering any mental discomfort. Perhaps that’s why blissful ignorance is such a dominant feature of our species. One of my personal favorite examples of blissful ignorance is delivered by the predictable anti-capitalism/anti-globalization protests that are almost always part of the peripheral theatrics accompanying G7 meetings and other similar gatherings of the supposed great and good.
These theatrical fringe moments comprise earnest middle-class protestors gathering to express their outrage at the evils of capitalism and globalization while stroking their smartphones and wearing their modestly-priced garments — both of which are 100% the products of capitalism and globalization. Then they return to their comfortable homes where they eat food that is the product of capitalism and globalization and watch entertainments that are likewise the product of the forces they’ve just been decrying. And their resulting ill-health from over-eating is palliated by medicines that are totally reliant on capitalism and global supply chains.
Thanks to impenetrable ignorance, our middle-class purveyors of outrage are utterly unaware of how silly they are being. Fortunately for their continued enjoyment of food, clothes, medicines, and toys, the world mostly ignores them.
If our pampered middle-class agents of faux discontent were to pause for a moment or two and make an effort to learn a little history and a little economics, they might discover something rather interesting.
As the Agricultural Revolution proceeded from its modest beginnings around eleven thousand years ago, specialization increased as hamlets grew into villages, villages grew into towns, and towns grew into cities. With specialization came protectionism. If one were making a decent living being a potter, the last thing one wanted was for more potters to appear on the scene and undercut one’s prices. And so craft guilds emerged to control the supply of craftspeople and thereby maintain prices at a higher level than would otherwise be the case.
And for thousands of years, life was good for guild-members and customers had no choice but to pay whatever prices the guilds chose to establish.
But then, like a naughty sprite in a children’s tale, the Industrial Revolution began to take hold. Slowly but surely, machines began to perform the tasks formerly the preserve of the craft guilds. Not surprisingly this led to a great deal of unhappiness among those whose livelihoods were assured by the monopolies enforced by the guilds. Ned Ludd was supposedly a young weaver who felt so threatened by the advent of mechanical looms that he tried to hold back the future by destroying them, hence (in Britain if not in the USA) the word Luddite to denote someone clinging futilely to outmoded ways. We also have the word sabotage in our vocabulary, originating from the practice of working as slowly as possible so as to reduce the output of machines and thus impede the fruits of invention. (French workers typically wore wooden shoes called sabots; walking slowly en mass thus resulted in a clattering clacking noise).
Despite all the best efforts of those whose livelihoods were brought to an end by mechanization, the future marched relentlessly on and the general population benefited immensely. Today we live in a world where we don’t need to patch and re-patch and re-re-patch clothes because we can afford only one or two pairs of pants and a single coat for all seasons. We have in our wardrobes a range and variety of clothing hitherto unimaginable except for the very wealthy. When we want to travel we do so in affordable automobiles that are luxurious beyond the reach of even emperors and kings a mere hundred and twenty years ago. The list of examples is endless. For all that well-fed and well-clothed lefty-trendy types wail about the supposed evils of capitalism the reality is that it has delivered unto ordinary people the world over a standard of living that has never before in human history been known — and life expectancy figures show this unambiguously. In 1800 CE in Europe, life expectancy was between 30 and 40 years depending on location and occupation. In 2000 CE in Europe, life expectancy was 77 years.
Of course this is not to claim, as Voltaire’s Doctor Pangloss no doubt would, that all is for the best in this best of all possible worlds. People are people and thus exploitation and sharp practices will always be with us. Political systems, being malformed and full of people, are always wide open to bribery, corruption, and intentional discrimination. But the problems arise from people being people, not because capitalism is uniquely evil. Indeed, it’s easy to argue the opposite: that capitalism has delivered astonishing benefits despite the fact people are always being people. The simple fact is that for all its many faults, the market economy has delivered more equity for more people than any other system ever attempted.
This is not, however, an essay on capitalism or on market economies (which are totally separate even though ignorant people always conflate the two). Rather, it is an essay on the impact of market economies on cozy craft guilds.
We no longer have to pay exorbitant prices for woven garments and so we have a wide variety of such garments in our homes. Thousands of weavers and tailors lost their jobs but millions of ordinary people benefited as a result. We no longer have to accept expensive hovels because stonemasons yielded to mass-produced brick and jobbing builders. One by one the craft guilds vanished or morphed into theatrical remnants devoid of substance. There are still masons today, but none have stone-dust under their fingernails. They play-act in private, the guild having transformed itself into self-indulgent make-believe suitable for grown children of all ages.
Today there are very few craft guilds that remain to exploit the general population. Bankers and doctors still cling on, but even these last cartels are slowly being hollowed out by modern technologies. Across the world, banks are being replaced by smartphone applications. In the West the banks are fighting a rearguard action but the direction is clear: within thirty years the high street bank will be merely a memory and ordinary people will have access to a much wider range of services at a much lower cost.
Doctors will be one of the last crafts guild to disappear, but just like bankers they too will fade from history in due course — and everyone will benefit as a result.
Doctors individually are in general well-meaning people, just as were most stonemasons and weavers and potters and blacksmiths. The problems arise from the fact they comprise a craft guild. This means their education is hopelessly antiquated relative to modern requirements and their craft practices are detrimental to their patients. The hard fact is that the world over, doctors are still trained in a medieval curriculum that relies on diagnosis of overt symptoms — an approach hopelessly out-of-touch with the fact today 90% of people suffer from chronic, not acute, ailments.
Furthermore the assumption of superiority over the patient and an approach that regards people merely as collections of symptoms means that essential collaboration between doctor and patient is rare indeed. Worse still, doctors know nearly nothing of health; they define health as “an absence of disease-indicating symptoms.”
While ordinary people who watch far too much television imagine doctors to be angels of life, saving victims with telegenic techniques and infallible diagnoses, the reality is quite different. Thirty percent of hospital deaths are due to adverse drug-drug interactions arising from the refusal of doctors to countenance electronic systems that would automatically detect such problems. Doctors routinely perform harmful operations because other doctors perform them too. Removal of tonsils and adenoids is still common in the USA, which is akin to sawing off a broken leg rather than putting it in a cast to heal. The USA has the world’s highest rate of C-section thanks to practices that as a matter of routine put the mother and baby’s lives in danger and then create a medical emergency that is resolved by the doctor “saving” mother and baby by slicing mother open. In the USA doctors routinely cut off the foreskins of male babies despite there being ample evidence to show this is (a) unnecessary, and (b) harmful to the boys concerned.
Doctors also leave instruments in patients or remove the wrong body-part because they refuse to use checklists as a normal part of surgery. Any attempt to improve outcomes by means of techniques and tools well-proven in other walks of life is resisted by doctors because it would seem to reduce their mystique and position-power. By handing out antibiotics as magic-pills, doctors ensured the development of drug-resistant bacteria. And most recently it’s now accepted that doctors massively inflated the initial death toll from SARS-COV2 by forcing patients into induced coma and artificial ventilation and thereby killing 90% — 95% of all those thus treated. And in a great many countries doctors can legally refuse to let patients see their own medical history, thus precluding any opportunity to rectify errors or develop a better perspective on their own health. This conveniently enables doctors to avoid their mistakes becoming known.
In short, doctors are just people like the rest of us. But unlike the rest of us they remain firmly ensconced within a protective craft guild than enables them to continue to perform poorly decade after decade. In fact, all the advances in life expectancy over the last century have resulted from improvements in hygiene, diet, and pharmacology. Not a single year has been added to average life expectancy due to improvements in doctor performance.
It is easy to see, therefore, that we are on the brink of huge improvements in the ways in which we establish and maintain individual health. All over the world the obesity epidemic is causing enormous — and enormously expensive — health problems. This is one obvious and easy challenge that the current craft guild system is wholly incapable of tackling yet will yield incalculable benefits once properly addressed. There are other benefits that are as yet unthought-of but which will automatically arise as we restructure the way we think about providing health services.
And that term “health services” is very revealing: today we have sickness-treatment services. Nowhere in the world is anything more than lip-service paid to health. Doctors know nothing about health because their entire training is focused on disease. The fruits of scientific empiricism have left the craft guild of the medical profession largely untouched. There is clearly a chasm between society’s needs and the guild’s ability to deliver what is required.
And thus we can see that things are about to change in a very big way indeed.
Of course change will be resisted. Doctors and their associations will fight fiercely to defend their privileges, dressed up as “protecting patients from unproven approaches that could jeopardize lives.” But just as bankers are slowly fading away despite their ability to channel billions of dollars into the pockets of always-pliable politicians, so too will the medical craft guild slowly fade away to be replaced by something far more fit for purpose.
And everyone will benefit, as everyone always benefits from the disappearance of craft guilds. Because the very purpose of a guild is to enhance the lives of its members at the expense of everyone else. No matter how it is dressed up (“maintaining quality and standards” “ensuring superior products” “we’ve always done it this way” “it would be very unsafe and unwise to change the way we do things” “we have a proven system”) the essence of a craft guild is protectionism.
It’s easy to weep for the countable jobs lost due to change. The many more new jobs that will be created can’t be counted yet, and we humans are hardwired to fear loss more than we value gain. But slowly and surely the market economy has eaten away at monopolies and guilds until today there are only two major examples remaining.
Banks are falling. The medical profession will soon feel the waters of change lapping around its ankles. And that will be, for the rest of us, a very good thing indeed.
After that, let’s see what we can do about lawyers….