Friday, October 16, 2015

Podiatrists, Dentists and Public Education

Why are dentists not part of the traditional medical profession? And why are podiatrists separate as well? Why do we have both psychologists and psychiatrists*? Logically, there is no reason for teeth or feet to be treated by someone outside of the medical profession. If anything, due to their utility, hands would seem to demand a different type of doctor. But there are many such oddities, such as why we have ophthalmologists and optometrists. And, when we look into the matter, the simple fact is, there is no real reason, they exist because of historical accident. Dentists were separate from doctors, being part of the barber-surgeon field, and thus were never absorbed into medicine proper. In fact, it is surprising surgeons were, given the Hippocratic hostility to bone setters and "those who cut". In fact, in English practice, there is still a trace of this historical accident, with surgeons being "Mister" rather than "Doctor". However, for the most part, the historical accident separating doctors from surgeons has been eliminated, while the oddity of dentists and doctors being separate has not**.

What is interesting is, while it is perfectly obvious on a bit of reflection that these divisions are justified by little more than historical accident***, very few of us ever consider it, and, if asked, the practitioners of these various professions would argue that the division is perfectly sensible, even justified. Then again, perhaps it is not that surprising. After all, much in our lives is the outcome of little more than historical accident, many of our traditions could have gone a completely different way without doing any harm, and yet we argue for them just as vehemently.

For example, suppose the movement for universal education had not arisen in New England, where the tradition of using the state to resolve personal issues was quite strong ("Ordered Liberty and Our Modern Mindset", "New England Versus Virginia (And Venice, And England, And Rome...)" and "A New View of Liberalism"), suppose it arose in a more "self help" oriented section of the country, say among immigrants in the cities, or backwoodsmen in the Appalachians. Imagine for a moment if, throughout our history, local communities had established charitable funds to build schools, run them through boards of donors, and generally pursued universal education as a social function rather than a government one. Now, imagine if someone in that world had suggested that government should run schools. What would be the response? "You want the people who run the post office to educate our children? The people who mismanage even the most basic functions? Sorry, but that is nonsense. Who would imagine such a thing?"

However, since historical accident tied together education and government****, today, whenever it is proposed to remove government from education, we instead hear the opposite, that to do so would mean only the rich would be educated, that government has to be involved, it is the only option. In short, as with the professions listed above, we cling to our historical accident, arguing it is the only possible way to do things.

I admit, I am as fond of tradition as anyone. I have even argued we should give a slight advantage to tradition for having stood the test of time. ("The Gadarene Swine Fallacy", "The Virtue of Novelty and the Value of Tradition" ,"The Trap of Tradition", "How Fast Things Change", "Culture and Government", "In Defense of Standards" , "Addenda to "In Defense of Standards"" , "O Tempora! O Mores!, or, The High Cost of Supposed Freedom" , "The Problem of Established Perspectives" , "A Bit of Clarification" , "Our Unique Age, A Tempting Falsehood" , "Inversion of Traditional Values", "Conservatism, Incremental Change and Federalism" and"In Praise of Slow Changes") But there is also a good argument that, if tradition is doing harm, or if there is a better solution, simply being tradition is not enough, we must move on and try another answer. And in this case, I think it is clear, the way we are doing things is not ideal.

Nor is this unique to public education, it is simply the easiest example I could find. Countless other topics could face the same argument. So much of what we do, especially what functions we assign to government, are the result of either historical accident or government self-aggrandizement, and yet we have come to believe they can only be performed by the state, that the way things are now is the only possible answer. Perhaps in the future, I will return to this topic, and look at some other examples. Until then, why not take a look around on your own? I am sure you can find a dozen examples without much effort.


* Actually, an even better question is why emotional issues are treated by medical doctors at all? After all, those with a known biological component, dementia and so on, are treated by neurologists, leaving psychiatrists, despite their medical background, still treating what amounts to emotional issues. (I know, I am in a minority for not seeing "mental illness" as analogous -- or even a form of -- to physical ailments -- and sadly Szasz lost a lot of credibility when he allowed Scientology front groups to use him -- but explain to me why, if they are physical ailments, mental "illnesses" can be cured by talking? Even talk someone out of cancer or diabetes or a broken leg? That alone makes me see them as very different things. Yes, drugs can help mental illness, but then again drinking has cured depression for centuries. It is striking that all those supposed drug cures tend to be drugs that produce stimulant or depressant effects, just like the supposedly bad drugs with which we aren't supposed to self medicate. But, this is a topic for another posts. See "Mental Illness" for some older, more general thoughts on the topic.)

** Another historical oddity is the requirement that those who count out pills have some sort of pharmacy degree. It is one of those strange laws which embody a reality from before the law was passed. Yes, pharmacists once did compound all their own drugs, and even today some small amount of pharmacy work involves putting together pharmaceuticals, but many who work in a pharmacy do little more than count out pre-made pills, or measure out liquids, maybe adding a flavor. There is no reason one needs a degree to do that. It is easy to imagine a perfectly safe pharmacy run by high school graduates supervised by a pharmacists who handles compounding, patient questions and so on. (And before anyone worries about mistakes causing harm, recall we get auto parts from the back of stores using people without even a high school diploma, and a mistake there can be every bit as fatal. Not to mention the total lack of educational requirements for those who handle our food, mistakes with which can be even more lethal than most pharmacy accidents.)

*** Yes, there are "reasons" for these divisions, and since the divisions exist, the world has grown around them, providing various distinctions between one and the other. But, viewed in terms of the system one would create, starting from scratch, and trying to form an efficient system, these splits make no sense. So, yes, given the world which arose following such divisions, they are now enshrined and apparently justified by present circumstance, but that is not the same as such a division making any sort of sense, or being a rational practice.

**** Actually, education and government were not as closely tied as we think. In many frontier towns, schools were funded by contribution rather than any tax. Granted, the same meetings that served as government in relatively unsettled areas also controlled the school, but as I argued before, if everyone in a town decides to host a Halloween party, that does not make it a government Halloween party. Similarly, though the local school was run by the same people who met to govern, it was not effectively a government school. Then again, it is unlikely most people at the time made the distinction. (Likewise, they did not point out barn raisings were not government activities, as it was self-evident, yet those too were performed by the same group that governed, and often scheduled in the same meetings.) Still, it is important to note something can be run collectively by a community and be non-government. It is a fact we often forget in modern times. ("Non-Governmental Communal Solutions", "Volunteer Fireman, Barn Raisings and Government", "Government Versus Culture - A Forgotten Distinction", "Culture and Government" and "Collective Ventures Versus Government")


Before anyone take offense at my description of pharmacists, I recognize the need for knowledge in the case of compounding, or in providing advice on interactions and the like, as well as the need for pharmacological skill in research and so on. But to be honest, how much of modern pharmacy work involves those things? I once applied for a programming job where I was going to write code for machines which automatically counted and bottled pills. Now, if a machine can do it, how much knowledge does a human need to do the same? And, being honest, is not about 90% or more of most work in large pharmacies nothing more than bottling premade medications? Actually, if we are completely honest, even in research, cannot the job of research pharmacist be performed by doctors or chemists or biologists, biochemists, and the like just as well? As I argue above, it strikes me that the law as written seems better suited to a previous state where pharmacists compounded much more of their own medicine. (I suppose I could be cynical and say the law as it stands does make it easier to enforce restrictions on access to pharmaceuticals, as requiring education is usually a part of licensing, and being able to "pull" a license makes regulation much easier. See "Business Licensing and Regulation", "Consumer Protection, Cartels and the Failure of Regulation", "The Problems With "Safe and Effective"", "Medical Regulations" and "Medical Regulation II".)


For those interested in my previous arguments about public education, see "There Are Other Solutions", "The Problem of Established Perspectives", "Reforming Education", "Never Ascribe To Evil, A Discussion of Education", "Why Vouchers are not the Answer" and "You Don't Drown in a Glass of Water - Vouchers Revisited".

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