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A look at medicine: Capitalism, children and ants
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Some of us believe in communism
Some of us believe in capitalism
Some of us believe in spiritualism
Some of us believe in materialism
But the children believe in friends
For the children of the world
Every boy and girl
All they’ll know is what we teach ’em
Most of us fail when we try to reach ’em
For the children believe in having friends
Children believe in friends
Children believe in having friends
Children believe in friends
—Donovan, Children of the World, 1976
Ants on a log
Floatin’ down a river
Runnin’ around
But not gettin’ anywhere
Power steer wheels
Just ain’t connected
And we can’t jump off like fleas on a dog
Can’t fly away like flies on a hog
We’re really just along for the ride like ants on a log
—Randy Travis, Ants on a Log, 1996 (written by Skip Ewing, Donny Kees)
A recent opinion piece in The New York Times by Roger Cohen brought me back several decades. As an undergraduate history of science major in the 1970s, one of the most polarizing debates on campus was over biologist E.O. Wilson’s seminal text, Sociobiology: The New Synthesis. As I remember the debate, Wilson, an expert on ants, sought to define a line of scientific inquiry into the evolutionary mechanics of social behaviors such as nurturance, altruism and aggression. The jump from the social behavior of ants and bees to humans led to a firestorm of controversy invoking fears of the rebirth of eugenics and social Darwinism. My fondest memory of the debate was more personal — taking a course at the time on animal behavior by Bert Hölldobler, a colleague of Wilson’s and a fellow ant expert, elective evening movies on ant behavior offered an opportunity for a cheap date with my then girlfriend and now wife. Little did I know then that capitalism and sociobiology would today become juxtaposed in my thoughts over the future of pediatrics and the health of our nation’s children.
The good news is that it is not just me that is making this connection. The focus of Cohen’s column (“Capitalism Eating Its Children;” May 29, 2014) is on statements by Mark Carney, the Canadian governor of the Bank of England, made during a recent conference of CEOs, bankers and investors. Carney compared the recent behavior of unchecked market fundamentalism to revolutions eating their young as exemplified by the erosion of the social capital essential for the long-term dynamism of capitalism itself. I only hope that some of those in attendance were members of the medical industrial complex, for as Carney argues, “prosperity requires not just investment in economic capital, but investment in social capital.” Having defined social capital as “the links, shared values and beliefs in a society which encourages individuals not only to take responsibility for themselves and their families but also to trust each other and work collaboratively to support each other,” it becomes abundantly clear that the business of medicine has similarly been hijacked.
William T. Gerson
Just as Carney reminded his audience that the purpose of banking is on a human scale, fundamentally connecting savers and borrowers and not about the bank or the transactions — medicine is about patients and doctors. The medical hijackers talk of monopolies, customers, relative value units (RVUs), ICD-10 and full-time employees (FTEs). The quality of a health care system relies on the quality of its doctors. Hospitals do not exist to ensure the prosperity of their administrators. Human capital is the capital that truly counts, and our children need friends.
Loss of social capital
Cohen further noted that at the same conference Bill Clinton remarked that ants, bees, termites and humans have all survived through an unusual shared characteristic: They are cooperative forms of life. Echoing sociobiology in the land of high finance — who would have ever thought it possible? But Cohen reminded us it is precisely the loss of social capital at all levels of community that most threatens the world’s stability and future prosperity. Nothing can be truer in regard to the well-being of our children and more important to the future of pediatrics.
American children today who live in poverty (approximately 16 million, or 22%) have rates of disease and death similar to children from half a century ago. And it is the social determinants of health affecting small children and their families that instigates this ugly toll. It is hunger, violence, drugs, and social and institutional dysfunction surrounding these children that condemn them. Adverse childhood experiences of abuse, neglect and household dysfunction correlate directly with lifelong negative outcomes. We need a concerted effort to change the world of poverty in our neighborhoods. It can and should begin with us to advocate for such a change. Maybe our new friends should be venture capitalists.
If we have not been successful voicing these concerns at the political level, whether due to a failure of political leadership to act or insufficient persuasiveness of our argument at that level, perhaps we need to look for allies among our financial and business leaders. As pediatricians, our moral standing, along with that of our children’s hospitals — particularly in the communities we serve — should allow us to forcefully advocate for investment in the health of our children and the systems needed to ensure their future well-being.
Make the right friends
Pediatricians and our institutions hold a special standing in our communities. The need for a broad political, health and educational coalition to attack the problems that face our nation’s youth has been clear for some time and in many areas quite successful. The entry of capitalists into this arena has been characterized by individual and foundation support that has a more mixed record of success. A broadened community-based effort spearheaded by the pediatric world seems to me to be the last best hope. We need to stop acting like ants on a log, or that wave might just topple us all. After all, children, not ants, believe in friends.
Disclosure: Gerson reports no relevant financial disclosures.