Big Quacks, Little Quacks, And Adam Smith

There is interesting news on the medical profession:

President Pratibha Patil on Saturday gave her assent to an ordinance dissolving scam-tainted Medical Council of India (MCI) and replace (sic) it with a seven-member panel of eminent doctors.

The MCI oversees medical education with a view towards preventing quackery. But their top chaps turned out corrupt, accepting bribes from an institute that turns out quacks.

Adam Smith would have called it “a squabble between big quacks and little quacks.” In his time, some Scottish universities were turning out quacks – “men who didn’t know a vein from an artery” – and John Rae’s Life of Adam Smith (1895) [Chapter XVII pages 271-280] contains a long letter Smith wrote on the subject of medical education. Smith wrote strongly against government interference in the matter and rallied against monopolisation of medical education by the universities.

John Rae introduces us to the occasion that led to this famous letter:

While living in London, Smith, along with Gibbon, attended Dr. William Hunter’s lectures on anatomy, as we are told by a writer who was one of Hunter’s students at the time, and during that very period he had an opportunity of vindicating the value of the lectures of private teachers of medicine like Hunter against pretensions to monopoly set up at the moment on behalf of the universities. In a long letter written to Cullen in September 1774 Smith defends with great vigour and vivacity the most absolute and unlimited freedom of medical education, treating the University claims as mere expressions of the craft spirit, and recognising none of those exceptional features of medical education which have constrained even the most extreme partisans of economic liberty now to approve of government interference in that matter.

The letter was occasioned by an agitation which had been long gathering strength in Scotch medical circles against the laxity with which certain of the Scotch universities – St. Andrews and Aberdeen in particular – were in the habit of conferring their medical degrees. The candidate was not required either to attend classes or to pass an examination, but got the degree by merely paying the fees and producing a certificate of proficiency from two medical practitioners, into whose qualifications no inquiry was instituted. In London a special class of agent – the broker in Scotch degrees – sprang up to transact the business, and England was being overrun with a horde of Scotch doctors of medicine who hardly knew a vein from an artery, and had created south of the Border a deep prejudice against all Scotch graduates, even those from the unoffending Universities of Edinburgh and Glasgow.

The letter from Smith to Dr. Cullen, Professor of Medicine at Edinburgh and a close friend, is too long to be quoted in full here, but this portion of the text is quite pertinent – and hilarious. Smith asks:

Do not all the old women in the country practise physic [medicine] without exciting murmur or complaint? And if here and there a graduated doctor should be as ignorant as an old woman, where can be the great harm ?

Indeed, I have just been cured of an ailment on the advice of an old lady untrained in medicine. She prescribed an ointment for a skin ailment, and it worked. If para-medics could practise with just two years training, they would benefit the poor and treat common infections easily. I hope, now that the MCI has been abolished, such para-medics are allowed.

However, medical education is not my subject, which is Economics. In this vitally important discipline, 90 percent of practitioners are quacks. Many hold PhD degrees and call themselves “Doctor” – like Chacha Manmohan S Gandhi. Adam Smith’s letter to Cullen contains strong words against this imposing title. Although he himself held the degree of LlD, Smith never called himself “Doctor.” He was known always as “Mr. Adam Smith,” Here is what he writes about the coveted title of “Doctor”:

The title of Doctor, such as it is, you will say, gives some credit and authority to the man upon whom it is bestowed; it extends his practice and consequently his field for doing mischief; it is not improbable too that it may increase his presumption and consequently his disposition to do mischief. That a degree injudiciously conferred may sometimes have some little effect of this kind it would surely be absurd to deny, but that this effect should be very considerable I cannot bring myself to believe. That Doctors are sometimes fools as well as other people is not in the present time one of those profound secrets which is known only to the learned.

I rest my case.