Martin Rossdale writes:
Dr Richman’s examples speak for themselves. There is certainly plenty more preventive medicine to be done in England, and if the diseases are not those which doctors have been taught to think of as preventable that only confirms the extent of the work of re-education and reforming of the medical imagination. Richman’s examples, however, show the limitations of the present school of social medicine. Like specialist medicine it is obsessed with recognizable diseases, the clinical entities of scientific medicine. We can depend on the liberals and radicals of bourgeois society to learn its lessons and clamour for reforms without being a whit closer to the injection of socialist thought or practice into modern medicine.
I was attempting something very different. We have a profession—medicine—which is profoundly bourgeois, and yet it has as its subject a discipline which needs all the warmth, humanity and understanding of which we are capable. It has been suggested that its existence is one of the contradictions of our society. I tried to show how it is necessary to our society, how its professed ethics bring it into conflict with the actual ethics of bourgeois society, how it resolves these at the personal and the technical level. There is no need for a fellow Socialist to remind me of the difference between psychiatric and organic disease. I was illustrating how doctors are taught to marshall their feelings and responses to the emotional and technical problems of sick people.
Richman accuses me of sectarianism. In fact, I was describing the character of medicine as a whole in England. Of course there are socialist doctors, nurses and health workers and I hope that in their relations with their patients their socialism is apparent. But the structure and emphasis of the Health Services is anything but socialist in effect, whatever the principles of free access for all. The actual application of the Health Services is heavily influenced by class determinants. We are rapidly approaching the time when we shall have openly to admit this. The significance of the renewal of private practice and the separatism of the teaching hospitals are in the trends they set. With personalized medicine at a price in one and all the advances of medical technology in the other, the rest of the Health Service can become an impoverished holdall for the undiscriminating and uncomplaining remainder. That, I agree, is cause for serious alarm.