I suppose it is a bit old fashioned to speak of the difficulties of serving both God and Mammon, both deities looking a bit neglected these days, but they provide a useful metaphor for the conflict that has led the capitalist west into the situation we are now in.
It is the conflict of the professional, how to balance the service provided with the remuneration sought. How fortunate were those of us who worked in the NHS not to have this conflict; we simply received a salary and were able to provide our services to rich and poor alike. Or at least some of us were, as many were drawn into private practice as well, receiving two incomes, in spite of having received their education and training at public expense.
When I first started in the early 1960s there was widespread abuse by consultants who drew their salary but did little work in the NHS, leaving it to their juniors, a throw-back to the times when their hospital appointments were honorary. Another dodge was to ensure that their NHS waiting lists were so long that people in desperation went private. It was perception of these abuses, particularly rife in London, that led to the reforms that so weighed the service down with administrative chores. They have not entirely cured the problem but they have alleviated it.
There is always easy money to be made in professions and short-cuts can always be taken. In law, the promotion as serious illnesses of pleural plaques and minor 'whiplash injury' have provided for rich pickings. In surgery, promotion of usually unnecessary operations such as circumcision, or of the benefits of expensive surgical rather than medical treatment, is a trap for the unwary patient.
In medicine, the assumption and advertisement of special expertise in treatment of, say, obesity, skin disease or asthma, where well-established management is available on the NHS, leads the gullible into Harley Street or its equivalent. But the most egregious example of abuse appears to be in plastic/cosmetic surgery. Nowhere else in medicine is it so apparent that the profession is a conspiracy against the public, a doctor's dilemma indeed.
Tens of thousands of women appear to have been persuaded that their breasts are not big enough and that this is a condition requiring surgery, often by a surgeon with no proper accreditation. Only two little cuts, a bag of gel into each, sew it up and a few thousand each for the surgeon, anaesthetist and the hospital. Oh yes, and if it all goes wrong, it wasn't our fault, off to your GP.
We made our money putting bags in breasts, it was the regulator's fault
that things went wrong. No need for us to keep records of our results, we
just knew everything would be all right.
How sickening to see the CEO of a Harley Street hospital pleading that they couldn't afford to deal with all those thousands of breast implants that they had inserted and now were faced with removing. Well, that's the market. Actually it isn't, as the NHS is quite used to mopping up the things that get spilt on the floor in private medicine, and the ethos in the NHS is that patients get the treatment they need no matter how they came by their illness.
We have seen this before. The very people who complain about too much red tape tying down their freedom to make money are the first to blame the regulator when things go wrong. It wasn't reckless gambling with our money in the city, it was a weak FSA. We made our money putting bags in breasts, it was the regulator's fault that things went wrong. No need for us to keep records of our results, we just knew everything would be all right. Nobody would have thought that a plastic bag could break and leak over the course of years of the sort of handling that its recipient might have anticipated.
We are all different and some have better luck than others in their appearance, but there is something rotten about a society that drives women to cosmetic surgery to make them feel attractive. The origins of plastic surgery are heroic, rebuilding war-wounded faces and limbs, and its practice in the NHS wholly commendable in reconstruction of injuries and burnt skin and after mastectomy, for example. Some people do indeed suffer terribly from an unfortunate appearance and it is humane and proper in such cases to try to improve it. But there is a line between that and cosmetic enhancement, and that line comes between the service of God and Mammon.
The great thing about the NHS is that it deals with real need, not desire. It may not be perfect but it strives to do its best. The private sector is there to make money, and this is the threat implicit in the NHS bill in England. There is a looming crisis in health care and it is very tempting for politicians to look for solutions in the private sector though, to its credit the Scottish Government is so far more enlightened. This mammary implant issue is a timely reminder that those solutions have hidden snags attached.
Professor Anthony Seaton is an emeritus professor in the school of medicine and dentistry at the University of Aberdeen