Rather Dismaying by Stephen Vaughn MD


I read a little excerpt from book written by a man whom I quite dislike, Vladimir Lenin. It is amazing how more sensible the thought of this awful man is, compared to the vanguard of the modernization movement in American medicine.

Lenin wrote during the revolution about a terrible problem – that great Marxist ideas often are useless when attempted in practice. That alone puts him head and shoulders ahead of our Medical Reformers in American medicine. Ideas, no matter how orthodox in a Marxist sense, might just be wrong, and the proof is in the product.

He realized that any movement of workers had an abundance of muscle, but a shortage of brains, especially trained ones. He apologized for having to take a right-wing approach to the reform of Russian industry – the Soviet Union needed experts, and very few experts come at to the attraction of honor and glory – most of them need to be paid well. He argued that paying expert scientists and engineers abundantly was a drop in the bucket compared to the waste that would be caused by their lack of guidance. Imagine that being discussed in Washington? That would be considered the Tea-Party loonies, although that VI Lenin put it to paper.

This problem of an overpaid expert class could be sorted out in the long run. The massive majority of Russians were peasants, and never had the opportunity to be trained to be specialists, scientists and engineers. The potential pool of university graduates was pre-determined by money, wealth, family ties and political pull. If the specialists could be drawn from all walks and classes of Russia – a huge population – then surely there would be plenty more of the best and brightest, and the need to pay the specialists so much would be watered down by supply.

If Lenin could have seen American medicine in the late 20th century, he might have seen the closest example of his dream put into practice. Universities, educating the brightest to be the intellectuals and specialists and movers and shakers, rather than those with ancient political connections and families. Imagine that!

There you have it – King Red understands the supply-and-demand curve of professional labor, and Washington doesn’t. His book on the Soviet Worker’s was on Google Books or some similar e-text; I’ve unfortunately lost the reference, I’ll get it. It’s full of the usual long-winded and blowsy language of the Professional Thinker, and somewhat dense and overly-thought-out; but not as bad as our modern intelligentsia’s bilge.

I think it was entitled “On workers’ control and the nationalisation of industry” and started around page 19 of the English translation.

Meanwhile, on marxist.org – you can guess the political leaning of the site – they bemoaned that
“The specialists in Russia 1917 were not like the specialists and technicians today. We will come to this more in a minute when we discuss Venezuela, but the technicians and specialists, lower-level managers and white-collar workers today have become more and more proletarianized. They face the same attacks, cuts and wage reductions as the workers do. It will be possible to bring them onboard, to convince them of our ideas and to win them over, as is happening in some cases in Venezuela today.” Yes, good luck with that. Lenin trusted only the $$ for impressing the professionals.

“Hence the Soviet state was forced to make a series of compromises, beginning by paying the technicians more than the average worker. Of course, a political commissar was put at their side to ensure their loyalty as they were sent to the factories to help in their operation, itself a brilliant measure of workers’ control, but nonetheless it was still a compromise. The Soviet state was faced with no other option – without the specialists industry would not run.” The division between the idealists – who don’t care if nothing really works – and the realists (like Lenin) who was bothered by the stagnation of intellectual purity – sounds like our local healthcare debate – but with very few realists left in the balance.

We can’t even invent new crappy ideas – we have to dredge up dreck, test-proven and evidence-based for the last century – to try one more time, in US healthcare. Sad.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Rather Dismaying by Stephen Vaughn MD

  1. politovski
    February 16, 2015 at 11:55 pm

    wow. this is a great read. and given James C. Puffer, MD’s salary for leading us over the cliff (So, What would you say it is that you do here?) it appears that, much like the central committee in the former USSR, that some comrades are more equal than others.

  2. William Braswell MD
    February 15, 2015 at 10:32 pm

    After receiving the standard computer generated extortion letter from The ABFM informing me that I don’t qualify for the 10 year sham but now have to fork out thousands for their 7 year sham I answered thusly:


    I think I will wait and see if there still is an ABFM in the next few years. Word on the street is not in favor of it. But in your favor I still feel noticeably threatened that I won’t be able to feed my family without your endorsement.

    I have seen over a hundred thousand underserved patient encounters in the last 20 years and have never used any of your antiquated, wasted evidence based, outdated guidelines. I was trained always to practice in the here and now (POEM) and there is nothing in your materials that is even worthy of a third year medical student and would even insult a mid level.

    I should be sharing my daily practice revelations with my peers, but instead I am required to memorize 1970’s information and your insulting junior nurses aid hand washing techniques. Note: I am trained to perform a field pre op sterile surgical hand wash with a canteen and a combat helmet.

    I would have been 80 years old when I finally paid off my quarter million in student loans had not my disabled youngest son just stepped in and helped me pay the predatory lenders off. Shame on me! I’m sorry but I really need to put your fees in our retirement account instead. Please be kind enough to stop taking my family’s hard earned money. We can’t afford you and your kind and your extortion letters just don’t do it for us anymore.

    Very Truly,

    William Braswell, M.D.

    “just say no to the ABFM”

    • Doug Farrago
      February 16, 2015 at 5:49 am

      Great letter.

  3. Pat
    February 15, 2015 at 12:32 pm

    Wow Stephen, great piece. Looks like we’ll all be tovarishes soon – the AAFP, ABIM, AAP, etc already provide the commissars.

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