The Psychiatric Times, December, 1990.
When I first realized that physicians now earn less from medicine than lawyers, MBAs, and insurance executives, I began collecting data on emerging investment opportunities in the new specialty of Exploitative Medicine. In the interest of collegiality, I am now sharing my harvest with my colleagues.
Today's brightest investment opportunity is in hospital-based Buddhist Endocrinology (BE)--which is still in its infancy, but growing with each DRG or UR denial. I consider this information valid because I received it directly from insiders. After signing an affidavit of sincerity, I was honored by visiting with entrepreneur T. Kelly Wombat, former professional wrestling promoter and now the president of BE Corp.
The affidavit notwithstanding, Mr. Wombat assured me that I am free to disclose large parts of our conversation. Indeed, as we settled into our chairs, he urged me to spread the message to doctor-investors. "We need all the capital we can get. Expertise is needed, too."
Asked what kind of expertise, he said, "Marketing and sales! A doctor who knows marketing can really make it big in BE Corp."
"What kind of medical expertise is needed?" I asked.
"Medical expertise doesn't matter. We have our own training programs. Licenses are the important thing. We've recently opened 44 BE Corp. units in California alone, and we need Medical Directors."
Pressing, I asked Mr. Wombat what kind of medical training is necessary for Buddhist Endocrinologists. "None! We don't really need MDs, but their credentials look good on our letterheads. That's the beauty of BE! Our customers come to our units as acts of faith, so as long as we keep the faith, nothing else matters."
"Nothing," he replied. "Thanks to fiction--TV, the movies, the courts--people now believe that wishes and faith are more important than facts and science. Besides, identifying BE as endocrinology provides all the credibility we need."
This worried me, so I asked the obvious: "Isn't this quackery?"
Wombat explained philosophically, "Who knows what quackery is, anyway? I don't. And--more importantly--our patients don't."
"What about Hume's Fork?" I asked.
"Hume's Fork distinguishes knowledge of the real world from knowledge of imaginary worlds."
"A Scottish philosopher."
"Who's he work for?"
"Nobody. He's been dead more than 200 years."
"Well, see? Outmoded! We, on the other hand, are on the cutting edge."
When I asked about the clinical methods and objectives of BE, Mr. Wombat obliged expansively. "You know what Buddha looks like? Well, a lot of Buddha-shaped Americans are getting tired of being put down for their obesity. They're looking for authoritative validation for their condition. These people are the core of our market. Before we came along, secular endocrinologists harangued them about their health. But we don't. We praise their spirituality! We teach them that faith is more important than health."
"Do you restrict your units to Buddhists?" I asked.
"Are you kidding? How could we do business if we did that? We accept anyone--provided they are well insured. And we don't proselytize. We teach that anyone shaped like Buddha is `Buddhist Enough.' And our market research confirms that 83.2 million Americans are Buddhist Enough! That number guarantees us annual 10-fold growth rates for many years. We've even introduced a new line of products for Buddhists Enough to join the fitness craze: Instead of stationary bicycles, rowing machines, and skiing machines, we encourage our customers to buy our line of stationary motorcycles, outboards, and snowmobiles."
Mr. Wombat's vision and enthusiasm compelled me to fantasize converting to Buddhism Enough, but I remembered to return to clinical issues. "I'm still not clear on how Buddhist Endocrinology relates to medical endocrinology."
"Well," he chuckled, "They're spelled the same way!" Then, turning serious, he explained, "We use the same words and ideas but we give new twists to them. Medicine stresses longevity--we stress spirituality. It's a matter of perspective. For example, medical endocrinologists say that diabetics should not overeat. We say that a person is spiritually blessed with overeating--and those blessings aren't diminished by a problem in the pancreas. In other words, we make pathology virtuous. So you see, Buddhist Endocrinology isn't really endocrinology at all."
Betraying my naivety, I asked, "What does spiritual mean?"
Mr. Wombat chuckled again. "Nobody knows! And at the same time, everybody knows! Spiritual means anything anyone wants it to mean. And spirituality is always considered good! We don't even have to sell it!"
"I'm really impressed," I said--and I was. "Tell me, was Buddhist Endocrinology your idea?"
"I wish I were that creative. In fact, entrepreneurs thrive on stolen ideas. Christian Psychiatry was the first enterprise to subordinate facts to faith."
Astonished, I asked, "Do you mean that Christian Psychiatry isn't really psychiatry?"
"Look . . ." Mr. Wombat indicated by a frown that our interview was about to end. "A lot of psychiatrists have complained that psychiatry excludes spirituality. Christian Psychiatry fixes that. Besides, if Christians Enough want their psychopathology validated as virtue, what's wrong with giving them what they want? A business can't thrive without happy customers. And everybody knows that Christian Psychiatry fills hospital beds faster than secular psychiatry these days."
As Mr. Wombat rose from his chair to usher me out of his office, I asked one last question. "But isn't it fraudulent to advertise something as endocrinology or psychiatry that isn't endocrinology or psychiatry?"
Expansive once again, Mr. Wombat said, "For questions of fraud, I'll refer you to our legal department." And he did.
Harlow Spartan, Esq. is the CEO of the parent company of BE Corp.--The Institute for Just Medicine: A Private Sector Public Interest Law Corporation. I introduced myself and we assumed our positions (I noticed that my chair was a little lower than Mr. Spartan's). Reassured by its name that the company works in the public interest, I went straight to the point. "In order to recommend investing in BE Corp. to my colleagues, I need to know whether Buddhist Endocrinology is fraudulent."
"It is not." Mr. Spartan was confident in his response, but he could see that I needed more explanation. "You see, it's not for you and me to determine fraud. Fraud is a legal term, so determining fraud is a legal function. In other words, fraud doesn't exist unless a court says it exists. And no judge or jury has ever found BE to be fraudulent."
"Have there been cases?" I asked.
"Just a couple--but we won those on the ground of religious freedom."
"Do you mean that Buddhism Enough is a religion?"
"It is if a jury says it is."
"I see. Still, my colleagues are concerned about deliberately deceiving the public--whether or not a court is involved."
"You're worried about lying, aren't you?" Mr. Spartan laughed condescendingly. "You doctors are awfully priggish about some things. Don't you understand that the law is a game of deception. Ergo, if lying weren't permitted in our society, there would be no legal profession, no courts--no justice at all. You wouldn't want a society without justice, would you?"
"Of course not, but . . ." I was overwhelmed by his arguments and intimidated by his higher chair. I couldn't think to respond, so I changed the subject. "Anyway, I wonder if it's ethical to advertise Buddhist Endocrinology as a medical specialty--considering that . . ."
"Ethical!" Mr. Spartan snorted. "Ethics is not a problem! We are a society of laws--not of ethics. And, in the past 30 years the medical profession has finally learned that fundamental fact. For centuries, the medical profession has paraded around wrapped in ethics pretending to be better than everybody else. But, thanks to modern law, that's stopped. Doctors had better worry about what's good for them and forget about what's `ethical' for their patients. And talk about fraud. Ethics is a fraud. Nobody knows what it means. In fact, I'll give you a thousand dollars for every person you can find that knows what ethics means. Not even our politicians know what ethics is."
Mr. Spartan was certainly good with words. By this time in the interview, I had forgotten my questions. I thanked Mr. Spartan for his time and departed, my spirits buoyed by knowing that my investment money was going to competent hands.
In summary, I am happy to provide hope for my colleagues who don't enjoy practicing medicine anymore. Now you can retire from medicine and quit helping people. You can invest in BE Corp. knowing that your money is cultivated by people whose thumbs are green, and that the programs you capitalize are entirely legal.
Of course, as a BE Corp. Medical Director and Vice President of the Southern California region, I might be accused of a conflict of interest. But remember--a claim is fraudulent only if a court says that it is fraudulent.