 When I was compiling quotes for a series of health care articles that we ran in freedom daily, most of those quotes came from articles that had appeared in the Freeman magazine published in the 1950s. And in those articles, the authors, writing from a free market perspective, of course, were talking about the health care threat that was coming from the leftists, those that were trying to use government to take over the health care system, to manage and control this vitally important part of our lives. This was back in the 1950s. Again, the essays appeared in the 60s, then again in the 70s. So anyone that thinks that this assault is dead had better place things in perspective. The battle will continue. And we were fortunate to have Dr. Saz, a hero not only for libertarians, but also for those in the psychiatry profession, address us tonight on health care, the latest excuse for the leviathan. Dr. Saz. Mr. Hornberger, friends, ladies and gentlemen, I want to thank you for this extremely generous introduction. It is my honor and my pleasure to be here, and I thank you for asking me to perform this service, this honor. I will forego the obligatory humor at the beginning, but not quite. Much of what I will say is actually will illustrate a remark that Will Rogers made. Will Rogers said, I don't have to make any jokes every time Congress passes a law. It's a joke. And some of the things which I will be mentioning to you will be the kind of legislation to which this applies. Also, I might say that after having the pleasure of hearing Joe Sobrand's address at lunch, it occurred to me to say with all modesty that this is really a footnote. What I'm going to tell you is a footnote to the general theme that he has outlined, and which has also intrigued me that really we don't have the kind of constitutional government that the founders dreamed of, but instead we have a different kind of government, and in some ways what kind of government we have is what I will be talking about. Now this year also happens to be the 50th anniversary of the publication of Hayek's Road to Serfdom. And it seemed to me that that I would get started with that watershed and between the publication of that book and the unraveling of the Soviet Union, we have now come to a situation where, which was in some ways always true in this country, but it is now quite obvious that no respectable individual defends socialism or communism as an effective economic policy. No one will say as whoever it was, Brezhnev, that we will overtake you, we will have better consumer economy than you do. No one says that. But in point of fact, in the United States going quite far back for reasons which are historical and cultural and perhaps unknowable, the word socialism has early acquired the negative connotations. So very, very few people who call themselves socialists, much less communists, but they don't have to because in this country the notion of protection, particularly protection from destitution and disease, has really replaced the need for socialism. And as I see it really is a whole health care rhetoric, is socialist rhetoric in terms of disease treatment and so forth. Obviously saying much more about that. Now when we talk about the government taking a role in protecting people from disease, the first thing I want to mention that the very concept of disease is not as simple as it may seem, and its meaning has changed. Now what is a disease? You might all think you know what a disease is, and of course you do, but you don't. Because those of you who think of this in a kind of a personal and down-to-earth way, mainly about yourself, will think that a disease is something, first of all, that you don't want. You'd rather be without. Secondly, that it is something that happens to you. Something like leukemia, or diabetes, or arthritis. I mean, this is not something that you want. And fourthly, it is something which one can genuinely philosophically say is not a part of you. In other words, if you have let's say tuberculosis or you have a sore throat, now, for this week, next week, when you haven't got it, you will still be you. It's not a part of you. But this is in some ways, the last but not least, there is a scientific dimension of it, which is very important, and again, you don't have to be a physician, or in any way a professional person, to realize that modern medicine is relatively recent, going really only back to about the middle, the second half of the 19th century, and depends really on the development of modern medical technology, mainly the autopsy, tissue staining, pathology, and then the more sophisticated techniques of examining the body, so that I have always thought that the analogy between the gold standard in economic affairs and pathological lesions in medicine make a very nice analogy. There is disease and not something that doctors make up. It is something that they find and they typically found it in dead bodies. How do you know that somebody has a disease, that somebody dies, and the pathologists examine the liver, the kidney, the lungs, and so on, and they find that someone has pulmonary tuberculosis, that their lung looks different from a normal lung, and so it's that simple. And sometimes, of course, there are new diseases, like AIDS, legionnaires and so on, but these are all found by pathologists on people who are, quote, sick in some ways. But the clinical diagnosis is always secondary, it's always stumped by the pathological diagnosis, it says, in medicine. Now, this was pretty much the case until, certainly even when I went to medical school, which was more than 50 years ago, but this has changed really since then quite rapidly. This was first of all not always true, and as I said, I'm not going to be saying much. This was never true of psychiatry, because psychiatrists always were the medical specialists who treated diseases which did not exist in the sense that pathologists never saw them. Pathologists, going back to psychiatry, pathologists never saw madness. They had pathologists in mental hospitals, they kept looking for diseases, and every once in a while they did find the diseases historically, the most important example being Neurosophilis. Neurosophilis, as you know, is a pretty bad thing, and if you have Neurosophilis after a while, you don't normally code, so that causes madness, and then, of course, if pathologists found this, then this became codes of disease. Now, one of the things which happens, and I just want to get this out of the vase, is that when a pathologist finds a disease, it's no longer a mental disease, then it's a real disease, it's a brain disease. And Neurosophilis still exists, it's very rare now, after the supericillin, but it still exists. But psychiatrists have nothing to do with it, if somebody has Neurosophilis now, it's treated by neurologists, or specialists in infectious diseases, with antibiotics, it's not a psychiatric disease. Another reason why this is important is because from a psychiatric basis, with which you are more or less familiar, in our day we have developed to a point where diseases are no longer defined by pathologists, but are defined essentially by a political process. And I will illustrate that as I go on, of which, generally speaking, diseases are things which are unwanted behaviors. Now, who are they unwanted by? They may be unwanted by the individual himself, in which case he or she may call it a disease, or they may be unwanted by psychiatrists, most typically by society, the authorities of the state, of which the best example, of course, is called drug abuse, substance abuse. Now, the important thing, well, I'll come back to that. Now, one more thing about disease. The entire healthcare debate is premised on an idea which is a wonderful idea, a very simple idea. There's only one thing wrong with it. It is totally fallacious. Now, let me tell you what that idea is, and I never see this mentioned. Again, it is something which when I tell you, you will say, well, of course, but I never see this mentioned, and it is absolutely crucial. Now, the premise is that diseases require treatment. So the thing to do is avoid diseases so you don't need the treatment which will then cost a lot of money to everybody, because obviously nobody pays for it anymore. You pay for everybody else's disease except your own disease. So the thing to do is to prevent diseases. Sounds all right? No. Diseases don't require treatment. Diseases, that's why I defined them, diseases are natural events, like oil in the ground. It's a phenomenon, cancer of the colon. Now, oil in the ground doesn't need extracting. People want it extracted, assuming they have some use for it. So diseases don't require treatment. Some people want their diseases treated, okay? And some people don't want their diseases treated. Now, you hear about how people shouldn't smoke, for example, I'll come back to that, because it will cost a great deal of money to treat it. Therefore, if you get lung cancer, I will have to pay for it, so you shouldn't smoke. Well, this has a certain rationale to it, given this socialist premise. There's only one thing wrong with it. There are all kinds of people with all kinds of diseases who don't want treatment. The relationship between diseases and treatment is arbitrary, is not logically if one than the other. A lot of people with diseases want treatment. A lot of people without any diseases want treatment. It used to be called hypochondriasis. Conversely, a lot of people with diseases don't want treatment. Now, who are some of the people with diseases who don't want treatment? Well, there are two huge groups. I could spend, maybe, you know, we are gaining an hour tonight, so maybe I should spend an extra hour talking to you. But one large group is called Christian scientists. Now, when you hear about smokers being penalized for causing extra health care costs, do you ever hear about Christian scientists being exempted from certain taxes? Because they don't utilize health care costs at all. You are a Christian scientist. It doesn't cost you anything. The taxpayer doesn't cost anything. Now, the other group, and I will perhaps say more about it, are so-called crazy people. Now, they don't... Their cost, their health care cost is astronomical, as things now stand. But in point of fact, they have a characteristic. And they don't want any treatment at all. I am talking about really mad people. When I talk about psychiatry by the way, I should clarify it. I am not talking about psychoanalysis counseling. To me, psychiatry is one of two things, which is the way it was born and which is its backbone. It is locking up innocent people called civil commitment and excusing guilty people because of insanity defense. That's what psychiatry is. In both cases, now this generally gets locked up. Keep in mind someone like Hinckley. Hinckley did not say, I was sick. Hinckley wanted to plead guilty. Other people said he was sick. They are still treating him. They are working on his schizophrenia. Now, you see, if you believe that, you'll believe anything. But nobody believes that. I think modern societies, especially this country, run on hypocrisy. Nobody believes any of this. Nobody believes that the war on drugs works and so on. But there are reasons why this goes on. Now, the other group of people are quotes, crazy people, who in current parlance, deeper ghoul parlance, suffer from denial. They are in denial. Now, what does that mean in denial? Denial means I don't want to see a doctor. Well, you would have thought this is a constitutional right. You don't have to see anybody you don't want to see. No, if you don't want to see a doctor, then you certainly have to see a doctor. And that's going to be very expensive. So there are two ways in which health care costs are incurred, that you are asking for it, or that somebody else says you have to get some health care. And that's then going to cost money. Now, I prepared a fairly elaborate paper, but everybody tells me that I shouldn't read the paper. So I'm not going to do that, but I do have some quotes which I do want to use. Now, Mises correctly told us, and he was one of the first to really ride this point, it became one of his hobby horses, it seems to me, that one cannot make rational economic calculations in a socialist economy. That's pretty obvious that you know, how do you know what people want? They can't see I don't want this kind of raincoat, I want that kind of button and so on, and somebody else tells you what there will be on the market. Now, if ever this was true of consumer goods, it seems to me that this is doubly true of medical services. Because there's absolutely no way of telling what kind of medical services the American people want. This again is so large a subject that I'm just going to do a very short shift of it. First of all, an unknown number, an unknown percentage of people, but I think it's a very large percentage, now go to physicians for the simple reason of getting a prescription for medicine, because in point of fact, all drugs, virtually all drugs that any intelligent person wants and needs are illegal. All of them. The only drugs which are not illegal, completely illegal, are the so-called over-the-counter drugs. But every effective drug, for example, if you have a bad sore throat and if you have sinusitis, you want an antibiotic, that's illegal. If you have to go to a doctor to get a prescription, that to me is analogous to having to go in the old days to some Soviet bureaucrats and having to get a permission to leave the country. Now, you could say you have a right to leave the country. Well, of course, if Mama and Papa give you permission to leave it. Now, you have access to this drug, provided you produce the right kind of symptoms. So you have to lie and say what it is that you want. The best example of which is the disease. Here is a disease, which is probably one of the most frequently used. I mean, I understand the most frequent drug is Zantek, is anti-acid drug and so on. But in older days, and even now, these drugs are high on the list, is for a disease called insomnia. Now, it's one of the rules of medical licensure and medical practice in every state that a physician is not permitted to prescribe a prescription drug for a patient unless that patient is his personal patient, unless he has examined the patient and therefore made a diagnosis that this is a drug required. Now, how does a physician make a diagnosis of insomnia? Here is this busy executive or housewife or whoever who has an appointment for 2 p.m., comes at 1.45, already, you know, has to sacrifice, all kinds of other things he wants to do. In the physician's office, maybe at 3.15, the physician will see him, by which time the physician is all worked up, he's a heavy schedule and the patient is all worked up. Now, how is a physician going to determine that this patient can't sleep? Then he goes home at 10 o'clock at night. It's a charade. But then you can get a prescription drug. Now, in a good old days, you could get barbiturates. Now, of course, you can no longer get barbiturates because barbiturates are very useful besides sleeping. For one night, you can sleep forever. And that you are not supposed to do. So it's really quite impossible to make that calculation. Secondly, it's impossible to make the calculation because physicians themselves talk people into all kinds of medical procedures. Which are economically problematic, very complex, hard bypass, expensive things that you know. You have these statistics. How many of these things are performed so much more often here than in England or Canada or somewhere else. So in point of fact, again, this is for this audience, I mean I'm carrying in some ways, goes to Newcastle. It's obvious that unless there was some other kind of arrangement, particularly complete access to drugs, and some very large measure of payment by patients, there would be no way of telling. There's no way of telling now how American citizens want to apportion their income into what is worth or how much is it worth when you're 80 years old to have some bone marrow transplant and this or that if you have to pay for it. As compared to something else that you could do for your family and so on. But now that you don't have to pay for it, of course this is a real seduction. I mean go for it because in some ways everybody feels well at least they can rip off the system. They can get all these things for nothing. All these treatments. Now actually, let me quote you here something. Belatedly, pathologists, epidemiologists, real doctors besides psychiatrists are waking up to this. And here is a typical comment from an article in the New York Times about the problem of what is it that's going on medically in the country and how you cannot tell what's going on. Belatedly, physicians complain, and I'm quoting now from this article, data from current medical records, insurance claim forms, and pharmacy records are severely biased and therefore all but unusable. Doctors may write in the record or the insurance claim form that they are doing a PSA test that's a prostate cancer test because a man has prostate cancer even when he is perfectly healthy. It is impossible to judge the outcomes of a clinical interaction on the basis of the paperwork that is now done. So when physicians, epidemiologists, pathologists will look back 50 years from now at records now, they will have absolutely no way of telling what was going on as compared to 100 years ago, 80 years ago in terms of the instance of syphilis or tuberculosis and so on. Now actually, all of what I have told you are just symptoms of a general phenomenon that has preoccupied me for nearly 40 years or ever since I went to medical school, perhaps even before, and has of course occurred to other people too, and that is the therapeutization, the transformation of politics into healthcare in general terms. And I discovered a remarkably beautiful statement by the poet who was of course much more than a poet, Winston Auden, who wrote the following. Now listen carefully because this really says it in a general way all, and then I will elaborate on it. What is peculiar, and I'm quoting, what is peculiar and novel to our age is that the principal goal of politics in every advanced society is not strictly speaking a political one, that is to say it is not concerned with human beings as persons or citizens, but with human bodies. In all technologically advanced countries today, whatever political label they give themselves, their policies have essentially the same goal, to guarantee to every member of society as a psychological, psychophysical organism the right to physical and mental health. Now this is now sort of taken as an elementary quote, right, that we have right, and you know the World Health Organization, the United Nations has this in its platform and so on. Well, back now to what is health. Well, one or two of the things which are defined as disease now are what used to be called bad habits. Now bad habits, now if they are medical, as I already indicated, are habits which cost, which will lead to disease and therefore cost the taxpayer money, of which the two examples that I will use are smoking and obesity, overeating, whatever that is. But before I come to that, I have to make a comment about how medical costs are now deferred, paid for, because that's infrastructure for the problems. The problems are the solution. The solution is to have, quote, health insurance. Now this whole thing very much like psychiatry one can't talk about unless one talks, you know, excuse me, even though I do it with an accent, but one has to talk English about it. Now health insurance is not health insurance. First of all, it's illness insurance. And secondly, it's not insurance at all. It's not insurance at all. Insurance is something which a person buys for something, for an event, for a future event from which he wants to protect himself, like his house burning down, okay? Therefore a homeowner's insurance does not pay for fixing the plumbing, repainting the house, or changing the light bulb. Now if you are a medicare like I am, you get a letter from the medicare system, go and get your flu shot, it won't cost you anything, and so on. So the most trivial things are now paid for. That's not insurance. No insurance can do that. Secondly, what do you think would happen to the homeowner insurance industry if state legislatures compelled every search insurance company to insure homeowners for burning down their own house? Now I kid you not. If you are in a group plan, the state legislatures many years ago have compelled insurance companies to insure on what they call on parity that you don't get schizophrenia. I don't know how many of you wake up, go to bed at night worrying that you wake up schizophrenia or that you wake up from a disease called substance abuse, called heroin addiction, or even alcoholism. Is this something that you get, or is this something that you do to yourself? This is why I said it emphasizes the beginning. Now these are things you do to yourself. And I'll come back to the two things, being overweight and smoking. Now is it possible to be overweight unless you put more calories into your mouth than you use up? I mean how many years of schooling do you need for this? Now if you have to actually do this act, how can this be a disease? But wait until you see what I'm going to read to you from quotes. Now smoking is the same thing. How can you have smoking disease if you don't smoke? By the way, all the psychiatric diseases, they are just more subtle. They are all in this class. Now you might say some people who have, I don't know, agoraphobia, who are afraid to get into an elevator, really don't want to get in, really would like to get into an elevator. To which my answer is yes and no. If they really wanted to, they would get into it. That's another lecture. Because in point of fact, I learned this, I was very, very young. Let me tell you a little autobiographical. I was read this in Hungary when I was very young. And again, maybe I remember it because it just gelled with something. Because this was a very popular book in Europe, hardly known here, called The Story of San Michela by a physician named Axel Munte, a British physician. This was an autobiographical. Anybody has ever heard of this book? One person. M-U-N-T-H-E. It's in a mass paper back in the English translation, too. This was a man who lived, who was actually a contemporary of Sharcoes, who was at his height around, you know, Freud studied with Sharcoe in the 1880s, 1890s. And there was very little, it might be worth going through this, because this sort of gives you also an idea of what the distinction between medical disease and psychiatric disease is really in a very brutal kind of way. In the Nazi period, the same experiment sort of was repeated that Betelheim wrote about. But this is a story that Munte tells. In, let's say, 1880, 1890, there were large mad houses, mental hospitals so-called, in St. Asylum, in France, where Sharcoe in Paris and so on, where Sharcoe worked and where Axel Munte, as a young physician, was a young physician. And, you know, medical diagnosis was in its infancy. So if there was a, let's say, 30-year-old, typically very often these were women, who couldn't walk, well, physicians had no very good way of finding out why this woman couldn't walk, because either she didn't want to walk, so she didn't have to work on some farm or something, whatever it's called, hysteria, what they then call, or couldn't walk because she had multiple sclerosis or amyotrophic lateral sclerosis and there was some neurological disease which paralyzed her. There was no CAT scan, none of these things, but there was a diagnostic test, absolutely full proof test. There would be 30 patients, let's say, all of them, none of whom could walk. And quite often in this derelict building, at two o'clock in the morning, somebody was smoking or something, and the building caught on fire. 15 patients ran out, paralyzed patients, and were found on the lawn the next morning, you know, cavortig and other 15 were incinerated. Well, that was a differential diagnosis. So this sort of, you know, what does it mean that I can't and I don't want to? I mean, obviously, if this can be overcome by this kind of an experiment of nature, then you have an answer. Now, compares this to one of the currently popular diseases, depression. Now, I am not saying that depression doesn't exist. Obviously, a lot of people don't feel very happy. I mean, life is no ball of cherries. Why should anybody feel happy? Actually, if you go to museums and look at pre-18th, 17th century pictures, they are all, everybody's supposed to be depressed. That was, you know, Martin Dolorosa, you know, that was in some ways the view of life. That life is a tragic experience and people are sinful and do all kinds of things and they should suffer, and suffer in hell. If you were virtuous, maybe you'll be happy in life hereafter. But this idea of keep smiling and everything is fine here is a very modern idea. After all, your wife died every time she got pregnant and you know, if you got sick, life was not very easy. Now, Parade Magazine on September 19, as I was writing this just a few weeks ago, on the previous week, it had a long cover article with Stipper Gore about how depression is a disease that's treatable. And then a week later, there was a shorter piece in which this message was repeated and the magazine reassured its readers quotes that you can find help for depression and encouraged the reader to write to their depressed friends offering this sample letter form, deer, plank, axe. I care about you and I am concerned that you are not yourself lately. I don't like to see you unhappy. I hear depression is an illness with very effective treatment. And two weeks later, in the depression screening reminder, Parade repeated its recommendation that people go for quotes depression screening. It's like cancer screening, which last year saved 1500 persons from suicide. Now again, suicide is not exactly my topic for tonight, but you realize, if you have any sense of history at all, that we are talking about the renaming of what used to be sins, of mortal sins as diseases. Suicide was self-murder, up until the 19th century. Exactly like abortion, adultery, fornication, all kinds of things. Homosexuality, masturbation. These were all sins. Now they are all mental diseases or mental or psychiatric treatments if it's masturbation. Now when I went to medical school, masturbation was still listed as the cause of schizophrenia. But none of this somehow makes any difference. Now depression cannot be a disease. And the fact that somebody can do something about it that makes you better doesn't mean that it's a disease. It simply means that you can be made to feel better by all kinds of things. Smoking, sex, winnings a lottery, and so on. All kind of divorce. Now one more point about how we pay for healthcare, which I forgot to mention and I mentioned the nonsense about insurance, first of all, which pays for trivial, which is not an insurance for catastrophic costs, but is some kind of a social redistribution scheme, a scheme of socialized medicine, or redistribution of costs from one person to the other. The last thing, which of course is wrong with it, this also is beginning to dawn on people, so it's not articulated. And there is no healthcare crisis with any kind of proper use of English in the sense that healthcare, certainly for those who can afford it and who can make use of it intelligently, has never been as good as it now is in this country and in many other advanced countries for the simple reason why automobiles have never been as good and airplanes have never been as good and telephones have never been as good. Obviously, I don't have to belabor that. That is better now. We have all kinds of diagnostic and therapeutic tools. So, period. So, there is no crisis in that sense. And even poor people, as economists point out, not only is a poor person they live better now than the richest person did 300 years ago, but even a poor person, a penniless, homeless person who has a bleeding peptic ulcer or a fractured leg who goes to Bellevue Emergency Room, gets better care than the king of England got 300 years ago. Again, because, well, it's obvious. Now, what is a crisis? Well, you're damn right there is a crisis. The crisis is that healthcare has become for entirely tax-related reasons, which all of you know much more about than I do, related to employment. Now, insofar as there is insecurity of employment, that's translated into insecurity of healthcare. What's the answer? Why should healthcare be connected to employment? We want to go back to the old company towns where the company gives you schools and grocery stores and everything else, like in West Virginia, 50 years ago. Why should it give you health insurance? This has become, of course, a business in some ways, the original German model. Again, this is sort of unquestionable. This was, as you know, the Clinton's selling point. Don't worry. You don't have to pay for it. Your employer will pay for it. Well, it's like saying, don't worry about it. Your parents will pay for it. Now, where that money will come from? Again, it's lost in this economic stupidification. So until that is, until healthcare is separated, so-called health insurance, from employment, I don't think we can talk any sense at all about healthcare. It's all nonsense. But to show you how inimical to American thinking's idea that one should not only pay for one's own healthcare, and you know, I don't have to remind this audience of that wonderful libertarian adage that people pay for what they value and value what they pay for. Well, this has been completely inverted, both in education. The Sheldon has so eloquently shown. And in healthcare, the idea is somehow that these are two things that are extremely important, but we shouldn't pay a penny for it. Now, somebody suggested about the abortion problem that maybe this is something that should be paid for by private insurance. And I happen to come across one of our leading politicians comment on this. And I will just first say what this person said and then I will identify the person, unless you can identify this person yourself. The answer to this one quotes, we are totally opposed to women getting private insurance for their private parts. I mean, if this isn't communist rhetoric, I don't know what it is. What's wrong with private insurance for private parts? Or any other parts? This was congresswoman Patricia Schroder. Now, let's go back a little bit to the history. And let me read to you what our great benighted president, Franklin Delano Roosevelt said about this, who really launched this thing, now actually the origin of this problem. And I describe this in my book, Our Right to Drugs. And there's a large literature on this. The origin of this, as Milton Friedman pointed out, the origin of this problem, of the politicization of health goes back to medical licensure. But even more, I would say, because medical licensure obviously is an indefensible kind of restraint of trade, but even more to prescription drug laws. Prescription drug laws, I think, is the beginning of the end in some ways of freedom in this country, in that it is a leading wedge of telling the American people, you are too stupid to determine what to put into your own mouth. Now if you are too stupid, then we'll tell you. And it begins with opium for Chinese immigrants, and it ends with cholesterol or wherever. Now let's see how it started, or sort of got its momentum. It was already in motion, but it was very languid. In 1940, one of the things which Roosevelt did, which is very little remembered perhaps, is that he dedicated the National Institutes of Health, not far from here, in Bethesda, and at the dedication of the NIH, Roosevelt said the following, quotes. I should have read this first, because it certainly sounds more like Hitler or Mussolini. We cannot be a strong nation unless we are a healthy nation, and so we must recruit not only men and materials, but also knowledge and science in the service of national strength. The ramparts we watch must be civilian in addition to military. End of quotes. So like in Italy, Germany, and the Soviet Union, it was time for American medicine to cease serving the interests of the patient and begin to serve the interests of, quote, national strength. 23 years later, Kenneth Arrow, Nobel laureate in economics, declared quotes. General social consensus that the laissez-faire solution for medicine is intolerable. This year, in the prestigious Chateau Lecture, Bernadine Healy, the former head of NIH, who recently resigned, hailed Roosevelt's medical patriotism and proudly proclaimed quotes in fulfilling its mission, the National Institute of Health is quintessentially political, but we hope it embodies politics and its best, the use of public resources and power for the public good. By seeking to intervene between our fellow creatures and their suffering or death, the National Institute of Health is our most authentic answer to the question of our humanity. There you got it. Not one word about doctors or patients or the doctors due to the patient or the patient as an individual. Now let me run through there is no health crisis here in the technological sense, in the correct sense. The reason, why there is one? In other words, what we have is a problem of cost increases. Now, why has the cost of healthcare increased? I have listed without explanation there are pretty clear seven reasons, which are usually not, some of these are usually not that clearly identified. Now one is the most obvious one I alluded to already is the development of sophisticated and costly diagnostic and therapeutic technologies. Well obviously, if you have CAT scan it costs as against if you just have a stethoscope it costs more. Second one is the result of the success of medicine there is an increasingly aging population beset by more and more and more incurable diseases. There's this idea that you save money by curing a disease is complete nonsense because a person will just get more diseases later. The economically most effective thing is for somebody to smoke a lot and drop dead certainly at age 50 if a coronary heart disease and he won't collect his social security he won't get any more diseases he has lived he has been productive then he's dead so it won't cost anymore what would be even more effective if nobody gets bored then there are no medical expenses at all. So thirdly and this I have emphasized this is sort of my hobby horse is a medicalization a terrible word but it does the job the medicalization of life there is categorizing more and more undesirable behaviors as diseases and now be careful more and more desired behaviors as treatments several people have asked me well if somebody has for example quotes a chemical imbalance doesn't it prove that that's a disease if they get better on Prozac? Well a lot of people feel better after they smoke Sigmund Freud was a leading example does that mean you suffer from nicotine deficiency until then you have to get back to what is a disease a disease is something that a pathologist finds in the body chemically visually in whatever way it is not the organisms response to a chemical which is subjective I feel better that's a very nice anecdote it's very important that's why people do whatever they do drink, eat get married get divorced have children and so on complain about children so it all makes you feel better and worse every thing is that life until you die every solution is a new problem think about it every solution is a new problem now say fourthly the transformation of the physician's role from ministering to the medical welfare of his patient to servicing healthcare consumers fifthly the creation of a vast so-called health insurance industry sixth the persistence of the illusion that we have a free market in drugs and medicine people talk about private practice drugs and so on as though this was really available and lastly I put lastly because it's probably economically not that great but it's very important ideologically is escalating role of litigation in medical practice and in listings this I have in mind not only malpractice litigation some of which of course is justified but a great deal of it like the verdict about the spilled coffee in McDonald's illustrates a mechanism which seems to me I mean again I'm going to give you my answer to it which seems to me so transparent people keep complaining about how irrational this is but I don't think this is irrational at all I mean you know I like this old Shakespearean I think Shakespeare was a very good quote psychiatrist he said there is method in madness which is another way of saying it's not met at all if you can figure out what the method is now what's the method in this large men awards, various awards it's perfectly sensible it's Marxism take from those who have it and give it to those who don't except we call it tort litigation now except for technical advances in medicine and the aging of the population every one of the other factors is due to the government's involvement in healthcare if the government was not involved in paying for cat scans and cat scans would be like lexuses or expensive hotel rooms so you know Mediterranean vacations and people who can pay for it would pay for it and people who can can't now maybe in the discussion period we can get back to you know well what about should healthcare be really a a market item I'm not going to discuss it now there are I have some comments here on two other subjects that I will just go by fast and there is one is that because of the fact that healthcare health insurance has increasingly subscribe defrate the expenses of the most trivial things including medicines you know which because five or ten dollars which people could pay for just like for lottery tickets but since even those are increasingly covered in healthcare another phenomenon has come into being which shows sort of the hypocrisy is in hypocrisy and there is again I don't know how many of you know this but you know why do we have prescription drugs well the rationale is that these many of the drugs and this is all true chemically biologically very complicated products and unless you're a physician unless you know about pharmacology and so you really don't know what they do you shouldn't just be able to go out and buy this but go through an expert who will give this to you well fine well how do you explain the fact that all of a sudden a prescription drug overnight becomes an over the counter drug well why because of economics because over the counter then you have to pay for it from your pocket and the insurance company no longer pays for it so now there is an economic incentive for making all kinds of drugs over the counter drugs just to give you a couple of examples and many of these are really imbecilic in the sense of infantilizing in the extreme in that many of these drugs are still prescription drugs if you get it in an adequate therapeutic dose if you get it in a dose which is so small that you really have to take two or three pills to get an effect best example is Advil Advil is ibuprofen prescription probably many of you have taken it I have had a bad back it's a wonderful drug it's a it's called motrin now if you go to a doctor he will give you motrin which comes 400mg 600mg 800mg pills Advil is 200mg that's probably too little now if you take two Advil then you got a prescription straight motrin that's legal same thing with Benadryl Benadryl is antistamine 25mg there's a whole list of this now and this list is now being increased all the time in order to get them out of the insurance scheme excuse me let me not lose my now manage the other thing I was going to talk about is managed competition but I'm not going to talk about managed competition because that's patently an oxymoron there's no such thing okay now let me turn to the two examples which I want to explain the two big diseases which now illustrate the problem of increasing health care costs and my argument about the government really being in an entirely new business and Benadryl point this out now because this seems to be a very very simple transformation which again let me sort of slice right through it whatever you think of the legitimacy of the state and the history of this debate from hops and lock on it makes a lot of sense to think of the state as some kind of a necessary if you like necessary evil as this organization this monopoly of power that has come into being by whatever fiction of consent or whatever but historically through some it makes some sense to say that we are going to forego the idea of adjudicating wrongs and using coercion and power and we're going to do this to protect us from what? to protect us from enemies abroad called for which we have soldiers and enemies abroad enemies at home called policemen well it seems to me that in the last 30, 40 years and now with total abandon in the last 10, 15 years today with total abandon United States in particular it's as if the government has said we have a new contract that will no longer protect you especially from enemies at home you cannot leave the hotel in New York at 10 o'clock and walk around you cannot leave your home because it's probably reorganized you will be pickpocketed you will be assaulted in the subway you will be pushed under the subway and we are not going to do anything about it because that's not our business our business to protect you from yourself therefore back to psychiatry this is where psychiatry came in psychiatry is a system which came into being in order to protect people from being dangerous to themselves or others you know that this is the key law in every modern society goes back to roughly 1700 in England has an interesting history now this was a way to get rid of unwanted people who committed no crimes I mean here is this middle aged or elderly or a grandfather or a wife let's say you want to go about your business and she's depressed she doesn't feed the babies she doesn't take care of herself she becomes an embarrassment but here you are at 1720 an English nobleman how do you get rid of her there's no divorce murder is illegal this was a problem that Macbeth had what is he going to do remember Macbeth calls for the doctor what's he going to do is lady Macbeth and here he murders his way to the pinnacle of power he wants to enjoy himself I always think of Macbeth as Lyndon Johnson lady but so what is he going to do so he calls the doctor and the doctor says no this is not a business for the doctor it's a business for the cleric and what does Shakespeare say is a correct treatment for depression suicide why because she's depressed because she's evil now this is all gone now we have to protect you from yourself he started with psychiatry and psychiatry mind you again be clear about this psychiatry was very important it still is important psychiatry began as I see it as a sewer of medicine this is how doctors got rid of troubles and patients now it's a sewer of society what do you think will happen to this gentleman who shot at the white house this afternoon do you have any doubt that he will be seen by a psychiatrist in the next 48 hours now what for is it prima facie a crime to go around and shoot at the white house in Pennsylvania what do you want to examine for what are you looking for his mental state what does that mean what mental state right first again this will come up with something why to show to the American people that no quotes say an American want to shoot at the white house god forbid who wants to do that and secondly probably to be able to dispose of him longer than the law would permit because I don't know what the legal penalty for this thing is but whatever it is he's going to be in the mental hospital longer than otherwise see when he's simply going to get out never in a pine box they're waiting for him to be cured this is all legal this is all not more than legal this is the ACLU everybody's forces except libertarians and even libertarians you know this is very hard not to crack you know what you do with crazy people and I'll be happy to have some discussion about this but now let's turn to that's why I thought I would take two examples of quotes craziness which are perfectly normal namely eating too much and smoking now let me give you a couple of quotes all from very recent as you know this has gone on for a long time too now several decades but now it's sort of getting a greater steam is building up behind this treating overweight as a disease a group of investigators notice that this is now a legitimate subject for the center for disease control and prevention they are not studying eating too much they don't call it that of course overweight I'm quoting from their report from July 94 overweight is increasing in US adults and continues to be a public health dilemma listen carefully because there are internal contradictions here that I don't want to belabor it's a public health dilemma for which no efficacious practical and long lasting preventive or therapeutic solution has yet been identified please keep that in mind because of what follows immediately overweight they repeat overweight is a condition known to be resistant to intervention nevertheless next sentence no pause nevertheless federal health authorities have targeted the reduction in the prevalence of overweight as a national health objective to be achieved by the year 2000 of course I have all this referenced now picking up the theme the new york times needless to say gets immediately on this bandwagon and ringing its hand it reports that the proportion of adult population considered overweight defined as being 20 percent or more over his or her desirable weight increased from 25 to 33 percent in one decade so naturally they go around and ask people what they think this in whom I won't identify at Columbia University stated quotes the proportion of the population that is obese is incredible if this was about tuberculosis it could be called an epidemic the problem with obesity is that once you have it it is very difficult to treat a Harvard university professor not to be outdone has numbers for it he has figured out that obesity cost a nation exactly no sense are mentioned now how can obesity cost anybody anything is beyond me but this is a new English the government is not doing enough stated Philipp Lee assistant secretary of health finally one more expert on obesity weighed in urging quotes a president's council on diet and health to be established the Democratic congressman rushed from New York promised to introduce legislation to create such a council now notice that also the experts agree must be treated and compare this to the fact that the FDA won't put a drug on the market even if it's used for 20 years in Europe and even though the customers are willing to take it and take a risk because they have not proved it yet that it's safe and efficacious unless you can prove that a drug treats a particular disease the FDA will not license it for sale in the US so in that case they are over strict in this case of obesity it's untreatable according to their own expert it's a government job to treat it now this of course is all nothing compared to smoking and I have several quotes here some of which I will probably not bore you with but the war on cigarettes has now escalated to such a point that any several commentators have in the last couple of years compared the tactic to Nazi and communist tactics and one of the most one of the ones that I like the best and I will quote this is a comment that Florence King wrote who I think in my opinion is probably the best humorist now in this country best satirist writing a national review now without mentioning where she got this from and I suppose most of you will recognize it let me just read to you what she wrote quotes when they came for the smokers I kept silent because I don't smoke when they came for the meat eaters I kept silent because I'm a vegetarian when they came for the gun owners I kept silent because I'm a pacifist when they came for the drivers I kept silent because I'm a bicyclist they never did come for me I am still here because there is nobody left in the secret police except sissis with rickets now this is a parody on the not at all funny lines attributed I understand that this is not no one really knows whether he said that but pastor Martin Nimler said this about how the Nazis came for the communists and the Jews and so on and when they came for him there was no one to speak of now the same I won't read this to you probably some of you have seen it perhaps you didn't notice it the R.G. Reynolds company has been running full page ads they came for this and alcohol what will be next cigarettes tomorrow sort of the civil libertarian now you see none of these people said this about marijuana or opium or all the other drugs now Vladimir Bukovsky won't read either he actually compared it to communist tactics and he suggested and he was wondering who won the cold war and whether this isn't cold war cold war number two we are living through today the new breed of coercive utopians striving to alter our culture etc now what does all this mean my reading of this is that this is all a part of what Joe Sobren was telling us at lunchtime with the following footnote if you like or appendix to it what has changed in the constitution why is this totally different approach and I'm going to put this to extremely simply but sometimes things are very simple the moral political religious if you like and I'm not a religious person so I don't want to parade on their false premises but that doesn't mean I can't share certain religious traditions or values had a basic premise which had never occurred to them to question and there is that they are dealing with other adults that is the politicians who were there so to speak existential equal who were equal before God who were responsible for moral agents now it never occurs to anyone now in the intelligentsia in this medically psychologically sophisticated age that anybody who does anything wrong is a moral agent only normal people are moral agents abnormal people have something wrong with them they had child abuse alcoholic fathers sex abuse they have neurosis they have multiple personality they are schizophrenic they are depressed and so on they are not moral agents and they will only be moral agents after we fix them and we have to first turn them into moral agents so they and this explains why virtually all the ads all the rhetoric Mrs. Reagan exemplified this is a war on drugs she all the time talked about keeping drugs from kids well who wants to hear about kids since why do politicians talk about kids who is keeping kids from Clorox and toilet cleaners and whatnot and knives we are not talking about kids kids are a problem for parents we are talking about what adults can do but there are no adults except the politicians and their psychiatric agents this is the light motif and Hillary and Tipper Gore and Bodys and the fact that I know that I am putting my food in my mouth not the punishing ones we don't punish anymore that was Kalemeninger's famous book the crime of punishment punishment is a crime crime is not a crime that was the best seller you are laughing that is now look at DSM4 look at the American Psychiatric Association why would criminals be immediately asked to have psychiatric exams if the presumption was there is something wrong with them or else they wouldn't have done what they have done there is no evil in my mouth let me show you how I see this transformation in so to speak religious terms seems to be our very concept of God and religion has become debodged and I apologize if I offend anyone I apologize even more if the point I make is not as good as I think it is it seems to me that a couple of hundred years ago and it doesn't matter whether it's a hundred years or two hundred years not that long ago let's assume that there was some natural calamity sudden flood or avalanche in the Alps which wipes out a little village let's say 60 people perish in this mudslide and water and three survive but in the old days I think a lot of people would have gone to church and entertained the idea that they ought to thank God for saving these three people and that this is a very important event but that maybe there was some element of divine punishment in killing the other 60 maybe they were sinners maybe there was something wrong with them this is now blasphemy now if something like this happens everybody inside the television cameras goes and thanks God for saving the three people the idea that the 60 died is not mentioned in this case obviously you can't sue anybody except maybe you can sue some ski lift operator if he owns a hill but that's not mentioned what I'm getting at is that we now think of God as only doing good things exactly like quotes adults if they do bad things they don't exist and this is reflected in the kind of gallop polls which ask people do you believe in God and 95% is yes do you believe in heaven 98% is yes do you believe in hell 2% now it seems to me that this all makes sense that we only have normal people which we are going to cure but we no longer have human beings I mean this Odin has also picked up so among other things then what we have since obviously people do bad things what we have also we no longer use this word why do do people bad things in old fashioned terminology and this term is still usable because we have temptations but we don't use that term anymore because people have temptations to gamble to eat too much to drink you know gluttony fornication and so we don't use these terms now we have disease terms now and therefore part of the government's job is to regulate the temptations and to protect you from being tempted to it don't be tempted by heroin you can't get it if you get it we will put you in jail for a long time we will tell you what to be tempted by lottery because this is extremely interesting because when I came to this country when I came to this country thank God before the war gambling was a far worse moral and political thing than drugs you could get you could get any prescription you could get all the barbiturates you wanted as a layperson if you knew the drugist if you knew what you were doing and you paid for it nobody worried about this it was prescription laws were permissive there was no triplicate prescription nobody was watching the doctors waiting to put them in jail so it was a totally different atmosphere there was no but gambling my God that was their everything now gambling is sponsored by the government hand in hand there is a new disease pathological gambling well you know what that is pathological gambling is when you lose it's it now now I have one other apropos of temptation what you shouldn't be tempted by one other delicious quote here from very recently by a psychiatrist naturally Roland Griffith a professor at Johns Hopkins not far from here who said in the New York Times explaining these various drugs quotes people think of chocolate and sodas as food but a case can be made that these are vehicles for drug self-administration now notice it's a very word drug self-administration and the other English word perfectly nice English word self-medication is now synonymous with doing something bad now you know what masturbation used to be called in the good old days self abuse we don't have self abuse we have drug abuse this is a very libertarian theme there is only one sin in a libertarian philosophy as I can see it and that's in an anti-libertarian philosophy that is to say and that's autonomy if you take care of yourself if you control yourself then you are no good nigga because then you don't need the create leader the protector most of us don't need the FDA to protect us from heroin we wouldn't be using heroin that's true for most Americans so you only need these things if you admit that you can't control yourself so we are all back to alcoholics anonymous and 12 steps the entire country in effect is supposed to see as soon as it reaches 18 dear president, dear country I can't control myself please control me now again Winston Auden has satirized this particular social attitude in the following words this is lovely he is now talking about the care takers quotes we are all here on earth to help others what on earth others are here for I don't know well believe it or not I am finished I have a concluding paragraph which I am going to read to you we have been traveling down the road to what I call therapeutic serfdom to take off from Hayek the therapeutic state we have been traveling down the road to therapeutic serfdom for a long time really away from 1906 from the food and drug law enactment perhaps for too long to reverse course assuming that there is popular desire to do so for which there is not the slightest sign liberty, as you learn at hand lies in the hearts of men and women when it dies there no constitution no law no court can save it no constitution no law no court can even do much to help end of quote I think we will seriously consider the possibility that liberty has in fact died in the hearts of a very large majority of American men and women and I venture to say that if that diagnosis is correct the autopsy will show that it died by overdosing on therapy thank you well it's only 940 I'll be happy to entertain any questions or anything that I know anything about so if you want to ask anything more psychiatric feel free to do so but you don't have to I don't need this please sir what is it? a tape work it's a good story well thank you I like that I mean diseases excuse anybody else could you comment on the work that people are doing in terms of trying to isolate DNA and other types of things like that to to predict people's predilection towards certain behaviors such as drug abuse and alcohol abuse I don't know where to begin to answer that question because to my mind enterprise is so patently fallacious again it doesn't have to invent the wheel it's already been invented the way you identify the etiology or cause of a disease is by you first identifying the disease it has to be something somebody has edema in the legs let's say like from heart failure you know possibly some stasis for some for surgical reason but then you have this person has too much water in the legs and you want to find out why this is a physiologic physical observable phenomenon drug abuse is a name for a behavior now by definition drug abuse is not the kind of thing although there may be exceptions to this in the case of alcohol or some other things but by and large historically drug abuse conforms to the Mark Twain formula quotes nothing so much change needs changing as other people's habits well what is drug abuse drug abuse is what somebody else does or how do you in other words you can study the the genetics or the biology of why two lips are black or white or red but you can't study why they are beautiful it's a judgment there's no genetics of why two lips are beautiful now drug abuse is a judgment what's drug abuse are you with me so I don't know what it is that these people are studying now that some people may be for temperamental personally biological reasons may be more inclined to drink let's say alcohol that's possible I mean there are all kinds of anthropological historical comments about that maybe the Irish are more inclined than Jews although that doesn't seem to hold up with acculturation and what not with cultural change but let's assume that's a case from a social policy point of view that would only mean that people of Irish descent would have to exercise more self-control because they are more interested in it but it's no different than some some bibliography is more interested in reading than somebody who is illiterate you see my point? I draw an absolutely impenetrable wall between behavior and disease disease as a happening but this is not this doesn't completely hold up there are some disease which are more functional but this is a very very important thing to keep in mind behavior is behavior I'm not denying the existence of behavior schizophrenia paranoia depression and so on phobia this exists but it's a means for behavior actually in my very first book I compare abnormal behavior to something which you can hear demonstrated right here in front of your eyes speaking with an accent it's an abnormal behavior who is responsible for it? I am I don't have to speak can you shut up? I could have spent my time taking voice lessons since I was writing books I could go back to Ireland so who is responsible for this? I can scheme child abuse where parents taught me Hungarian this is a habit a habit pattern just as identifiable as alcoholism or paranoia a paranoid person thinks that people are after him very often people are sometimes they are not so what? what's next? it's a constitutional right you have a right to be paranoid you have a right to be schizophrenic see you cannot understand any of these things this is to my mind that's why I think I was interested in libertarianism before I knew how to read and write because it seems to me the issue is freedom the issue is freedom from being coerced by physicians but there are civilized society modern society nobody can coerce you except policemen judges legislators and doctors psychiatrists not ordinary doctors you can go to a dermatologist with no matter what and you can be sure that you can leave the office you cannot go to a psychiatrist and be sure you can leave the office and you certainly can't go into a psychiatric hospital where the door only speaks one way now you're all laughing but this is a phenomenon which has not been taken seriously and which I am convinced will destroy western countries because this is an era nobody can be in favor of craziness of madness or illness so people say well you are in favor of people being ill how can you be in favor of them? untreated illness people say SARS wants to deprive mental patients of disease I already indicated there is no connection between disease and treatment treatment is something you have because you want it and pay for it most doctors treat non-existent diseases yes sir I'm involved in two industries that are licensed and in both cases the licensing boards are controlled by the industry could you tell me about the AMA and their part in what you've been talking about well I didn't understand the first part of you I can tell you something about the AMA probably nothing that you don't know already but I didn't understand the first half of the question about you are involved with this licensing can you elaborate on that or it's not important? you know what from a purely technical point of view who else should be controlling it in other words from a purely technological point of view I would not be that particularly opposed to doctors being in charge of determining what is correct medical practice who else should determine it politicians or stockbrokers or electrical engineers there's nothing wrong with that the question is why should they have any political power the American Medical Association is simply just another labor union that has sprung with you know when I went to medical school there was no greater crimes and group practice I mean even places like the Mayo Clinic where I looked at scans because the idea was that anything other than a direct contract within a patient with a doctor and confidential personal relationship between those two essentially a free market relationship anything else but unethical now of course this was built on top of the fact that already they enjoyed licensure and the special privileges of excluding non-doctors chiropractors and so on this whole competitive thing again I don't know what to say about this except to read all of these things as we read the stock market or as we read economic reports or the symptoms of our own bodies the fact is that and this is where Libertarian is Libertarian should keep this in mind that freedom autonomy the drive for freedom is only one of the things that people want now those of us in this room put this particularly high but there are all kinds of other values that people rank very high often much more highly than liberty of which health is very high security dependence on authority now most people like this idea that they can look in the yellow pages and every doctor is every other doctor that these are fungible entities that you don't have to find out who this doctor is and how good he is so this phenomenon, this licensure caters to that and I don't think this is imposed on the people I think this fact satisfies a human want it seems to me and perhaps I didn't dwell on that enough that really the underlying problem is that there are not enough adults who feel like adults that people are infantile most people and want to be treated as children and this is the result of it and you see I mean people weeping when Kennedy dies Roosevelt dies as though they lost their father I mean they should have been happy I mean because they're lawmakers I mean implication is the more loss it makes the better and so on but this is but they take care of you I mean it's the twins shall never meet I mean the question is how do you look at these people somebody that you need to take care of you or somebody who's bothering you now most people look upon doctors in the AMA and they're going to protect them from quacks the fact that they are licensing quacks that the whole thing is somehow the distinction between quackery and real medicine is best known in hindsight 50 years later you can decide if it was good medicine Doctor is there is there anything that you've noted in your members of the profession that makes you optimistic either in the short term or the long term Well I am no Pollyanna but I'm not totally pessimistic in the sense that the march of that science civilization, knowledge and so on are cumulative, are progressive we know more and more all the time and nothing can do anything about this and beyond then the genie is out of the bottle you know just as soon as a hydrogen bomb was exploded I understand the story of the hydrogen bomb Russian one is that as soon as Teller managed to make one here and it was exploded the Russians could tell from the fallout how it was made boom so we didn't have to really spy for it that may help so knowledge is cumulative and to the extent to which we have more knowledge and more technological progress doctors will be able to explore you no matter what now I am not all that pessimistic either that there will be there is only so far you can push people I think the interactability of the war on drugs the very fact that we are engaged in this quest of building more and more prisons and so on and that this is constantly in the news and the polarization between blacks and whites that this has created I think all of this may act as a corrective after all we are creating a race war with war on drugs now this is how we this is how we will reap now what end of that will be again that may be a catastrophe or it may be something relatively corrective that we will see that this is something which was a stupid thing to do this is a tiger that's very hard to dismount it's very very hard to dismount which seems to me that until we distinguish between two very simple English words and this would be relatively easy to do between or three English words two of which are synonymous or could be synonymous the two good ones are cure and care okay now the other one is coercion now how this can be coupled is the problem and we know now that the medical progression as it has become more and more statized is more and more in the business it's more and more like psychiatry as it has always been people understood that and this is also very difficult to talk about excuse me for taking a little longer to answer this question see when I grew up things were relatively simpler and unless you know the history of this again you'll be confused even when I grew up in Hungary 1920s 1930s it was very very clear that psychiatry was essentially like a jail function there were blue-coated policemen and white-coated policemen and there were prisons in which you were locked up by the law and there were medical prisons psychiatric prisons which were locked up by mad doctors now this is a history you realize that long before there was psychiatry there were mental hospitals psychiatry doesn't start like medicine it's beginning of psychiatry it's the beginning of mental hospitals then there had to be a rationalization for why people are in there and for that mental illness was created that in a nutshell is the history of psychiatry so this was psychiatry okay now up until the Freudian Revolution and this is very interesting civil rights and so on I don't know if you realize that there was no such thing as a Jewish psychiatrist well think of the great psychiatrist Pinel, Eskirol, Krepelein, Bloiler, Wagner Jaure how come there were no Jewish psychiatrists just like there were no Jewish generals in Europe a Jew could not become a state hospital director which was what a psychiatrist was these were state hospitals look at the terminology this was a statist operation just like he couldn't become a general in the army so then comes Freud who is now described as a psychiatrist now Freud was all kinds of things he was never a psychiatrist he never broke the mental hospital he never had a single patient who didn't want to be his patient psychoanalysis originally was what it would now be called anti-psychiatry psychoanalysis was a contract between two people one of whom paid the other for a service and this is how the voluntary part of what we now call psychiatry came in we have two kinds of psychiatry voluntary and involuntary which are in exactly the same relation to one another as a prosecuting attorney and the defense attorney except this is now homogenized so that when you are in trouble out there let's assume you are indicted for a crime you think you are going to somebody who will help you but you are going to a prosecuting attorney because they are not identified as which is which and in fact all psychiatrists are supposed to be now agents of the state by law so this has become an extremely intractable problem but this is how it started this is entirely different to some extent this function to people has now been taken over by social workers and psychologists but because of the legal under structure of this this has now become very confused and the entire mental health industry as I see it is essentially a statist operation and in point of fact to put it very simply and you don't have to know anything about this except what you already know I dare say if every last cent paid by the federal and state governments or more mental health where withdrawn tomorrow morning psychiatry, psychology and social work as we know it would disappear from the face of America thank you