Kevin S. Decker on the strange charm of incompetent medics

Although we don’t use the word much anymore, “quack” is a term that ably describes Dr Leo Spaceman (Chris Parnell), 30 Rock’s resident medical nutcase. Like House, M.D., he doesn’t let a pesky code of ethics stand in the way of recommending “wildly experimental treatments” for his particularly tough cases. But here the resemblance between the two famous television doctors ends, for Spaceman is also clearly incompetent. Although Dr Spaceman seems like every patient’s worst nightmare, he’s praised and recommended by famous clients, like Tracy Jordan and Jack Donaghy. How can this be? The paradox of Dr Spaceman’s popularity despite his ineptitude is partly explained by 30 Rock fans, who agree that Parnell’s character steals every scene he’s in. But there’s more to it than this.

Sociologist Talcott Parsons may have an explanation. According to Parsons, our expectations of others in any kind of social interaction can be unpacked in terms of four pattern variables. Role expectations follow a pattern, and each pattern is comprised of five either/or possibilities: (1) openness to emotion or emotional neutrality; (2) orientation to self-interest or to the common good; (3) status achieved through effort or symbolic status; (4) orientation to general problems or to particular cases; and (5) competence that is specific or very broad.

According to Parsons, the decisions that we make about how to present ourselves in a social situation where role expectations aren’t clear involve us in making either/or choices in these five areas, or falling back on pre-established habits. However, for the professional, many of these choices are already made. This means that if you want to be called a medical professional by the community of your peers in the first place, you must show that you can put distance between yourself and your patients (emotional neutrality); that you don’t let the solution of medical problems become “personal” (orientation to general problems); that you are oriented in your daily work to the common good; that you recognise your status is tied to your own hard work; and that you develop specific competence. Understanding where doctors fall in the pattern variables, we’re on the right track to see how doctors fit into the overall social system.

As Parsons says, “A social system consists in a plurality of individual actors interacting with each other in a situation which has at least a physical or environmental aspect, actors who are motivated in terms of a tendency to see the ‘optimization of gratification,’ and whose relation to their situations, including each other, is defined and mediated in terms of a system of culturally structured and shared symbols.” It’s not difficult to understand Parsons’ meaning if we rephrase this in terms of the social system of 30 Rock: “30 Rock’s social system consists in people acting their roles (Liz Lemon as producer of the show, Kenneth as dependable country bumpkin, and so on) in situations that are stressful, where time is key and where people’s efforts are not very well integrated. In one way or another, every person acts out of the ‘optimization of gratification’ or self-interest, and some characters such as Tracy and Jenna are pathologically self-absorbed. These people’s relations are defined by the symbols they all accept, like titles, power, or sexuality.”

Now we can isolate at least three kinds of reasons why Dr Spaceman fails to adhere to the norms of being a responsible medical doctor: when situations out of the ordinary demand the behaviour, when self-interest distorts professional responsibilities, or when the symbolic role of the doctor is no longer a match with his actual duties. Since Parsons’ pattern variables are supposed to bind doctors to certain behaviours even in situations out of the ordinary, we should focus on the last two possibilities: the role of self-interest and the symbolic role of being a doctor in American culture.

Everyone who goes to the doctor does so in the service of self-interest; it’s the doctors who have to wrestle with deeper issues of whether or not treating a patient’s request is really in the patient’s interest or not. Dr Spaceman combines the virtues of doctor and drug dealer and blissfully avoids making the important distinction between therapy (getting patients back on their feet) and enhancement (offering Jenna pills “that keep people awake under any circumstances”). However, despite his incompetence and lack of ethics, I think that Leo’s “everything over the counter” policy is not fundamentally a function of bad character. Instead, it is a symptom of a wider phenomenon that Karl Marx called “the fetishism of commodities.”

A commodity is anything of value that can be traded for another thing of value, but determining the value of a thing for the parties who want to trade is the sticky part. In his economic magnum opus Capital, Marx considers different sorts of value, including the common-sense notion of “use-value,” by which we would put a higher price on a hammer that is better made and longer lasting than a cheaply made one. But there are also other ways of increasing the desirability of certain commodities, and therefore justifying a higher price on the open market. Marx thinks that some “mystification” is involved, the same sort of magical tricks that a shaman might use to instil respect for a wooden totem. He writes, “The mysterious character of the commodity-form consists therefore simply in the fact that the commodity reflects the social characteristics of men’s own labour as objective characteristics of the products of labour themselves.” Marx means that commodity fetishism drives consumer interest and willingness to pay more for things because products are given a kind of supernatural aura through celebrity endorsements, clever marketing, and the mentality of “keeping up with the Joneses.” Marx goes so far as to say that modern free market economies depend upon this mystification to keep the cycle of wage labour and consumer spending afloat.

Are medical services (and even doctors) “fetishised,” provoking desires that an outside observer would find puzzling or irrational? For the answer, look no farther than your own television screen and the romanticised prime-time commercials for drugs you can’t live without, like Cialis, Cymbalta, and Viagra. Direct appeal to the consumer by the pharmaceutical industry is only one of a number of curious results of the conversion of American health care to a managed care system throughout the 1990’s. While, on the one hand, preventive services and procedures (like cataract surgery) that would have been paid for in the pre-HMO insurance tradition are less likely to be approved for coverage, the demand for better and more exotic “high end” pharmaceuticals, life-saving therapies and technology has skyrocketed. This has led to an absurd imbalance in resource allocation decisions between care that many need, but can’t get approved, and that few need, but can afford. A large bureaucracy, using statistics and appeals to the bottom line, stands in the way of the general populace’s opportunity to decide wisely about their own care. But the social values concerning status and power that enable commodity fetishism among all of us makes the selfish actions of the few seem more acceptable. So, Jack expects Liz to agree when he tells her she’s one of the lucky to get a flu shot because of her status at TGS with Tracy Jordan. He instructs her, “Important people get better health care. They also get better restaurant reservations, bigger seats in planes….” “A more refined class of prostitute,” interrupts Dr Spaceman.

The point of the last section is that bureaucracies in medical care and other areas of life impose a system aimed at consistency and efficiency upon people, asking less of them in making good judgments. The flip side of this is that despite all its claims to being a neutral and objective science of human health, medicine is not immune to the effects of commodity fetishism. Commodity fetishism ensures that if there is enough subtle pressure to keep providing “purples from Peru” and endorsing Tracy Jordan’s Meat Machine, the professionals will make that happen. So one way of affirming the truth of Dr Spaceman’s claim that “After all, medicine’s not a science!” is to say that the dark side of the medical profession is found in the emergence of a market that serves the perfectly human desire to define the ideal of health in socially fashionable ways. If correct, this is a difficult truth to swallow, but it’s no worse than a visit to the doctor.

Kevin S. Decker is assistant professor of philosophy at Eastern Washington University

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