Ever at the Mercy of Well-Intentioned Regulations

Abstract

> One of the greatest delusions…is the hope that the evils in this world are to be cured by legislation.1 > > Thomas B. Reed, 1886, speech > The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding.2 > > Louis Brandeis, 1928, dissenting opinion, Olmstead v United States Physicians and scientists are privileged members of contemporary society. They are trusted authorities who are obligated to provide expertise without the influence of self-interest. Coupled to this obligation, they have historically been given the privilege of managing their own affairs. In recent years, however, increasingly stringent policies and mandates developed with the best of intentions by a wide range of regulatory bodies have challenged the autonomy of physicians and scientists. In this editorial, I will explore the forces underlying these changes and consider their consequences for society and for the practice of medicine and biomedical research. Physicians and scientists hold what the sociologist Max Weber defines as charismatic authority3 in matters related to their disciplines. According to his construct, charismatic authority is one of three forms of legitimate influence in society, the other two being rational authority (ie, that governed by laws and rules) and traditional authority (ie, that related to cultural norms). Authoritative “charisma,” according to Weber, refers to “specifically exceptional…qualities…not accessible to” other members of society. Physicians possess a unique, complex body of knowledge that can directly affect the physical and emotional well-being of individuals. Similarly, scientists possess a complex body of knowledge that can have broad-reaching effects on the lives of individuals. Science and the rational determinism of the scientific method have become fundamental tenets of modern society and in large measure govern social acceptance of the authority of physicians and scientists. Yet this essential authority can be compromised by aberrant behaviors that exploit the privileges vested in these professions to the disadvantage of members of society. To …