1. Ronald F. White, Ph.D. Professor of Philosophy College of Mount St. Joseph

2. The growth in the number of health care experts and technology are explicable in terms of complex adaptive systems theory. Biological evolution and cultural evolution play a role in both the reliance upon experts and technology.

3. Medicine addresses human values. Therapy: Human beings get sick. (Therapy) –Physical disease Infectious disease Genetic Disease Injury Mental disease Enhancement: Human Beings want to improve the quality and quantity of life. –Physical enhancement Cosmetic surgery Breast enlargement/reduction Hair growth/removal Sexual –Menopause –Viagra Mental Enhancement (emotional and intellectual) –Counselors –Drug therapy »Attention deficit disorder –Quantity of Life: Human beings prefer to live longer lives (if quality). Life extending biotechnology

4. What is an expert? What are the various classes of “health care experts or professionals”? –Physicians –Dentists –Pharmacists –Nurses –Non-physician practitioners –Allied health professionals –Health services administrators Experts and Complex Systems –Prediction and control of complex systems Limits of Science Exercise of Power in Social Systems Unanticipated consequences

5. Why is health care characterized by a proliferation of “experts?” Evolutionary Foundation –Variation –Replication –Selection Human beings and control of destiny –Biological determinants (genes) –Cultural Determinants (beliefs) Biological Evolutionary Forces –Pain and Pleasure –Human Predisposition toward hierarchical social relationships. Leaders and followers Social Status of Leaders Males and Females –Morality Feelings of sympathy reciprocation Cultural Forces –Beliefs Teaching and Learning –From Religious experts to Scientific Experts Materialism and Reductionism Marriage counselors Child Psychologists –Role of Institutions Churches Educational Economic Forces (buyers and sellers) –Innovation –Competition between experts –Monopoly by experts Natural monopolies Artificial monopolies

6. The Social Construction of Disease –Control of Human Beings and their Environment. Malleability of the Concept of Disease –From Natural Processes to Disease (childbirth) –From Vice to Disease (alcoholism) Marriage counselors –Sex as a skill Child psychologists Self-help experts (Norman Vincent Peale) Moral Values –Beneficence-alleviation of pain and suffering –Utility-social good –Liberty –Justice Information (Beliefs) –Public and private education –Mass Media Technology

7. Forms of Medical Technology –Information Technology –Drugs and Devices Technology and Culture –Automobiles –Telephones –Computers Biomedical Technologies –Beginning of life –End of Life –Life sustaining –Life enhancing

8. Evolutionary –Increased Variation –Selection (competition) –Direction Progressive- Regressive- Equilibrium Role of Government –Experts –Central Planning Role of Corporations (sellers) –From Judeo-Christian and Hippocratic Medicine to Big Business Role of Individuals (buyers)