Adam Smith’s scathing attack on FOOL doctors and the self-seeking monopoly of the “medical” profession

Adam Smith felt that many doctors were FOOLS. He was scathing in his attack on the medical monopoly. Smith thought that it was not very practicable in any event for the public to obtain a satisfactory test of medical efficiency, that it was certainly not practicable if the competition by the private teachers were suppressed, that otherwise the medical examination might become as great a quackery as the medical degree, and that the whole question was a mere squabble between the big quack and the little one.

You propose, I observe, that no person should be admitted to examination for his degrees unless he brought a certificate of his having studied at least two years in some university. Would not such a regulation be oppressive upon all private teachers, such as the Hunters, Hewson, Fordyce, etc.? The scholars of such teachers surely merit whatever honour or advantage a degree can confer much more than the greater part of those who have spent many years in some universities, where the different branches of medical knowledge are either not taught at all, or are taught so superficially that they had as well not be taught at all. When a man has learnt his lesson very well, it surely can be of little importance where or from whom he has learnt it.

The monopoly of medical education which this regulation would establish in favour of universities would, I apprehend, be hurtful to the lasting prosperity of such bodies corporate. Monopolists very seldom make good work, and a lecture which a certain number of students must attend, whether they profit by it or no, is certainly not very likely to be a good one.

I have thought a great deal upon this subject, and have inquired very carefully into the constitution and history of several of the principal universities of Europe; I have satisfied myself that the present state of degradation and contempt into which the greater part of these societies have fallen in almost every part of Europe arises principally, first, from the large salaries which in some universities are given to professors, and which render them altogether independent of their diligence and success in their professions; and secondly, from the great number of students who, in order to get degrees or to be admitted to exercise certain professions, or who, for the sake of bursaries, exhibitions, scholarships, fellowships, etc., are obliged to resort to certain societies of this kind, whether the instructions which they are likely to receive there are or are not worth the receiving.

All these different cases of negligence and corruption no doubt take place in some degree in all our Scotch universities. In the best of them, however, these cases take place in a much less degree than in the greater part of other considerable societies of the same kind; and I look upon this circumstance as the real cause of their present excellence. In the Medical College of Edinburgh in particular the salaries of the professors are insignificant. There are few or no bursaries or exhibitions, and their monopoly of degrees is broken in upon by all other universities, foreign and domestic. I require no other explication of its present acknowledged superiority over every other society of the same kind in Europe.

 The title of Doctor, such as it is, you will say, gives some credit and authority to the man upon whom it is bestowed; it extends his practice and consequently his field for doing mischief; it is not improbable too that it may increase his presumption and consequently his disposition to do mischief. That a degree injudiciously conferred may sometimes have some little effect of this kind it would surely be absurd to deny, but that this effect should be very considerable I cannot bring myself to believe. That Doctors are sometimes fools as well as other people is not in the present time one of those profound secrets which is known only to the learned. [Source]