One of the points he made has been given a name of its own, the Shirky Principle. Like most really revolutionary ideas, it can be summed up simply enough: “Institutions will try to preserve the problem to which they are the solution.”
This is best understood by a specific example, so let’s consider the weight loss industry. This is a booming field, worth billions of dollars a year in the United States alone, and it’s backed by a constant drumbeat of pronouncements from government, health care officials, and the mass media. It’s also a total failure by every objective measure. The more money gets poured into weight loss, the more government and corporate programs push weight control, the more people go on diets and work out at the gym and gobble weight loss medicines by the handful, the fatter Americans become. Why?
A thought experiment gives the answer readily enough. Imagine for a moment that somebody worked out a cheap, effective treatment for obesity: pop one pill, let’s say, and your metabolism resets itself to keep you thin. What happens? A lucrative industry goes broke, and all its stockholders and bondholders lose money in a big way. All the businesses that make money off people who want to lose weight, and all the pundits and influencers who tell people how to exercise and diet, have to find something else to do with their time. Thus it’s in their interest to fight obesity—but it’s not in their interest to win.
That’s why steps that could have an immediate effect on the issue never get taken. It so happens, for example, that a stunningly large number of Americans are prescribed antidepressants by their physicians. It also happens that many of the most popular antidepressants have uncontrolled weight gain—up to 5 lbs. a month, every month, as long as you take the drug—among their common side effects. Has anyone talked about correlating obesity with antidepressant use, and explored the possibility getting people who have weight problems off antidepressants, or at least switch them to drugs that don’t have that side effect? Surely you jest.
It’s also worth noting that in the United States, there’s a remarkably exact negative correlation between obesity and altitude. On average, the higher you are above sea level, the thinner you are. Just one of those weird statistical oddities? Not in a society that dumps oceans of untested chemicals into the groundwater, which flows downhill and ends up in the tap water that people drink. It would be easy enough to test tap water in different localities for chemical pollutants, and then compare the concentration of each pollutant with local rates of obesity, to figure out which pollutants are most likely to be messing up people’s endocrine systems; focused studies could then settle the matter once and for all.
Of course nothing of the sort is being done, and it seems vanishingly unlikely that anything of the sort will be done. Partly that’s because it would inconvenience whichever chemical companies are producing and dumping the main culprits, but it’s also because the weight loss industry would suffer a devastating financial setback if any major cause of obesity were to be identified and removed. It’s so much easier, and so much more lucrative, to keep on pushing remedies that don’t work, and raking in the profits.
(And if, dear reader, you’re about to pound your fist on the keyboard because you’re sure that the cure for obesity is diet and exercise, and fat people just need to be bullied even harder than they are already, I’d encourage you to stop and think about the subject for a change. Government at all levels, the entire medical establishment, the media, and the weight loss industry have been pushing diets and exercise for more than a century now, and flinging abuse at fat people has become a national sport in the US. Those methods have not worked. Doing more of them isn’t going to work any better. In fact, the more diets and exercise have been pushed, and the more bullying has been directed at fat people, the more common obesity has become What’s that saying about doing the same thing and expecting different results?)
What’s true of the weight loss industry is equally true of the medical industry as a whole. It’s reached the point that the saying “a patient cured is a customer lost” is a bleak joke throughout American society, and for good reason. Old-fashioned notions of curing and healing were replaced long ago by what medical professionals call the “disease management” model: in effect, keeping you sick enough that you have to keep going to the doctor, without making you so sick that you lose your job and your medical coverage. That’s why so many pharmaceuticals these days have so many ghastly side effects. As computer geeks say, this is a feature, not a bug, since every time a side effect shows up, that’s another visit to the doctor and another plump bill.
This sort of exploitation routinely rises to levels that would face legal charges in a less corrupt society. One friend of mine spent years suffering from asthma so serious that she had to make repeated trips to the hospital. A few years ago she read about the role that wheat allergy plays in some cases of asthma like hers, and decided to try removing wheat from her diet. Her asthma went away. At her next appointment, she related this to her doctor, and the doctor nodded and admitted that she was familiar with the syndrome. My friend, astonished, asked, “Why didn’t you tell me?” The doctor’s response: “We prefer to medicate for that.”
No doubt they do prefer to medicate, and they have ample financial reasons for that preference. The fact remains that my friend had been burdened with a wholly unnecessary sickness for years, because her doctor was more interested in making money than in helping her patients. That’s the Shirky Principle in a nutshell: it’s so lucrative for physicians to fight disease that they are very, very careful never to win the fight.