AI and ‘Iatrocracy’ – A Cautionary Tale

I was adding some final flourishes on the topic of ‘iatrocracy’ to my forthcoming book with Natewindé Sawadogo – Sickness and Social Order: Professions, States and Markets since you ask – when I decided to dig more deeply into the history of the word.

Richard Smith, former editor of the British Medical Journal, gave it currency in August 2020, in a blog reviewing The Virus in the Age of Madness by the French philosopher, Bernard-Henri Lévy.

Lévy’s book, which appeared in French in June 2020 and in English in July 2020, is plainly a work of passion. The original text from Plato actually uses the example of physicians to discuss the role of experts in government and everyday life rather than being specifically concerned with physicians as potential rulers. More to the point, the word ‘iatrocracy’ is not used by either Lévy or Plato, at least in translation – only in Smith’s review. Nevertheless, the term was taken up by a number of writers, including myself, to discuss the wider social and political implications of state responses to the COVID-19 pandemic. Was ‘following the science’ really such a good idea or did it come at the expense of other desirable features of human societies?

Further investigation revealed that the word had been around for rather longer than Smith might have implied – although he seems to assume that readers will be familiar with it. We can be fairly confident is it was not coined in Ancient Greece, although it welds together two Greek elements. ‘Iatros’ is often rendered as ‘physician’, although it would be more correct to translate it as ‘healer’. The use of the word ‘physician’ is better seen as an origin myth associating the 19th century creation of the modern medical profession with the iconic heritage of Western civilization. ‘Healer’ is a more neutral term and encourages us to look cross-culturally at the role of specialists in resolving problems thought to arise in bodies and minds. ‘Cracy’ comes from ‘kratos’ and refers to the exercise of power or authority in a social or political system. Merging ‘iatros’ and ‘kratos’ gives us ‘iatrocracy,’ government by physicians.

So who does invent the word and when? Google’s AI-assisted search pointed to the US novelist Sinclair Lewis, in Arrowsmith (1925), a satire on the social and scientific pretensions of the American medical profession. Fortunately, it is in the Internet Archive, which has a word search facility – that finds no evidence of the term. Google’s AI appears to have worked back from a letter in Time magazine on September 30, 1935, from NH Wendell, Jr in Chicago, who does use the term to refer to the desire of one of Lewis’s characters, Dr Holabird, that medicine should “rule, coordinate, standardize and make useful the whole world of intelligence, from trousers-designing to poetry.”

Wendell’s letter is one of a number of responses to an earlier Time article about a book, Man, the Unknown by a French physician and scientist, Dr Alexis Carrel, who spent much of his career in the US. Carrel was the 1912 Nobel Prize in medicine for his contribution to vascular surgery. He later developed technologies that eventually supported organ transplantation. However, like many Nobel laureates, he became convinced that people like him represented a human elite that should be favoured by eugenic state policies. He was a close associate of Charles Lindbergh in the 1930s and returned to France to work with the Vichy regime, dying before he could be put on trial for collaboration with the Nazis. Wendell was a Chicago banker who was prominent enough to have his 1934 marriage to a divorced New York actress, Dorothy Day, reported in the New York Times.

The New York Times may be a key linkage because the earliest use of the word ‘iatrocracy’ that I have been able to authenticate is in an unsigned comment (Topics of The Times 1933) on the inaugural address by Dr Bernard Sachs as incoming president of the New York Academy of Medicine. Dr Sachs was a leading neurologist – one half of Tay-Sachs disease – and a member of the Goldman Sachs banking dynasty. He had apparently urged the Academy’s members to take a more active role in government and politics. The anonymous commentator declares (my emphasis):

The critic goes on to argue, like Smith and Lévy, that a government of physicians would ultimately be no better or worse than a government of politicians, because it would still depend on its members’ political skills. The same would be true of government by any other group of professionals or experts

In this context, ‘manipulation’ does not seem to have the current sense of something that is covert, deceitful or underhand. The skills of the politician are those of reconciling competing values, interests and goals rather than imposing a particular doctrine.

What did I learn from this exercise – apart from the history of a word? First, the AI-assisted search found some useful material. However, it was really important to return to those sources. The AI threw up quite a number of references where authors had described iatrocracy without using the word itself – the weight that it placed on Lewis’s book was a good warning sign. Its references to Illich and Foucault are another example – I could not find either of them using the word in print, at least in English, and Georges Canguilhem, who is also cited, only seems to have used it once. The AI also seemed capable of giving different answers to the same question. On another run, it attributed the origin of the term to a US sociologist, Daryl Evans, at a 1989 meeting of the Society for Disability Studies, but its cited source actually links Evans to a different term ‘normate’ although correctly citing Canguilhem at another location.

In fairness, the AI comes with a health warning about possible errors but everything in this blog has been checked and supplemented with some old-fashioned detective work by its human author.