“When the government is powerful, the people become weak.”
—Lao Tzu, Tao Te Ching
Few sensible scientists today deny the importance of Darwin’s theory of evolution. The general principle – that new species arise by natural selection, through the survival of the fittest – is widely understood and accepted.
It may seem obvious, but it is important to recognise that, for natural selection to happen, it must operate in a natural setting. If we tamper with the natural environment, we upset the balance of things. We remove the level playing field.
Humans, of course, do this all the time, and rightly so. We look after, for example, the weak and diseased, who would not survive if nature were allowed to take its course.
There are times, however, when the survival of the fittest by means of natural selection is in fact the best option.
Take the selection and training of medical students and doctors. Few would deny that we want our doctors to be the best – the fittest – that we can have. We do not want to select and train Dr B. Minus when we could have Dr A. Plus.
And, for hundreds of years, that is exactly what we did. Entry to all stages of medical training was controlled by a system of competitive exams and interviews where generally (but not always – the old boy network has always been powerful) the fittest survived and the less fit fell by the way. Sure, it was wasteful, but it was a meritocracy in which the fittest shone through, and which in the main worked to society’s advantage. We got mostly good doctors most of the time.
Over the last few years, the government has taken to meddling with medical selection and training.
It has introduced the disastrous MTAC and MMC programmes, which has ruined the careers of thousands of junior doctors.
It has shifted away from excellence based assessment (who shines out above the rest?) to competency based assessment (has this doctor met the minimum standard?).
It has introduced a bizarre compulsory on-line application system for medical jobs which combines staggering structural rigidity with eye-watering operational laxity.
And soon it will introduce revalidation, yet another centralised state control mechanism for regulating not only how doctors practice, but whether they practice at all.
State interference in and control of a profession on such an unprecedented scale has unwanted side-effects. When the government is powereful, the people do indeed become weak. A fog of apathy has engulfed the profession, while an Orwellian climate of fear ensures few step out of line. Those that do are quickly mown down. Mediocrity, not meritocracy, rules the day.
In such an over-regulated, controlled, unnatural setting, survival of the fittest by means of natural selection fails. Instead, we have unnatural selection, and thereby the survival of the conformist.
And we are all the worse for it.