The Problem with Capitalism in the Trichological Sciences

ABSTRACT

Karl Marx and Friedrich Engels exposed a pattern of societal conduct they chose to name capitalistic bourgeoisie. The bourgeoisie created a common language of communication through collaboration, gathered in circles such as free academies, scientific academies, literary circles, and the media, that provided forums for the emerging bourgeoisie to conceive of new social orders. One aspect of bourgeoisie culture is conspicuous consumption, central to which, is a culture of prestige through material consumption. Capitalism is an economic system based on private ownership and the operation for profit. Characteristic features of capitalism include competitive market, commercialism, property rights recognition, capital accumulation, material consumption, culture of prestige, sycophancy, and coterie. Critiques of capitalism allege that it is exploitative, alienating, unstable, unsustainable, and inefficient. In turn, critical theory inspired philosophers such as Michel Foucault to conceptualize how we form identities through social interaction. When the patient’s body entered the field of medicine, it also entered the field of power where the patient can be manipulated by professional authority. Without forcibly being a proponent of political theory, as an academic, one is inevitably confronted with Marxism in terms of philosophy. As a discipline at the interface of medicine, lifestyle, and cosmetics, trichology is particularly susceptible to the primary aims of profit, consumption, and prestige that characterize the capitalistic bourgeoisie. The trichological sciences, particularly trichoscopy, have discovered a profitable market for itself. The practice of trichology is not immune to malpractice. It has created an industry that dwells on the autistic thinking of patients and doctors, and because it is prosperous, makes propaganda among lay people and doctors that necessarily leads to abuses.

“The will of the capitalist is certainly to take as much as possible. What we have to do is not to talk about his will, but to enquire about his power, the limits of that power, and the character of those limits.” – Karl Marx

INTRODUCTION

In 1848, Karl Marx (1818–1883) and Friedrich Engels (1820–1895) [Figure 1] exposed a pattern of societal conduct they chose to name capitalistic bourgeoisie which they made accountable for social inequity and injustice. According to Marx, the bourgeoisie are those who own the means of production and monopolize wealth, and stand in contrast to the working-class proletariat majority, whose labor power is exploited by the bourgeoisie. The bourgeoisie created a common language of communication through their collaboration, gathered in circles such as free academies, scientific academies, literary circles, and the media, that provided forums for the emerging bourgeoisie to conceive of new social orders, and lay claims to dictating central functions of society. One aspect of bourgeoisie culture that has been criticized is conspicuous consumption, central to which, is a culture of prestige through conspicuous material consumption. The bourgeoisie improved its own chances of gaining favorable positions in a system of material, social, political, and cultural inequality.

Figure 1.

Karl Marx and Friedrich Engels

Historical materialism is the term used to describe Marx’s theory of history. Marx locates historical change in the rise of class societies and the way humans labor together to make their livelihoods. For Marx and Engels, the ultimate cause and moving power of historical events are to be found in the economic development of society and the social and political upheavals wrought by changes to the mode of production. Historical materialism provides a challenge to the view that historical processes have come to a close and that capitalism is the end of history.

Capitalism is an economic system based on the private ownership of the means of production and their operation for profit. Central characteristics of capitalism include capital accumulation, competitive markets, price system, private property, property rights recognition, voluntary exchange, and wage labor. In a capitalist market economy, decision-making and investments are determined by owners of wealth, property, or ability to maneuver capital or production ability in capital and financial markets, whereas prices and the distribution of goods and services are mainly determined by competition in goods and services markets. Prominent critiques of capitalism allege that it is inherently exploitative, alienating, unstable, unsustainable, and inefficient. Specifically, the socialists argue that capitalism consists of irrational activity, such as the purchasing of commodities only to sell at a later time when their price appreciates, rather than for consumption, even if the commodity cannot be sold at a profit to individuals in need; they argue that making money, or accumulation of capital, does not correspond to the satisfaction of demand. Early socialists criticized capitalism for concentrating power and wealth within a small segment of society. Marx saw capitalism as a historical stage, once progressive but which would eventually stagnate due to internal contradictions and would eventually be followed by socialism. Marx claimed that capitalism was nothing more than a necessary stepping stone for the progression of man, which would then face a political transformation. Ultimately, as Marxian economist Ernest Mandel (1923–1995) remarked, “Marxism is always open, always critical, and always self-critical.”

In turn, critical theory inspired postmodern philosophers such as Michel Foucault (1926–1984) [Figure 2] to conceptualize how we form identities through social interaction. In fact, in the genealogy of medicine, knowledge about the human body, the term “Le regard medical” (The medical gaze) identifies the doctor’s practice of objectifying the body of the patient, as separate and apart from his or her personal identity. In the treatment of illness, the intellectual and material structures of “la Clinique,” the teaching hospital, made possible the inspection, examination, and analysis of the human body, yet the clinic was part of the socioeconomic interests of power. Therefore, when the patient’s body entered the field of medicine, it also entered the field of power where the patient can be manipulated by the professional authority of the medical gaze.

Figure 2.

Michel Foucault

Without forcibly being a proponent of political theory, as an academic and intellectual, one is inevitably confronted with Marxism in terms of philosophy.

TRICHOLOGY

As disciplines at the interface of medicine, lifestyle, and cosmetics, both dermatology and especially trichology are particularly susceptible to the primary aims of profit, consumption, and prestige that characterize the capitalistic bourgeoisie.

The professional market for cosmetic interventions into the skin has preceded those into the hair for a number of reasons: first, the market for facial rejuvenation has been dominated by plastic surgeons until botulinum toxin and fillers were introduced. Second, investigative dermatology found a profound interest in the study of skin aging, particularly as it relates to ultraviolet exposure, and exposed mechanisms at the level of the DNA and repair mechanisms, opening venues for effective preventive measures and pharmacological treatments of aging-related conditions of the skin. Finally, at the level of the health professional, the condition of the skin has been overrated in relation to the hair, mostly due to economic reasons.[1]

Moreover, yet, as early as 1860, a quasi-scientific interest in hair loss and hair care originated in a London barbershop under a self-styled Professor Wheeler. By 1902, this interest in hair disorders became known as trichology, and the first institute of trichologists was founded, offering courses by home study for the training of students internationally who desire more knowledge about hair. Trichologists are not medically qualified but are taught the practice of care and treatment of the human hair and scalp in health and disease within their restricted but specialized role. However, there have been criticisms regarding the role of trichologists who monopolize publicity and proliferate in the high street, versus the individuals following medical ethics in the practice and advertisement of their profession. In fact, in may jurisdictions, trichology is considered a paramedical discipline. It was against this backdrop that in 2010, Yesudian proposed the term dermatotrichologist,[2] and we alternatively coined the term trichiatrist for board-certified dermatologists dealing with the scientific study of the hair and scalp in health and disease.[3,4,5] The quality and stringency of the trichiatrist’s graduate medical training are identical to that of fellow physicians of any other discipline, allowing the trichiatrist to be comprehensive in counseling patients, prescribing medication, conducting physical examinations, ordering laboratory tests, and participating with the other medical disciplines in the diagnosis and treatment of hair problems as they may relate to systemic disease.[3,4,5] Meanwhile, there are individuals who profess themselves publicly as professors of trichology, while there exists no such academic title.[2]

TRICHOSCOPY

Nevertheless, trichology has discovered a profitable market for itself, particularly with the introduction of dermoscopy of the hair and scalp (trichoscopy) into dermatologic practice. As in no other field of medicine, paid online courses are flourishing internationally and with a primary commercial aim, ultimately combining profit and consumption with academic learning on the occasion of Carribean cruises.

Using dermoscopy, signature patterns are seen in a range of pathologic hair and scalp conditions. Some predominate in certain diseases, while others can even help making a diagnosis in clinically uncertain cases. Tosti was the first to systematically evaluate, classify, and summarize them in her original textbook in 2007.[6] As yet, epiluminescence microscopy of the hair and scalp was practiced by trichologists long before its nominal introduction into dermatology as trichoscopy by Rudnicka in 2006,[7] though with a lesser understanding of clinical–pathological correlations in default of the respective medical education. Since then, the number of publications on dermoscopic patterns of diverse conditions of the hair and scalp has risen exponentially, culminating in diagnostic algorithms, textbooks and atlases, online courses, and eventually the founding of the International Trichoscopy Society in 2017 that reunites its proponents and experts for exchange of knowledge and opinions on the occasion of its meetings.

Moreover, yet, as with any medical problem, a patient complaining of hair loss requires a comprehensive medical history, physical examination, and appropriate laboratory evaluation to identify the cause. As a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a more comprehensive dermatological examination. Despite the enthusiasm emerging with its establishment as a dermatologic tool in the diagnosis of hair and scalp disorders, caution is warranted not to elevate trichoscopy to something like a fetish status within medical practice. Moreover, the sensitivity and specificity of its signature patterns have not been studied biostatistically on the same mathematical level as the diagnostic criteria in the other medical disciplines.[8,9]

MALPRACTICE

Finally, as in any discipline, the practice of trichology is not immune to malpractice, either deliberately or carelessly. In his original publication, “Autistic Undisciplined Thinking in Medicine and How to Overcome It,” Swiss psychiatrist Eugen Bleuler (1857–1939) [Figure 3] described a specific form of malpractice in medicine reflecting autistic-undisciplined thinking. Autism is not limited to psychopathology, but inherent to the thinking of man throughout history in his striving for power through knowledge, with thousands of theories lacking basis in reality. Bleuler recognized the drive character of autistic thinking and how it leads to conclusions that are unshakable because they are determined by, and fulfill emotional needs, rather than rational argumentation. Even with correct questions, the complexity of some problems in medicine is sometimes too sophisticated to do justice to plain thinking and the borderlines between hypothesis and autistic sham explanation disappear. Statistics, careful research design, and the attempt to impose stringent methods on our thinking are essential. The habituation of the public to useless medicine, to misconceptions, is not hygiene, but negligent endangerment. It has created an industry that largely dwells on the autistic thinking of patients and doctors, and because it is prosperous makes propaganda among lay people and doctors that leads to abuses.[10] Example of abuse in trichological practice due to autistic-undisciplined thinking is the popularity of scientifically nonproven therapies.[11]

Figure 3.

Eugen Bleuler

IGNORISM

One of the most remarkable abuses on the academic level that has so far found little attention or mention, particularly in contrast to plagiarism, is the act of ignoring the scientific work of others where it would be appropriate to acknowledge. Unless due to poor literacy or failure to appreciate the significance of another’s work, this is usually deliberately practiced in an atmosphere of hostility. However, selectively excluding others’ work of relevance is to be regarded at the least as reprehensible as copying others’ work. While plagiarism may not contribute to the advancement of science due to lack of originality, ignoring the ideas of freelance peers obstructs the progress of science. We have formerly coined the term ignorism for this academic dishonesty by virtue of the word’s original definition in the urban dictionary: (1) method used (by religions and cults) to promote comfortable and simple lies over the scientific truths (of the universe) and (2) standpoint backed up only by personal notions and no real evidence or logic.[12] The bourgeois capitalist will defend his position and profits at any price and will foster insider relationships with the like-minded through coterie, organized in circles, such as academies, interest groups, and the print media, while ignoring the nonconformists and critics. Alliances are strategic, true comradeship is of a higher order.

Through a traditional history of quackery and snake oil salesmanship, among the medical disciplines, trichology is particularly prone to deceptive marketing, health-care fraud, or scam. At times, one gets the impression that particular individuals are celebrating either nonsense or themselves. Modesty is prerequisite to decency. Those who abuse a scientific platform to perform themselves, prove themselves as unworthy of their audience.

COVID-19

In particular, the novel viral pandemic COVID-19 has recently sparked uncertainties and controversies worldwide as to its origin, natural course, and treatment. In this situation, the medical disciplines strive to contribute to a better understanding of the disease, ideally with a sound and sober approach and the best available evidence gained from the scientific method of observation and statistics, while other took the opportunity for publicity and the respective reverberation in the social media. In fact, Science Integrity Digest (www.scienceintegritydigest.com) has recently drawn attention to the practice of some groups of authors cranking up the number of papers on their resumes. In one of the journals indicted in this practice, allegedly, the Editor-in-Chief and associates, many from the editorial board with invited co-authorships of reputed dermatologists involved in hair, publish dozens of papers, frequently in the form of letters to the editor, on COVID-19, with some peer reviews taking <24 h, and then cite themselves in other publications.[13] Ultimately, this practice has culminated in violations of medical ethics.

A clinical trial with the anti-androgen proxalutamide as an experimental drug and cure for COVID-19 in Brazil, “disrespected almost the entire protocol” and may have contributed to the deaths of as many as 200 people, said the National Health Council, which oversees clinical research in Brazil. Some of those people were not adequately informed of the risks they were undertaking in the trial, and some did not know that they were taking part in one, it said. To test proxalutamide’s possible use against COVID-19, the initiator of the study, an endocrinologist and clinical director for Applied Biology, a Californian hair loss company that teamed up with Kintor Pharmaceuticals, proxalutamide’s manufacturer based in China, oversaw its prescription to a man exhibiting severe COVID-19 symptoms. The report, which stated that after 24 h, the patient showed “marked improvement of symptoms and markers of disease severity,” was published in British Medical Journal (BMJ) Case Reports.[14] Following, the principal investigator supervised the drug’s administration to 645 patients with COVID-19 at nine hospitals in Brazil’s Amazonas region as it was hit with a severe wave of infections. Altogether, 317 patients received proxalutamide and 328 a placebo. The treatment was prescribed by doctors as if it were an established medical treatment, although it was approved only for clinical studies. The number of people given the drug was also larger than the number approved for the trial. The trial, which was not peer-reviewed, found that the 14-day recovery rate was 81.4% with proxalutamide and 35.7% with placebo. At 28 days, the all-cause mortality rate was reported to be 11.0% with proxalutamide and 49.4% with placebo. Around 200 people died in the trial, mostly in the control group. “The reported results would be a miracle-if they were true,” said epidemiologist Jesem Orellana who closely followed the effects of the gamma variant of COVID-19 on the Amazon region at Brazil’s leading public health institute, Fiocruz. “Everything about this trial is suspicious and anything but clinical and randomized.” If the published results were true, the trial should have been stopped and unblinded to ensure better treatment of the control group. If they were not, 200 people were subjected to die in research that has no scientific value at all. The consent form given to patients omitted key sections that guarantee the rights of research participants and explain the trial, said the National Health Council. “In the entire history of the National Health Council, there has never been such disrespect for ethical standards and research participants in the country,” it said in a statement. In addition, the UNESCO office for Latin America found the way the study was conducted “alarming” and said the study could be one of the gravest ethical scientific misconduct in the region’s history. Arthur Caplan, head of New York University’s Division of Medical Ethics, told the BMJ that if the alleged practices were true, the trial would be “an ethical cesspool of violations, from consent and design to over-optimistic reporting of results and hiding deaths.” Ultimately, the publication of the respective study outcomes[15] was retracted.[16]

PROBLEM-SOLVING

The characteristics of the capitalistic bourgeoisie within trichology are summarized in Table 1.

Table 1.

Characteristics of the capitalistic bourgeoisie

Competitive market

Commercialism

Property rights recognition

Capital accumulation

Material consumption

Culture of prestige

Sycophancy

Coterie

Ignorism

Fraud

The question arises what can be concretely done against the abuses of capitalistic thinking in the sciences: science should be separated from entertainment, consumption, and profit. Sponsorship of speakers and their research by the pharmaceutic and cosmetic industry should be restricted to prevent dependency and corruption. It is not enough to declare potential conflicts of interest. In fact, the impression arises that particular individuals take a fancy in exposing as many affiliations as possible to underline their prominence. Academic institutions should come up for the costs of their invited speaker’s expenditure, while scientific meetings should waive the registration costs of their invited speakers to prevent individuals from paying for the opportunity to speak in public. Scientific meetings should primary aim at scientific progress and not at financial returns beyond coverage of costs, and at prestige, which comes by itself depending on the scientific quality and ethical standards.

Finally, the Father of Western medicine, Hippocrates [Figure 4] (460-370 BC), required from the physician with regard to professional ethical standards in the relationship between the teacher or professor, and the pupil or student: “…to teach them this art, if they shall wish to learn it, without fee …” (from the Hippocratic Oath).

Figure 4.

Hippocrates

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.