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Markets and Medicine: Adam Smith and John Gregory

  • Robin Downie


It is generally assumed that transactions in a free market are based on self-interest. It is equally assumed that transactions between doctor and patients are aimed at the interests of the patient and in that sense are benevolent, fiduciary or based on trust. Influential statements of these positions derive from Adam Smith and from Smith's neighbour and contemporary John Gregory. Examining the views of Smith and Gregory but moving the issues into a contemporary context this paper will argue that the opposition of self-interest and benevolence is misleading and that in the modern world medicine and the market have a similar ethical framework.



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1 Smith, Adam (1776), The Wealth of Nations, ed. Sutherland, Kathryn (Oxford: Oxford World’s Classics, 2008), 22.

2 Gregory, John (1772), Lectures on the Duties and Qualifications of a Physician. In McCullough, L.B. John Gregory’s Writings on Medical Ethics and the Philosophy of Medicine (Dordrecht, London, Boston: Kluwer, 1998), 170.

3 McCullough op. cit., 1.

4 Richard & Susskind, Daniel, The Future of the Professions (Oxford: Oxford University Press, 2015).

5 Editors, ‘Looking Back on the Millennium’, New England Journal of Medicine, 42 (2000), 42–4.

6 American Board of Internal Medicine, Project Professionalism (Philadelphia: American Board of Internal Medicine), 5.

7 Smith WN, op. cit., 292.

8 Smith, Adam (1778) Lectures on Jurisprudence ed. Meek, R.L. & Raphael, D.D. (Oxford: Oxford University Press, 1978), 1.

9 Wicksteed, Philip, The Common Sense of Political Economy (London: Routledge, 1933), 174.

10 Wicksteed, op. cit., 179.

11 Wicksteed, op. cit., 180.

12 Aristotle, Nicomachean Ethics, trans. Ross, D. (Oxford: Oxford University Press, 1971), 1.

13 Smith WN op. cit., 53–95.

14 Gregory, op.cit., 166.

15 Smith WN, op.cit.,101.

16 Smith WN, op.cit., 21.

17 Plato, Republic, ed. Lee, Desmond, (Harmondsworth: Penguin Books, 1974), 558562 .

18 Smith, Adam, The Theory of Moral Sentiments, ed. Raphael, D.D. & Macfie, A.L. (Oxford: Oxford University Press, 1976), 180–83.

19 Adam Smith (1778) (LJ), 503.

20 Elliott, Carl, Better than Well: American Medicine Meets the American Dream (New York & London: Norton, 2003).

21 Smith WN, 292.

22 Smith WN, 413–415.

23 Smith WN, 433.

24 Hunting, P., History of the Society of Apothecaries (London: Society of Apothecaries, 1998).

25 Gregory, op.cit., 158.

Markets and Medicine: Adam Smith and John Gregory

  • Robin Downie


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