Prescription for Profit; The Narrative of Fetishism in the Healthcare System

Not so long ago, the physician was, more than a seller of services, a refuge for the suffering. The therapeutic relationship was built upon trust, empathy, and a moral commitment in which the patient's health was regarded not as a commodity for exchange, but as a human right and a professional duty. Today, however, looking at the current mechanisms of the healthcare system, one can scarcely find a trace of that original bond. What has taken its place is a cycle in which treatment has become a lucrative transaction, and the patient appears in the guise of a customer—and at times, a commodity. To understand this great displacement, one can draw upon the concept of "rationalization," which Max Weber proposed as the defining feature of modernity. Weber showed that the expansion of instrumental rationality—that is, the calculation of profit and cost and continuous optimization—though it brings remarkable technical progress, simultaneously drives moral and emotional values out of many spheres of life. Modern medicine has been no exception to this rule. When efficiency is defined solely by the shortest visit time, the greatest number of patients, and the highest financial turnover, the human relationship between physician and patient is gradually hollowed out. What comes to matter is not listening to the patient's suffering, but the swift management of their body as a clinical case. In such a context, health gradually becomes a commodity for buying and selling—a phenomenon better understood with the help of Karl Marx's concept of "commodity fetishism." In this condition, human relations disappear behind relations among things. In today's medicine, surgery, medication, testing, and even the physician themselves acquire a value determined not by the patient's need, but by market logic. Unnecessary tests, prescriptions of particular drugs, and surgeries lacking clear therapeutic justification are all signs of this commodification. In the midst of this, those who lack financial means are deprived of quality services, and social inequalities are reproduced through the channel of the healthcare system. This transformation, however, is not confined to the physician; patients as consumers also contribute to the reproduction of the same logic. Georg Lukács, expanding Marx's concept of fetishism, spoke of "reification" in all aspects of life—where human activities become detached from the human being and circulate in the form of alien commodities. In this space, the physician too becomes alienated from their own work and turns into a seller whose labor is valued in the market. At the same time, the phenomenon that Thorstein Veblen called "conspicuous consumption" penetrates the field of health. When costly cosmetic surgeries, admission to luxurious private hospitals, or the use of certain medications are employed not for treatment but for displaying social status, health too becomes a symbol of ostentation. The patient, instead of seeking well-being, pursues social validation through medical consumption, and physicians, by turning themselves into "brands" and competing to attract affluent patients, fuel this cycle. The inevitable result of this process is the weakening of trust as the backbone of the therapeutic relationship. Anthony Giddens regards trust in expert systems as one of the pillars of life in modern society. We are compelled to trust the physician because we do not possess the specialized knowledge necessary for treatment. But this trust is fragile and requires transparency and ethical commitment to survive. When the patient realizes that the physician is not concerned with their healing but with profit, the social capital of the therapeutic relationship erodes. Trust gives way to cynicism, the patient turns from a "suffering human being" into a "suspicious customer," and a cycle of mutual mistrust takes shape: the physician sees the patient as a potential complainant, and the patient sees the physician as a profit-seeking seller. In this context, the social roles of physician and patient have also been transformed. Talcott Parsons, as one of the founders of medical sociology, defined the therapeutic relationship on the basis of a set of mutual expectations: the physician must combine altruism and technical competence with affective neutrality, and the patient is obliged to strive for their own recovery and cooperate with the physician. In this view, the physician, through diagnosis, legitimates the illness and temporarily relieves the patient from the pressures of their social roles. But with the commodification of health, this balance collapses. The physician is no longer merely a healer, but an economic actor who regards illness as an opportunity for income; and the patient is reduced from an active partner in treatment to a passive body that must only comply and pay. Thus, the patient's right to decision-making is ignored, and the relationship moves from participation and mutual understanding toward domination and one-sidedness. What confronts us today is not merely a technical or budgetary crisis, but a deeply social and moral problem. The healthcare system is caught in the siege of a threefold logic: an instrumental rationality that has substituted efficiency for ethics, a commodification that has turned treatment into merchandise for sale, and a consumerism that has reduced health to a display for acquiring prestige. A return to a relationship based on trust and human dignity is possible not by eliminating scientific and technical advances, but by restraining market logic and recognizing the human place of the patient. Medicine must learn once again that the object of its work is not a body for commerce, but a human being with suffering, hope, and an inalienable right to health.