Response to Open Peer Commentaries on “Irrational Exuberance: Cardiopulmonary Resuscitation as Fetish”

We appreciate the opportunity to respond to the numerous open peer commentaries in response to our article, “Irrational Exuberance: Cardiopulmonary Resuscitation as Fetish” (Rosoff and Schneiderman 2017). We were also impressed by the wide-ranging perspectives provided by the commentators drawn to this topic. Our purpose in labeling CPR as a fetish was not so much to suggest that this specific therapeutic intervention bears the hallmarks of objects usually associated with religious import as representative of deities and hence imbued with the power of the divine, but to draw attention to the many ways in which it has assumed a beneficial power far beyond that supported by data. While physicians and nurses know well the limitations on the benefits bestowed to patients receiving CPR either in hospitals or “in the field,” they are also aware that in the right context, CPR, like any other targeted and properly utilized therapy, can have a significant salutary effect on the lives of patients. However, it is the often-indiscriminate use of this intervention and its marketing portrayal to the lay public as a lifesaving treatment for everyone everywhere suffering cardiac arrest (or what can be interpreted as such) that generate misunderstanding. It is the placement of CPR on a therapeutic pedestal that gives us pause. While we have focused on CPR as a fetish, it is not unreasonable to place this characterization within the context of the fetishization of medicine and medical interventions in general. Physicians and the health care industry have gone to great lengths to increase expectations in patients that there are pills and cures for everything. Medicine, although not necessarily with physicians as its ministers of medical interventions, has become exalted as much more effective in many areas than it actually has any factual basis to claim. It is the ex ante assumption of success that presumably grounds the belief that unless there is good evidence to the contrary, everyone would—and perhaps should—desire CPR if their heart should stop. We have called this supposition into question. Fox and Kotva offer extremely interesting insights into the religious context in which most fetishization occurs, recognizing an expansive, inclusionary definition of the worship part of religion. While we used the term fetish more as a rhetorical device than as an incisive penetration into how medicine, especially in modern-day America, has been transformed into yet another form of religion with the doctor as god (at least sometimes), it is no doubt true that many people have disturbingly inaccurate beliefs about the power of doctors to fix everything. This is likely based in part on how doctors mostly acquiesce to be portrayed as such, and not just on TV dramatizations, but also in the advertisements our hospitals, medical centers, clinics, and so on use to extol virtuous powers to heal and ignore the power to hurt. In this same vein, Paris and Moore offer thoughtful commentary on our ideas and a useful coda to the sentiments expressed by Fox and Kotva, especially their recalling the Hippocratic corpus and its charge to physicians to not intervene in diseases that have “overmastered” the patient by providing treatments that are likely to not provide any benefit. In a related context we admit that we did not expect to awaken the slumbering giant of psychoanalytic theory when we referred to current-day beliefs about the efficacy of CPR as a fetish, but the interesting commentary by Rosenberg and Doolittle places this discussion within the framework of Freudian theory. Arthur Caplan and Ariane Lewis seem to echo many of our concerns and raise others that we did not, such as the influence of the “rescue impulse” (also discussed by Nancy