But medicine is an art as well as a science. I propose, further, that because commercial trading is fundamentally alien to gift relationships, the spread of managed care is progressively destroying medicine's network of gift relationships, providing a second major source of professional anger and anxiety. As scholar and essayist Lewis Hyde has pointed out, the concept of art as a gift is both subtle and essential, manifesting itself in two different ways. And second, a work of art is truly art only if the spirit in which the artist creates it is principally one of giving, rather than selling, it to the world. Art done principally for sale may be well crafted and may be successful in the marketplace, but it is commercial art, not really art at all.
Art is, of course, only one special kind of gift among the many kinds that people can exchange.
But in other times and places, gift exchange rather than commercial exchange served as almost the entire basis for social relationships, particularly in smaller, less technologically oriented societies. First, a gift is something that must be given away. Second, when a gift is given, nothing is expected in the way of immediate return. Third, a gift received must soon be passed on, in turn, by the recipient to others. And, finally, it is understood that the gift, increased in size or value, will ultimately return to the original giver, at which point it will again be given away.