Human biology and the practice of medicine are based on a belief that people are nearly enough alike that the secrets of disease in a king may be found by cutting into a pauper. Solidarity, a belief that humans are all of one species, that we are social animals who stand or fall together, whose survival depends on helping one another, and whose genetic diversity is a strength rather than a weakness, has sound foundations in human biology. To be understood, this must include scientific, evidence-based approaches to psychology, sociology, history and politics, because they all help to make our extraordinary species what it is.

Medical fascism

Despite this humane tradition of solidarity, doctors were in the front ranks of the imperial and eugenic movements in Europe and North America before the First World War. These laid foundations for fascism – the belief that our species is naturally ranked in league tables of worth and talent, created by eternal competition, rewarding the strong and punishing the weak. These movements rested on denial of shared human identity, on assumptions that differences between people were more important than what they had in common, and that positive or negative values of these differences were obvious, predictable and constant over time. They celebrated primacy of intuitive feelings over evidence, of charismatic leadership over socially inclusive and participative politics, and power itself over the ends it pursued. All these features fitted well with the state of medical practice between the two world wars, when medical authority drew power from its still very loose association with science, but kept itself virtually immune from scientific criticism. Surgical practice particularly tended to follow an engineering rather than biological model, associated more with hopeful certainty than with measured doubt. Fascism readily accepted the idea of social surgery in a time of crisis, in which substantial suffering for some was a necessary price to pay to restore health to society, justifying suspension of customary laws.

Fascist ideas drew initially on social Darwinism, developed mainly in Britain and the US. These associated competition for means to live within and between species, with competition for means to live within and between societies.