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THE ROLE OF MILITARY STRATEGIES IN MEDICAL THINKING ADAM L. HARTMAN* At first blush, there appears to be no relationship between military strategy and medicine. National defense and health care seem to be competing constantly for funds and for national attention. Within the culture of medicine, the metaphor of war surrounds us: the "wars" on cancer and AIDS, "battling" disease, a physician's "armamentarium," and so forth. On a more practical level, the military has made a number of important contributions to medicine, most notably in the areas of public health and trauma, and medicine has reciprocated, especially in reducing the number of casualties in war due to disease. The armed forces can make one other profound contribution to medicine: military strategies. These strategies, especially the ancient but fundamental ones, can offer a different perspective on how we actually think about problems in medicine, in areas ranging from research to clinical care. This article will demonstrate such an approach by matching quotations from the landmark military strategy text, The Art of War, by Sun Tzu (translated by Thomas Cleary) with examples in medicine which, intentionally or not, demonstrate certain military strategic concepts. The purpose of this article is to provide the reader with a unique perspective on everyday medicine and science. Sun Tzu, described as a Chinese warrior-philosopher, wrote The Art of War over 2,000 years ago [I]. It is a classic because of its potential for broad application and its fundamental nature. Contemporary movie The author gratefully acknowledges the assistance of Dr. Kathyrn Montgomery Hunter. The author was in the Howard Hughes Medical Institute-NIH Research Scholars Program during the preparation of the manuscript and is an Armed Forces Health Professions Scholarship Program (Navy) student. The views expressed are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. *Address: c/o Office of Student Affairs, Northwestern University School of Medicine, 303 East Chicago Avenue, Chicago, IL. 60611.© by The University of Chicago. All rights reserved. 0031-5982/93/3602-0805$01 .00 Perspectives in Biology and Medicine, 36, 2 ¦ Winter 1993 | 177 buffs will remember Charlie Sheen's upstart character reciting a passage from the text to the greed monger played by Michael Douglas in Wall Street. Despite its use by businesspeople, military leaders, and politicians, applications to medicine are not that far-fetched. Indeed, even the translator recognizes this fact. In his introduction, he explains Sun Tzu's belief of how the "best" military victories are those won without engagement in a battle, or, in a medical sense, how illness is best won over by practicing prevention before the onset of illness rather than by engaging in surgery after the fact [1, p. 2]. The meaning of this literary work for medicine, however, is much more profound than this simplistic, yet powerful, notion. Infectious disease offers a fairly obvious application of Sun Tzu's strategic thinking. The pathogenic organism serves as the invader, while the host acts as the defender. Each side employs certain offensive and defensive maneuvers; it is the balance of these factors that determines who will emerge the victor. Though this example is a gross oversimplification of host-parasite interactions, it is one of the most common examples of military strategy applied to medical thinking. Another common example is civil war as a metaphor for autoimmune disease. But there are other potential applications of such thinking that are far more elegant and subtle than these examples. Diagnosis The contour of the land is an aid to an army; sizing up opponents to determine victory, assessing dangers and distances, is the proper course of action for military leaders. Those who do battle knowing these will win, those who do battle without knowing these will lose. [1, p. 145] Whenever you want to attack an army, besiege a city . . . first you must know the identities of their defending generals, their associates, their visitors, their gatekeepers, and their chamberlains, so have your spies find out. [1, p. 171] Successful military operations require significant amounts of data in order to formulate and execute plans and orders. This information is...

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