Caesar’s Women — McCullough’s Idolatry and Politics in Ancient Rome

Caesar’s Women (1997) is the fourth installment of the “Masters of Rome” historical book series by novelist Colleen McCullough. The complete series spans the period from 110 B.C. to 27 B.C. This tome covers the eight years of the Late Roman Republic from 67 B.C. to 59 B.C., including the revolt of Aemilius Lepidus; the Conspiracy of Catilina and the passing of the Senate’s Ultimate Decree; the curious episode of the Consul Marcus Calpurnius Bibulus (also an augur) withdrawing to his house to watch the stars and cancel the legislative acts of his very active fellow Consul Julius Caesar; and the sacrilege of Clodius Pulcher, and Caesar’s consequent remark that his wife must be above suspicion. The main characters are Julius Caesar (not unexpectedly given the title of this volume), who is mostly in Rome, intriguing and womanizing, while ironically presiding over Rome’s civic religion as supreme Pontifex Maximus; Marcus Licinius Crassus, the plutocrat; Marcus Tullius Cicero, the great advocate who becomes consul at the time of the Catilina crisis; Marcus Porcius Cato, the unyielding politician and stoic philosopher; Publius Clodius, the young iconoclastic rogue; Marcus Junius Brutus, the studious youngster and heir to the Caepio fortune, who is hen-pecked by his mother Servilia; and of course, Pompey Magnus, who is at this time unquestionably the First Man of Rome.

Servilia Caepionis (c. 100 BC – After 42 BC). Mother of Marcus Junius Brutus and Mistress of Julius Caesar

The women protagonists are those revolving around the life of Caesar: His mother, Aurelia; his mistress, Servilia (and other enterprising females in similar categories); his beautiful and dutiful daughter, Julia; his second and discarded wife, Pompeia Sulla; and the Vestal Virgins. We also have a glimpse at the lives and personalities of other Roman women of some historical importance: Terentia Varro (Cicero’s wealthy and imperious wife), Fulvia (Clodius wife, politically inclined and granddaughter of Gaius Gracchus), Clodia (Quintus Caecilius Metellus Celer’s wife, mistress of the lyric poet Catullus, and possible poisoner of her own husband, an ex-consul and conservative senator).

Despite the title, this novel covers the historical period in question at least in Rome (from 67 B.C. to 59 B.C.), not just Caesar’s romantic adventures. Moreover, Caesar’s Women include not only mistresses but also the close female relatives in his family and social circles, women who duly influenced his political life. That is not to say there is no lustful sex, gossip, and romantic intrigues in and outside the bedroom. In fact, the sexual liaison between Caesar and Servilia crosses into the potboiler genre and regrettably hints at outright pornography.(1) I am no prude, and will admit that eroticism in small doses in a historic novel may be a treat if done with finesse, but sex and gross vulgarities in large doses may be a put off to many readers who may have previously enjoyed the first three volumes of McCullough’s historical acumen in novelistic form. For example, the reader will come across such sexual vulgarities and obscenities in Latin as irrumator, fellator, pipinna, cunnus, mentulla, verpa, which she sprinkles throughout her book, translates for our benefit, and fastidiously defines in a glossary that is significantly abbreviated in this tome. The reader should be prepared to encounter “juicy” female genitalia before penetration and the like. Moreover, descriptions of young prepubertal girls is a bit disturbing in that the author describes them with sexual overtones, as if they were sexual nymphs or mature adults — one can only smell the odor of pederasty in the air without the author actually crossing the line into overt pornography. For example, a 15-year-old Brutus is already in love with the 8-year-old Julia (Caesar’s daughter who often is kissed by her father on her lips), and whose lips are “faintly pink as delicious as strawberries.”(2)

My main criticisms stem out of McCullough’s ubiquitous political bias affecting her historical trustworthiness and which become even more accentuated in this volume.(3-5) McCullough has been denying the existence of ideology or political factions in ancient Republican Rome, but in this volume she finally deigns to admit the existence of an ultraconservative faction in the Senate, the boni (i.e.,”the good men”), whom she ardently detests and defines as a “clique.” Typical references to this conservative faction are: “The boni were brilliant at currying favor with the knights”; “Gaius Piso was a choleric, mediocre, and vindictive man who belonged completely to Catulus and the boni“; and referring to Catulus, Bibulus, Lucullus, Cato, and Domitius Ahenobarbus — all boni men — she rails, “odd how all the obnoxious ones stuck together, even in marriage.”(6) No such repetitive blanket, derogatory references were made of even the most obnoxious, populist demagogues — i.e., Appuleius Saturninus, Publius Sulpicious, Lucius Cornelius Cinna, Gnaeus Papirius Carbo, etc., either in previous volumes, or of iconoclastic and irascible populists in this volume, such as Aemilius Lepidus (who marched on Rome), Clodius Pulcher, Decimus Brutus, Marc Antony, not even of the conspirator Sergius Catilina, and God forbid, not of the faultless Julius Caesar, McCullough’s “quintessential Roman.” 

Bust of Cicero (106 BC – 43 BC) in the Capitoline Museums, Rome.

Cicero is derided with a vengeance, and his deserving the title of Pater Patriae is cast in doubt with lethal subtlety, while the conspiracy and insurrection of Catilina is treated as if it was of no serious concern to the Republic. Thus the necessity for Cicero’s Senatus Consultum Ultimum (i.e., “The Senate’s ultimate decree to defend the Republic,” imposing martial law) is also brought into question. All the boni conservatives are simply block heads. According to McCullough, Cicero’s reputation has not only been inflated by time, but he was a timid “idiot” and an indecisive “turd”; Marcus Porcius Cato, known to history as the Stoic philosopher, is “thick and narrow”; Caecilius Metellus Pius Scipio, “whose ancestry was far greater than his intellect,” is like Cato “thick.”(7) On the other hand, the populist young thug Clodius Pulcher is not only “shrewd” and “brilliant,” but “what he says,” in the mouthpiece of Caesar, “is usually right.”(8) Here is a telling paragraph that refers to Clodius’ circle of “brilliant” populist rogues, including young Marc Anthony, who went around the forum and the Subura wreaking havoc and intimidating citizens:

“Until the execution of their stepfather [a Catilina conspirator], no one had ever taken the Antonii seriously. Or was it that men looked no further than the scandals trailing in their wake? None of the three owned the ability or brilliance of young Curio or Decimus Brutus or Clodius, but they had something in its way more appealing to the crowd the same fascination exerted by great gladiators or charioteers: sheer physical power, a dominance arising out of brute strength.”(9)

Inscribed bronze bust of Cato the Younger (95 BC – 46 BC)

And so we are left with disparate incongruity and laughable proposition that the gang of young thugs led by Clodius creating mayhem for the populist cause in Rome are “brilliant” youngsters, whereas the  conservative senators, who want to preserve the old ways and traditions of the Roman institutions — i.e., the unwritten constitution or the mos maiorium — of the Republic, are a “clique” of rancorous, obstructionistic old men, narrow, thick heads, led by Cato (who incidentally was younger than Caesar, and Brutus, Cato’s nephew, considerably younger). According to McCullough, the boni were not patriots but cantankerous obstructionists who only wanted to impede the good, conscientious reforms of the quintessential Roman — Julius Caesar. Why? Because they were jealous of the demigod’s intellect and looks, and unjustly insisted (their prescient accusations seemed to have escaped the author) that his goal was to ultimately betray the government, overthrow the Republic, and become dictator for life.

Curiously, in the previous volume, Fortune’s Favorites, Caesar lectures Pompey on the importance of abiding by the laws of Rome. Now in this volume, we have Caesar, once again, turning the table on history and common sense, explaining to Cato why he (Caesar) favored Sulla’s abrogation of the power of the Tribunes of the Plebs because they had been obstructionists and too pliable in the hands of the odious, conservative senators, the boni! McCullough also takes the opportunity to use one of her favorite metaphors as a double entendre by having Caesar, who had allegedly not only cuckolded Cato but had also been carrying on an affair with Cato’s half-sister, Servilia, humiliate Cato without mercy. He tells Cato the Philosopher: “I have more intelligence in my battering ram than you do in your citadel.”(10)

1st century AD Roman bust of Gnaeus Pompeius Magnus “Pompey the Great” ( 106 BC – 48 BC), after an original from c. 55–50 BC

Young Caesar in his teens and twenties is a prodigy without equal; in his thirties now, he can walk on water, while everyone else sinks or floats! He is arrogant, cynical, punctilious, who demeans all that others have accomplished. And yet this is the time when Pompey the Great has conquered for Rome half a world in Spain, Asia Minor, the Middle East, and cleared the Mediterranean Sea of pirates, making it effectively Rome’s Mare Nostrum, while Caesar has stayed at home. True, Caesar won his corona civica (Oak leaf crown) in combat and succeeded in being elected Pontifex Maximus, but compared to the accomplishments of Crassus, who helped Sulla win the battle of the Colline Gate and suppressed Spartacus, or Pompey, who has more than doubled the territories and wealth of Rome, Caesar has done relatively little. Yet Pompey is treated with derision. Crassus, except for his greed, is forgiven, as he is Caesar’s only friend and confidante. In her previous volumes, particularly The First Man in Rome and The Grass Crown, McCullough had characters, such as Rutilius Rufus, give informative and historically accurate speeches that were literary and charming. No more: Cicero has lost his literacy and eloquence, and is no longer “completely reliable”; Pompey’s letters are written like a school child; only Julius Caesar can orate great speeches and write laws as literary masterpieces.(11)

In Caesar’s Women, McCullough continues to deny the existence of “political parties or factions in the modern sense.”(12) The Optimates, she prefers to relegate to a “clique,” preferring as I have mentioned, the term boni for the “ultraconservatives”; but she does finally use the term Populares to refer to some of her demagogic heroes.(13) The fact is that a great divide had been developing in Roman society since the time of the political turmoil that the Gracchi brothers had fomented during the years 133-121 B.C. In the end, the crescendo political strife would culminate with the conflict between Julius Caesar and the Senate that would rend the Republic apart and usher in the Empire.

There might not have been organized modern political parties, but there were definite political factions, two ideological camps — i.e., the Optimates (“the best men,” or conservatives) and the Populares (” the people’s men,” or liberals), vying for the reins of power. The Optimates were fighting to preserve their aristocratic privileges, as well as the mos maiorium, the old ways, traditions, and the unwritten constitution of the Republic, opting to maintain decentralization of power. They represented the interest of the Senate, the old Roman noble families (which had provided at least half of all the consuls in the previous century), and the new nobility (i.e., the nobiles, recently ennobled plebeian or patrician families that had produced men who had served as consuls and thus reached “consular” status).

Gaius Julius Caesar (100 BC – 44 BC), the Tusculum portrait, possibly the only surviving sculpture of Caesar made during his lifetime. Archaeological Museum, Turin, Italy.

The Populares were vying to overthrow the old order, so they could become the new masters via the centralization of authority resting on one man, who could use force if needed, and whose power base rested on the support of the lower classes of Roman society. The support of the lower classes was to be preserved by the Populares by the distribution of cheap (or free) grain and games (i.e., “bread and circuses”), the breaking up of latifundia for free land redistribution, and if necessary the most radical measure bandied about — the cancellation of debts. Their champions were the ten Tribunes of the Plebs working through the legislative Assemblies and utilizing their veto power. The legions were to be loyal to the strong man, the popular general at the helm, and not the Senate. (We know how that worked out, not only in the late Republic but also later in the Empire.) All the ingredients were there for the fatal brew, and I can think of no better raison d’être for the inception of political combat and the ushering in of civil war than those two aforementioned, distinct political and ideological camps preparing for war.

As I have stated before, McCullough’s persistent denial of the existence of the Optimates vs. Populares political contest (which despite this denial is still obvious in her books) must be attributed to McCullough’s effort not to make her irrepressible political leanings too obvious in these historic novels for which she has claimed total objectivity and veracity.(1,4,5) McCullough, were she one of her own characters, would be in the vanguard of the popularist onslaught leading at the helm with Clodius and Fulvia in the overthrow of the mos maiorium and the Republic — and to place Caesar as the “First Man in Rome,” even before his conquest of Gaul!

Julia (76 BC – 54 BC) from Promptuarii Iconum Insigniorum. The inscription reads: “Julia; Gaius Caesar’s daughter; Pompey’s wife.”

McCullough does have an enchanting moment in her novel that deserves mention: the love match and betrothal of Pompey the Great and Julia. The embellishment of this romance makes this story more charming than the more probable reality of an arranged political match. She is well justified in the embellishment as Caesar really loved deeply the two Julia’s in his family, daughter and aunt, and Pompey ended up loving his various wives with a remarkable intensity and uxoriousness. This is the best segment of the book and it concerns Pompey and Caesar’s daughter, Julia, more than it concerns Caesar!

In the Author’s Notes, McCullough writes: “I have done my research: thirteen years of it before I began The First Man in Rome, and continually since (which sometimes leads to my wishing I could rewrite the earliest books!).”(14) But the problem with this volume lies not in scholarship but in her over prurient style, infatuation with her subject to the detriment of other historic figures, and her political leanings permeating and marring her work.

I have given the previous three volumes thumbs up  (i.e., 4 stars out of 5), despite annoying flaws and persistent criticisms. Alas, this book regrettably fails to live up to the expectations of the previous volumes (3 stars). It fails, first among other things, because of the author’s blinding adoration of Julius Caesar, which surpasses the infatuation she had previously incurred with her primer amor, the demigod Gaius Marius, and secondly, because of her insuppressible and increasing political bias and animus permeating and detracting from her work, as I have tried to convey in the above critique. Regrettably, I cannot recommend this book as a stand alone, single volume, but it is still a necessary volume for those of us who have read the previous installments and must continue to plow through the “Masters of Rome” series to the bitter end.


1. McCullough C. Caesar’s Women. William Morrow and Company, Inc., New York, 1997, p. 45-47; 59-61.

2. Ibid., p. 8, 12.

3. Faria MA. The First Man in Rome – The Apotheosis of Gaius Marius. A book review of The First Man in Rome (1990) by Colleen McCullough., June 4, 2013.

4. Faria MA. The Grass Crown — Ancient Rome: Marius vs Sulla and the Marsian Wars! A book review of The Grass Crown (1991) by Colleen McCullough., June 6, 2013.

5. Faria MA. Fortune’s Favorites in Ancient Rome — Sulla, Pompey, Crassus and Caesar. A book review of The Grass Crown (1991) by Colleen McCullough., July 8, 2013.

6. McCullough. Op cit., p. 32, 62-63.

7. Ibid. In the voice of various characters or the author: Cato “thick,” p. 348; Scipio’s “intellect,” p. 364; Cicero “a timid idiot,” p. 268, 357 and “turd,” p. 366.

8. Ibid., p. 313, 443.

9. Ibid., p. 387

10. Ibid., p. 399-400.

11. Ibid., p. 409.

12. Ibid., p. 656. In the Glossary, McCullough insists under “Faction” that “Political ideologies did not exist nor did party lines.”

13. Ibid., p. 375-386.

14. Ibid., p. 635.

Reviewed by Dr. Miguel A. Faria

Miguel A. Faria, Jr., M.D. is Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine. He is an Associate Editor in Chief and World Affairs Editor of Surgical Neurology International (SNI), and an Ex-member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC). 2002-05; former Editor-in-chief of the Medical Sentinel (1996-2002). Author, Vandals at the Gates of Medicine (1995); Medical Warrior: Fighting Corporate Socialized Medicine (1997); and Cuba in Revolution: Escape From a Lost Paradise (2002). His website is

This article may be cited as: Faria MA. Caesar’s Women — McCullough’s Idolatry and Politics in Ancient Rome., August 14, 2013. Available from:–mcculloughs-idolatry-and-politics-in-ancient-rome

(Caesar’s Women by Colleen McCullough (1996). William Morrow and Company, Inc., New York, NY, 696 pages)

The photographs used to illustrate this exclusive article for Hacienda Publishing came from a variety of sources and do not necessarily appear in Colleen McCullough’s historic novel titled, Caesar’s Women. A shortened and unillustrated version of this article appeared also in book reviews.

Copyright ©2013 Miguel A. Faria, Jr., M.D.

Vandals at the Gates of Medicine—Have They Been Repulsed or Are They Over the Top?

As we ponder the destructive changes unfolding today in health care and medical practice, we find ourselves questioning whether the government push and attempted takeover of the health care industry was truly repulsed by the American people following the consummation of the great health care debate of 1993 and 1994.

Despite all the media hullabaloo about a growing medical marketplace and the supposedly conservative changes brought about by the November 1994 Republican revolution, corporate socialized medicine is making headway, becoming a reality, step-by-step under the rubric of managed care and a mislabeled “free market.” The fact is that we still face an ominous threat from those who seek to destroy the noble profession of medicine, enslave the healers, and dispose of those whose quality of life they deem not worth living.

The supremacy of the patient-doctor relationship, and the ability of physicians, including practicing dermatologists, to do all they can for their patients is being increasingly challenged (and likely will continue to be challenged in the uncertain future of the 21st Century), unless we prevail in derailing the juggernaut of managed competition and corporatism.

Today, many of the major health care corporations with their burgeoning networks are acting in collusion with government bureaucrats to impose managed competition/managed care and to change the time-honored ethics of the medical profession. Where once the supreme medical ethic dictated that physicians place their individual patients’ interest above their own (and above that of the state) in the spirit of true altruism and charity, today’s ethics of corporate socialized medicine and managed competition propound that the physician place cost considerations and the interest of third-party payers above that of their patients.

For the first time in the history of medicine, American physicians are being coaxed or coerced, whatever the individual case might be, to ration health care by restricting their patient’s access to specialists or expensive treatments — that is, forced, involuntary rationing for the sake of cost containment, and as to make their HMOs more efficient and profitable.

Cicero and the Fall of the Roman Republic

Thirty years ago, Millard F. Caldwell, a Justice of the Supreme Court of Florida, drew parallels between what was happening to the United States in 1965, at the time of the Great Society of Lyndon Johnson, and the series of events that took place at the time of the dissolution of the Roman Republic in the 1st Century B.C. at the time of the great orator, statesman, and patriot, Cicero.

Likewise, a generation later, I would like to draw further historic parallels between what is happening in our country today, and quoting Cicero, illustrate and bring to your attention the fateful events that took place at the death knells of the Roman Republic.

Even before the inception of the first millennium, Marcus Tullius Cicero (106-43 B.C.) the great orator and statesman, decried and eloquently spoke against the politics of envy and growing confiscatory taxation, while trying to explain the reasons for the general dissatisfaction of the population — this, at a time when Rome had reached its zenith in both wealth and power. He went on to presage civil strife, and the violent overthrow of the Republic, after the populace had traded in their votes and their vigilance for panem et circenses (bread and circuses), and their rights and liberties for false security and the yoke of oppression.

Cicero pleaded to his fellow lawyers: “None of you will challenge the lawmakers and cry to them, this is unconstitutional, and an affront to a free people and it must not pass!” He asked, “Will one of these, your own, lift his eyes from his ledgers long enough to scan the Twelve Tables of Roman Law, and then expose those who violate them and help to remove them from power, even if it costs their lives? These fat men. Will six of them in this city, disregarding personal safety, rise up from their offices and stand in the Forum, and tell the people the inevitable fate of Rome unless they return to virtue and thrift and drive from the Senate the evil men who have corrupted them for the power they have bestow?”

To paraphrase Judge Caldwell, does that sound like 1996 and our indifference to the growth of government into every aspect of our lives? Does it remind you of our preoccupation with our personal affairs and our unwillingness to “rock the boat?”

As the Roman situation continued to deteriorate, and the people traded their voices and their votes for state benefits, Cicero again asked: “Are we not free? Shall a man be denied his right to speak under the law which establishes that right?…It is not freedom which permits the Trojan Horse to be wheeled within the gates…He who is not for Rome and Roman Law and Roman liberty is against Rome…He can not ride two horses at the same time…Though liberty is established by law, we must be vigilant….”

Again, does that sound like the moderate politicians who straddled the fence in 1996 and betrayed the trust of their fellow citizens and professional colleagues by making compromises that violate our constitution and the codes of ethics of our profession in exchange for a filigree of political and personal power. Does it ring a familiar bell with your friends and complaisant colleagues you deal with in your day to day walks of life?

As time passed, Cicero, the patriot, continued his personal struggle for liberty and finally became Consul of the Republic. It seemed that for a time the corruption of those who were subverting the constitutional rule of the Republic had ceased. But, behind the scenes, “moderate” politicians and the establishment were seeking to silence and banish Cicero. To defend himself, Cicero appeared before the Roman Senate to plead his case: “The Senate, in truth, has no right to censure me for anything, for I did but my duty and exposed traitors and treason against the State. If that is a crime, then I am indeed a criminal.”

The future members of the First Triumvirate (60 B.C.), Marcus Crassus, Julius Caesar, and Pompey the Great, were present. They did not come to Cicero’s assistance, but rather, turned their faces against him. “You have succeeded against me. Be it as you will. I will depart…For this day’s work, lords, you have encouraged treason and opened the prison doors to free the traitors. A nation can survive its fools, and even the ambitious, but it can not survive treason from within.”

Cicero was indeed banished from Rome, but he was not exiled from his conscience. The Roman general Sulla once told Cicero the middle class—the merchants, lawyers, and physicians—were too timid to stand up for their natural rights and justice. Now, his former friends who had deserted him, the ever acquiescent lawyers, the complaisant doctors, and the bustling businessmen told him: “We do not meddle in politics. Rome is prosperous and at peace. We have our villas in Caprae, our racing vessels, our houses, our servants, our pretty mistresses, and our comfort and treasures. We implore you, Cicero, do not disturb us with your lamentations of disaster. Rome is on the march to the mighty society for all Romans.”

Cicero was in anguish and despair, but he continued to fight for the natural rights of man and honest government. He began to write a book to further plead his case. His publisher then asked him, “But who will read it? Romans care nothing for law any longer, their bellies are too full.”

When Marcus Junius Brutus came to Cicero complaining that Caesar had betrayed the Republic, Cicero responded: “Do not blame Caesar, blame the people of Rome who have so enthusiastically acclaimed…him and rejoiced in their loss of freedom and danced in his path and gave him triumphal processions…Blame the people who hail him when he speaks in the Forum of the ‘new, wonderful good society’ which shall now be Rome’s, interpreted to mean ‘more money, more ease, more security, more living fatly at the expense of the industrious.’ Julius was always an ambitious villain, but he is only one man.” And yes, the Republic had been betrayed and the public trust violated.

Shocked to Reality

So, my confreres, what has been done to our profession and what is now taking place in our country, not just in health care but in every aspect of our lives, occurs with our tacit consent. We are reluctant to stand up and be counted, as the medical profession is destroyed piecemeal from within and from without. We are reluctant to call managed care for what it is, “corporate socialized medicine.” We are reluctant to expose the ethics of managed competition, a perversion of Hippocratic ethics, harnessed for the institution of rationing as to achieve the bottom line for the health care mega-corporations. The dedicated and devoted physicians in the trenches, the honest healers, the busy and competent physicians, have always been an easy mark because we have been laboring in the trenches, putting our trust and livelihood in the hands of the purported leadership—the moderates and the compromisers—who have repeatedly betrayed our trust and our profession from within the gates.

As forewarned by Cicero, the Roman Republic after nearly four centuries of glorious constitutional rule, triumphant conquests, and enormous expansion, fell prey to populist demagogues who claimed to speak for the people and the lower classes, but spoke for their own selfish ends and their unquenchable thirst for political power. They promised land, bread and circuses; instigated riots and insurrections; and preached class hatred and warfare. Yet, they had forgotten Aristotle’s axiom, “inferiors revolt in order that they may be equal, and equals that they may be superior.” How many times have we heard class warfare rhetoric, demagogic calls for wealth redistribution using, for example, the politics of envy mantra: “The Republicans are seeking to cut Medicare by $270 billion dollars to pay for a $245 billion dollar package of tax breaks for the rich.” When in reality, the differences in the “cuts” (that is, only reductions in the rate of growth of Medicare) between the Democratic and Republican packages are virtually insignificant (in terms of government largesses)—a mere $40 billion over 7 years. But, for populist politicians, perception is reality and that is what counts, not facts or figures. To correct the alleged inequalities, they call for more government and pass seemingly innocuous legislation like the Kassebaum-Kennedy Bill that threatens to criminalize the practice of medicine.

A long, bloody civil war ensued. Cicero was assassinated. Chaos reigned in Rome. Law and order and the ancient Roman precept of the rule of law were discarded. For all intent and purposes, the Republic was transmogrified first into a motley mass democracy, with populist politicians currying favor with the unruly masses and threatening to establish a tyranny of the government-dependent majority — a majority which, no longer informed and vigilant, could be manipulated on the promise that they would be given other peoples’ money, land, and wealth. This chaotic situation could not stand, and it too quickly degenerated into virtual mobocracy (the rule of the mob). The time was fast approaching that would ring the death knell of the Republic.

In the end, as is well known from the pages of history, when law and order disintegrate, the citizenry yearn for peace and security, and unfortunately, especially if misinformed, end up giving up their liberties and handing power over to a strong man, a dictator, who promises to give security and re-establish law and order. That is just what happened when Julius Caesar crossed the Rubicon, seized power after a bloody civil war, and formally overthrew the Republic in 44 B.C. Roman citizens gave up their votes and their time-honored constitutional, republican principles happily, quid pro quo, public largesse and other panem et circenses, to which they had become immorally inured. This included getting on the public dole for bread and other government subsidies, and being given free gladiatorial entertainment in the many Roman arenas.

Great men, statesmen, philosophers, and republican leaders like Pompey the Great (106-48 B.C.), Cato the Younger (95-46 B.C.), Marcus Tullius Cicero* , and later, Seneca the Younger (3 B.C.-A.D. c. 65), died honorably for their republican sentiments and their firm beliefs in the natural rights of man, the rule of law, and the tenets of the Roman constitutional Republic.

In our own day, likewise, the final battle for the survival of the private, independent practice of medicine and dermatology represents more than just a struggle between two sectarian factions attempting to dictate the mechanism of health care delivery; more importantly, philosophically, it is a struggle that symbolizes the titanic conflict between two rival ideologies: One vision believes in the ethics of Hippocratic medicine, restores the sanctity of the patient-doctor relationship (based on genuine compassion, charity and trust); respects private contracts and free associations; and advocates individually-based, free market incentives in the form of MSAs in which patients are empowered and physicians are free to practice Hippocratic medicine. This vision, sadly, is quickly fading under managed care and the direction that we are headed.

The alternative view represents corporate socialized medicine centered around the concept of managed care/managed competition, whereby HMO bureaucrats dictate patient care from afar, claiming to rely on the false “ethics of caring,” but in reality basing their policies on what is actually closer to the Swiss philosopher Ernest Truffer’s veterinary ethics, an ethic that forces physicians to act in the interest of the corporate entity as third-party payer, rather than in the interest of their patients; mandates coercive compassion; responds only to pressure by politically-powerful special interests; and insists on statism and collectivism, rather than voluntary individual incentives. Medical care becomes a right rather than a mutually beneficial professional relationship based on ancient Hippocratic principles and ethics. Physicians are no longer dedicated independent practitioners, but docile, complaisant employees of the networks that employ them.

In short, gentlemen, the Vandals are not over the top, nor have they been repulsed; they remain battering at the gates with their minions are, however, within the gates, subverting the walls of the House of Medicine.

For vigilant and informed physicians, there is no longer room on the sidelines. If we are not successful in our efforts, our fate will be the catastrophic stumble and inevitable plunge down the bottomless pit of corporate socialized medicine, and the enslavement of the medical profession under the yoke of managed care. This plunge would signify the commencement of a New Dark Age of medical care regression and your enslavement as caring dermatologists; health care rationing for your patients; and perhaps, in the not-too-distant future, a brave new world of government or corporate-imposed, active euthanasia — rationing by death — as the ultimate and most efficient form of cost control. You can be sure the brunt of this cataclysm will be borne out, and the responsibility placed squarely on your shoulders. You and your patients will be the biggest losers.

Judge Caldwell’s contemporaries believed in 1965, at the time of Johnson’s Great Society and the inception of Medicare, that America, then, was going through a second American Revolution, a revolution of a destructive generation that would saddle us with government dependency and welfare; rampant crime; gigantic, intrusive government; and politicized medicine. Alas, they were correct. Moreover, the children are yet to be devoured by the flames of their misguided revolution. I assert, today, we are still going through this trial by fire. It’s time to counter-attack and restore the true ideals of our nation and our profession.


* Cicero sided with the Senatorial republican forces led by Pompey the Great and after Octavian (Augustus) took Rome, Cicero was executed by order of Marc Antony (c.83 B.C.-30 B.C.)

Written by Dr. Miguel Faria

This article may be cited as: Faria MA. Vandals at the Gates of Medicine—Have They Been Repulsed or Are They Over the Top? Surg Neurol 1997 Jun;47(6):584-7. Available from:

(This was also a speech presented before the members of the Georgia Neurosurgical Society on May 24-26, 1996. The oration was inspired from the writings of Dr. Faria’s book, Vandals at the Gates of Medicine: Historic Perspectives on the Battle Over Health Care Reform and other essays.)

Copyright ©1997 Miguel A. Faria, Jr., M.D.