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Andrew's inability to overcome the materialist aspirations of his fellow doctors becomes a dominant theme in the narrative. Andrew is unable to persuade the doctors to cooperate because of the desire to accumulate more wealth. In Vale View, it is clear that money controls all of the doctors' approaches to medicine. In their first dinner meeting, Dr. Llewellyn informs Manson of the economic structure that governs all doctors controls their interactions with one another and with patients: “I must make money, Dr. Manson!' He paused. 'I should just mention that the doctors have agreed to pay me a small part of their salaries.” The strength and lure of materialism surprises Manson. He does not fully understand why or how money should play such a critical role in how the doctors work with one another.
Manson struggles to comprehend how the needs of the patients and how the practice of medicine takes a back seat to the pursuit of money. When Dr. Llewellyn indicates that the importance of his motive for making money, Manson recognizes that other doctors share this motivation. He is unable to convince them to retreat from this position of materialism and is unable to persuade them to embrace a position that is not so embedded in that of money. It is an early indicator that money holds so much sway in the medical profession, something that Manson speaks to at the end of the money: “Doctors should work together and share their knowledge - make a real study of the causes and cures of their patients' diseases, instead of just giving bottles of medicine. ” The driving force of "fortune" building that is present in the Vale View medical professionals is something that Andrew cannot overcome, something that represents Andrew's failure with the doctors in Vale View.
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