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Sunday, December 29, 2002In contrast, here’s how the editorial staff of the BMJ feels: Take the impending attack on Iraq, apparently over its possession of "weapons of mass destruction." How should we respond to the British and American governments' claims regarding Iraq's nuclear, chemical, and biological arsenal, or the Iraqi government's denials? Such weapons have undeniable consequences for health, which makes them our business. But taking the claims or counterclaims at face value, or declaring ourselves unconvinced by one side, or ignoring the dispute completely, are all equally political decisions. At a time when even National Geographic magazine is devoting 35 pages to weapons of mass destruction, readers might expect us to come to a judgment over the risks they currently pose. They might also expect us to beconcerned with the source of the anthrax used the last time a weapon of mass destruction was deployed. It’s quite a stretch to take bombs and other weapons and make them a medical issue simply because we use them to hurt each other. By that logic, baseball bats would be medicalized. The editors must realize this on some intrinsic level, for to justify their very broad definition of medicine, they quote two old Prussians. The first is Karl von Clausewitz who famously said that "war is the continuation of politics by other means." The editors use him to justify their belief that the current war on terrorism ("phoney war" is the term they used) isn’t so much a matter of defense as of politics. They use the other Prussian to justify the politicization of medicine. That Prussian is Rudolf Virchow, the philosophical father of public health medicine, who said that “politics [was] nothing but medicine on a grand scale." Interesting choice. Virchow’s philosophy of medicine was later taken to its logical extreme by his countrymen, when Prussia was no more. That philosophy became a central tenet of a German political movement that considered the state a biological unit and themselves its healers. One of its leaders described the political movement as “nothing but applied biology.” That leader was Rudolf Hess. That political movement was the National Socialist movement, more commonly known as the Nazis. And, in fact, Nazi Germany is a good example of all that is wrong with politicizing medicine. Few German physicians opposed the politics of the Nazis. They enthusiastically embraced it. Many of its biological ideas were de rigeur in medical intellectual circles- eugenics and its spawn being chief among them. Those were the ideals of the times - and not just in Germany. In England and in America, the same sorts of ideas had gained hold. But thankfully in England and in America, medicine wasn’t politicized to the same extent as Germany. There was room to debate the issue in our journals and in our medical societies. There was no room for debate in Nazi Germany. For, when medicine is politicized, then the dominant political view wins all arguments. In Germany, doctors had one of the highest ratios for Nazi Party membership than any other profession, and their membership in the SS was seven times that of other academics. (Pretty sobering, isn’t it?) These were the doctors who were the heads of medical societies, the editors of journals, and the chairs of medical departments in the universities. They censured colleagues who disagreed with them. They even went so far as to supress research that contradicted their political beliefs. In his book, The Nazi Doctors, Robert Lifton interviewed several of those German doctors. They aren’t monsters, but normal men who, guided by their politics, believed they were doing the right thing. They sincerely believed that their medical science upheld their political beliefs, when in fact it was their political beliefs that shaped their science. That’s how they became Hitler’s willing executioners. They had let politics trump medicine, and disgraced themselves in the process. Granted, the editors of the BMJ and The Lancet don’t espouse the same beliefs as Nazis. But, the consequences of politicizing medicine are no different, whether the politics is right, left, or center. It clouds judgement, and it stifles dissent. It’s one thing to politicize a newspaper or a magazine - other newspapers and magazines, of different political bents, can challenge their views. It's quite another thing to politicize a medical society or a medical journal. Medical societies and medical journals aren’t the same as newspapers and magazines. It’s the role of medical societies to represent a wide range of physicians, of all political persuasions. It’s not their role to give a stamp of approval or disapproval to government policies - especially not policies that have nothing to do with the practice of medicine. It’s the role of medical journals to provide us with unbiased, well-done medical research on which to base our practice of medicine. It is decidedly not their role to serve as political mouthpieces - whether of the government or of its opposition, nor is it their role to serve as soapboxes for the political views of their editors. Leave politics to the politicians, for as another medicopolitical quotation puts it, “Politics is a choice of enemas. You’re gonna get it up the ass, no matter what you do.” Choose Your Enema II: On a more local note, I received an email from my professional society, The American Academy of Physicians, suggesting that I discuss the importance of raising the Medicare fee schedule with my patients. The idea is that by lobbying my patients, I can get them to in turn lobby our Senators and Congressman to halt legislation that will lower Medicare reimbursement. I’m ashamed of them for suggesting it. The doctor’s office is not the place for political discussions. A doctor is there for one purpose and one purspose only - to serve the patient. Not to use his influence with the patient for his own political gains. It isn’t hard to imagine a patient interpreting that sort of lobbying as medical blackmail. If they don’t comply, or if they don’t agree, will the doctor continue to give them quality care? Or will he be prejudiced against them? Some things are just plainly wrong.Using the authority of the physician as a soapbox for what in the end is a purely political cause is one of them. I’ll be more than happy to write my Congressman and my Senators. I’ll write a letter to the editor of the newspaper if they want. I’ll march on Washington if they ask. I’ll even volunteer to work on campaigns of sympathetic politicians. But I'll do all of that in my private role, not my professional one. And I’ll do all of that on my own time, not on my patients’ time. I refuse to beat them over the head with my politics. posted by Sydney on 12/29/2002 08:09:00 AM 0 comments 0 Comments: |
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