1.
Featured
Article: Why Politicized Science is Dangerous by Michael Crichton, MD
Imagine that there is a new
scientific theory that warns of an impending crisis, and points to a way out.
This theory quickly draws support from leading scientists, politicians and
celebrities around the world. Research is funded by distinguished
philanthropies, and carried out at prestigious universities. The crisis is
reported frequently in the media. The science is taught in college and high
school classrooms.
I don't mean global warming. I'm talking about another theory, which rose to
prominence a century ago.
Its supporters included Theodore Roosevelt, Woodrow Wilson, and Winston
Churchill. It was approved by Supreme Court justices Oliver Wendell Holmes and
Louis Brandeis, who ruled in its favor. The famous names who supported it
included Alexander Graham Bell, inventor of the telephone; activist Margaret
Sanger; botanist Luther Burbank; Leland Stanford, founder of Stanford
University; the novelist H. G. Wells; the playwright George Bernard Shaw; and
hundreds of others. Nobel Prize winners gave support. Research was backed by
the Carnegie and Rockefeller Foundations. The Cold Springs Harbor Institute was
built to carry out this research, but important work was also done at Harvard,
Yale,
These efforts had the support of the National Academy of Sciences, the American
Medical Association, and the National Research Council. It was said that if
Jesus were alive, he would have supported this effort.
All in all, the research, legislation and molding of public opinion surrounding
the theory went on for almost half a century. Those who opposed the theory were
shouted down and called reactionary, blind to reality, or just plain ignorant.
But in hindsight, what is surprising is that so few people objected.
Today, we know that this famous theory that gained so much support was actually
pseudoscience. The crisis it claimed was nonexistent. And the actions taken in
the name of theory were morally and criminally wrong. Ultimately, they led to
the deaths of millions of people.
The theory was eugenics, and
its history is so dreadful -- and, to those who were caught up in it, so
embarrassing -- that it is now rarely discussed. But it is a story that should
be well known to every citizen, so that its horrors are not repeated.
The theory of eugenics postulated a crisis of the gene pool leading to the
deterioration of the human race. The best human beings were not breeding as
rapidly as the inferior ones --- the foreigners, immigrants, Jews, degenerates,
the unfit, and the "feeble minded." Francis Galton, a respected
British scientist, first speculated about this area, but his ideas were taken
far beyond anything he intended. They were adopted by science-minded Americans,
as well as those who had no interest in science but who were worried about the
immigration of inferior races early in the twentieth century ---
"dangerous human pests" who represented "the rising tide of
imbeciles" and who were polluting the best of the human race.
The eugenicists and the immigrationists joined forces to put a stop to this.
The plan was to identify individuals who were feeble-minded --- Jews were
agreed to be largely feeble-minded, but so were many foreigners, as well as
blacks --- and stop them from breeding by isolation in institutions or by
sterilization.
As Margaret Sanger said, "Fostering the good-for-nothing at the expense of
the good is an extreme cruelty
there is not greater curse to posterity than
that of bequeathing them an increasing population of imbeciles." She spoke
of the burden of caring for "this dead weight of human waste."
Such views were widely shared. H.G. Wells spoke against "ill-trained
swarms of inferior citizens." Theodore Roosevelt said that "Society
has no business to permit degenerates to reproduce their kind." Luther
Burbank, "Stop permitting criminals and weaklings to reproduce."
George Bernard Shaw said that only eugenics could save mankind.
There was overt racism in this movement, exemplified by texts such as "The
Rising Tide of Color Against White World Supremacy" by American author
Lothrop Stoddard. But, at the time, racism was considered an unremarkable
aspect of the effort to attain a marvelous goal --- the improvement of
humankind in the future. It was this avant-garde notion that attracted the most
liberal and progressive minds of a generation.
Eugenics research was funded by the Carnegie Foundation, and later by the
Rockefeller Foundation. The latter was so enthusiastic that even after the
center of the eugenics effort moved to
Since the 1920s, American eugenicists had been jealous because the Germans had
taken leadership of the movement away from them. The Germans were admirably
progressive. They set up ordinary-looking houses where "mental
defectives" were brought and interviewed one at a time, before being led
into a back room, which was, in fact, a gas chamber. There, they were gassed
with carbon monoxide, and their bodies disposed of in a crematorium located on
the property.
Eventually, this program was expanded into a vast network of concentration
camps located near railroad lines, enabling the efficient transport and of
killing ten million undesirables.
After World War II, nobody was a eugenicist, and nobody had ever been a
eugenicist. Biographers of the celebrated and the powerful did not dwell on the
attractions of this philosophy to their subjects, and sometimes did not mention
it at all. Eugenics ceased to be a subject for college classrooms, although
some argue that its ideas continue to have currency in disguised form. . .
The past history of human
belief is a cautionary tale. We have killed thousands of our fellow human
beings because we believed they had signed a contract with the devil, and had
become witches. We still kill more than a thousand people each year for
witchcraft. In my view, there is only one hope for humankind to emerge from
what Carl Sagan called "the demon-haunted world" of our past. That
hope is science.
But as Alston Chase put it, "when the search for truth is confused with
political advocacy, the pursuit of knowledge is reduced to the quest for
power."
That is the danger we now face. And this is why the intermixing of science and
politics is a bad combination, with a bad history. We must remember the
history, and be certain that what we present to the world as knowledge is
disinterested and honest.
To read Crichton's entire essay, go to www.crichton-official.com/fear/index.html.
To read Michael Crichton's Op-Ed in the
*
* * * *
2.
In the News: The Resurrection of Al Gore, by Karen Breslau, Wired Magazine, May 2006
He invented the Internet (sort of). He became President (almost). Now Al Gore has found his true calling: using the power of technology to save the world.
One evening last December, in front of nearly 2,000
people at Stanford's Memorial Auditorium, Al Gore spoke in uncharacteristically
personal and passionate terms about the failed quest that has dominated much of
his adult life. Save for his standard warm-up line - "Hi, I'm Al Gore, and
I used to be the next president of the
After the souped-up
climatology lecture, a smaller crowd dined at the
. . . Along the way, Gore has become a neo-green entrepreneur,
taking his messianic faith in the power of technology to stop global warming
and applying it to an ecofriendly investment firm. The company, Generation
Investment Management, which he cofounded nearly two years ago, puts money into
businesses that are positioned to capitalize on the carbon-constrained economy
Gore and his partners see coming in the near future. All the while, he has been
busy polishing his reputation as the ultimate wired citizen: Not far from the
Stanford campus, Gore sits on the board of directors at Apple and serves as a
senior adviser to Google. Farther up Highway 101 are the
For Gore, the private-sector
ventures are all pieces of the same puzzle. He's challenging the power of the
investment and media industries to decide what information matters most and how
it ought to be distributed. "I find a lot of joy in the fact that these
parts of my life post-politics have connected into what feels like a coherent
whole, in ways that I didn't consciously plan," Gore told me at the
Technology Entertainment Design conference in Monterey, California, where -
again - he was the star attraction. "I think I'm very lucky."
This is not, of course, the
image of Al Gore stored in the nation's memory. He's been filed away as a
tragic character who saw his victory hijacked by the Supreme Court. (In the
film, he addresses the experience in a poignant passage: "That was a hard
blow, but what do you do? You make the best of it.") How Gore has
reengineered himself as a hero of the new green movement is a story known so
far by only the relative few who have seen him in action lately. "You have
a sense that this is the moment in his life, as though all the work he's been
doing is now coming to a head," says film director Davis Guggenheim, who
spent months traveling with Gore while shooting An Inconvenient Truth.
"City by city, as he gives this presentation, he is redeeming himself in a
classically heroic way - someone who's been defeated and is lifting himself out
of the ashes."
To read the entire article, please go www.wired.com/wired/archive/14.05/gore_pr.html
To decide whose ashes, read the Feature above
and the Book Review below.
To read George Will on Gore, please go to www.washingtonpost.com/wp-dyn/content/article/2006/06/09/AR2006060901550.html
* * * * *
3.
International
Medicine: Was the
Artic Really Tropical in The Past? Are We in the Ice Age Now?
Studies Portray Tropical
. . .The findings, published
today in three papers in the journal Nature, fill in a blank spot in
scientists' understanding of climate history. And while they show that much
remains to be learned about climate change, they suggest that
scientists have greatly underestimated the power of heat-trapping gases to warm
the
Previous computer
simulations, done without the benefit of seabed sampling, did not suggest an
ancient
"Something extra
happens when you push the world into a warmer world, and we just don't
understand what it is," said one lead author, Henk Brinkhuis, an expert on
ancient Arctic ecology at the
The studies draw on the work
of a pioneering 2004 expedition that defied the
While there is ample fossil
evidence around the edges of the
To read the entire report,
go to www.nytimes.com/2006/06/01/science/earth/01climate.html.
* * * * *
4.
Medicare:
Government & Bureaucratic Medicine by Any Name Always Put Patients on Hold
Needs of Patients Outpace Doctors, by Lisa Girion,
Staff Writer, Los Angeles June 4, 2006
An
aging
A looming doctor shortage
threatens to create a national healthcare crisis by further limiting access to
physicians, jeopardizing quality and accelerating cost increases.
Twelve states - including
The shortages are putting pressure on medical schools to boost enrollment, and
on lawmakers to lift a cap on funding for physician training and to ease limits
on immigration of foreign physicians, who already constitute 25% of the
white-coated workforce. . .
"People are waiting weeks for appointments; emergency departments have
lines out the door," said Phil Miller, a spokesman for Merritt, Hawkins
& Associates, a national physician search firm. "Doctors are working
longer hours than they want. They are having a hard time taking vacations, a
hard time getting their patients in to specialists." . . .
The number of medical school graduates has remained virtually flat for a
quarter-century, because the schools limited enrollment out of concern that the
nation was producing too many doctors.
But demand has exploded, driven by population gains, a healthy economy and a
technology-driven boom in physicians' repertoires, which now include such
procedures as joint replacement and liposuction. . . .
Yet much of the physician workforce also is graying, and headed for the door. A
third of the nation's 750,000 active post-residency physicians are older than
55 and likely to retire as the boomer generation moves into its time of
greatest medical need.
By 2020, physicians are expected to hang up their stethoscopes at a rate of
22,000 a year, up from 9,000 in 2000. That is only slightly less than the
number of doctors who completed their training last year . . .
How did so many smart people and groups - including the American Medical Assn.
- predict a doctor glut not too long ago?
They say they bought into a notion that health maintenance organizations would
ratchet down physician demand by promoting preventive care and reducing tests
and procedures. Tightly managed care was expected to become so widespread and
effective that it would put many physicians out of work. . .
The predictions didn't come true. . .
Another idea that didn't pan out was that technology would reduce the use of
physicians. Minimally invasive surgical techniques and other advances, however,
actually have expanded demand for physicians by making it possible to perform
operations on patients who are older and sicker than those who got surgery in
the past, said Dr. David Etzionsi, a surgical resident who studied future
surgeon needs for the
What's more, older people generally are healthier today than in the past,
Etzioni said. "Operating on a 70-year-old now is much different than 30
years ago. So surgeons are more aggressive about patients they would do
procedures on."
The AMA changed its position on the physician workforce a year ago,
acknowledging that a shortage was emerging. The consensus has shifted so
quickly that experts who view the physician workforce as adequate - though
poorly distributed, inefficient or wasteful - now are seen as contrarians.
Momentum for change is building. This month, the executive council of the Assn.
of American Medical Colleges will consider calling for a 30% boost in
enrollment, double the increase it called for last year.
The
To read the entire article,
please go to www.latimes.com/business/la-fi-doctors4jun04,1,302429.story.
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Will Making Doctors Look Gluttonous
Reduce Medicare Costs?
Pricing Out Medicare - will
unveiling the expense of care help cut costs? by Avery Comarow, USNews
and World Reports
Medicare paid hospitals more than
$35,000 on average in 2005 to insert a heart defibrillator; an uncomplicated
spinal fusion ran nearly $17,000--not including physician and various other
charges. How will Americans react to knowing such numbers? With heightened
appreciation for the escalating cost of medical care, the Centers for Medicare
and Medicaid Services hopes.
Last week, to sensitize consumers to
the need to rein in costs, CMS revealed its latest reimbursements for more than
40 inpatient conditions and procedures, from chronic lung disease to intestinal
surgery (cms.hhs.gov/healthcareconinit). Adjustments for local
variations in wage levels and other factors create a wide payment
range--$30,151 to $41,193 for heart valve surgery, for instance. A bonus: The
number of cases per hospital is included, so consumers can quickly weed out
low-volume centers.
For now, making prices public is
primarily a consciousness-raising exercise, says CMS official Herb Kuhn,
because hospitalized Medicare patients don't pay a percentage of the cost and
wouldn't benefit from lower prices. But Medicare outpatients have to shoulder a
20 percent copay and might shop for cheaper care if and when prices for their
procedures are posted. That, at least, is the eventual goal.
www.usnews.com/usnews/health/articles/060612/12cost.htm
[Medicare telling patients what their inpatient costs are
will not be a conscious-raising exercise. Patients don't really care if it continues
to be essentially free. They feel they are entitled to this care and fully
deserve it, regardless of cost. But requiring patients to pay a 10 percent
co-payment for all inpatient procedures will be conscious-raising immediately -
or before if their friends tell them about it before they even reach the
hospital. That will drastically reduce unnecessary health-care costs. We think
by more than 50 percent.]
* * * * *
6. Medical Myths: Increasing
Government and the medical bureaucracy limited medical
school enrollment because they thought they had the magic formula to control
medical costs with managed care and HMOs. However, demand continued upwards and
another failed government program threw the country into another morass with a
shortage of doctors. Now the prevailing wisdom is to reverse the unfortunate
government and medical bureaucracy predictions and increase medical school
enrollment. Congress and the government, including the medical bureaucracy,
fail to see this as a problem. The huge cost they imposed on the taxpayers by
their previous inability to predict the future is simply relegated to their
learning curve.
But their learning curve does not progress upwards. It
is always in a downward spiral. Just as the Medicare predictions of its cost in
the 1960s were exceeded by hundreds of percents, these predictions will also
fail. By using the monies forcibly taken from the taxpayers, which caused our
present predicament, Congress sees no problem in forcing its citizens to pay
even more taxes to correct their previous mistakes and create another problem.
The current correction will not reduce the inequity between patient demands and
physician supply. It will artificially skew them just in another direction.
Only a free economy will correct the inequity. Is the obvious solution
possible?
Getting the Government Out of Medicine Will Reduce the
Physician Shortage
* * * * *
7.
Overheard in the
Medical Staff Lounge: Dr Sam and Medicare
Dr Sam announced
a breakthrough in his dealings with Medicare. After several months of no
reimbursements, he had received a check for $3 last week and a check for $6
this week. That would pay nearly 20 minutes of his insurance biller's wages for
the extra 20 to 30 hours she had invested in researching the problem with
Medicare. Or to look at it another way, he had received $9 for the extra $800
($27/hour x 30 hours) he had paid his billing clerk in order to try to
understand Medicare's harassment. And
now he will bear the cost of the many hours of research required to learn how
to leave Medicare without putting his medical license in jeopardy.
Dr Rosen noted that the VA lost a large number of their
medical records from the Electronic Medical Record system. The people
developing EMR are working overtime to make them safe. We don't need artificial
incentives from the federal government, former House of Representative Speakers
and White House inhabitants to speed the process leading to further security
risks. The electronic medical record will evolve as it should based on its
merits.
Socialized Medicine. The discussion move to how did the University
Professors buy into Socialized Medicine. Arent they in the business of
training doctors for community practice? A Medical Student on his
preceptorship was at our table. He stated that the professors all seem to be
funded by the National Institutes of Health or some other government program.
He felt their allegiance shifted to the source of their funding. He thought
that was just following the money? Did that mean that all the new doctors are
basically socialists? Although he had no proof, it was his impression that more
than half of the class was becoming socialistic. They were primarily interested
in obtaining a 40-hour a week job with no continuing after hours or weekend
patient responsibilities. He felt the appeal was the greatest among his female
classmates, which are now the majority.
Is Government Funding of Research Destroying
the Private Practice of Patient Centered Medicine?
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
Editorial: The
Magic Promise by Brien
Seeley, MD
One night, while being pampered at Syrah,
I wondered how clinical empathy has survived the pressures of corporate
medicine. Does heartfelt well-wishing bestow restorative powers?
J.M. Barrie thought so, invoking such magic in Peter Pan when children's
earnest well-wishes restore Tinker Bell from being poisoned. Like many
physicians, I have witnessed miraculous recoveries from life-threatening
illnesses in patients surrounded by caring loved ones. Though fairy tale magic
strains the science of medicine, I believe that clinical empathy survives
because it bestows its own kind of magic--what I call the Magic Promise of
medicine.
The Magic Promise inspires patients with faith that their physician's heart is
with them. The promise goes beyond the tacit "integrity of intent"
that their physician will do right and be competent. It is not mere trust or
confidence. This promise convinces patients that their physician truly cares about
them and will therefore ease their suffering and heal them with kindness as
well as the most effective treatment available. The magic is that this promise
comes true.
Like the twice-warmed woodchopper, when patient and physician exert the
emotional labor needed to connect genuinely, they are later warmed by an easier
course through the illness. Conversely, a bad outcome in a "needlessly
nervous Nellie" may mark a failure to forge the Magic Promise.
The Magic Promise is built on the faith created by clinical empathy. Such
empathy is born of sensitive attunement to nuance rather than from the knitted
brow of convergent deliberation. It resides beyond signs, symptoms, and test
results, and it takes more than merely "being together." Empathy is a
two-way street where each must perceive the other's feelings. As the physician
looks deeply into their eyes and listens to their concerns, patients must sense
genuine, natural feelings of kindness in the physician in order to connect.
We can feel the connection when it happens. It is unmistakable; it burdens the
heart as a kind of love. Physicians who connect with their patients enrich the
meaning of their own lives, becoming artists rather than mere technicians.
The late Dr. Frank Norman was surely a Knight of the Order of The Magic
Promise. His calm confidence paralleled his graceful, natural ability to
connect to patients' feelings. Using humor, axiom, and personal anecdotes, he
bonded his Magic Promise with his humanity. Such physicians, trained before the
days of capitation, practiced perceptive and receptive attunement as the
fundamental, time-honored creed of medicine. Today, less experienced physicians
may need formal training to learn how to establish clinical empathy. Either
way, the task is essential to healing.
The Magic Promise transcends the placebo effect. It is not a sugar pill, sham,
or empty wishes. It is not manipulation. It is genuine. Its good outcomes do
not rely on evidence-based medicine and cannot be measured under "pay for
performance." It now appears that the promise's magic derives from a
heartfelt, liberating faith that steadily moves the patient toward healing by
actual neurobiologic mechanisms.
Recent fMRI studies show the
neuro-anatomic substrates by which such faith consistently finds its way
through uncertainty and contradiction to restore a peaceful mental state. A
sense of teamwork between physician and patient breeds an inner desire for
"us" to succeed, a hunger for recovery that amplifies each little
sign of improvement into hope and expectancy. This induces salutary visceral,
cardiovascular, and musculoskeletal effects via hormones, neurotransmitters,
and autonomic pathways and generates endorphins, easing pain and anxiety.
Must we choose empathy over reason? No. Neuroscientist Dr. Antonio Damasio has
shown that feelings are not a contaminant to reasoning, but rather are what
make reasoning possible. Indeed, clinical autism would confront one with an
endless decision tree. Feelings--wrought of a complex matrix of memories, innate
drives, dreams, and emotions--are what sift our myriad choices into Plan A and
Plan B. When Plan A fits the empathic connection, it instinctively becomes the
right choice.
This issue of Sonoma Medicine examines clinical empathy. I hope it
will strengthen the ranks of the Order of The Magic Promise. New members are
always welcome.
Dr. Seeley serves on the SCMA Board of Directors and the Editorial
Board.
To read the
original article, please go to www.scma.org/magazine/scp/sp06/seeley.html. To review the
entire series on Clinical Empathy, click on Table of Contents at the bottom
of the webpage.
* * * * *
9.
The
Physician/Patient Bookshelf: State of Fear by Michael Crichton, MD,
There is something
fascinating about science. One gets such wholesale returns of conjecture out of
such a trifling investment of fact.
-Mark Twain
Within any important issue,
there are always aspects no one wishes to discuss.
-George Orwell
"In late 2003, at the
Sustainable Earth Summit conference in
In
In
In the jungles of
In
At the International Data
Environmental Consortium (The IDEC): In a small brick building adjacent to a
University in Tokyo, which bears the University's Coat of Arms leading the
casual observer to assume an association, but which is totally independent, a
network of servers equipped with multilevel quad-check honeynets is at work.
The nets are established in both business and academic domains, which enable
them to track backward from servers to user with an 87 percent success rate.
"The National
Environmental Resource Fund, an American activist group, announced that it
would join forces with Vanutu in the lawsuit, which was expected to be filed in
the summer of 2004. It was rumored that wealthy philanthropist Gorge Morton,
who frequently backed environmental causes, would personally finance the suit,
expected to cost more than $8 million. Since the suit would ultimately be heard
by the sympathetic Ninth Circuit in
In
In
"But the law suit is
never filed." Why was the Vanutu
suit, which was to have been funded by George Morton, dropped?
Thus begins "State of
The novel is not politically
correct and thus the reviews from the media were predictable. Or as David
Kipen at the SF Chronicle states, "Unless I'm mistaken, State of
Crichton has given us his
own scientific point of view in a special message at the end. The Op-Ed in
section one above is also recorded in the Appendix. There is an extensive
bibliography consisting of 32 pages of more than 150 references in support of
the author's position.
According to the Wall Street
Journal, "In STATE OF FEAR, Michael
Crichton delivers a lightening technopolitical thriller...every bit as
informative as it is entertaining."
This book is informational reading and
studying especially in view of the anxiety about global warming. Crichton's
cautions are relevant and should give us insight into how the government uses
taxpayer's monies to direct scientific and medical research.
The 16 CD audio version performed by
George Wilson is very well done. For physicians who drive between hospitals and
their office, it's an easy way to brush up on how political science works. In
fact, it packs a more powerful punch than silent reading.
But be sure you do not have a tight
schedule. Several times during the past month after parking, I was unable to
cease listening, open the door to my car, and meet my time constraints. One evening
on my way home, I phoned my wife, "Would you mind if I drive to
www.harpercollins.com/global_scripts/product_catalog/book_xml.asp?isbn=0066214130
The Physician/Patient bookshelf began
ten years ago in Sacramento Medicine. Books written by physicians and
nurses on any topic were reviewed, as well as books by any author on a medical
topic. Most of the more than 100 books reviewed have been published in the
electronic journal, HealthCareCommunicationNetwork. They can be found topically
at 
www.healthcarecom.net/bookrevs.htm.
They have been reposted alphabetically at www.delmeyer.net/PhysicianPatientBookshelf.htm. To see the posted version, click on State of
* * * * *
10. Hippocrates & His Kin: The Pros and Cons of Aging
Pro: You know so much more stuff.
Con: You can't remember any of it.
Pro: I used to burn the candle
at both ends.
Con: Now I can't find the
matches.
PDE-5 Inhibitors May Relieve Male Urinary Symptoms
Phosphodieterase-5
inhibitors may have a role in the relief of lower urinary tract symptoms,
according to two studies presented at the Annual Congress of the European
Association of Urology.
Daily tadalafil (Cialis)
therapy significantly improved symptom scores in men with benign prostatic
hyperplasia in a placebo-controlled, phase II trial reported by Dr. Kevin T.
McVary. The 12-week, double-blind study enrolled 281 participants. Not
unexpectedly, a sexually active subset with erectile dysfunction also experienced
significantly improved erectile function with tadalafil. In the second study,
investigators combined sildenafil (Viagra) with alfuzosin (Uroxatral), an alpha1-blocker, as a therapy for
previously untreated lower urinary tract symptoms (LUTS) and erectile
dysfunction. Dr. Steven A. Kaplan reported that the combination was more
effective than either agent alone in the three-armed study, which enrolled 62
men with the two conditions. www.internalmedicinenews.com/article/PIIS1097869006734035/fulltext
I understand this study is
over subscribed and has a waiting list of volunteers.
Hippocrates and His Kin column
started in Sacramento Medicine during my editorship in 1994. These are posted
at www.healthcarecom.net/hhkintro.htm. After it had run its
course, it appeared briefly on my web page at www.delmeyer.net/HMC.htm as Hippocrates Modern
Colleagues. It was resurrected one year ago this month in MedicalTuesday www.medicaltuesday.net/archives/June2805.html. Feel free to click on any
of these sites during your spare time to review vignettes of interest during
the past twelve years.
* * * * *
11. Restoring Accountability in Medical Practice,
Government and Society: