Aug 07 2008
Medicine’s ethics and basis in science hang by a thread at times. At least in the US of A. I will present a few examples and illustrate them with correlates from other fields in which decisions with wide effects are sometimes made by the whim of one person. And that’s not just the declaring of war or whatever we call it these days.Start with an anecdote of mine from the mid-1970s or so. I somehow got involved in a dispute with the staff of then Gov. Jerry Brown over his proposal to de-license medical practice. He sent out early holistic medicine vibes and viewed health and medicine as fields open to anyone to practice by simply hanging out a shingle. I asked to meet with my state assemblyman and complained about the situation. I stated that physicians determined what medical practice is. He smiled benevolently and broke the news. “No, doc, we (in state government) do.“
I immediately recognized what he was saying. All licensure is granted by the state, and all regulations and laws referring to each occupation’s license are determined essentially by a majority vote and a governor’s signature. All those heroes in the history of medicine and science not withstanding. It was an awakening.
Jerry Brown’s vision did not materialize and he came to recognize holistic and alternative medicines as so much goofy stuff and quackery, as he later confided at a fund-raiser (yes, I went.)
In the California Assembly, all sessions and committee assignments are determined by one person – the speaker. I recall when Jess Unruh and Willie Brown held Assembly members hostage at the Capitol until certain legislation was passed. Nothing anyone else could do about it.
Shift to the Reagan Administration. Reagan was bound to a religious view of life. He put out an administrative edict for all agencies receiving federal funds, that malformed babies are life, must be treated as normal, including the max in pediatric intensive care. Anencephalics previously left to expire had to be kept alive by extraordinary means, through the edict of one person. Not only that, but signs had to be posted in all nurseries announcing the edict, and that there would be penalties for anyone who observed a violation and did not report it. I flashed back to the Germany of WW II, the Gestapo, and to the then USSR which suffered under similar policies and reporting.
So it was nothing new when George W. Bush came out last week with yet another edict for institutions receiving federal funds. With a detailed description of stages of fertilization of the ovum and against any contraception that interrupts implantation. A president again determining a life/death issue formerly left to the individual as a basic freedom.
This one-person, massive effect phenomenon occurred again last week when House Speaker Pelosi adjourned the House of Representatives before a discussion or vote could occur on an energy bill – despite the bipartisan formation of one such bill. Her decision for public consumption was to save the environment by preventing more oil drilling, but few could miss the political reality – no solution under Bush; wait until after the November election. Low income public be damned.
A similarly close vote occurred with the override of Bush’s veto of the Medicare bill – a narrow override, which also prevented a ten percent cut in Medicare physician fees. Close, and a message should be sent to HHS to clean up the fraud in Medicare before more fee cuts. But who is listening to that rational approach?
In California, Governor Schwartzenegger announced a cut or delay in minimum wage and other cuts for people who could least afford them, while political fat cats on state boards and commissions collect six-figure salaries for messing up the state workings with unnecessary smog controls, boutique fuel requirements, additives that don’t work, prohibited nuclear reactors, and so on. While MediCal fees are lowered every few years to the point of less than the cost of rent and utilities.
And lastly, the courts. Roe vs. Wade and progeny, eminent domain, gun control and others all being determined by a 5:4 vote by a widely split court, one justice making the difference..
Did I say lastly? You have obviously been waiting for modern scientific medicine’s first two legal shots taken from Senator Tom Harkin with his National Center for CAM, and his commercial twin, Senator Hatch and his 1994 DSHEA act. Each of these was created by one individual expressing personal fantasy and self-interest with political hits on medicine. Each has lasted almost a generation.
There is a serious lesson to be learned here that many of us do not see. In clamoring for a national health care scheme or a single payer plan with extraordinary power to pay for pseudoscience and quackery, we may be asking for a medical system run for and by political schemers and seekers with power to install their strange ideas, immune from reason or opposing majorities. As bad as HMOs and insurance companies appear to be, they pale in comparison with the power of the state and the potential for one person with personal or political urges and fantasies to do with medicine as one pleases.
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