To the best of my ability: the need for political physicians

Yesterday, an unusual series of nationwide events were held on college campuses and in hospitals. Medical students marched in white coats and staged demonstrations against police violence. They staged die-ins in public areas. I was at the event at the University of California, San Diego, which was held in the highest-traffic area on campus. At the end, all in attendance raised their hand and recited the Hippocratic Oath (the modern version).

UC San Diego medical students recite the Hippocratic Oath. December 10, 2014.
UC San Diego medical students recite the Hippocratic Oath.
December 10, 2014.

It was quite an event. The events were planned well- public areas, the use of a distinctive symbol of medicine, and the use of the Oath as a unifying statement- all great, and less common than they should be. Medical students are not on the front lines of the social justice movement in the way law students or politicized undergraduates are. That is a shame, because medicine cannot be apolitical.

The reality of medicine is that world conflict and society place obstacles in front of doctors and aid workers. Certain populations and areas of the world face political oppression and in some cases genocide. If doctors accepted and only treated people where it was legal to do so, they would be condemning others. The Red Cross is a great institution of neutrality, but that sometimes their inaction can cause harm. Why do Doctors Without Borders exist? Because they thought the Red Cross were undermining the duty to heal by staying out of certain conflict zones. But to practice medicine without heed to borders means going outside the system. Whose lives are saved is at some level a political decision.

In the United States the political establishment has intruded on medicine. In Florida is now illegal for doctors to ask their patients about gun ownership, and whether that gun is safely stored. Guns are a major political issue, but they are also a major public health problem. Owners using a convenient gun to kill themselves, or the dozens of children shot and killed by other children who found an unsecured gun are something physicians have a clear duty to prevent. But they are being prevented from doing so in Florida, and many other states are considering similar laws.

With regards to abortion, physicians have been tied by unfair standards in their clinical practice, all to prevent them from performing a legal medical procedure. In states like Ohio, efforts are being made to restrict what doctors can talk about, what information they provide, and preventing doctors that perform abortion from providing sex education in schools. Laws are also attempting to provide anti-abortion doctors cover to lie to their patients, even though such conduct is grossly unprofessional.

Doctors are confronted with a healthcare system that is grossly inefficient and still very expensive. Their expertise has always been in conflict against insurance companies who will only pay for certain treatments and drugs, and stretched by patients who have no money to pay out-of-pocket. A dysfunctional system has led to incredible rates of infant mortality, obesity, and heart disease.

And why is the rate of infant mortality so high? One key part is the terrible poverty many kids are born into- the gap widens postnatal, not prenatal. Poverty is a public health crisis. There are diseases of the poor, and life expectancy drops dramatically based on race and income.

At the event, I saw a medical student with a sign stating “Homicide is a Public Health Issue”. Of course. Doctors must deal with the after-effects of crime, including violence by police officers on suspects. Physicians cannot heal those that the police kill, and unnecessary force is a danger, like smoking and not wearing a seat belt.

The health of a society is rooted in political decisions. Economic inequality due to tax breaks, black poverty caused by bad schools and unjust police action. Thousands and thousands of unsecured firearms that doctors in Florida can no longer ask about. Doctors are not the only experts being hemmed in and told how to do their jobs- mandatory minimum sentences have swelled prison populations while crime itself has gone down. Judges used to have wide discretion and take each criminal case as unique, but now laws have tied their hands. Not to idolize judges or doctors, but their education and experience is important, and shouldn’t callously be discarded by legislation.

Get onto the streets, medical students, residents, fellow, and fully specialized physicians! More of these events need to happen, the medical lobby is powerful but also conservative. The rank-in-file need to push for a healthier world, and that requires wading into politics. The American people sure need a new, clean bill of health.


Gunned down for nothing in America



So the story of a Florida man shot for texting in a movie theater by a retired police officer has gained quite a lot of American media attention. It’s a strange, unprompted tragedy that deserves the scrutiny- though more on a policy level than the dark humor of an individual taking the law about not texting in a theater far too seriously.

An editorial by Ana Marie Cox in The Guardian points out that this sort of unprovoked gun violence is not rare in the United States. Rather, it’s commonplace to the point that many incidents don’t gain publicity outside of local coverage. And in the case of the movie shooting, it was almost immediately overshadowed by an incident in a New Mexico middle school. Often tragic, preventable gun murders stack up and overload the system. It ends:

You keep a gun out of the argument, you will save lives. This is not hypothetical. A person may be intent on killing someone else, but it is simply harder to do with anything else. That’s why forms of homicide other than guns account for only about a third of all homicides. Someone gets angry at someone else, they may reach for a weapon. If we make guns harder to get, by requiring a test for the license, or by banning handguns more broadly, the one at hand might be far less deadly.

The gun debate in America is one of the worst-argued issues of concern, with a lot of crappy logic and willful dishonesty. It may be even worse and circular than the abortion debate. However, the fact that even basic self-evident truths are not agreed upon- American has a lot of guns, a lot of gun homicides, a lot of gun suicides, very lax training and licensing standards, a large number of gun owners use or store guns in a dangerous way (etc. etc. oh god etc.) means one thing: people will continue to be shot in contexts that would have ended differently if the shooter hadn’t owned a gun or carried it with them.