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THE PLEXUSThe NYU School of Medicine Journal of Thou ht

Loser

Doctor


2/12

Weaving through much of the content of this issue is

the notion that physicians responsibility spans more than

just their immediate clinical or scientic endeavors. Ofcourse, this is nothing new. The concerns of those who

practice medicine can never be and have never been fully

divorced from the system through which care is delivered

or from the bioethical debates such delivery inevitably

engenders. Similarly, concern for the health of populations

has fallen squarely within the realm of the physician for some

time. Thus, most of us are probably fairly comfortable with

a physician who stakes positions on such health-centered

issues as the healthcare system, medical ethics, or public

health. Appropriately, all three of these topics are addressed

by writers in this issue of the Plexus.However, it is clear that there are potentialities for

physician input, advocacy, and activism within an ever wider

scope of affairs, regarding issues less directly related to the

day-to-day practice of most physicians, but equally essential

to the broader ethical framework under which he or she

operates. In this line of thought, a doctors responsibilities

are widened to issues of human rights, whether political,

economic or social. They would include those matters

which have profound ramications for human health: the

behavior of governments, the waging of wars, the treatment

of prisoners, and so forth.

Such a widening has both drawbacks and advantages.The former would be the complications involved in

politicizing ourselves professionally. Therefore, any

endeavors taken up by physicians would require a great deal

of partisan impartiality, factual clarity, and moral vision.

Conversely, given the voice and power that physicians

have, and given the enormous human costs or benets that

government action can effect, physician involvement is

critical if we are ever to effectively confront the epidemics

both biological and social that continue to plague us.

The Editors

THE PLEXUSVolume I, Issue 2

December, 2004

Board of Editors: Samantha Brenner (08),Adam Gaffney (08), and Al Garfall (07).

Contributors: Amber Alayyan (07), Cedric

Dark (05-06), ared Goldberg ('05), Varun

Sharma ('08), Jeffrey Shyu (08), and Sayone

Thihalolipavan ('08).

The NYUSoM Journal of Thought

All content is available online at http://

students.med.nyu.edu/plexus. Letters to the editor

should be mailed to [email protected], and

be no more than 200 words in length. Article submis-

sions should be rst discussed with an editor.

Contents of this Issue

Amber Alayyanblasts the Bush administrations choice for

he next Attorney General, Alberto Gonzales, by examining

his role in policies of torture and execution. From Naked

Statues to Naked Prisoners, page 2.

Al Garfall considers the role of the Catholic Church in

politics and the reelection of George Bush. When ReligionDictates Politics, page 3.

Sayone Thihalolipavan decries the basis of hate in this

poetic piece. Stripped page 3.

Cedric Darkcritiques the health reform proposals of both

he AMA and AMSA in this response to last issues health-

care debate. AMA and AMSA: A Plague on Both Your

ouses, page 4.

Varun Sharma argues that the errors of doctors are the trueculprit behind soaring healthcare costs. Medical Error: The

Source of Healthcare Woes, page 4.

Adam Gaffney looks into the past at the case of the Doc-

or-Statesman Rudolf Virchow to nd inspiration in a coun-

errevolutionary present. Politics and Physicians: Lessons

rom the Past, pages 5 to 6.

ared Goldberg examines the deleterious effects of alco-

hol on society and health, in light of a recent sports brawl.

Beer, Brawls and Basketball, page 7.

Samantha Brenner takes the pulse of the student body,

asking where students (claim) to study. The Halls of NYU-

SoM: Locations for Learning, page 8.

effrey Shyu reviews the philospoher Habermas most

recent look at the ethics of designing the newborn.Haber-

as, Human Nature and the Future of Liberalism, page 9.

Cover: Winner, Loser, Lawyer, Doctor: The Intersection of

Bush, Kerry, Alberto Gonzales and Rudolf Virchow at this

hour of American politics. All photographs public domain or

fair use.


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A

fter the presidential elections in

early November, Attorney General

John Ashcroft declared the countrysafe and then resigned. To ll Ashcrofts

post, President Bush has nominated White

House counsel Alberto Gonzales, a friend

and loyal supporter of the president.

Gonzales, like me, is from Texas.

He served as a partner in a Houston law

rm whose clients include Halliburton and

Enron. Gonzales served as then-Governor

Bushs general counsel and a Texas

Supreme Court Justice. As Texas Chief

Legal Counsel, Gonzales was responsible

for drafting legal summaries in 57 clemency

cases. He repeatedly failed to apprise Gov.Bush of critical issues regarding each case,

such as ineffective counsel, conict of

interest, and even evidence of innocence.

Bush used these memos to approve

executions (of which there were 152 in

his 6 years as

governor).

A s

White House

c o u n s e l ,

G o n z a l e s

m a i n t a i ned

his allegiance

to Bush and

his former

clients. He

argued with

C o n g r e s s

to keep the

details of Vice

P r e s i d e n t

C h e n e y s

e n e r g y

commission

m e e t i n g ssecret. He

has also

defended the administrations indenite

and ncommunicado detention of terrorism

suspects, who are labeled enemy

combatants and denied due process of

law.

Regarding the issue of torture,

Gonzales oversaw the development

of policies for managing prisoners in

Guantanamo, Afghanistan, and Iraq. In

a number of Justice Department memos

sent in 2002, Gonzales states that laws

against torture do not apply to the

Presidents detention and interrogation

of enemy combatants and goes on to

attempt to change the denition of torture.In a memo earlier that year, he called the

Geneva Conventions obsolete, writing

that because

the war on

terror is a new

kind of war,

the Geneva

Conventions do not bind the U.S. in the

war in Afghanistan (the third and fourth

Geneva Conventions initiated by the

UN and signed by the U.S. after WWII

dene the proper treatment of prisoners

and civilian populations, respectively, in political conicts). U.S. military and

government ofcials, including Colin

Powell, warned against this agrant

deance of federal and international law,

but Gonzales advised the President against

hese warnings, thus setting

he stage for Abu Ghraib.

One would assume

hat as the leading law

enforcement ofcer in

he country, the Attorney

General would actually

enforce the laws and legal

standards of the country.

lberto Gonzales has

lready proven himself

ncapable of upholding

such laws and principles.

is appointment to the

ofce of Attorney General

may be problematic and

potentially dangerous for

the country. The U.S.

cannot out international

law and then expect theworld to maintain the very

moral standards we ignore.

Physicians can play a role in

the torture of political detainees either

actively or passively. As we now know,

in Abu Ghraib and Guantanamo Bay,

U.S. military physicians were complicit

in acts of torture by denying prisoners

medications for existing medical

conditions, treating detainees so they could

return to interrogation, falsifying death

certicates to wrongly attribute prisoners

deaths to natural causes, and designing

and implementing psychologically and

physically coercive interrogations.

hysicians also play a passive role

in torture by not speaking or acting againstsuch acts. As future doctors, we are no

responsible for the exploits committed by

our military

but as a group

we will be held

accountable for

our actions or

lack thereof in condemning these methods

and deeds. The recent nomination o

Alberto Gonzales for Attorney Genera

provides each of us with such

opportunity to act against the militarys

practice of torture.

Torture, as an interrogation technique

has been shown to be ineffective in eliciting

accurate information from prisoners. As

physicians, we can work against this archaic

practice by documenting signs of torture in

our patients. More immediately, as medica

students we can actively condemn the

employment of torture by our military. A

number of people argue that writing letter

to senators and representatives is futile, and

on some issues, they would be rightbut

not on this one. The Senate will reviewGonzaless nomination to the appointmen

of Attorney General beginning in January

2005. We can, and as future physicians we

should encourage our senators to ensure

that the review of Gonzaless nomination

be thorough and fairexamining both hi

record and future plans for the Departmen

of Justice.

The following link is to a sample

etter drafted by the organization Human

Rights First. By providing your address

he letter will be sent to your senators onour behalf: http://action.humanrightsr

t.org/campaign/gonzales/

Human Rights First, Physicians fo

Human Rights, Amnesty Internationa

he AFL-CIO, the NAACP, and other

organizations have also signed a letter to

Senators Hatch and Leahy on the Senate

Judiciary Committee. The letter include

more background information on Alberto

Gonzales, and it can be found at: http

//www.phrusa.org/research/torture/pdf/

gonzales-coalition_041129.pdf

FROM NAKED STATUES TO NAKED PRISONERS

by Amber Alayyan

Political Matters

lberto Gonzalez as the Next Attorney General

Gonzalez being sworn in

as White House Council byCommander in Chief G.W. Bush

The U.S. cannot out international

aw and then expect the world to maintain

the very moral standards we ignore.


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As a member of that rebellious and

sinful 44%, Im a little sour over

he role our Church leaders may

ave played in Kerrys defeat.

by Al Garfall

S

ortly before the presidential

election, the Catholic Archbishop of

enver declared that voting for John

Kerry is a serious sin requiring confession.His exact words, as reported in the New

York Times, were: if you vote this way,

are you cooperating

with evil? And if

you know you are

cooperating with

evil, should you go

to confession? The

answer is yes. Other

bishops denied the Eucharist to Kerry and

other democratic politicians in their

dioceses. In Catholic dioceses throughout

the country, bishops spoke passionatelyabout the primacy of abortion and stem-cell

research, essentially instructing Catholics

to be single-issue voters on these so-called

life issues.

Its not surprising, therefore, that

Kerry, a Catholic himself, lost the Catholic

vote 51%-48%. Among Catholics that

attend mass regularly, the split was 55%-

44%. In Ohio, where Bush won overall

by 136,000 votes, Bush received 780,000

Catholic votes, 156,000 more than Kerry.

For comparison, both Bill Clinton in 1996

and Al Gore in 2000, neither of whom are

Catholic, took 53% of the Catholic vote in

their respective elections.

As a member of that rebellious and

sinful 44%, Im a little sour over the role

our Church leaders may have played in

Kerrys defeat. My politics aside, though,

I take issue with the idea of any single-

issue endorsements from religious leaders,

particularly from Catholic bishops.

Is it ever justied for a religious

leader to speak up politically? I hope so.

Rev. Martin Luther King Jr. comes to mind.Similarly, the Catholic Church has a long

history of speaking out and acting with great

inuence against tyrants and tyrannical

ideologies. Were a candidate or ideology

so clearly a paragon of either Catholic

virtue or anti-Catholic vice, I hope that the

Church would speak out. My view is that

the bar for such an endorsement should be

pretty high, though, because unlike voters,

the Church is under no obligation to choose

sides. While politicians and political

parties cannot function without bending

their values here and there, the Church

can continue its ministry and maintain its

positions on issues without compromising

its principles to endorse a candidate on a

single-issue basis.

Was either John Kerry or GeorgeBush so in line with the Churchs ideals

so as to deserve its endorsement? Without

going into too much

detail, the answer is

clearly no. Kerry is

unabashedly in favor

of stem cell research

nd is pro-choice.

While Bush is pro-

life on stem cell research and abortion, his

other policies fall far short of the Churchs

ideals on issues like the death penalty,

economic fairness, and the integrity of the

social safety net. Interestingly, even Bushs

position on abortion is too liberal for the

Catholic Church because Bush makes

exceptions for rape and incest.

The standard explanation the Churchoffers for its endorsement is that these life

issues trump all others, which I suppose

excuses Bush voters from having to go to

confession for the evils with which they

knowingly cooperate. I question the

sincerity of this explanation, however

because it lets politicians off the hook to

engage in a patently un-Catholic mora

calculation as they stake out their positions

For example, if I were a politician and I

wanted the Churchs endorsement, how

Political Matters

When Religion Dictates Politics

Continued on page11

3

by Sayonne Thihalolipavan

What if you were stripped of every single one of your human rights?

Freedom of expression, health, maybe even your life?

Would you remain silent, or protest the strife?

Knowing that prejudices prevent breathing in the beauty of THIS room

since education is not deemed worthy as a right.

In a cloudy, sinister fog of civil unrest,

South Africans endured a life of torture, detest

In hopes of experiencing a lucid, serene night

What if YOU were stripped of every single one of your human rights?We habitually take for granted the entitlements given upon birth;

Yet human rights are violated uncaringly throughout the world

Why hate, discriminate? Because it is effortless.

We must expand energies to embrace diversities,

Become knowledgeable, celebrate human peoples, take political

Action, admit biases, and forgive. Oh lord we must forgive!

Molecularly we are 95% similar in DNA,

Realistically why must we trip over the 5 that remain.

Prejudices may lead to poverty and lack of equality,

You can take my property and privacy but you cant take away my dignity;

I will rise against your hate and use your own abhorrence to ame my retaliation

Claiming my birth right of international amnesty

Sticks and stones may break my bones,

But unsaid words will permanently disgure my soul.

Discrimination will only lead to elimination of the human race

Like a prophecy rights will unfold whether through actions mine

Or my soul reborn in future generations

ou loathe me. ove you, fellow, human brother, but despise your actions

What if I was stripped of every single one of my human rights?

I would cry...in hopes that you heard my pain and would help heal my plight

Because before race, color, religion, and everything else that separates us,

We are human.

This spoken-word piece was performed at the NYU SoM Coffeehouse Event on 12/01/04

STRIPPED


5/12

by Varun Sharma

The most interesting thing about the American health

care system is that it is one sector of the economy whereconsumers believe they can get something for nothing.

People want health insurance, but no one wants to pay for it. While

both the AMA and AMSA pose solutions to the problem of 45

million uninsured, neither proposes truly viable options. AMSAs

proposal is too radical to garner signicant congressional support;

AMAs proposal does little to affect health insurance status and

more to cut taxes.

It is far easier to debunk the myth that Medicare for all

is the solution to the plight of the uninsured. In reality, all you

Physicians for a National Health Plan (PNHP)-junkies out there

should really advocate for Medicaid for all Medicaids benets

are far superior to medicares.

But why is AMSAs approach utterly unrealistic? On paper,a single-payer health system with basic benets guaranteed to all

Americans looks beautiful. But so too did the concept of bringing

Joe Gibbs,

B i l l

P a r c e l l s ,

and Tom

C o u g h l i n

to the NFC

East. We all

know how well that went. Although, many in DC myself included

are still pondering an 8-8 record with a potential wild card spot.

So if they get the wild card, should we consider introducing that

single-payer bill in the next Congress and see what happens?

Realistically, in order to enact such as system, you would have to

alter the anti-tax individualism of the American psyche.

The AMSA plan is basically a reiteration of the Physicians

for a National Health Plan (PNHP) strategy of 1989 and 20032.

First on this agenda is the imposition of global budgets on

hospitals. Additionally, the AMSA/PNHP plan would regulate

capital costs as a means of controlling the medical arms race

between competing hospitals. This will cut costs, but it will

introduce inequalities between facilities and may also stie further

technological advances.

AMSA/PNHP also wants to eliminate any cost sharing, i.e.

payment of some percentage of healthcare costs at the time ofservice. This is, in my view, the worst idea proposed. Cost sharing

represents one of the best means to limit health expenditures. Its

effects are also unfortunately overly oppressive to low-income

persons. But if you keep cost sharing, means test it, and cap the

amount any one person must pay out-of-pocket throughout the

course of the year, health expenditures will stay down and people

will be relieved of nancial stress.

The AMSA/PNHP plan is remarkably lenient towards

physicians: we would retain the freedom to practice fee-for-

service (which fosters over-utilization), salaried (which fosters

by Cedric Dark

Continued on page 10

I

s health care a right or a privilege? That simple question can

illicit a very passionate response from almost anyone, but really

the debate is largely irrelevant. Healthcare now takes up 15% of

our GDP and is projected to drain 30% of our GDP within the nexfew decades. At 30% of GDP, there just simply will not be enough

money to pay for healthcare regardless of how loudly we scream

nationalized or

privatized.

Bureaucracy

nd administrative

costs are commonly

targeted as the

culprits behind the

rise in healthcare costs, and rightly so. However, the true problem

s more deeply rooted. Carelessness, poor judgment and poor

treatment by doctors, combined with the inefcient managemen

of hospitals, amounts to billions in wasted dollars, and worseclose to 100,000 avoidable deaths every year.

One reason for the very sloppily-run state of health care

s due to inherent characteristics of medicine itself. Medicine

nvolves providing a service to a largely uninformed consumer

population, rendering them almost completely dependent o

their supplier. A patient has little input with regard to the tests

nd treatments he must pay for. This imbalance of power has

helped foster a culture in medicine of poor communication and a

ack of accountability. There is little way to effectively evaluate

the performance of doctors and hospitals. This has left the task

of holding doctors accountable to malpractice lawyers, a system

which in the end only serves to raise the costs for patients.

On top of all this, within the last decade, the powers doctors

did possess to order diagnostic tests and treatment options have

being transferred to the middle men. Insurance companies ar

dictating the terms under which doctors can practice medicine

by constraining the time allotted to doctors per patient, and by

imiting the diagnostic tests and treatments doctors can provide

ultimately compromising patients care. This has done nothing to

meliorate healthcare spending and has only served to aggravate

patients and undermine doctors.

Unfortunately, hundreds of thousands of avoidable deaths a

year is not enough to warrant enough panic to change the system

but the rising and unsustainable costs of healthcare will hopefully

be enough of a wake up call. This is too important of an issue to beeft to the politicians and lobbyists. It is doctors who must commi

to changing medicine from the inside. A way must be found to

bring back power to doctors so that they can practice the medicine

they deem best and patients must be empowered to choose the

best possible care for themselves and their families. The bitteres

pill will be difcult for doctors to swallow, but the time has come

to try ideas like opening up doctors records to evaluation, and

ncreasing the competitiveness between doctors and hospitals

The solution to the nations healthcare woes does not revolve

round nding ways to allocate health insurance, but in trying new

deas to radically reform the way medicine is practiced.

edical Politics

AMA AND AMSA:A Plague on Both Your Houses

4

Medical Error:The source of healhcare woes

Carelessness, poor judgement,

n poor treatment on t e part

of doctors amounts to billions in

wasted dollars.

Cost sharing represents one of the best

means to limit health expenditures. Its

e ects are a so un ortunate y over y

oppressive to low-income persons.


6/12

prize winning Laurie Garrett devastatingly

documents in her book,Betrayal of Trust

The Collapse of Global Public Health

the American public health apparatus

s alarminglyunprepared for the

slew of dangers

e face, from

bioterrorism to th

emergence of drug

esistant HIV and

uberculosis.

ut still, we continue to do little, or

nothing.

In short, given a modicum of the

depressing images and numbers tha

inundate our airwaves, newspapers, and

medical journals, many of us cannot help but see our current course as absurd and

self-destructive. We are forced to re-ght

the battles of a hundred years ago. This

would be disheartening enough, were

not the stakes so much higher today, in

the nuclear age, in the age where human

beings are now the primary mover o

nature. The reactionary right conveniently

denies problems or our ability to solve

them, and the postmodern left all too often

forgets its priorities or loses its resolve

The opposition seems omnipotent, and so

the question remains: what can we do in

these dim days?

erhaps I have painted a picture

somewhat too dark. One could write

equally emphatically on the medica

gains of the last few decades. However, it

seems that while medicine has advanced

enormously technologically, progress

socially has simply not kept pace.

To gauge our progress, and provide

some context for our current predicament

it might be worthwhile to change gears and briey turn to history. Lets look back t

the nineteenth-century and consider the

case of one of medicines most brillian

minds, the German doctor-statesmen

Rudolf Virchow, born in 1821.

Scientically speaking, Virchows

achievements are undeniable. Three years

from medical school, Virchow had made

two of his major discoveries, the rst of

leukemia in 1845, and the second of the

processes of thrombosis and embolism

such despair, then, is a sense that almost

everywhere, the illiberal, the discredited

and the delusional are on the march.

Each day our nation seems more deeply

sucked into an imperialadventure gone awry.

We watch a US soldier

empty bullets into an

unarmed man, while

talking heads defend it.

We read about torture

at Abu Ghraib, and

then learn that a man who all but legally

approved of such actions will probably be

our next Attorney General.

With our eye xed on war, concern

for the cultivation of our childrens minds,

our environment and our public healthsuffer. Anti-evolution teaching creeps

back into public schools (Badkhen, Anna.

Anti-evolution teachings gain foothold in

U.S. schools. San Francisco Chronicle,

November 30, 2004). An overwhelming

scientic consensus on the massive dangers

of global warming is inexplicably rivaled

by those who alternately deny its existence

or would, in a single breath, agree that it

exists while assuring us of its benecence

to the world economy. Our public health

system deteriorates, while the ranks of the

uninsured continually rise. As the Pulitzer-

Physicians and Politics:Lessons from the Past

by Adam Gaffney

Continued on next page

What overwhelms so many with

uch despair, then, is a sense

hat almost everywhere, the

lliberal, the discredited and the

elusional are on the march.

edical Politics

5

The collective despair that has gripped

much of the nation since November

2 can not be wholly attributed to

electoral defeat. Elections are bought orwon and politicians rise and fall: what is

most disheartening today to progressives is

not merely the loss of a political campaign,

an experience with which they are all too

familiar, but instead a sense that they

have lost hope itself. The replacement

of the incumbent-in-chief might entail

continuities, but also unpredictability: who

knows what changes determined activism

and a more consciousness President could

bring.

Instead, the status quo has

endured, and any battle now to be fought by progressives will be one solely

of reaction and resistance. However

successful campaigns to limit healthcare

cuts, slow the rollback of constitutional

protections, or diminish the degradation

of the environment might be, our very

success will still signify an overall

failure. Depressingly, liberals are the new

conservatives (in seeking to maintain a

moderate past), for conservatives have

become revolutionaries, albeit quite

reactionary ones.

What overwhelms so many with

The Commander-in-Chief addresses the troops.


7/12

edical Politics

Most prominently, Virchow is considered

to be the father of modern pathology. In

his day, much of disease theory was based

on Humoral Pathology, the truly ancient

concept that an imbalance of the bodys

so-called four humors was the underlyingmechanism of all disease. His actions did

much to conclusively quash this age-old

quasi-scientic quackery, and replace it

with something quite new. The cell was

to be studied as the basic unit of life and

the underlying site of disease; cellular

pathology was born.

While these scientic achievements

were certainly historic, it is his medical

philosophy and action which serve as an

example of the best of his time, and to

which we now turn. Indeed, it reects

badly on our own time that we are stilllargely outthought by Virchow and some

of his contemporaries of more than 150

years ago. Virchows political upbringing

occurred in an extraordinarily volatile time.

In 1848, the old reactionary and oppressive

European despotisms and monarchies were

swept out of power in a long-awaited and

massively popular democratic revolution,

which blazed through the continent in

a matter of weeks. One by one the old

regimes fell, with workers, students,

professionals, and scientists, including

our Virchow, manning the barricades: this

was the so-called springtime of peoples,

and hopes and dreams were soaringly high.

Virchow himself was extremely active and

optimistic with this democratic opening.

It was, however, not to last: in 1850, the

old regimes

regrouped,

m a r c h e d

and regained

p o w e r ,

those of

revolut ionw e r e

e n t i r e l y

annihilated,

and all changes and dreams with them.

Virchows involvement with the

revolution of 1848 was only part of a

lifetime of activism. Before and after,

he took part in the Medical Reform

movement which took root in his day and

sought to remake the role of the doctor

in society. Among his various proposals

aimed at improving the professionalism

of the physician, Virchow

was a visionary public

health advocate who made

associations between

socioeconomic condition

and disease that many of

his contemporaries could

not. Most famously, in 1848the Prussian government,

apparently unaware of the

politics of our doctor, naively

sent him to report on a

devastating typhoid epidemic

that was sweeping Silesia.

The government was surely

alarmed when he released his

report: not content to merely

detail the epidemiological

aspects of the epidemic,

Virchow publicly lambasted

the government: he blamedthe economic, political

and social injustice of

the Prussian despotism

for the ravages of the

epidemic. Virchow understood the social

underpinnings of disease: he wrote of what

he called articial epidemics, which

could be overcome by social change:

the improvement of medicine would

eventually prolong human life, he wrote

but improvement of social conditions

could achieve this result more rapidly and

more successfully.

Some of his positions of more than 150

years ago remain relevant today; indeed, we

have done very little to fulll them. In the

German journal edical Reform, Virchow

advocated the constitutional right of an

individual to

h e a l t h c a r e

- everyone

should receive

[healthcare]

according to

his needs- while today

healthcare is

c o n v e r s e l y

becoming a right only of wealth

(Ackernknecht, E.H. Rudolf Virchow:

Doctor, Statesman, Anthropologist.

Madison: The University of Wisconsin

Press, 1953). He favored prison reform and

saw the penitentiary system as a massive

public health failure; unfortunately, this

too remains unchanged, as documented by

Human Rights Watch among others, our

prison system remains a moral atrocity

the mentally ill are locked away in abusive

conditions, we turn a blind eye to torture

and rape, and treatment for AIDS and other

deadly ailments is often denied to inmates

In many ways he epitomized medica

humanism, and whether in his opposition

to the death penalty or the public health

absurdities of his time, he was on the

vanguard of nineteenth-century medica

thought.

Virchows advocacy was not

however, limited solely to the pen

and he continued to see his civic and

political responsibilities as inseparab

from his medical ones, even after the

failure of 1850. Following a period in

exile (after the return of the autocrats)

and an understandable period of lessened

politicization, Virchow participated in the

formation of the Progressive Party onceconditions in Germany permitted his return

to politics and Berlin. In his capacity as

a legislator and a city council member

Virchow transformed Berlin into a modern

city. In 1860 Berlins sanitation system had

undergone little evolution since the middle

ages, with sewage routinely dumped in

the streets and contaminated water widely

consumed. Through careful study and

political persistence, Virchow successfully

authored a vast public health effort that

With the political tide owing in his

direction, Virchow articulated and forwarded

he best ideas of his contemporaries. And

with the political tides running against him,

his determination did not wane, and hefought for the principled opposition.

Continued on page11

6

VirchowContinued from page 5

Virchow, the physician-advocate.


8/12

edical Politics

Continued on page 10

I would much rather be seated next

to somebody who has a passion for

he game, than next to a raucous

drunk with a wanton disregard for the

consequences of their actions.

A little wet behind the ears, Artest?

I

t was only tting that, of all places, I

found myself at a bar while watching

the replays of the ght breaking out at

the basketball game between the DetroitPistons and Indiana Pacers. People stood,

some cheering, some speechless, while the

scene of professional athletes ghting with

spec ta tors

u n f o l d e d .

This scene

has since

b e e n

r e p l a y e d

c o u n t l e s s

times as

commentators discuss who was right andwho was wrong; who should be deemed

guilty and who spared from judgment;

and who was punished justly and who

got off too easy. As an ordinary, curious

individual (and a fourth year with, perhaps,

too much free time), I have watched

replays of this scene many times. What

strikes me each time, however, outside of

the agrant violence, is the amount of beer

that I see being poured by the fans all over

the place.

Alcohol and sporting events seem

to go hand in hand these days. Withthe amount of advertising that alcohol

companies and professional sports do

together, it is hard to imagine professional

sports existing without alcohol. Is having

the access to alcohol at sporting events a

basic right? Is it a necessity? Or should it

be banned? As a kid growing up, I recall

the joy of watching professional football

and baseball. Going to the stadium to

watch a game was such a thrill. The joy

of the sport itself was all I needed for

entertainment. Is that no longer the case?

Is it possible to enjoy watching a game ifa bottle (or several bottles) of beer cannot

be imbibed? Perhaps banning beer sales

at sporting events would cause only true

fans, who have a love of the game and

sportsmanship, to attend. Maybe the

economics of professional sports in this

era will not allow for this. But as a sports

fan, I would much rather be seated next

to somebody who has a passion for the

game, than next to a raucous drunk with

a wanton disregard for the consequences

of their actions. Make no mistake: I am in

no way defending the action of the players

(who were not drinking alcohol) involved

in this event. Nor am I saying that alcohol

is, alone, responsible for what took place.

However, alcohol undoubtedly played a

signicant role in dening the events of

that night.

The problems with alcohol that

are manifested at

sporting events are

merely a reection

of those affecting

the rest of our

society. Alcohol

burdens our society

with needless

violence, crime, and health problems. It iseasy to suggest that people be responsible

when they drink. The problem is that when

people are not responsible, it is the rest of

society that suffers the consequences. In

1998, alcohol abuse cost the country over

$180 billion. Studies in 1995 showed that

25 to 40 percent of hospital beds were used

for treating those with complications of

alcohol abuse.

And each year,

over 16,000

people are

slaughtered indrunk driving

crashesmany

of whom are

innocent victims

caught in the

wrong place at

the wrong time.

Unfortunately,

for most, the

mentality is that

alcohol abuse is

not a problem -

until something

happens to a

loved one.

As a

result, society is

too accepting of

the consequences of alcohol. Lawmakers

and alcohol companies ght to secure the

right to abuse alcohol, while the safety

for the rest of us is neglected. Back in

my home state of Maryland, where I have

testied at legislative hearings to support

stronger drunk driving laws, it was no

until the Federal Government threatened

to withhold millions of dollars per year

that the legal limit of alcohol for driving

was lowered from 0.10 to 0.08 percent

Does anybody actually think it is safe to

drive with a blood alcohol level of .08?

Say what you will about my home state

but Marylands drunk driving laws are on

par with those of the rest of the country

What is more frustrating is that there are

devices available that could stop drunk

drivers from being able to get behind the

wheel. Ignition interlock devices require

that the driver provide a breath sample

that is alcohol-free before the car can be

started. Such a device would surely save

countless lives annually. Unfortunatelysociety seems more concerned that ignition

interlock devices impinge on their civi

liberties. Protect the liberties of the

drunk drivers. Forget about my freedoms.

The fact remains that alcohol is a

drug. As such, we must respect it as a

drug, and hold it to the same scrutiny to

which we hold other drugs, by recognizing

the benets i

provides,

more importantly

by being wa

of its adverseeffects. I am in no

way advocating

turning the clock

back to the er

of prohibition

If people wan

to enjoy alcoho

responsibly, they

should be able to

do so. However

it means tha

we all have

certain societa

responsibilities.

As future

physicians,

will have the

o p p o r t u n i t y

and duty, to identify patients with risk

factors for alcohol abuse. In this role, i

is imperative that we intervene in these

situations before it is too late and make

sure that patients get the proper treatment

7

BEERS, BRAWLS, AND BASKETBALLby Jared Goldberg


9/12

From the Halls of NYUSoM

LOCATIONS FOR LEARNINGhere do you like to study, and why?

enjamin Young, 06

Amber Wheeler, 07When Im informally

studying, Ill study

in the library by the

computers, and then,

w en t e ru er ts t e

road, I switch to AHC.

My room easier

access to snacks and

T.V. and things to help

me procrastinate.

Bo Chen, 07

Bobst 10th oor, facing

the big windows you get a

great view of the skyline.

Kira Zavilevich, 06

owntown n o st.

like to get away from

the medical center. I

like the downtown area

and the library doesnt

feel so clausterphobic

with the natural sunlight.

Clarence Lin, 08

Coles conference rooms

I think its just right: not

too noisy, not too quiet.

risty Ahrlich, 06

My room because

theres no one to drive

me crazy there. Theres

nice distractions, if

on t wanna su y, on

have to. If I get really

esperate, c ean.

Sandra Kamholz, 08Bobst for the view

of Washington Square

ark, and the distance

from the medical

school. The natural ligh

s a g p us.

oto Po Con ucte y Samant a Brenner

Cedric Dark, 05

Some place you dont falasleep. You gotta have

your creature comfor

while you study. Hence

I prefer Starbucks.

have never been a

library person. Just don

order the vanilla cream

because its warm milk

and itll put you to sleep.

8


10/12

NYU Med Book Review

J

rgen Habermas, eminent German

social theorist, joins the contemporary

bioethics debate with a collection of

three lectures in The Future of Human

Nature. It is an interesting book, and I

have summarized

some of the main

arguments and offer

a brief response.

In it, he

argues against

liberal eugenics

the right of parents

to program the

genomic blueprints

of their children. Heregards eugenics as a potential restriction

on the unborn programmed individuals

freedom to choose their identities and their

life courses: that is to say, their status as

moral beings is in danger. And as society

is constituted by moral beings interacting

with one another, this threat deeply

challenges the liberal values of freedom

and equality, as well as the rationale for

why we should be moral at all.

In our postmetaphysical world,

persons may no longer rely exclusively

on a single ontological narrative or divine

inspiration for moral

guidance. Modern

society is constituted

as pluralistic, and a

constitutional state must

take a neutral position

towards opposing

worldviews to secure

the human right to

individual autonomy.

For Habermas, what

grounds this view

is a species-ethic,

or the ethical self-

understanding of

the species our understanding of

what it means for us to be human. A

rationality conceived from intersubjective

communication is what creates and sustains

the species ethics. But within this ethic isthe understanding that we are the authors

of our own lives, and since other people are

authors of their own lives as well, we must

treat them as equal members of society.

Therefore the underlying sustenance of

the species-ethic is our subjective ability to

view ourselves as free and self-actualized,

and thus moral, agents.

Habermas sees the contingency

of birth as a crucial element of what it

means to be moral and human. However,

advances in genetic technology will soon

remove births contingency, and parentswill have the potential to articially design

their children. Although he is in favor of

therapeutic eugenics (i.e. to treat serious

monogenetic diseases) using an argument

of future informed consent, Habermas

opposes the enhancing type of eugenics

(i.e. modifying the genome for enhancing

appearance, intelligence, musical aptitude,

etc.). He bemoans what he describes as the

instrumentalization of the species. By

allowing people to mold their children for

preferential traits, the children become the

objects of the parents preferences. This

restricts the ability of the children to develop

an individuated ethical self-understanding

Species instrumentalization also results inthe obfuscation of the subjective-objective

distinction. A human life becomes no

simply an end to itself but a product of

technology.

abermas also contends that libera

eugenics creates an intergenerationa

asymmetry that threatens the egalitarian

foundation of liberal society and the

constitutional state. How so? Mora

beings are required for a society founded

on freedom and equality. Moral beings

are presupposed as autonomous and free

and so we are required to respect theself-understanding of other moral beings

Genetic intervention leads to the creation

of people who may not be able to achieve

these prerequisites for moral determination

This disrupts our ability to see these people

as agents of moral action and judgment.

ut why is the contingency of birth a

truly necessary component for the formation

of moral individuals? Throughout history

conceptions of what constitutes a mora

individual have changed in a manner tha

by Jeffrey Shyu

Habermas: On the Instrumentalization of Species

One could argue that a parents

overzealous efforts at training his or

her children into gifted musicians or

thletes is not all that different from

modifying their genomes before birth

o give them a predisposed aptitude

for these abilities.

Continued on next page

9

The Future of Humanature

y Jurgen Habermas$49.95

Polity Press

Habermas in his study.


11/12

laziness), or capitated (which fosters

under-utilization). If I were emperor of the

medical world, I would make primary care

physicians either capitated or salaried and

let specialists function at fee-for-service

rates. All hospitalists should be salaried.

One more thing - forget institutional long-term care. It just costs too much.

The AMA proposal has its own

problems. This is basically the GOP

viewpoint

that almost

all of us will

share once

we stop

r e c e i v i n g

loans and

climb the

tax bracket.

As nosurprise to

anyone, the AMAs big thing is tax credits.

Aside from the fact that only thirty-three

percent of the uninsured are likely to take

up any credits offered , there are other

problems lurking.

The rst major hurdle to effective

tax credits is that it comes nowhere near

covering the full cost of a health plan

in the twenty-rst century. The average

family plan costs almost $10,000 today,

and the tax credits offered (according to the

President) will pay approximately 3,0004.

Fortunately, the AMA is not as nave.

Their position clearly states that effective

tax credit policy will require signicant

subsidies to the low income earners (up to

100% of the cost).

Another criticism of the AMA

strategy is that the people who will likely

take advantage of the tax credit will

probably already have insurance. Yes,

some of the 45 million uninsured will be

covered; however, many people already

with insurance will simply receive a backdoor tax cut. The primary beneciaries of

these tax credits would still be low-income

individuals earning less than 20,000 and

families earning 30,000-40,000 per year.

Another point, which the AMA poorly

elaborates, is that these tax credits must be

received in a fashion where they are only

useful for health insurance. That is, these

tax credits cannot be used to purchase

other goods. To accomplish this, vouchers

are key.

The AMA plan also emphasizes

consumer choice in insurance companies,

which is not necessarily a good thing. In

the language of the eld, choice equals

fragmentation of the risk pool by the forces

of adverse selection. In other words,

given the opportunity, those most at risk

and those at least at risk will choose to

buy into different plans according to their

needs, thus fragmenting the risk pool.The smaller the risk pool, the larger the

costs; the larger the risk pool, the smaller

the costs. Therefore, too much choice is a

bad thing.

Ultimately, however, choice

also means that some will choose

to go without insurance. An easy

way to x this would be to mandate

insurance on the individual. We do

it for cars, why not for health?

any solutions have therefore

been offered for our patchwork

and complex healthcare system.What should be realized is that

political compromise is necessary. While

a single-payer system seems ideal to some,

signicant opposition will arise; too many

players have too much too lose. It is in the

spirit of incremental change, as the AMA

plan suggests, that real change will happen

to our healthcare system. Nevertheless

AMSA should retain single-payer as

its long term, audacious goal. AMSA

must, however, work for smaller, but stil

signicant, reforms. Before universalizing

healthcare for all, let us make it universa

for children as it is now for those above

age 65; let us make it universal for HIVpatients as it is now for those with ESRD

Most importantly, AMSA must continue to

ght for its long-term goal because many

including the AMA, will too easily be

satised with the relatively minor steps

along the way.

References1 NEJM. 1989. 320: 102-8.2 JAMA. 2003. 290: 798-805.3 Health Insurance Survey. Kaiser Family

Foundation. April 2004. Available at: http//www.kff.org/healthpollreport/archive_

April2004/12.cfm4 Ofce of the White House Press Secretary

Making Health Care More Affordable

Available at: http://www.whitehouse.gov

news/releases/2004/09/20040902.html Sep

2, 2004.

HabermasContinued from page 9has resulted in greater inclusiveness. It is

quite conceivable that our species-ethicwill change again to include those who

have their genetic codes programmed.

And have we not seen similar arguments

before, in response to test tube babies and

so on? Their unnatural origins have not

threatened the moral foundation of society.

How is preimplantation genetic diagnosis

fundamentally different?

One could argue that a parents

overzealous efforts at training his or her

children into gifted musicians or athletes

is not all that different from modifying

their genomes before birth to give them

a predisposed aptitude for these abilities.

Habermas distinguishes the two by arguing

that whereas it is possible for a child to

reject the social intervention of the parents,

the latter is irreversible. However, logically

it is possible to reverse a genetically

arranged aptitude; after all, doesnt

therapeutic gene therapy strive to correct

the genetic mistakes that otherwise result

in terrible diseases?

AlcoholContinued from page 7

Ultimately, however choice also

means that some will choose

o go without insurance. An

asy way to x this would be

o mandate insurance on the

individual. We do it for cars,

why not for health?

AMSA vs. AMAContinued from page 4

and support before they seriously hur

themselves or somebody else. At the

present time, there is still plenty that w

can do, such as setting good examples

and keeping our friends out of dangerous

situations. This responsibility may be as

simple as taking the car keys away from

a friend who has been drinking, or telling

them to refrain from that nal drink of the

night. Sometimes such simple acts that can

make a substantial difference. During thi

upcoming holiday seasons travels, I can

only hope that the other drivers with whom

I am sharing the road have had that kind ofguidance.

break?

TE F T P EX

Sub issions for the January


12/12

remade the citys sewers, thereby greatly

reducing the transmission of infectious

disease in the rapidly growing city.

Finally, and perhaps most signicantly,

Virchow remained an opponent of the

gathering authoritarianism, imperialism

and militarism of the German government,

as a consistent foe of its archconservative

uniter, Otto van Bismarck. His biographer,

Ackernknecht, asserts that the Progressive

Partys constitutional resistance to

Bismarck, under Virchows leadership,

was the nal attempt of the German

middle class to oppose Bismark on a large-

scale in the political arena. Given the

future authoritarian plunge that Germany

would later undergo in the 1930s (withunforgettably grave ramications for the

world), this is no small thing.

I believe these to be important

considerations given our current political

predicament, with all of its ramications

for human health and well being. With

the political tide owing in his direction,

Virchow articulated and forwarded the

best ideas of his contemporaries. And

with the political tides running against

him, his determination did not wane, and

he fought for the principled opposition,

while enacting practical reforms. Despite

my uneasiness with drawing analogies

from history, we might agree that his

steadfastness provides us with a valuable

model, and a suggestion for a way out of

despair, and into the future.

This historical summation hasthree purposes: one, to present what I

consider to be an admirable gure, who

we might agree reects the potential and

responsibilities inherent in the profession

of the physician; two, to demonstrate

our failure to progress beyond what the

medically astute were demanding more

than a century and a half ago; and nally,

to again posit the inextricability of the

political/social tasks of the physician, with

his or her medical ones.

The challenges of today and

tomorrow are frighteningly immense, and

the injustices and microbes that aficted

Virchows world continue to plague our

own. Human beings greatest epidemic,

war, continues to mock our purported

advancement. And the forces of reaction

are as powerful as ever.

Informed, organized, and devoted,

American physicians might pose an

enormously powerful force in resisting the

coming regression, and then proactively

confronting the injustices of our day. We

certainly have diverse political views

something both inevitable and benecial

and doubtless there are many who disagree

with not only the propositions presented

here, but also those of Virchow himself

So be it. Let us argue and nd a common

denominator of agreement. But we must be a louder voice on the profound issue

of our day. We are unlikely to shift the

tide of history if our greatest, most urgen

and most emotional political concern is

increasing Medicare rates or establishing

malpractice caps.

There is more hope and power in

science yet to be unleashed; perhaps even as

Virchow put it, may it remain for science

to treasure and to bring to realization the

beautiful motto: Peace on Earth (Nuland

S.B. Doctors: The Biography of Medicine

New York: Vintage Books, 1995.)

Catholics & Kerry cont. from pg 3)

many mentally retarded criminals would

I be allowed to sign death warrants for if

I promised to vigorously oppose stem cell

research? If a politician wants the bishops

to call a vote for his or her opponent a sin

but also wants to launch a war that violates

the Churchs just war principles, how many

pro-life judges does he have to promise

to nominate? Answering these absurd

questions requires a messy utilitarian

worldview that the Pope has passionately

spoken and written against. Yet, these are

exactly the questions that politicians will

now ask themselves, thanks to the Churchs

posturing during the 04 campaign, as they

plan their strategy to win the Catholic

vote.

I believe the Church will eventually

pay dearly for its decision to play power

politics. First, it will soon nd that the lifeissues, which the Church hierarchy spoke

about in such simple and unequivocal

terms, are complicated. If preliminary

analyses are correct, abortion rates in many

states have risen during Bushs rst term,

reversing a ten-year declining trend. Based

on the experience of more liberal countries

with legal abortion, better social support,

and lowerper capita abortion rates than the

US, this may be

due to economic

d e t e r i o r a t i o n

during Bushs

rst term. ShouldBush voters go

to confession

for all the extra

abortions that

might take

place during

his second

term, during

which he may

i n a d e q u a t e l y

address social

conditions that

are associated with abortion? I dont think

so, but by the Churchs new spreadsheet-

style morality, wouldnt they have to?

Second, politicians are much less

likely to take the Churchs views seriously

now that it has been manipulated so easily

in the 2004 election. Democrats wil

likely consider the Church hierarchys

consideration a lost cause, and Republican

will quickly learn that some

empty pro-life or homophobic

rhetoric will evoke enough

tough talk about sinful voting

from a couple bishops to swaysome voters.

Im certainly not saying

the Church should have

endorsed John Kerry agains

its principles. Indeed, an

endorsement for John Kerry

would have been problematic

for exactly the same reasons

Rather, the Church should think

more about moral leadership

and less about maximizing its

political inuence. The Church

should have abstained from taking sidesin this election and continued to hold

both candidates feet to the re on all the

issues without reducing itself to a puppet

for either.

VirchowContinued from page 6

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