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THE PLEXUS

The NYU School of Medicine Journal of Thought

Winner
WinnerLoser

LawyerDoctor
Lawyer

Volume I, Issue 2
December 2004
THE PLEXUS
The NYUSoM Journal of Thought
Contents of this Issue
Amber Alayyan blasts the Bush administration’s choice for
the next Attorney General, Alberto Gonzales, by examining
Volume I, Issue 2 his role in policies of torture and execution. From Naked
December, 2004 Statues to Naked Prisoners, page 2.

Board of Editors: Samantha Brenner (‘08), Al Garfall considers the role of the Catholic Church in
Adam Gaffney (‘08), and Al Garfall (‘07). politics and the reelection of George Bush. When Religion
Dictates Politics, page 3.
Contributors: Amber Alayyan (‘07), Cedric Sayone Thihalolipavan decries the basis of hate in this
Dark (‘05-’06), Jared Goldberg ('05), Varun poetic piece. Stripped
Stripped, page 3.
Sharma ('08), Jeffrey Shyu (‘08), and Sayone
Thihalolipavan ('08). Cedric Dark critiques the health reform proposals of both
the AMA and AMSA in this response to last issue’s health-
care debate. AMA and AMSA: A Plague on Both Your
Houses, page 4.
Weaving through much of the content of this issue is
the notion that physicians’ responsibility spans more than
Varun Sharma argues that the errors of doctors are the true
just their immediate clinical or scientific endeavors. Of
culprit behind soaring healthcare costs. Medical Error: The
course, this is nothing new. The concerns of those who
Source of Healthcare Woes, page 4.
practice medicine can never be and have never been fully
divorced from the system through which care is delivered
Adam Gaffney looks into the past at the case of the Doc-
or from the bioethical debates such delivery inevitably
tor-Statesman Rudolf Virchow to find inspiration in a coun-
engenders. Similarly, concern for the health of populations
terrevolutionary present. Politics and Physicians: Lessons
has fallen squarely within the realm of the physician for some
from the Past, pages 5 to 6.
time. Thus, most of us are probably fairly comfortable with
a physician who stakes positions on such health-centered
Jared Goldberg examines the deleterious effects of alco-
issues as the healthcare system, medical ethics, or public
hol on society and health, in light of a recent sports brawl.
health. Appropriately, all three of these topics are addressed
Beer, Brawls and Basketball, page 7.
by writers in this issue of the Plexus.
However, it is clear that there are potentialities for
Samantha Brenner takes the pulse of the student body,
physician input, advocacy, and activism within an ever wider
asking where students (claim) to study. The Halls of NYU-
scope of affairs, regarding issues less directly related to the
SoM: Locations for Learning, page 8.
day-to-day practice of most physicians, but equally essential
to the broader ethical framework under which he or she
Jeffrey Shyu reviews the philospoher Habermas’ most
operates. In this line of thought, a doctor’s responsibilities
recent look at the ethics of designing the newborn. Haber-
are widened to issues of human rights, whether political,
mas, Human Nature and the Future of Liberalism, page 9.
economic or social. They would include those matters
which have profound ramifications 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
All content is available online at http://
politicizing ourselves professionally. Therefore, any
students.med.nyu.edu/plexus. Letters to the editor
endeavors taken up by physicians would require a great deal should be mailed to nyuplexus@yahoogroups.com, and
of partisan impartiality, factual clarity, and moral vision. be no more than 200 words in length. Article submis-
Conversely, given the voice and power that physicians sions should be first discussed with an editor.
have, and given the enormous human costs or benefits that
government action can effect, physician involvement is
Cover: Winner, Loser, Lawyer, Doctor: The Intersection of
critical if we are ever to effectively confront the epidemics
Bush, Kerry, Alberto Gonzales and Rudolf Virchow at this
– both biological and social – that continue to plague us. hour of American politics. All photographs public domain or
The Editors fair use.
Political Matters

FROM NAKED STATUES TO NAKED PRISONERS
Alberto Gonzalez as the Next Attorney General
by Amber Alayyan sent in 2002, Gonzales states that laws deaths to natural causes, and designing

A
against torture do “not apply to the and implementing psychologically and
fter the presidential elections in President’s detention and interrogation physically coercive interrogations.
early November, Attorney General of enemy combatants” and goes on to Physicians also play a passive role
John Ashcroft declared the country attempt to change the definition of torture. in torture by not speaking or acting against
“safe” and then resigned. To fill Ashcroft’s In a memo earlier that year, he called the such acts. As future doctors, we are not
post, President Bush has nominated White Geneva Conventions “obsolete,” writing responsible for the exploits committed by
House counsel Alberto Gonzales, a friend that because our military,
and loyal supporter of the president. the “war on The U.S. cannot flout international but as a group
Gonzales, like me, is from Texas. terror is a new law and then expect the world to maintain we will be held
He served as a partner in a Houston law kind of war,” the very moral standards we ignore. accountable for
firm whose clients include Halliburton and the Geneva our actions or
Enron. Gonzales served as then-Governor Conventions do not bind the U.S. in the lack thereof in condemning these methods
Bush’s general counsel and a Texas war in Afghanistan (the third and fourth and deeds. The recent nomination of
Supreme Court Justice. As Texas Chief Geneva Conventions initiated by the Alberto Gonzales for Attorney General
Legal Counsel, Gonzales was responsible UN and signed by the U.S. after WWII provides each of us with such an
for drafting legal summaries in 57 clemency define the proper treatment of prisoners opportunity to act against the military’s
cases. He repeatedly failed to apprise Gov. and civilian populations, respectively, in practice of torture.
Bush of critical issues regarding each case, political conflicts). U.S. military and Torture, as an interrogation technique,
such as ineffective counsel, conflict of government officials, including Colin has been shown to be ineffective in eliciting
interest, and even evidence of innocence. Powell, warned against this flagrant accurate information from prisoners. As
Bush used these memos to approve defiance of federal and international law, physicians, we can work against this archaic
executions (of which there were 152 in but Gonzales advised the President against practice by documenting signs of torture in
his 6 years as these warnings, thus setting our patients. More immediately, as medical
governor). the stage for Abu Ghraib. students we can actively condemn the
A s One would assume employment of torture by our military. A
White House that as the leading law number of people argue that writing letters
counsel, enforcement officer in to senators and representatives is futile, and
Gonzales the country, the Attorney on some issues, they would be right—but
maintained General would actually not on this one. The Senate will review
his allegiance enforce the laws and legal Gonzales’s nomination to the appointment
to Bush and standards of the country. of Attorney General beginning in January
his former Alberto Gonzales has 2005. We can, and as future physicians we
clients. He already proven himself should encourage our senators to ensure
argued with incapable of upholding that the review of Gonzales’s nomination
Congress such laws and principles. be thorough and fair—examining both his
to keep the His appointment to the record and future plans for the Department
details of Vice office of Attorney General of Justice.
President may be problematic and
Cheney’s potentially dangerous for The following link is to a sample
e n e r g y the country. The U.S. letter drafted by the organization Human
commission cannot flout international Rights First. By providing your address,
Gonzalez being sworn in
meetings law and then expect the the letter will be sent to your senators on
as White House Council by
secret. He Commander in Chief G.W. Bush world to maintain the very your behalf: http://action.humanrightsfirs
has also moral standards we ignore. t.org/campaign/gonzales/
defended the administration’s indefinite Physicians can play a role in Human Rights First, Physicians for
and incommunicado detention of terrorism the torture of political detainees either Human Rights, Amnesty International,
suspects, who are labeled “enemy actively or passively. As we now know, the AFL-CIO, the NAACP, and other
combatants” and denied due process of in Abu Ghraib and Guantanamo Bay, organizations have also signed a letter to
law. U.S. military physicians were complicit Senators Hatch and Leahy on the Senate
Regarding the issue of torture, in acts of torture by denying prisoners Judiciary Committee. The letter includes
Gonzales oversaw the development medications for existing medical more background information on Alberto
of policies for managing prisoners in conditions, treating detainees so they could Gonzales, and it can be found at: http:
Guantanamo, Afghanistan, and Iraq. In return to interrogation, falsifying death //www.phrusa.org/research/torture/pdf/
a number of Justice Department memos certificates to wrongly attribute prisoners’ gonzales-coalition_041129.pdf
gonzales-coalition_041129.pdf.
2
Political Matters
When Religion Dictates Politics
by Al Garfall their values here and there, the Church economic fairness, and the integrity of the

S
can continue its ministry and maintain its social safety net. Interestingly, even Bush’s
hortly before the presidential positions on issues without compromising position on abortion is too liberal for the
election, the Catholic Archbishop of its principles to endorse a candidate on a Catholic Church because Bush makes
Denver declared that voting for John single-issue basis. exceptions for rape and incest.
Kerry is a serious sin requiring confession. Was either John Kerry or George The standard explanation the Church
His exact words, as reported in the New Bush so in line with the Church’s ideals offers for its endorsement is that these “life
York Times, were: “if you vote this way, so as to deserve its endorsement? Without issues” trump all others, which I suppose
are you cooperating going into too much excuses Bush voters from having to go to
with evil? And if As a member of that rebellious and detail, the answer is confession for the evils with which they
you know you are sinful 44%, I’m a little sour over clearly no. Kerry is knowingly cooperate. I question the
cooperating with unabashedly in favor sincerity of this explanation, however,
evil, should you go
the role our Church leaders may of stem cell research because it lets politicians off the hook to
to confession? The have played in Kerry’s defeat. and is pro-choice. engage in a patently un-Catholic moral
answer is yes.” Other While Bush is pro- calculation as they stake out their positions.
bishops denied the Eucharist to Kerry and life on stem cell research and abortion, his For example, if I were a politician and I
other democratic politicians in their other policies fall far short of the Church’s wanted the Church’s endorsement, how
dioceses. In Catholic dioceses throughout ideals on issues like the death penalty, Continued on page11
the country, bishops spoke passionately
about the primacy of abortion and stem-cell
research, essentially instructing Catholics
STRIPPED
to be single-issue voters on these so-called by Sayonne Thihalolipavan
“life issues.”
It’s not surprising, therefore, that What if you were stripped of every single one of your human rights?
Kerry, a Catholic himself, lost the Catholic Freedom of expression, health, maybe even your life?
vote 51%-48%. Among Catholics that Would you remain silent, or protest the strife?
attend mass regularly, the split was 55%- Knowing that prejudices prevent breathing in the beauty of THIS room
44%. In Ohio, where Bush won overall since education is not deemed worthy as a right.
by 136,000 votes, Bush received 780,000 In a cloudy, sinister fog of civil unrest,
Catholic votes, 156,000 more than Kerry. South Africans endured a life of torture, detest
For comparison, both Bill Clinton in 1996 In hopes of experiencing a lucid, serene night
and Al Gore in 2000, neither of whom are What if YOU were stripped of every single one of your human rights?
Catholic, took 53% of the Catholic vote in We habitually take for granted the entitlements given upon birth;
their respective elections. Yet human rights are violated uncaringly throughout the world
As a member of that rebellious and Why hate, discriminate? Because it is effortless.
sinful 44%, I’m a little sour over the role We must expand energies to embrace diversities,
our Church leaders may have played in Become knowledgeable, celebrate human peoples, take political
Kerry’s defeat. My politics aside, though, Action, admit biases, and forgive. Oh lord we must forgive!
I take issue with the idea of any single- Molecularly we are 95% similar in DNA,
issue endorsements from religious leaders, Realistically why must we trip over the 5 that remain.
particularly from Catholic bishops. Prejudices may lead to poverty and lack of equality,
Is it ever justified for a religious You can take my property and privacy but you can’t take away my dignity;
leader to speak up politically? I hope so. I will rise against your hate and use your own abhorrence to flame my retaliation
Rev. Martin Luther King Jr. comes to mind. Claiming my birth right of international amnesty
Similarly, the Catholic Church has a long Sticks and stones may break my bones,
history of speaking out and acting with great But unsaid words will permanently disfigure my soul.
influence against tyrants and tyrannical Discrimination will only lead to elimination of the human race
ideologies. Were a candidate or ideology Like a prophecy rights will unfold whether through actions mine
so clearly a paragon of either Catholic Or my soul reborn in future generations
virtue or anti-Catholic vice, I hope that the You loathe me. I love you, fellow, human brother, but despise your actions
Church would speak out. My view is that What if I was stripped of every single one of my human rights?
the bar for such an endorsement should be I would cry...in hopes that you heard my pain and would help heal my plight
pretty high, though, because unlike voters, Because before race, color, religion, and everything else that separates us,
the Church is under no obligation to choose We are human.
sides. While politicians and political
This spoken-word piece was performed at the NYU SoM Coffeehouse Event on 12/01/04
parties cannot function without bending
3
Medical Politics
AMA AND AMSA: Medical Error:
A Plague on Both Your Houses The source of healhcare woes
by Varun Sharma

I
by Cedric Dark s health care a right or a privilege? That simple question can

T
illicit a very passionate response from almost anyone, but really,
he most interesting thing about the American health the debate is largely irrelevant. Healthcare now takes up 15% of
care system is that it is one sector of the economy where our GDP and is projected to drain 30% of our GDP within the next
consumers believe they can get something for nothing. few decades. At 30% of GDP, there just simply will not be enough
People want health insurance, but no one wants to pay for it. While money to pay for healthcare regardless of how loudly we scream
both the AMA and AMSA pose solutions to the problem of 45 “nationalized” or
million uninsured, neither proposes truly viable options. AMSA’s “privatized.” Carelessness, poor judgement,
proposal is too radical to garner significant congressional support; Bureaucracy and poor treatment on the part
AMA’s proposal does little to affect health insurance status and and administrative
more to cut taxes. costs are commonly
of doctors amounts to billions in
It is far easier to debunk the myth that “Medicare for all” targeted as the wasted dollars.
is the solution to the plight of the uninsured. In reality, all you culprits behind the
Physicians for a National Health Plan (PNHP)-junkies out there rise in healthcare costs, and rightly so. However, the true problem
should really advocate for “Medicaid for all” – Medicaid’s benefits is more deeply rooted. Carelessness, poor judgment and poor
are far superior to medicare’s. treatment by doctors, combined with the inefficient management
But why is AMSA’s approach utterly unrealistic? On paper, of hospitals, amounts to billions in wasted dollars, and worse,
a single-payer health system with basic benefits guaranteed to all close to 100,000 avoidable deaths every year.
Americans looks beautiful. But so too did the concept of bringing One reason for the very sloppily-run state of health care
Joe Gibbs, is due to inherent characteristics of medicine itself. Medicine
B i l l involves providing a service to a largely uninformed consumer
P a r c e l l s , Cost sharing represents one of the best population, rendering them almost completely dependent on
and Tom means to limit health expenditures. Its their supplier. A patient has little input with regard to the tests
Coughlin effects are also unfortunately overly and treatments he must pay for. This imbalance of power has
to the NFC oppressive to low-income persons. helped foster a culture in medicine of poor communication and a
East. We all lack of accountability. There is little way to effectively evaluate
know how well that went. Although, many in DC – myself included the performance of doctors and hospitals. This has left the task
– are still pondering an 8-8 record with a potential wild card spot. of holding doctors accountable to malpractice lawyers, a system
So if they get the wild card, should we consider introducing that which in the end only serves to raise the costs for patients.
single-payer bill in the next Congress and see what happens? On top of all this, within the last decade, the powers doctors
Realistically, in order to enact such as system, you would have to did possess to order diagnostic tests and treatment options have
alter the anti-tax individualism of the American psyche. being transferred to the middle men. Insurance companies are
The AMSA plan is basically a reiteration of the Physicians dictating the terms under which doctors can practice medicine
for a National Health Plan (PNHP) strategy of 19891 and 20032. by constraining the time allotted to doctors per patient, and by
First on this agenda is the imposition of global budgets on limiting the diagnostic tests and treatments doctors can provide,
hospitals. Additionally, the AMSA/PNHP plan would regulate ultimately compromising patients’ care. This has done nothing to
capital costs as a means of controlling the “medical arms race” ameliorate healthcare spending and has only served to aggravate
between competing hospitals. This will cut costs, but it will patients and undermine doctors.
introduce inequalities between facilities and may also stifle further Unfortunately, hundreds of thousands of avoidable deaths a
technological advances. year is not enough to warrant enough panic to change the system,
AMSA/PNHP also wants to eliminate any cost sharing, i.e. but the rising and unsustainable costs of healthcare will hopefully
payment of some percentage of healthcare costs at the time of be enough of a wake up call. This is too important of an issue to be
service. This is, in my view, the worst idea proposed. Cost sharing left to the politicians and lobbyists. It is doctors who must commit
represents one of the best means to limit health expenditures. Its to changing medicine from the inside. A way must be found to
effects are also unfortunately overly oppressive to low-income bring back power to doctors so that they can practice the medicine
persons. But if you keep cost sharing, means test it, and cap the they deem best and patients must be empowered to choose the
amount any one person must pay out-of-pocket throughout the best possible care for themselves and their families. The bitterest
course of the year, health expenditures will stay down and people pill will be difficult for doctors to swallow, but the time has come
will be relieved of financial stress. to try ideas like opening up doctors’ records to evaluation, and
The AMSA/PNHP plan is remarkably lenient towards increasing the competitiveness between doctors and hospitals.
physicians: we would retain the freedom to practice fee-for- The solution to the nation’s healthcare woes does not revolve
service (which fosters over-utilization), salaried (which fosters around finding ways to allocate health insurance, but in trying new
Continued on page 10 ideas to radically reform the way medicine is practiced.

4
Medical Politics
Physicians and Politics:
Lessons from the Past
by Adam Gaffney

T
such despair, then, is a sense that almost prize winning Laurie Garrett devastatingly
he collective despair that has gripped everywhere, the illiberal, the discredited documents in her book, Betrayal of Trust:
much of the nation since November and the delusional are on the march. The Collapse of Global Public Health,
2 can not be wholly attributed to Each day our nation seems more deeply the American public health apparatus
electoral defeat. Elections are bought or sucked into an imperial is alarmingly
won and politicians rise and fall: what is adventure gone awry. What overwhelms so many with unprepared for the
most disheartening today to progressives is We watch a US soldier such despair, then, is a sense slew of dangers
not merely the loss of a political campaign, empty bullets into an we face, from
an experience with which they are all too unarmed man, while
that almost everywhere, the bioterrorism to the
familiar, but instead a sense that they talking heads defend it. illiberal, the discredited and the emergence of drug
have lost hope itself. The replacement We read about torture delusional are on the march. resistant HIV and
of the incumbent-in-chief might entail at Abu Ghraib, and tuberculosis.
continuities, but also unpredictability: who then learn that a man who all but legally But still, we continue to do little, or
knows what changes determined activism approved of such actions will probably be nothing.
and a more consciousness President could our next Attorney General. In short, given a modicum of the
bring. With our eye fixed on war, concern depressing images and numbers that
Instead, the status quo has for the cultivation of our children’s minds, inundate our airwaves, newspapers, and
endured, and any battle now to be fought our environment and our public health medical journals, many of us cannot help
by progressives will be one solely suffer. Anti-evolution teaching creeps but see our current course as absurd and
of reaction and resistance. However back into public schools (Badkhen, Anna. self-destructive. We are forced to re-fight
successful campaigns to limit healthcare “Anti-evolution teachings gain foothold in the battles of a hundred years ago. This
cuts, slow the rollback of constitutional U.S. schools.” San Francisco Chronicle, would be disheartening enough, were
protections, or diminish the degradation November 30, 2004). An overwhelming not the stakes so much higher today, in
of the environment might be, our very scientific consensus on the massive dangers the nuclear age, in the age where human
success will still signify an overall of global warming is inexplicably rivaled beings are now the primary mover of
failure. Depressingly, liberals are the new by those who alternately deny its existence nature. The reactionary right conveniently
conservatives (in seeking to maintain a or would, in a single breath, agree that it denies problems or our ability to solve
moderate past), for conservatives have exists while assuring us of its beneficence them, and the postmodern left all too often
become revolutionaries, albeit quite to the world economy. Our public health forgets its priorities or loses its resolve.
reactionary ones. system deteriorates, while the ranks of the The opposition seems omnipotent, and so
What overwhelms so many with uninsured continually rise. As the Pulitzer- the question remains: what can we do in
these dim days?

Perhaps I have painted a picture
somewhat too dark. One could write
equally emphatically on the medical
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
briefly turn to history. Let’s look back to
the nineteenth-century and consider the
case of one of medicine’s most brilliant
minds, the German doctor-statesmen
Rudolf Virchow, born in 1821.
Scientifically speaking, Virchow’s
achievements are undeniable. Three years
from medical school, Virchow had made
two of his major discoveries, the first of
leukemia in 1845, and the second of the
processes of thrombosis and embolism.
The Commander-in-Chief addresses the troops. Continued on next page
5
Medical Politics
Virchow of the physician, Virchow
Continued from page 5 was a visionary public
Most prominently, Virchow is considered health advocate who made
to be the father of modern pathology. In associations between
his day, much of disease theory was based socioeconomic condition
on Humoral Pathology, the truly ancient and disease that many of
concept that an imbalance of the body’s his contemporaries could
so-called four humors was the underlying not. Most famously, in 1848
mechanism of all disease. His actions did the Prussian government,
much to conclusively quash this age-old apparently unaware of the
quasi-scientific quackery, and replace it politics of our doctor, naively
with something quite new. The cell was sent him to report on a
to be studied as the basic unit of life and devastating typhoid epidemic
the underlying site of disease; cellular that was sweeping Silesia.
pathology was born. The government was surely
While these scientific achievements alarmed when he released his
were certainly historic, it is his medical report: not content to merely
philosophy and action which serve as an detail the epidemiological
example of the best of his time, and to aspects of the epidemic,
which we now turn. Indeed, it reflects Virchow publicly lambasted
badly on our own time that we are still the government: he blamed
largely outthought by Virchow and some the economic, political
of his contemporaries of more than 150 and social injustice of
years ago. Virchow’s political upbringing the Prussian despotism
Virchow, the physician-advocate.
occurred in an extraordinarily volatile time. for the ravages of the
In 1848, the old reactionary and oppressive epidemic. Virchow understood the social prison system remains a moral atrocity -
European despotisms and monarchies were underpinnings of disease: he wrote of what the mentally ill are locked away in abusive
swept out of power in a long-awaited and he called ‘artificial epidemics,’” which conditions, we turn a blind eye to torture
massively popular democratic revolution, could be overcome by social change: and rape, and treatment for AIDS and other
which blazed through the continent in “the improvement of medicine would deadly ailments is often denied to inmates.
a matter of weeks. One by one the old eventually prolong human life,” he wrote In many ways he epitomized “medical
regimes fell, with workers, students, “but improvement of social conditions humanism,” and whether in his opposition
professionals, and scientists, including could achieve this result more rapidly and to the death penalty or the public health
our Virchow, manning the barricades: this more successfully.” absurdities of his time, he was on the
was the so-called “springtime of peoples,” Some of his positions of more than 150 vanguard of nineteenth-century medical
and hopes and dreams were soaringly high. years ago remain relevant today; indeed, we thought.
Virchow himself was extremely active and have done very little to fulfill them. In the Virchow’s advocacy was not,
optimistic with this democratic opening. German journal Medical Reform, Virchow however, limited solely to the pen,
It was, however, not to last: in 1850, the advocated the constitutional right of an and he continued to see his civic and
old regimes individual to political responsibilities as inseparable
regrouped, With the political tide flowing in his h e a l t h c a r e from his medical ones, even after the
marched - “everyone failure of 1850. Following a period in
and regained direction, Virchow articulated and forwarded should receive exile (after the return of the autocrats)
p o w e r , the best ideas of his contemporaries. And [healthcare] and an understandable period of lessened
those of with the political tides running against him, according to politicization, Virchow participated in the
revolution his needs” formation of the Progressive Party once
w e r e
his determination did not wane, and he - while today conditions in Germany permitted his return
entirely fought for the principled opposition. healthcare is to politics and Berlin. In his capacity as
annihilated, c o n v e r s e l y a legislator and a city council member,
and all changes and dreams with them. becoming a right only of wealth Virchow transformed Berlin into a modern
Virchow’s involvement with the (Ackernknecht, E.H. Rudolf Virchow: city. In 1860 Berlin’s sanitation system had
revolution of 1848 was only part of a Doctor, Statesman, Anthropologist. undergone little evolution since the middle
lifetime of activism. Before and after, Madison: The University of Wisconsin ages, with sewage routinely dumped in
he took part in the Medical Reform Press, 1953). He favored prison reform and the streets and contaminated water widely
movement which took root in his day and saw the penitentiary system as a massive consumed. Through careful study and
sought to remake the role of the doctor public health failure; unfortunately, this political persistence, Virchow successfully
in society. Among his various proposals too remains unchanged, as documented by authored a vast public health effort that
aimed at improving the professionalism Human Rights Watch among others, our Continued on page11
6
Medical Politics

BEERS, BRAWLS, AND BASKETBALL
of their actions. Make no mistake: I am in stronger drunk driving laws, it was not
by Jared Goldberg

I
no way defending the action of the players until the Federal Government threatened
t was only fitting that, of all places, I (who were not drinking alcohol) involved to withhold millions of dollars per year
found myself at a bar while watching in this event. Nor am I saying that alcohol that the legal limit of alcohol for driving
the replays of the fight breaking out at is, alone, responsible for what took place. was lowered from 0.10 to 0.08 percent.
the basketball game between the Detroit However, alcohol undoubtedly played a Does anybody actually think it is safe to
Pistons and Indiana Pacers. People stood, significant role in defining the events of drive with a blood alcohol level of .08?
some cheering, some speechless, while the that night. Say what you will about my home state,
scene of professional athletes fighting with The problems with alcohol that but Maryland’s drunk driving laws are on
spectators are manifested at par with those of the rest of the country.
unfolded. I would much rather be seated next sporting events are What is more frustrating is that there are
This scene to somebody who has a passion for merely a reflection devices available that could stop drunk
has since of those affecting drivers from being able to get behind the
b e e n the game, than next to a raucous
the rest of our wheel. Ignition interlock devices require
r e p l a y e d drunk with a wanton disregard for the society. Alcohol that the driver provide a breath sample
countless consequences of their actions. burdens our society that is alcohol-free before the car can be
times as with needless started. Such a device would surely save
commentators discuss who was right and violence, crime, and health problems. It is countless lives annually. Unfortunately,
who was wrong; who should be deemed easy to suggest that people be responsible society seems more concerned that ignition
guilty and who spared from judgment; when they drink. The problem is that when interlock devices impinge on their civil
and who was punished justly and who people are not responsible, it is the rest of liberties. Protect the “liberties” of the
got off too easy. As an ordinary, curious society that suffers the consequences. In drunk drivers. Forget about my freedoms.
individual (and a fourth year with, perhaps, 1998, alcohol abuse cost the country over The fact remains that alcohol is a
too much free time), I have watched $180 billion. Studies in 1995 showed that drug. As such, we must respect it as a
replays of this scene many times. What 25 to 40 percent of hospital beds were used drug, and hold it to the same scrutiny to
strikes me each time, however, outside of for treating those with complications of which we hold other drugs, by recognizing
the flagrant violence, is the amount of beer alcohol abuse. the benefits it
that I see being poured by the fans all over And each year, provides, but
the place. over 16,000 more importantly,
Alcohol and sporting events seem people are by being wary
to go hand in hand these days. With slaughtered in of its adverse
the amount of advertising that alcohol drunk driving effects. I am in no
companies and professional sports do crashes—many way advocating
together, it is hard to imagine professional of whom are turning the clock
sports existing without alcohol. Is having innocent victims back to the era
the access to alcohol at sporting events a caught in the of prohibition.
basic right? Is it a necessity? Or should it wrong place at If people want
be banned? As a kid growing up, I recall the wrong time. to enjoy alcohol
the joy of watching professional football Unfortunately, responsibly, they
and baseball. Going to the stadium to for most, the should be able to
watch a game was such a thrill. The joy mentality is that do so. However,
of the sport itself was all I needed for alcohol abuse is it means that
entertainment. Is that no longer the case? not a problem - we all have
Is it possible to enjoy watching a game if until something certain societal
a bottle (or several bottles) of beer cannot happens to a responsibilities.
be imbibed? Perhaps banning beer sales loved one. As future
at sporting events would cause only true As a physicians, we
fans, who have a love of the game and result, society is will have the
sportsmanship, to attend. Maybe the too accepting of A little wet behind the ears, Artest? o p p o r t u n i t y,
economics of professional sports in this the consequences of alcohol. Lawmakers and duty, to identify patients with risk
era will not allow for this. But as a sports and alcohol companies fight to secure the factors for alcohol abuse. In this role, it
fan, I would much rather be seated next right to abuse alcohol, while the safety is imperative that we intervene in these
to somebody who has a passion for the for the rest of us is neglected. Back in situations before it is too late and make
game, than next to a raucous drunk with my home state of Maryland, where I have sure that patients get the proper treatment
a wanton disregard for the consequences testified at legislative hearings to support Continued on page 10

7
From the Halls of NYUSoM
LOCATIONS FOR LEARNING
Where do you like to study, and why?
Photo Poll Conducted by Samantha Brenner

Amber Wheeler, ‘07 Clarence Lin, ‘08
“When I’m informally
“Coles conference rooms
studying, I’ll study
— I think it’s just right: not
in the library by the
too noisy, not too quiet.”
computers, and then,
when the rubber hits the
road, I switch to AHC.”

Sandra Kamholz, ‘08
Benjamin Young, ‘06 “Bobst — for the view
“My room — easier of Washington Square
access to snacks and Park, and the distance
T.V. and things to help from the medical
me procrastinate.” school. The natural light
is a big plus.”

Cedric Dark, ‘05
Some place you don’t fall
Kira Zavilevich, ‘06 asleep. You gotta have
“Downtown in Bobst. I your creature comforts
like to get away from while you study. Hence,
the medical center. I I prefer Starbucks. I
like the downtown area have never been a
and the library doesn’t library person. Just don’t
feel so clausterphobic order the vanilla cream
with the natural sunlight.” because it’s warm milk
and it’ll put you to sleep.

Kristy Ahrlich, ‘06
Bo Chen, ‘07 “My room — because
there’s no one to drive
“Bobst — 10th floor, facing me crazy there. There’s
the big windows you get a nice distractions, if I
great view of the skyline.” don’t wanna sudy, I don’t
have to. If I get really
desperate, I’ll clean.”

8
NYU Med Book Review

Habermas: On the ‘Instrumentalization’ of Species
by Jeffrey Shyu inspiration for moral

J
guidance. Modern
ürgen Habermas, eminent German society is constituted
social theorist, joins the contemporary as pluralistic, and a
bioethics debate with a collection of constitutional state must
three lectures in The Future of Human take a neutral position
Nature. It is an interesting book, and I towards opposing
have summarized
some of the main One could argue that a parent’s
arguments and offer
a brief response.
overzealous efforts at training his or
In it, he her children into gifted musicians or
argues against athletes is not all that different from
‘liberal eugenics’ modifying their genomes before birth
– the right of parents
to program the to give them a predisposed aptitude
genomic blueprints for these abilities.
of their children. He
regards eugenics as a potential restriction worldviews to secure
on the unborn programmed individuals’ the human right to
freedom to choose their identities and their individual autonomy.
life courses: that is to say, their status as For Habermas, what
moral beings is in danger. And as society grounds this view
is constituted by moral beings interacting is a ‘species-ethic’,
with one another, this threat deeply or the ethical self-
challenges the liberal values of freedom understanding of Habermas in his study.
and equality, as well as the rationale for the species – our understanding of preferential traits, the children become the
why we should be moral at all. what it means for us to be human. A objects of the parents’ preferences. This
In our postmetaphysical world, rationality conceived from intersubjective restricts the ability of the children to develop
persons may no longer rely exclusively communication is what creates and sustains an individuated ethical self-understanding.
on a single ontological narrative or divine the species ethics. But within this ethic is Species instrumentalization also results in
the understanding that we are the authors the obfuscation of the subjective-objective
of our own lives, and since other people are distinction. A human life becomes not
authors of their own lives as well, we must simply an end to itself but a product of
treat them as equal members of society. technology.
Therefore the underlying sustenance of Habermas also contends that liberal
the species-ethic is our subjective ability to eugenics creates an intergenerational
view ourselves as free and self-actualized, asymmetry that threatens the egalitarian
and thus moral, agents. foundation of liberal society and the
Habermas sees the contingency constitutional state. How so? Moral
of birth as a crucial element of what it beings are required for a society founded
means to be moral and human. However, on freedom and equality. Moral beings
advances in genetic technology will soon are presupposed as autonomous and free,
remove birth’s contingency, and parents and so we are required to respect the
will have the potential to artificially design self-understanding of other moral beings.
their children. Although he is in favor of Genetic intervention leads to the creation
therapeutic eugenics (i.e. to treat serious of people who may not be able to achieve
monogenetic diseases) using an argument these prerequisites for moral determination.
The Future of Human of future informed consent, Habermas This disrupts our ability to see these people
Nature opposes the enhancing type of eugenics as agents of moral action and judgment.
(i.e. modifying the genome for enhancing But why is the contingency of birth a
by Jurgen Habermas appearance, intelligence, musical aptitude, truly necessary component for the formation
$49.95 etc.). He bemoans what he describes as the of moral individuals? Throughout history,
Polity Press “instrumentalization” of the species. By conceptions of what constitutes a moral
allowing people to mold their children for individual have changed in a manner that
Continued on next page
9
AMSA vs. AMA consumer choice in insurance companies, plan suggests, that real change will happen
Continued from page 4 which is not necessarily a good thing. In to our healthcare system. Nevertheless,
laziness), or capitated (which fosters the language of the field, choice equals AMSA should retain single-payer as
under-utilization). If I were emperor of the fragmentation of the risk pool by the forces its long term, audacious goal. AMSA
medical world, I would make primary care of adverse selection. In other words, must, however, work for smaller, but still
physicians either capitated or salaried and given the opportunity, those most at risk significant, reforms. Before universalizing
let specialists function at fee-for-service and those at least at risk will choose to healthcare for all, let us make it universal
rates. All hospitalists should be salaried. buy into different plans according to their for children as it is now for those above
One more thing - forget institutional long- needs, thus “fragmenting” the risk pool. age 65; let us make it universal for HIV
term care. It just costs too much. The smaller the risk pool, the larger the patients as it is now for those with ESRD.
The AMA proposal has its own costs; the larger the risk pool, the smaller Most importantly, AMSA must continue to
problems. This is basically the GOP the costs. Therefore, too much choice is a fight for its long-term goal because many,
viewpoint bad thing. including the AMA, will too easily be
that almost Ultimately, however choice also Ultimately, however, choice satisfied with the relatively minor steps
all of us will means that some will choose also means that some will choose along the way.
share once to go without insurance. An easy
we stop
to go without insurance. An way to fix this would be to mandate References
r e c e i v i n g easy way to fix this would be insurance on the individual. We do 1
NEJM. 1989. 320: 102-8.
loans and to mandate insurance on the it for cars, why not for health? 2
JAMA. 2003. 290: 798-805.
climb the individual. We do it for cars, Many solutions have therefore 3
Health Insurance Survey. Kaiser Family
tax bracket. why not for health? been offered for our patchwork Foundation. April 2004. Available at: http:
As no and complex healthcare system. //www.kff.org/healthpollreport/archive_
surprise to What should be realized is that April2004/12.cfm
anyone, the AMA’s big thing is tax credits. political compromise is necessary. While 4
Office of the White House Press Secretary.
Aside from the fact that only thirty-three a single-payer system seems ideal to some,
Making Health Care More Affordable.
percent of the uninsured are likely to take significant opposition will arise; too many
Available at: http://www.whitehouse.gov/
up any credits offered3, there are other players have too much too lose. It is in the
news/releases/2004/09/20040902.html Sep
problems lurking. spirit of incremental change, as the AMA 2, 2004.
The first major hurdle to effective
tax credits is that it comes nowhere near
covering the full cost of a health plan
in the twenty-first century. The average Habermas Alcohol
family plan costs almost $10,000 today, Continued from page 9 Continued from page 7
and the tax credits offered (according to the has resulted in greater inclusiveness. It is and support before they seriously hurt
President) will pay approximately $3,0004. quite conceivable that our species-ethic themselves or somebody else. At the
Fortunately, the AMA is not as naïve. will change again to include those who present time, there is still plenty that we
Their position clearly states that effective have their genetic codes programmed. can do, such as setting good examples,
tax credit policy will require significant And have we not seen similar arguments and keeping our friends out of dangerous
subsidies to the low income earners (up to before, in response to test tube babies and situations. This responsibility may be as
100% of the cost). so on? Their ‘unnatural’ origins have not simple as taking the car keys away from
Another criticism of the AMA threatened the moral foundation of society. a friend who has been drinking, or telling
strategy is that the people who will likely How is preimplantation genetic diagnosis them to refrain from that final drink of the
take advantage of the tax credit will fundamentally different? night. Sometimes such simple acts that can
probably already have insurance. Yes, One could argue that a parent’s make a substantial difference. During this
some of the 45 million uninsured will be overzealous efforts at training his or her upcoming holiday season’s travels, I can
covered; however, many people already children into gifted musicians or athletes only hope that the other drivers with whom
with insurance will simply receive a back is not all that different from modifying I am sharing the road have had that kind of
door tax cut. The primary beneficiaries of their genomes before birth to give them guidance.
these tax credits would still be low-income a predisposed aptitude for these abilities.
individuals earning less than $20,000 and Habermas distinguishes the two by arguing
families earning $30,000-40,000 per year. that whereas it is possible for a child to
Another point, which the AMA poorly reject the social intervention of the parents,
elaborates, is that these tax credits must be the latter is irreversible. However, logically break?
received in a fashion where they are only it is possible to reverse a genetically
useful for health insurance. That is, these arranged aptitude; after all, doesn’t WRITE FOR THE PLEXUS
tax credits cannot be used to purchase therapeutic gene therapy strive to correct
other goods. To accomplish this, vouchers the genetic mistakes that otherwise result
are key. in terrible diseases? Submissions for the January
The AMA plan also emphasizes
Catholics & Kerry (cont. from pg 3) reversing a ten-year declining trend. Based now that it has been manipulated so easily
on the experience of more liberal countries in the 2004 election. Democrats will
many mentally retarded criminals would
with legal abortion, better social support, likely consider the Church hierarchy’s
I be allowed to sign death warrants for if
and lower per capita abortion rates than the consideration a lost cause, and Republicans
I promised to vigorously oppose stem cell
US, this may be will quickly learn that some
research? If a politician wants the bishops
due to economic empty pro-life or homophobic
to call a vote for his or her opponent a sin
deterioration rhetoric will evoke enough
but also wants to launch a war that violates
during Bush’s tough talk about sinful voting
the Church’s just war principles, how many
first term. Should from a couple bishops to sway
pro-life judges does he have to promise
Bush voters go some voters.
to nominate? Answering these absurd
to confession I’m certainly not saying
questions requires a messy utilitarian
for all the extra the Church should have
worldview that the Pope has passionately
abortions that endorsed John Kerry against
spoken and written against. Yet, these are
might take its principles. Indeed, an
exactly the questions that politicians will
place during endorsement for John Kerry
now ask themselves, thanks to the Church’s
his second would have been problematic
posturing during the ’04 campaign, as they
term, during for exactly the same reasons.
plan their strategy to win the Catholic
which he may Rather, the Church should think
vote.
inadequately more about moral leadership
I believe the Church will eventually
address social and less about maximizing its
pay dearly for its decision to play power
conditions that political influence. The Church
politics. First, it will soon find that the “life
are associated with abortion? I don’t think should have abstained from taking sides
issues,” which the Church hierarchy spoke
so, but by the Church’s new spreadsheet- in this election and continued to hold
about in such simple and unequivocal
style morality, wouldn’t they have to? both candidates’ feet to the fire on all the
terms, are complicated. If preliminary
Second, politicians are much less issues without reducing itself to a puppet
analyses are correct, abortion rates in many
likely to take the Church’s views seriously for either.
states have risen during Bush’s first term,

Virchow while enacting practical reforms. Despite certainly have diverse political views,
Continued from page 6 my uneasiness with drawing analogies something both inevitable and beneficial,
remade the city’s sewers, thereby greatly from history, we might agree that his and doubtless there are many who disagree
reducing the transmission of infectious steadfastness provides us with a valuable with not only the propositions presented
disease in the rapidly growing city. model, and a suggestion for a way out of here, but also those of Virchow himself.
Finally, and perhaps most significantly, despair, and into the future. So be it. Let us argue and find a common
Virchow remained an opponent of the This historical summation has denominator of agreement. But we must
gathering authoritarianism, imperialism three purposes: one, to present what I be a louder voice on the profound issues
and militarism of the German government, consider to be an admirable figure, who of our day. We are unlikely to shift the
as a consistent foe of its archconservative we might agree reflects the potential and tide of history if our greatest, most urgent
uniter, Otto van Bismarck. His biographer, responsibilities inherent in the profession and most emotional political concern is
Ackernknecht, asserts that the Progressive of the physician; two, to demonstrate increasing Medicare rates or establishing
Party’s constitutional resistance to our failure to progress beyond what the malpractice caps.
Bismarck, under Virchow’s leadership, medically astute were demanding more There is more hope and power in
was the final attempt of the German than a century and a half ago; and finally, science yet to be unleashed; perhaps even as
middle class to oppose Bismark on a large- to again posit the inextricability of the Virchow put it, “may it remain for science
scale in the political arena. Given the political/social tasks of the physician, with to treasure and to bring to realization the
future authoritarian plunge that Germany his or her medical ones. beautiful motto: Peace on Earth” (Nuland,
would later undergo in the 1930s (with The challenges of today and S.B. Doctors: The Biography of Medicine.
unforgettably grave ramifications for the tomorrow are frighteningly immense, and New York: Vintage Books, 1995.)
world), this is no small thing. the injustices and microbes that afflicted
I believe these to be important Virchow’s world continue to plague our
considerations given our current political own. Human beings’ greatest epidemic,
predicament, with all of its ramifications war, continues to mock our purported
for human health and well being. With advancement. And the forces of reaction
the political tide flowing in his direction, are as powerful as ever.
Virchow articulated and forwarded the Informed, organized, and devoted, From your Plexus staff and
best ideas of his contemporaries. And American physicians might pose an editors
with the political tides running against enormously powerful force in resisting the
him, his determination did not wane, and coming regression, and then proactively
he fought for the principled opposition, confronting the injustices of our day. We