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The NYU School of Medicine Journal of Thought
Volume I, Issue 2 December 2004
The NYUSoM Journal of Thought
Volume 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), Jared Goldberg ('05), Varun Sharma ('08), Jeffrey Shyu (‘08), and Sayone Thihalolipavan ('08).
Contents of this Issue
Amber Alayyan blasts the Bush administration’s choice for the 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 Religion Dictates Politics, page 3. Sayone Thihalolipavan decries the basis of hate in this poetic piece. Stripped, page 3. Stripped Cedric Dark critiques the health reform proposals of both the AMA and AMSA in this response to last issue’s healthcare debate. AMA and AMSA: A Plague on Both Your Houses, page 4. Varun Sharma argues that the errors of doctors are the true culprit behind soaring healthcare costs. Medical Error: The Source of Healthcare Woes, page 4. Adam Gaffney looks into the past at the case of the Doctor-Statesman Rudolf Virchow to find inspiration in a counterrevolutionary present. Politics and Physicians: Lessons from the Past, pages 5 to 6. Jared Goldberg examines the deleterious effects of alcohol 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 NYUSoM: Locations for Learning, page 8. Jeffrey Shyu reviews the philospoher Habermas’ most recent look at the ethics of designing the newborn. Habermas, Human Nature and the Future of Liberalism, page 9.
Weaving through much of the content of this issue is the notion that physicians’ responsibility spans more than just their immediate clinical or scientific endeavors. Of course, 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 doctor’s responsibilities are widened to issues of human rights, whether political, 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 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 benefits 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
All content is available online at http:// students.med.nyu.edu/plexus. Letters to the editor should be mailed to firstname.lastname@example.org, and be no more than 200 words in length. Article submissions should be first discussed with an editor. 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.
Alberto Gonzalez as the Next Attorney General sent in 2002, Gonzales states that laws deaths to natural causes, and designing by Amber Alayyan
FROM NAKED STATUES TO NAKED PRISONERS
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, The U.S. cannot flout international and loyal supporter of the president. the “war on 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 world to maintain the very your behalf: http://action.humanrightsfirs Commander in Chief G.W. Bush 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.
When Religion Dictates Politics
their values here and there, the Church economic fairness, and the integrity of the 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, the role our Church leaders may of stem cell research because it lets politicians off the hook to evil, should you go have played in Kerry’s defeat. to confession? The 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 by Sayonne Thihalolipavan to be single-issue voters on these so-called “life issues.” What if you were stripped of every single one of your human rights? It’s not surprising, therefore, that Freedom of expression, health, maybe even your life? Kerry, a Catholic himself, lost the Catholic Would you remain silent, or protest the strife? vote 51%-48%. Among Catholics that Knowing that prejudices prevent breathing in the beauty of THIS room attend mass regularly, the split was 55%since education is not deemed worthy as a right. 44%. In Ohio, where Bush won overall In a cloudy, sinister fog of civil unrest, by 136,000 votes, Bush received 780,000 South Africans endured a life of torture, detest Catholic votes, 156,000 more than Kerry. In hopes of experiencing a lucid, serene night For comparison, both Bill Clinton in 1996 What if YOU were stripped of every single one of your human rights? and Al Gore in 2000, neither of whom are We habitually take for granted the entitlements given upon birth; Catholic, took 53% of the Catholic vote in Yet human rights are violated uncaringly throughout the world their respective elections. Why hate, discriminate? Because it is effortless. As a member of that rebellious and We must expand energies to embrace diversities, sinful 44%, I’m a little sour over the role Become knowledgeable, celebrate human peoples, take political our Church leaders may have played in Action, admit biases, and forgive. Oh lord we must forgive! Kerry’s defeat. My politics aside, though, Molecularly we are 95% similar in DNA, I take issue with the idea of any singleRealistically why must we trip over the 5 that remain. issue endorsements from religious leaders, Prejudices may lead to poverty and lack of equality, particularly from Catholic bishops. You can take my property and privacy but you can’t take away my dignity; Is it ever justified for a religious I will rise against your hate and use your own abhorrence to flame my retaliation leader to speak up politically? I hope so. Claiming my birth right of international amnesty Rev. Martin Luther King Jr. comes to mind. Sticks and stones may break my bones, Similarly, the Catholic Church has a long But unsaid words will permanently disfigure my soul. history of speaking out and acting with great Discrimination will only lead to elimination of the human race influence against tyrants and tyrannical Like a prophecy rights will unfold whether through actions mine ideologies. Were a candidate or ideology Or my soul reborn in future generations so clearly a paragon of either Catholic You loathe me. I love you, fellow, human brother, but despise your actions virtue or anti-Catholic vice, I hope that the What if I was stripped of every single one of my human rights? Church would speak out. My view is that I would cry...in hopes that you heard my pain and would help heal my plight the bar for such an endorsement should be Because before race, color, religion, and everything else that separates us, pretty high, though, because unlike voters, We are human. the Church is under no obligation to choose 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
by Al Garfall
AMA AND AMSA: A Plague on Both Your Houses
The source of healhcare woes
by Varun Sharma
by Cedric Dark
he most interesting thing about the American health care system is that it is one sector of the economy where consumers 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. AMSA’s proposal is too radical to garner significant congressional support; AMA’s 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” – Medicaid’s benefits are far superior to medicare’s. But why is AMSA’s approach utterly unrealistic? On paper, a single-payer health system with basic benefits 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 , Cost sharing represents one of the best and Tom means to limit health expenditures. Its Coughlin effects are also unfortunately overly to the NFC oppressive to low-income persons. 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 19891 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 stifle further technological advances. AMSA/PNHP also wants to eliminate any cost sharing, i.e. payment of some percentage of healthcare costs at the time of service. 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 financial stress. The AMSA/PNHP plan is remarkably lenient towards physicians: we would retain the freedom to practice fee-forservice (which fosters over-utilization), salaried (which fosters Continued on page 10
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 next few 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 Carelessness, poor judgement, “privatized.” Bureaucracy and poor treatment on the part and administrative of doctors amounts to billions in costs are commonly wasted dollars. targeted as the culprits behind the rise in healthcare costs, and rightly so. However, the true problem is more deeply rooted. Carelessness, poor judgment and poor treatment by doctors, combined with the inefficient management of hospitals, amounts to billions in wasted dollars, and worse, close to 100,000 avoidable deaths every year. One reason for the very sloppily-run state of health care is due to inherent characteristics of medicine itself. Medicine involves providing a service to a largely uninformed consumer population, rendering them almost completely dependent on their supplier. A patient has little input with regard to the tests and treatments he must pay for. This imbalance of power has helped foster a culture in medicine of poor communication and a lack 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 are dictating the terms under which doctors can practice medicine by constraining the time allotted to doctors per patient, and by limiting the diagnostic tests and treatments doctors can provide, ultimately compromising patients’ care. This has done nothing to ameliorate 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 be left to the politicians and lobbyists. It is doctors who must commit 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 bitterest pill will be difficult for doctors to swallow, but the time has come to try ideas like opening up doctors’ records to evaluation, and increasing the competitiveness between doctors and hospitals. The solution to the nation’s healthcare woes does not revolve around finding ways to allocate health insurance, but in trying new ideas to radically reform the way medicine is practiced.
Physicians and Politics:
Lessons from the Past
such despair, then, is a sense that almost prize winning Laurie Garrett devastatingly everywhere, the illiberal, the discredited documents in her book, Betrayal of Trust: and the delusional are on the march. The Collapse of Global Public Health, Each day our nation seems more deeply the American public health apparatus sucked into an imperial is alarmingly adventure gone awry. What overwhelms so many with unprepared for the We watch a US soldier such despair, then, is a sense slew of dangers empty bullets into an we face, from that almost everywhere, the unarmed man, while bioterrorism to the talking heads defend it. illiberal, the discredited and the emergence of drug We read about torture delusional are on the march. resistant HIV and at Abu Ghraib, and tuberculosis. then learn that a man who all but legally But still, we continue to do little, or approved of such actions will probably be nothing. our next Attorney General. In short, given a modicum of the With our eye fixed on war, concern depressing images and numbers that for the cultivation of our children’s minds, inundate our airwaves, newspapers, and our environment and our public health medical journals, many of us cannot help suffer. Anti-evolution teaching creeps but see our current course as absurd and back into public schools (Badkhen, Anna. self-destructive. We are forced to re-fight “Anti-evolution teachings gain foothold in the battles of a hundred years ago. This U.S. schools.” San Francisco Chronicle, would be disheartening enough, were November 30, 2004). An overwhelming not the stakes so much higher today, in scientific consensus on the massive dangers the nuclear age, in the age where human of global warming is inexplicably rivaled beings are now the primary mover of by those who alternately deny its existence nature. The reactionary right conveniently or would, in a single breath, agree that it denies problems or our ability to solve exists while assuring us of its beneficence them, and the postmodern left all too often to the world economy. Our public health forgets its priorities or loses its resolve. system deteriorates, while the ranks of the The opposition seems omnipotent, and so 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. Continued on next page
he collective despair that has gripped much of the nation since November 2 can not be wholly attributed to electoral defeat. Elections are bought or won 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
by Adam Gaffney
The Commander-in-Chief addresses the troops.
of the physician, Virchow Continued from page 5 was a visionary public Most prominently, Virchow is considered health advocate who made between to be the father of modern pathology. In associations condition his day, much of disease theory was based socioeconomic 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. The government was surely pathology was born. 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 economic, political largely outthought by Virchow and some the of his contemporaries of more than 150 and social injustice of Prussian despotism years ago. Virchow’s political upbringing the 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 Some of his positions of more than 150 vanguard of nineteenth-century medical was the so-called “springtime of peoples,” 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 individual to political responsibilities as inseparable old regimes h e a l t h c a r e from his medical ones, even after the regrouped, With the political tide flowing in his - “everyone failure of 1850. Following a period in marched and regained direction, Virchow articulated and forwarded should receive exile (after the return of the autocrats) the best ideas of his contemporaries. And [healthcare] and an understandable period of lessened p o w e r , those of with the political tides running against him, according to politicization, Virchow participated in the his needs” formation of the Progressive Party once revolution his determination did not wane, and he - while today conditions in Germany permitted his return w e r e fought for the principled opposition. healthcare is to politics and Berlin. In his capacity as entirely c o n v e r s e l y a legislator and a city council member, annihilated, becoming a right only of wealth Virchow transformed Berlin into a modern and all changes and dreams with them. Virchow’s involvement with the (Ackernknecht, E.H. Rudolf Virchow: city. In 1860 Berlin’s sanitation system had Statesman, Anthropologist. undergone little evolution since the middle revolution of 1848 was only part of a Doctor, 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
BEERS, BRAWLS, AND BASKETBALL
of their actions. Make no mistake: I am in stronger drunk driving laws, it was not 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 merely a reflection devices available that could stop drunk to somebody who has a passion for has since of those affecting drivers from being able to get behind the the game, than next to a raucous b e e n 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 burdens our society that is alcohol-free before the car can be consequences of their actions. 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
by Jared Goldberg
Where do you like to study, and why?
Photo Poll Conducted by Samantha Brenner Amber Wheeler, ‘07
“When I’m informally studying, I’ll study in the library by the computers, and then, when the rubber hits the road, I switch to AHC.”
LOCATIONS FOR LEARNING
From the Halls of NYUSoM
Clarence Lin, ‘08
“Coles conference rooms — I think it’s just right: not too noisy, not too quiet.”
Benjamin Young, ‘06
“My room — easier access to snacks and T.V. and things to help me procrastinate.”
Sandra Kamholz, ‘08
“Bobst — for the view of Washington Square Park, and the distance from the medical school. The natural light is a big plus.”
Cedric Dark, ‘05 Kira Zavilevich, ‘06
“Downtown in Bobst. I like to get away from the medical center. I like the downtown area and the library doesn’t feel so clausterphobic with the natural sunlight.” Some place you don’t fall asleep. You gotta have your creature comforts while you study. Hence, I prefer Starbucks. I have never been a library person. Just don’t order the vanilla cream because it’s warm milk and it’ll put you to sleep.
Kristy Ahrlich, ‘06 Bo Chen, ‘07
“Bobst — 10th floor, facing the big windows you get a great view of the skyline.” “My room — because there’s no one to drive me crazy there. There’s nice distractions, if I don’t wanna sudy, I don’t have to. If I get really desperate, I’ll clean.”
NYU Med Book Review
Habermas: On the ‘Instrumentalization’ of Species
by Jeffrey Shyu
ürgen 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 One could argue that a parent’s arguments and offer overzealous efforts at training his or a brief response. 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 for these abilities. genomic blueprints of their children. He regards eugenics as a potential restriction worldviews to secure on the unborn programmed individuals’ the human right to autonomy. freedom to choose their identities and their individual life courses: that is to say, their status as For Habermas, what this view moral beings is in danger. And as society grounds is constituted by moral beings interacting is a ‘species-ethic’, with one another, this threat deeply or the ethical selfof Habermas in his study. challenges the liberal values of freedom understanding and equality, as well as the rationale for the species – our understanding of preferential traits, the children become the what it means for us to be human. A objects of the parents’ preferences. This why we should be moral at all. 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. Habermas also contends that liberal Therefore the underlying sustenance of the species-ethic is our subjective ability to eugenics creates an intergenerational view ourselves as free and self-actualized, asymmetry that threatens the egalitarian foundation of liberal society and the and thus moral, agents. Moral Habermas sees the contingency constitutional state. How so? 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 opposes the enhancing type of eugenics as agents of moral action and judgment. Nature But why is the contingency of birth a (i.e. modifying the genome for enhancing 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, “instrumentalization” of the species. By conceptions of what constitutes a moral Polity Press allowing people to mold their children for individual have changed in a manner that Continued on next page
inspiration for moral guidance. Modern society is constituted as pluralistic, and a constitutional state must take a neutral position towards opposing
AMSA vs. AMA
consumer choice in insurance companies, which is not necessarily a good thing. In Continued from page 4 laziness), or capitated (which fosters the language of the field, choice equals under-utilization). If I were emperor of the fragmentation of the risk pool by the forces medical world, I would make primary care of adverse selection. In other words, physicians either capitated or salaried and given the opportunity, those most at risk let specialists function at fee-for-service and those at least at risk will choose to rates. All hospitalists should be salaried. buy into different plans according to their One more thing - forget institutional long- needs, thus “fragmenting” the risk pool. term care. It just costs too much. The smaller the risk pool, the larger the The AMA proposal has its own costs; the larger the risk pool, the smaller problems. This is basically the GOP the costs. Therefore, too much choice is a viewpoint bad thing. that almost Ultimately, however choice also Ultimately, however, choice all of us will means that some will choose also means that some will choose share once to go without insurance. An easy to go without insurance. An way to fix this would be to mandate we stop r e c e i v i n g easy way to fix this would be insurance on the individual. We do loans and to mandate insurance on the it for cars, why not for health? climb the individual. We do it for cars, Many solutions have therefore tax bracket. been offered for our patchwork why not for health? As no and complex healthcare system. surprise to What should be realized is that anyone, the AMA’s big thing is tax credits. political compromise is necessary. While Aside from the fact that only thirty-three a single-payer system seems ideal to some, percent of the uninsured are likely to take significant opposition will arise; too many up any credits offered3, there are other players have too much too lose. It is in the problems lurking. spirit of incremental change, as the AMA 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 family plan costs almost $10,000 today, Continued from page 9 and the tax credits offered (according to the has resulted in greater inclusiveness. It is President) will pay approximately $3,0004. quite conceivable that our species-ethic Fortunately, the AMA is not as naïve. will change again to include those who Their position clearly states that effective have their genetic codes programmed. tax credit policy will require significant And have we not seen similar arguments subsidies to the low income earners (up to before, in response to test tube babies and so on? Their ‘unnatural’ origins have not 100% of the cost). Another criticism of the AMA threatened the moral foundation of society. strategy is that the people who will likely How is preimplantation genetic diagnosis take advantage of the tax credit will fundamentally different? One could argue that a parent’s probably already have insurance. Yes, some of the 45 million uninsured will be overzealous efforts at training his or her covered; however, many people already children into gifted musicians or athletes with insurance will simply receive a back is not all that different from modifying door tax cut. The primary beneficiaries of their genomes before birth to give them 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 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 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 in terrible diseases? are key. The AMA plan also emphasizes
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 still significant, reforms. Before universalizing healthcare for all, let us make it universal for children as it is now for those above age 65; let us make it universal for HIV patients as it is now for those with ESRD. Most importantly, AMSA must continue to fight for its long-term goal because many, including the AMA, will too easily be satisfied with the relatively minor steps along the way. References 1 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.cfm 4 Office 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.
Continued from page 7 and support before they seriously hurt themselves or somebody else. At the present time, there is still plenty that we 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 final drink of the night. Sometimes such simple acts that can make a substantial difference. During this upcoming holiday season’s travels, I can only hope that the other drivers with whom I am sharing the road have had that kind of guidance.
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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 Church’s 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 Church’s 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 find that the “life issues,” 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 Bush’s first term,
reversing a ten-year declining trend. Based on the experience of more liberal countries with legal abortion, better social support, and lower per capita abortion rates than the US, this may be due to economic deterioration during Bush’s first term. Should Bush voters go to confession for all the extra abortions that might take place during his second term, during which he may inadequately address social conditions that are associated with abortion? I don’t think so, but by the Church’s new spreadsheetstyle morality, wouldn’t they have to? Second, politicians are much less likely to take the Church’s views seriously 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 has three purposes: one, to present what I consider to be an admirable figure, who we might agree reflects 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 finally, 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 afflicted Virchow’s 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
now that it has been manipulated so easily in the 2004 election. Democrats will likely consider the Church hierarchy’s consideration a lost cause, and Republicans will quickly learn that some empty pro-life or homophobic rhetoric will evoke enough tough talk about sinful voting from a couple bishops to sway some voters. I’m certainly not saying the Church should have endorsed John Kerry against 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 influence. The Church should have abstained from taking sides in this election and continued to hold both candidates’ feet to the fire on all the issues without reducing itself to a puppet for either. certainly have diverse political views, something both inevitable and beneficial, 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 find a common denominator of agreement. But we must be a louder voice on the profound issues of our day. We are unlikely to shift the tide of history if our greatest, most urgent 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.)
Continued from page 6 remade the city’s sewers, thereby greatly reducing the transmission of infectious disease in the rapidly growing city. Finally, and perhaps most significantly, 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 Party’s constitutional resistance to Bismarck, under Virchow’s leadership, was the final attempt of the German middle class to oppose Bismark on a largescale in the political arena. Given the future authoritarian plunge that Germany would later undergo in the 1930s (with unforgettably grave ramifications for the world), this is no small thing. I believe these to be important considerations given our current political predicament, with all of its ramifications for human health and well being. With the political tide flowing 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,
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