Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Government Policies almost always affect the health of the Nation-positively or negatively!
- Dr.Wayengera Misaki (4 November 2004)
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Medicine and politic should be separated
- Yair Liel (5 November 2004)
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"Medicine on a grand scale"
- Graham Ellis (5 November 2004)
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By all means mix but don't confuse
- Keith Kudkins (5 November 2004)
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Stimulating debate or stirring up ill-feeling?
- Ayan Panja (5 November 2004)
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Re: By all means mix but don't confuse
- Bert P. van Leeuwen (6 November 2004)
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Striking a balance
- Sharif S Hussain (6 November 2004)
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Pandora's e-box
- Adrian S. Blaj (6 November 2004)
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To be or not to be...political --- that's the question
- Adrian S. Blaj (7 November 2004)
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BMJ Politics
- Phil Taussky (8 November 2004)
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A more constructive approach to writing about health and conflict
- Bruce E Laurence (8 November 2004)
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Health and politics are now closely twined?
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (8 November 2004)
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politics is medicine writ large
- Hyman Davies (8 November 2004)
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Medicine and politics are intertwined whether we like it or not
- Maurice Conlon (8 November 2004)
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Waste of an entire BMJ issue
- Abhijit Bal (9 November 2004)
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Open letter to Dr Abbasi
- Daniel Y. Ellis (9 November 2004)
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Re: politics is medicine writ large
- Gabrielle J. Halpern (10 November 2004)
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Re: politics is medicine writ large
- Mark Struthers (10 November 2004)
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Re: Re: politics is medicine writ large
- Mark Struthers (10 November 2004)
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Re: Re: Re: politics is medicine writ large
- Gabrielle J. Halpern (10 November 2004)
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Re: Re: politics is medicine writ large
- Hyman Davies (10 November 2004)
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The Inseparability of Medicine and Politics
- Stefan P. Kruszewski, M.D. (10 November 2004)
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Finding Neverland
- Mark Struthers (11 November 2004)
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Dr.Wayengera Misaki, Doctor Mulago National referal Hospital,Uganda
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There is no doubt that Medicine as a whole-clinical,Public health,research&Educational(?Academic Medicine) in any nation is affected by the policies that the reigning goverments adopt...be it in the developing or developed world. The Isreal-Palestine Conflict has seen the health of many citizens in both nations affected-with many being maimed,losing loved one(talk of psychiatric disease)et cetera Lets however consider two extremes taken outside of this Israel- Palestine focus. The health sector of many African nations have especially lagged behind because of poor governance. Politicians embark on developing other sectors with no biase towards health(lets not talk of the corruption covered up by many), as though the nation can exist without the civilains. Yet when the daughters of the very politicians say become gravid at term, they are flown to the UK, France for just a C/section that a well motivated intern would have performed here.. i am talking about poor pay for the mediacl workers in many African counties-Uganda as my evidence. Ultimately, it's the civilian who pays the taxes(that are wrongly appropriated) that faces the wrath & stress of the poorly paid MO because of poor goverment policy. In such a situation, medicine is inseperatable from politics. Turn to the developed world: Kerry no doubt had a fore run for votes against Bush because of his stand on stem cell research-especially from the terminally ill(forget the fact that Bush won the elections)..., meaning that even in the developed world, policy is inseperable from Medicine. In conclusion. i say YES, Medical jounals should publish both politics & Medicine-for who knows-we may increase the readership to the very policy makers so they can hear our pleas...please! Competing interests: None declared |
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Yair Liel, Senior Endocrinologist Soroka University Medical Center
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As an Israeli, I have a strong position over the Israeli-
Palestinian conflict. Nevertheless, browsing a medical
journal I like to get objective evidence, rather than
partial facts or unfounded statements (that sometimes
are wose than lies) fueled by bursts of emotions, by
people from both sides of the conflict. I am not
suggesting that physicians abstain from politics, but I
prefer that medical journals should be saved for
professional topics (including general moral issues).
Specific political controversies, even
if disguised as health issues, be diverted to other
platforms.
Competing interests: None declared |
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Graham Ellis, Research Fellow Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF
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Sir - "Medicine is a social science and politics is nothing but medicine on a grand scale" Rudolph Virchow. I read with interest the debate regarding the role of political reporting and discussion within the medical press. [1,2] We can have no doubt about the importance of politics in the "public health" at national and international level. As professionals with a duty of care, we cannot ignore abuses of human rights and health inequalities. Medicine is not seperate from the effects of the social science that is politics. Despite this, I beleive there should be some governing principles regarding the reporting of political events and opinions within the leading medical press. I am convinced that the principles of scientific reporting (in an evidence based era) and that of political reporting should share the some core objectivity. That is, we should be reporting only facts, avoiding publication bias and avoiding personal judgements. There is the same grave danger from partisanship in politics that there is from poor quality peer review and publication bias. Readers of the medical literature are required to exercise their own judgement over the facts and should be presented with the facts in an objective, unbiased and non-judgemental manner. Anything else risks a distortion of the purpose and quality of the medical literature. 1. Kamran Abbasi Should journals mix medicine and politics? BMJ 2004; 329: 0-g 2. Palestine: the assault on health and other war crimes: More heat than light in this debate Tom Marshall BMJ 2004 329: 1102. [Letter] Competing interests: None declared |
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Keith Kudkins, Medical Director / Consultant Anaesthetist Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4EE
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One of the most interesting and healthy features of the BMJ is the mix of articles it contains, from peer-reviewed evidence through opinion to frank prejudice. Provided it is clear what level of thought is behind each contribution, this is good. What is not good is the use of impartial scientific evidence to make a balatntly political point - as the Editor of the Lancet quite unashamedly did on Radio 4 this week, when asked about the paper estimating 100,000 civilian deaths in Iraq as a result of US and UK military action. The line between the two is a fine one; unfortunately, on this occasion, he crossed it. Competing interests: None declared |
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Ayan Panja, GP London
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Dear Editor, I am not Israeli nor am I Palestinian, but I feel that articles like Dr Summerfield's (BMJ 2004;329:924) and Dr Fellerman's (BMJ 2004;329:1110) with such trenchant opinion covering issues so sensitive will doubtless rouse a lot of emotion. This can be good, bad or ridiculous and it comes down to what the aim of the BMJ is when it comes to publishing these 'political' articles. Remember the article on Pakistan vs India and the 'power of a six'? That was political too, in many ways and was largely seen as a waste of time by readers. It led to numerous inflammatory and some rather childish rallies and responses - and for what? Clearly that 'paper' on cricket may seem less serious in the global political arena when compared to these review articles about the Middle East, but just as Indians and Pakistanis vehemently defended their own teams, cultures and people in the rapid responses to Dr Abbasi and Mr Khan, the same is likely to happen here - passionate voices from either 'side' citing anecdotes and evidence against one another. There will be predictable groups of approvers and opposers from either camp with very few objective onlookers. In fact, can many people be well enough informed and truly objective? The BMJ and its' readers need to decide whether what is printed in these articles is reportage or just opinion and whether the pieces are, (by design or not), more political than medical. And if that is the case, does it matter? To some, yes, to others not, so perhaps the journal is right to be political - as long as the medical vs. political balance is calibrated. Competing interests: None declared |
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Bert P. van Leeuwen, pharma industry physician the Netherlands
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In addition to remarks about Richard Horton ("mix but don't confuse - blatant politics"), that I did not hear, I would like to point out that the Lancet's study on deaths in Irak struck a cord. Especially, the inappropriate response by Jack Straw, criticising the methods used and brilliantly reduced to nonsense by Richard Peto, showed that the Lancet had hit a soft spot, that the British government did not want to have exposed. In that light, it is not just useful, but an obligation for any medical journal to show the influence of politics, as well as the many others, on health in the wider sense. Surely, scientific evidence must be presented in an impartial way, but the implications of this evidence and the reasons why it was presented now, should also be identified; not mixed in the same article, but surely in the same edition, albeit clearly identified. I surely hope the BMJ will follow the Lancet's lead in this respect. Competing interests: employee pharma industry |
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Sharif S Hussain, Medical Student Imperial College
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Doctors are human beings too, they also have opinions that need to be expressed. However, this has to be balanced by the potential harm this can cause with ones' patients. I believe where politics directly affect the health of a people, as doctors we should express this. This may help us campaign through peaceful means to bring about change for the good at least in the aspect of health. We as human beings and then as doctors have taken it on ourselves to serve the people and to bring them out of dis-ease, into ease. Political strife can have both physical and mental disease associated with it - and if we can improve the situation by any means - then we should be bringing such opportunities to the attention of our fellow doctors. So that we may take a step towards helping people around the World and not just within our locality. Kind regards Competing interests: None declared |
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Adrian S. Blaj, Psychiatrist London, England
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There is no doubt in my mind that Kamran Abbasi is a man of vision. I could have imagined his exuberant smile on his face receiving 4-500 plus rapid responses to Derek's article alone in a very short space of time. From a newsgroup moderator's point of view this is a supreme accolade and achievement (people forget that a moderator is not a judge - his own existence as a moderator is to drive customers towards his business). People power thesis is no longer a myth - albeit still in a nascent phase and for the time being disguised in 'nerd power'. What is revitalising and welcomed by editors and publication may become a nightmare for some other institutions. I have in mind - for example - doctors and other professionals working in the NHS being flooded by a deluge of questions and complaints. It would only be a matter of time until the ordinary patients are going to learn that every hospital trust has a certain logical way of allocating e-mail addresses. If patients get the hung of this process and have the name of the person they are interested in, rest assured that no God in this universe is able to protect us. Furthermore, if the complaints are going to be distributed further up the 'food chain', one can be almost certain that some high- power people would consider asserting themselves just out of boredom of just making a point. There is no point in mentioning the patients using the e-mail service announcing their doctors they have made immediate plans to commit suicide - the trouble with this method of communication is that the messages get stored on a server and most certainly could be retrieved (even if one deletes them from the e-mail box) and used in courts. Competing interests: None declared |
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Adrian S. Blaj, Psychiatrist London, England
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Should journals mix medicine and politics? I have read this question front to back, back to front, upside down and still have the feeling there is something which is not right. The very way the question is formulated invites people to think monochrome - to say either no or yes. My first reaction was to say no purely because one does not know where medicine stops and politics begins (or viceversa). Then, I said yes simply because if one goes to the extreme and becomes a 'puritan', devoid of politics and deeply immersed in medicine, he/she falls into the category of intense participation into politics on the account of doing the politics of apolitics! In other words politics by omission. Therefore the above question 'Should journals mix medicine and politics?' becomes redundant as one can plainly see that both the politics of omission and commission make us deeply political animals. I dare reformulate this question in Shakespeare's words: to be or not to be... Political in this case. And this leads me to link politics to the very existence of human beings. Politics represents life, the lack of it - death? The refusal of becoming involved in politics may cause death and suffering not only at home but further afield. Just imagine the havoc created by a sudden conversion of the NHS professional force to overt politics if they decide to go on strike on the account of a 100% increase in their salaries or in protest of the immense human misery and suffering created by the war in Iraq. The trouble is that this force would be capable of destabilising governments regardless of their orientation... Competing interests: None declared |
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Phil Taussky, Resident Neurosurgery Neurosurgical University Clinic, Inselspital bern, 3010 Bern, Switzerland
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Dear Sir, I agree with Dr. Abbasi who writes in his editorial piece "Should journals mix medicine and politics?" that "medicine cannot exist in a political void." Yet, this raises some other questions. Mainly, is the BMJ the right journal to inform us about politics? Is the BMJ the right publication to enlighten us about a highly complex issue as the Israeli Palestinian conflict? And even so, why then address the Israeli Palestinian conflict, which is emotionally charged, yet completely irrelevant for the daily realities of the majority of its readers and the way they practice medicine? Personally, I'd rather read Jane's Defense Weekly when I need more information about the Israeli Palestinian conflict, and turn to the BMJ to learn more about treating my patients. Sincerely, Phil Taussky, MD Competing interests: None declared |
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Bruce E Laurence, director of public health high peak and dales primary care trust, DE45 1AD
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Reading the recent spate of articles on the Israeli Palestinian conflict in the BMJ, and in other journals it is striking how little that is constructive or new emerges from these exchanges. Indeed they rather mirror the current tit for tat futility of the conflict itself. Both sides have inflicted great violence on the other, and many have suffered injustice. Therefore, supporters on either side feel fully justified and become more entrenched under attack, while few readers are likely to change their opinions reading articles which seldom contain any serious or balanced, political or sociological analysis. Is there a more constructive role for the BMJ? Perhaps it lies in certain areas. I would like to hear more from those using health work, or links between health workers to promote more peaceful co-existence, whether in Israel and Palestine or elsewhere. Another is in documenting, without amateur political analysis, health problems of citizens on both sides, to expose the many effects of the conflict. A third role would be to encourage, inform and monitor efforts to develop services that can mitigate these effects. Finally there is value in holding to account health professionals and their organisations for their actions, if done sensitively, and without blaming health workers for what is out of their control. Health, conflict and politics are inter-related. But ten years as a relief worker have taught me that health workers speak most powerfully where they base their discussions on health information. When they stray too far from that, they lose credibility and only elicit defensive reactions from those who they seek to influence. Finally views would carry more weight with the majority of readers of a scientific journal, if they attempted to show some degree of even- handedness and a recognition of the moral complexity of such a long-running conflict. Competing interests: None declared |
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Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Director, CME&R POBox.2292, Buraidah Mental Health Hospital, KSA.
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Sir, Bad politics is linked, interalia, with bad health consequences of unimaginable proportions. Likewise, good politics is linked, interalia, with very good health consequences of imaginable proportions. Unfortunately todays most politicians are engaged overwhelmingly in bad politics and hence sick health is pervasive globally. Health and politics, in present circumstances, are inseparable and medical journals like bmj.com should not shirk its responsibility of highlighting the most burning political issues directly adversely impinging the health of the people worldwide. Reference: Kamran Abbasi. Should journals mix medicine and politics? BMJ 2004; 329: 0-g [Full text Competing interests: None declared |
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Hyman Davies, retired general practitioner Manchester M25 0ET
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I agree with Graham Ellis quoting Rudolf Virchow, 'Medicine is a social science and politics is nothing but medicine writ large'. These words uttered 150 years ago are as true today as they were then. What a pity that so many of your Jewish rapid responders equate loyalty to Israel with uncritical support of Ariel Sharon's brutal policies, which apart from exacerbating Palestinian anger and retaliation are responsible for so much anti-semitism in the world today. No one condones suicide bombing and the killing of innocent Israeli civilians, but the barbarity of the treatment which Ariel Sharon is meting out to the Palestinians is quite disproportionate. I commend to my Jewish colleagues who support Ariel Sharon an article in today's edition of Ha'aretz, by Gideon Levy, entitled 'Re-election of Israel's enemy'. He is referring to George Bush. The bitter truth is that Ariel Sharon has no intention of allowing the Palestinians to have a state of their own. In 1998 in a speech to the Tsomet Party he stated 'It is the duty of Israeli leaders to explain to public opinion, clearly and courageously a certain number of facts that are forgotten with time. The first of these is that there is no Zionism, no colonialisation or Jewish State, without the eviction of the Arabs and the expropriation of their lands' And it is evident that this policy continues today. True lovers of Israel, will strive to change that policy by joining with such organisations as Peace Now, B'tzelem, Rabbis for Human Rights, Jews for Justice for Palestinians, and the many others who believe that Israel's security is inextricably bound with that of the Palestinians. Competing interests: None declared |
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Maurice Conlon, General Practitioner Ridgacre House Surgery, Birmingham, B32 2TJ
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Editor: A simple truth: the single most effective way to improve health has nothing to do with medical advances; it simply requires the creation of prosperity. Should medicine and politics be mixed? The reality is that their separation, even were it desirable, would be impossible. Competing interests: None declared |
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Abhijit Bal, Specialist Registrar Aberdeen Royal Infirmary, AB25 2ZN
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Dear Editor, I do agree that medicine depends on political situation to a great extent. That however does not mean that a medical journal must dedicate space for political articles that may incite the readers to express their opinion one way or the other. Interstingly, the article on Palestine led to more responses than perhaps all other articles in the same issue of BMJ put together. So not only has BMJ wasted space, it has led people to devote more time to politics than medicine. By the time readers get over with the article on Palestine, the next issue is available and the chances are that the medical articles of the earlier issue were completely neglected by a vast majority of doctors. This is just a guess but I think it could be true. BMJ has not wasted precious space in one issue, it has in fact wasted an entire issue. Competing interests: None declared |
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Daniel Y. Ellis, Spr in Emergency Medicine Lister Hospital, SG1 4AB
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Dear Dr Abbasi, Are we to be grateful to you as acting editor of the BMJ for allowing a ‘Jewish’ doctor (in your words) to respond to Summerfield’s article? Actually, the flurry of activity in this week’s BMJ has proved rather well that the publishing of Summerfield’s uncorroborated diatribe was a mistake for which you still find yourself unable to apologise. In real terms Fellerman’s article is excellent and presents all the facts and all the evidence for everyone to see. But why are you publishing it, Dr Abbasi? Was it planned? Clearly not as the article is obviously written in response to Summerfield. So did you originally plan to publish something else to show the other side of the story? Past evidence from the BMJ would suggest otherwise. For example, the last Summerfield rant aimed largely at Israeli doctors and at the head of the Israel Medical Association Yoram Blachar (6th September 2003), only generated a handful of rapid responses. The BMJ graciously allowed Blachar to reply in print but also gave Summerfield another opportunity to rubbish him in the same issue. Not quite as even handed as one would expect. Your current editorial explains how the BMJ will not shy away from difficult issues. I agree, but difficult issues still require balanced articles and inaccuracy together with deceit should not be allowed to sneak in, even under the title ‘personal views’. Articles which give a fair and even-handed outlook on the situation in the Middle East would indeed be welcome. However, a quick search of the BMJ shows a penchant for anti-Israel articles and letters instead. (Summerfield, Halileh and Hartling, Hopkinson, Jabbour, Alofs, Bhutta – all easily referenced by searching the BMJ site.) I think we can safely assume that without the torrent of criticism directed at the BMJ for publishing Summerfield’s article we would not have seen any riposte, let alone Fellerman’s impressive article and it is that which I find disturbing. So the BMJ has seen fit to publish an accurate, referenced article on the Middle East and for this I suppose I should be grateful. Shame it required an international outcry to force you to act. This entire episode has been farcical and has allowed the BMJ to descend into the unpleasant world of the gutter press. For your part in this debacle Dr Abbasi, you owe us all, at the very least, an apology. Competing interests: None declared |
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Gabrielle J. Halpern, Dept. of Medical Genetics Rabin Medical Center, Petah Tikva, 49100, Israel
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Dr. Davies is entitled to his interpretation of the writings of Israeli journalists, but as with most things in this pluralistic country, there are several opinions ranging from the far left-wing to the far right -wing, with everything in between as well. The journalist Gideon Levy and newspaper Ha'aretz, quoted by Dr. Davies, are well known to be very left- wing, as are all the organizations he mentions (Peace Now, B'tzelem, Rabbis for Human Rights, Jews for Justice for Palestinians). Thus he is not citing middle-of-the-road journalistic opinion and is most certainly not quoting sources that are representative of the opinions of the majority of the Israeli Jewish population. In order to have a look at the "other" side, by which I mean a more balanced view with, admittedly, a right-wing slant, Dr. Davies would do well to read some of the articles in the Jerusalem Post, especially the excellent opinion by Evelyn Gordon in yesterday's edition (November 9). Dr. Davies talks about "Ariel Sharon's brutal policies" and the "barbarity of the treatment which Ariel Sharon is meting out to the Palestinians", but totally ignores the history. Yes, he concedes that "No one condones suicide bombing and the killing of innocent Israeli civilians", but apparently does not consider that we have a right to defend ourselves by doing our best to prevent such atrocities from being perpetrated. If his home city of Manchester (where I am also from originally) were plagued by the threat of terrorist attacks to the extent that he would be afraid to go out to restaurants, markets etc., or even to travel on a bus - which is very much the situation in Israel - I am quite sure that he would - completely justifiably - demand that something should done to prevent such attacks and protect the civilian population. Dr. Davies - please open your mind to the "other" side as well. We Jewish Israelis want peace every bit as much as you do, but if in order to appease the Palestinians and their supporters we have to commit national suicide, we are not prepared to play ball. We want to live too. Competing interests: I am an ex-pat British Jew now living in Israel |
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Mark Struthers, GP Bedfordshire, UK. mark.struthers@which.net
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As a practising GP, I wonder if I could be permitted to express utmost praise for this response written by retired Manchester GP, Hyman Davies – illuminated as it is by common sense and an understanding of the reality of Israel’s predicament. The election of Bush will give Israel four more years of freedom to act with impunity in the occupied territories, as Gideon Levy implies in his Sunday article at www.haaretz.com. George W Bush, the enemy of Israel, will undermine the secure future for the occupying society he purports to guarantee and anyway has no care for the population under a brutal occupation. Israel’s security is indeed inextricably bound with that of the Palestinians: that is the reality and there is no point in denying it. Competing interests: convinced that America is not a force for good anywhere in the world and that 'might' may be strong but it is wrong. |
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Mark Struthers, GP Bedfordshire, UK. mark.struthers@which.net
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Could I ask Gabrielle Halpern if she really thinks the right wing solution is actually working? Does she think the tit for tat retaliatory methods used by right wing leaders like George Bush and Ariel Sharon are going to bring long-term peace and security - such that she will feel free to buy vegetables without being blown up? I may be simple but I don’t understand how appeasing the Palestinians and their supporters would be committing national suicide. Is that perhaps another right wing nightmare inflicted on Israelis to keep them playing ball with Ariel Sharon’s brutal policies? That doesn’t seem like fair play to me – a game played by the international rules outside America. The right wing agenda makes America feel safe. Does it really make you feel safer in Israel? Competing interests: a Labour Party member until Britain dropped cluster bombs during 'Operation Iraqi Liberation'. |
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Gabrielle J. Halpern, Dept. of Medical Genetics Rabin Medical Center, Petah Tikva, 49100, Israel
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I would answer Dr. Struthers thus: it is painfully obvious that whatever one thinks about right-wing versus left-wing politics, not only has the left-wing ideology not brought a solution any closer, but it has caused immeasurable damage. The now all-but-defunct Oslo Accords, which were concocted by a group of left-wing politicians and ratified by Yitzchak Rabin, a left-wing Prime Minister, were a recipe for disaster. Ehud Barak, also a left-wing Prime Minister, offered Yasser Arafat 90% (later increased to 97%) of the land in the disputed territories for a Palestinian State that would exist alongside and at peace with the State of Israel. Arafat's response to this was to initate the second Intifada - otherwise known as a war - which has been going on for the past 4+ years with thousands killed and wounded on both sides. Any concessions offered by Israeli left-wing politicians have been regarded by the Palestinians as a display of weakness and an invitation to up the ante and demand yet more concessions. It was precisely because the Israeli public were becoming thoroughly fed up and disillusioned with left -wing ideology that in the last general election Ariel Sharon was elected with the biggest landslide in Israel's history. Dr. Struthers says that he does not understand how appeasing the Palestinians and their supporters would be committing national suicide. Very simple - the Palestinians have frequently admitted that their ultimate goal is to establish a Palestinian State on all (ALL) the territory between the River Jordan and the Mediterranean - i.e. including the territory which is now the State of Israel. Not to fight these Palestinian aspirations would indeed be committing national suicide. Talking of "brutal policies", what label would Dr. Struthers give to the terrorist groups (including Fatah, which is part of the Palestinian Authority) whose policies are to send suicide bombers with the aim of killing as many innocent civilians as possible? Competing interests: I am an ex-pat British Jew now living in Israel |
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Hyman Davies, retired general practitioner Manchester M25 0ET
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Dr Gabrielle Halpern appears to imply that there is some kind of stigma in being left wing and urges me to read the Jerusalem Post which has a ‘right wing slant’. I do not read the Jerusalem Post but I do read the Jewish Chronicle and this has more than a right wing slant, so I am blameless so far as looking only at one side of the argument is concerned. I never claimed that Gideon Levy and the other left wingers represent the majority opinion of the Israeli population. More’s the pity. If the majority of Israelis held Gideon Levy’s views they wouldn’t be in the mess they are in at present. It never ceases to intrigue me how a nation that can condemn a general (Ariel Sharon) for responsibility (albeit only indirect) for the massacres in Sabra and Shatilla refugee camps, can go on to elect that same person as its prime minister. Dr Halpern refers to Manchester and what it would do if it were subject to terrorism. Well, we did have an IRA bomb destroy almost the whole of our city centre, but we didn’t go into Ireland with helicopter gunships, tanks and bulldozers, murdering innocent Irish civilians, and razing their homes to the ground. The irrefutable fact, whatever wing your politics may be, is that Israel is illegally occupying Palestinian land, so to give them back their land is by no stretch of the imagination a matter of appeasement, and to talk about ‘the right to defend ourselves’ is akin to entering somebody’s house, occupying it, displacing the owners, and then complaining that the displaced persons are throwing stones in your windows. I fear that the kind of peace that Dr Halpern dreams of is one in which the land is ‘freed’ of Palestinians, and I am sure that that will not happen. Competing interests: None declared |
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Stefan P. Kruszewski, M.D., Addiction Psychiatrist Harrisburg, Pennsylvania USA
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Medicine and politics are obligatory companions, as inseparable as tea and biscuits. Although academic reactionaries and purists may argue that medicine should not be tainted by political agendas, rarely has this been, or is it, reality. (1) Medicine--as practiced in times and regions as diverse as pre- Christian Hippocrates, Freud’s Vienna or Massachusetts’s Back Bay--invokes relationships, all of them illustrating a political connectedness to governing authorities. When I hear fellow Pennsylvania physicians speak of politics in medicine, the substance often reflects those controversies that attract media scrutiny and hefty emotional responses: Fee-for-service vs. managed care reimbursements, Darwinian evolution vs. creationism, stem cell research vs. right-to-life arguments, clean needles for IV drug users vs. moral objections, and/or financial support for AIDS prevention and treatment vs. financial resources allocated elsewhere. However riveting are those arguments, it is the day-to-day interrelationship of politics and medicine---those that border on the mundane—that cement the relationship. The existence of that bond makes the case, at least for me, that our relationships to, and with, governing bodies are fundamental to medicine and therefore critical to medical reporting. (2) In psychiatric medicine, the evolution of this interrelationship, particularly as it pertains to 19th and 20th century U.S. federal and state policies, is highlighted by involuntary commitment, deinstitutionalization, Federal, State and private sector funding sources, psychiatric epidemiology and pharmacoepidemiology(3). As is true of both psychiatric and non-psychiatric medicine, our profession in Pennsylvania is licensed by authorization of the Department of State. The Secretary of State is an official appointment of the elected Governor. The regulatory oversight and management of conduct for practitioners of the healing arts (including medicine, dentistry, veterinary, podiatry, nursing, etc) is defined by Pennsylvania Code (applicable laws of Pennsylvania) as well as federal and local/community standards. Similar laws and standards define the compensation for our services from federal programs (Medicare), federally-subsidized state programs (Medicaid) and from private insurers who are under State and Federal licensing and regulation. Medical practitioners prescribe within the directives and guidelines of the Federal Drug Enforcement Agency (DEA) and, where applicable, individual state agencies that monitor controlled substances. (Not all US states have separate registries for controlled substances; Pennsylvania is one that does not.) Like its counterparts in the UK(MHRA, NPSA; others), our pharmaceutical and therapeutic prescribing habits have Federal watchdogs, including the U.S. Food and Drug Administration, multiple collateral advisory committees and Federally-funded programs that assist the process of research and information dissemination (National Institute of Health/National Institute of Mental Health/Substance Abuse and Mental Health Services Administration: NIH/NIMH/SAMHSA; others.) The American Psychiatric Association (APA) and its collaborative organizations devote a prodigious effort to legislative and political agenda. The current APA website’s Homepage highlights three “front and center” advocacy items: Endorsement of recent Congressional passage of an $83 million dollar ‘Suicide Prevention Bill’, and two subsequent links to the APA Advocacy Action Center and APAPAC, both sites that promote lobbying efforts on behalf of APA’s constituency. (4) Oversight regulation, advocacy and legislative agendas, investigatory and legal mandates underscore medicine’s inseparable coexistence with politics. With issues of medical record confidentiality, academic research freedoms, parity, tort reform, the involuntary commitment of individuals, the duty to warn, the continued evolution of Lyndon Johnson’s Community Mental Health Act of 1965 or George W. Bush’s New Freedom Commission’s recommendation to screen American’s youth for psychiatric disease, psychiatry is as much about legal and political agendas as it is about mental illness and mental health. Whether the issues pertain to psychiatry or non-psychiatric medicine, it is crucial for journals to discuss political trends and counter-trends in medicine---just as it is expected that they deliberate the epidemiology and pathophysiology of heart disease, cancer or schizophrenia. Medical journals and physicians would be well served, I believe, by confronting-- not denying--the issues and the political forces that shape them. REFERENCES: 1. Krakauer, E. Yale J Biol Med. 1992 May-June; 65(3):243-9. 2. Abbasi, K. Should journals mix medicine and politics?BMJ 2004; 329: 0-g 3. Center for Mental Health Services, Mental Health, United States 2000. Manderscheid, R.W. and Henderson, M.J., eds. DHHS Pub No. (SMA) 01-3537. Washington, DC: Supt. of Docs., US Govt. print. Off., 2001) 4. American Psychiatric Association Homepage, (Accessed 11.05.04) Competing interests: None declared |
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Mark Struthers, General Practitioner Bedfordshire, UK. mark.struthers@which.net
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Last night, I was lucky enough to be able to go out to see a new film about Peter Pan, a sad story of love, loss and hope for a future. It made me cry. One hundred years ago, J.M. Barrie, a Scottish dramatist, wrote this enchanting play, a fantasy around childish innocence. And on this day, Remembrance Day for the slaughtered of a century of war, I am reminded of Israel’s and Gabrielle Halpern’s tragic search for Neverland. I am sad and could weep for Ms Halpern that she is still afraid to travel by bus, eat in restaurants, watch cinema films and buy vegetables in the market in Tel Aviv. Israelis deserve peaceful, safe lives; Palestinians deserve justice. The brutal policies of the right wing are clearly not working now and cannot possibly bring a future free of violence. A policy of revenge will always be destructive and counterproductive to the desire for secure lives. The left wing move for peace need not have been a failure: it was not however pursued by Israel with any sincerity or integrity. The Israeli people should not indulge the politicians’ fantasy that Yasser Arafat - who died today – was the only leader who has failed his people, the Middle East and the whole world. That Neverland exists is all about believing. If you truly believe, anything is possible. I cannot believe that terrorising the childhood innocents of Israel and Palestine is the path to a New Jerusalem, the way to Neverland for Muslim, Jew or Christian. I pray that both sides in this perpetual conflict will grow in stature and maturity and stop this killing of the future and find their way to the promised Neverland. Competing interests: I believe in fairies and am clapping furiously to keep Tinkerbell’s light shining bright. I don’t believe America is a grownup. |
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