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THE PLEXUSThe NYU School of Medicine Journal of Thou ht
Loser
Doctor
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Weaving through much of the content of this issue is
the notion that physicians responsibility spans more than
just their immediate clinical or scientic endeavors. Ofcourse, this is nothing new. The concerns of those who
practice medicine can never be and have never been fully
divorced from the system through which care is delivered
or from the bioethical debates such delivery inevitably
engenders. Similarly, concern for the health of populations
has fallen squarely within the realm of the physician for some
time. Thus, most of us are probably fairly comfortable with
a physician who stakes positions on such health-centered
issues as the healthcare system, medical ethics, or public
health. Appropriately, all three of these topics are addressed
by writers in this issue of the Plexus.However, it is clear that there are potentialities for
physician input, advocacy, and activism within an ever wider
scope of affairs, regarding issues less directly related to the
day-to-day practice of most physicians, but equally essential
to the broader ethical framework under which he or she
operates. In this line of thought, a doctors responsibilities
are widened to issues of human rights, whether political,
economic or social. They would include those matters
which have profound ramications for human health: the
behavior of governments, the waging of wars, the treatment
of prisoners, and so forth.
Such a widening has both drawbacks and advantages.The former would be the complications involved in
politicizing ourselves professionally. Therefore, any
endeavors taken up by physicians would require a great deal
of partisan impartiality, factual clarity, and moral vision.
Conversely, given the voice and power that physicians
have, and given the enormous human costs or benets that
government action can effect, physician involvement is
critical if we are ever to effectively confront the epidemics
both biological and social that continue to plague us.
The Editors
THE PLEXUSVolume I, Issue 2
December, 2004
Board of Editors: Samantha Brenner (08),Adam Gaffney (08), and Al Garfall (07).
Contributors: Amber Alayyan (07), Cedric
Dark (05-06), ared Goldberg ('05), Varun
Sharma ('08), Jeffrey Shyu (08), and Sayone
Thihalolipavan ('08).
The NYUSoM Journal of Thought
All content is available online at http://
students.med.nyu.edu/plexus. Letters to the editor
should be mailed to [email protected], and
be no more than 200 words in length. Article submis-
sions should be rst discussed with an editor.
Contents of this Issue
Amber Alayyanblasts the Bush administrations choice for
he next Attorney General, Alberto Gonzales, by examining
his role in policies of torture and execution. From Naked
Statues to Naked Prisoners, page 2.
Al Garfall considers the role of the Catholic Church in
politics and the reelection of George Bush. When ReligionDictates Politics, page 3.
Sayone Thihalolipavan decries the basis of hate in this
poetic piece. Stripped page 3.
Cedric Darkcritiques the health reform proposals of both
he AMA and AMSA in this response to last issues health-
care debate. AMA and AMSA: A Plague on Both Your
ouses, page 4.
Varun Sharma argues that the errors of doctors are the trueculprit behind soaring healthcare costs. Medical Error: The
Source of Healthcare Woes, page 4.
Adam Gaffney looks into the past at the case of the Doc-
or-Statesman Rudolf Virchow to nd inspiration in a coun-
errevolutionary present. Politics and Physicians: Lessons
rom the Past, pages 5 to 6.
ared Goldberg examines the deleterious effects of alco-
hol on society and health, in light of a recent sports brawl.
Beer, Brawls and Basketball, page 7.
Samantha Brenner takes the pulse of the student body,
asking where students (claim) to study. The Halls of NYU-
SoM: Locations for Learning, page 8.
effrey Shyu reviews the philospoher Habermas most
recent look at the ethics of designing the newborn.Haber-
as, Human Nature and the Future of Liberalism, page 9.
Cover: Winner, Loser, Lawyer, Doctor: The Intersection of
Bush, Kerry, Alberto Gonzales and Rudolf Virchow at this
hour of American politics. All photographs public domain or
fair use.
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A
fter the presidential elections in
early November, Attorney General
John Ashcroft declared the countrysafe and then resigned. To ll Ashcrofts
post, President Bush has nominated White
House counsel Alberto Gonzales, a friend
and loyal supporter of the president.
Gonzales, like me, is from Texas.
He served as a partner in a Houston law
rm whose clients include Halliburton and
Enron. Gonzales served as then-Governor
Bushs general counsel and a Texas
Supreme Court Justice. As Texas Chief
Legal Counsel, Gonzales was responsible
for drafting legal summaries in 57 clemency
cases. He repeatedly failed to apprise Gov.Bush of critical issues regarding each case,
such as ineffective counsel, conict of
interest, and even evidence of innocence.
Bush used these memos to approve
executions (of which there were 152 in
his 6 years as
governor).
A s
White House
c o u n s e l ,
G o n z a l e s
m a i n t a i ned
his allegiance
to Bush and
his former
clients. He
argued with
C o n g r e s s
to keep the
details of Vice
P r e s i d e n t
C h e n e y s
e n e r g y
commission
m e e t i n g ssecret. He
has also
defended the administrations indenite
and ncommunicado detention of terrorism
suspects, who are labeled enemy
combatants and denied due process of
law.
Regarding the issue of torture,
Gonzales oversaw the development
of policies for managing prisoners in
Guantanamo, Afghanistan, and Iraq. In
a number of Justice Department memos
sent in 2002, Gonzales states that laws
against torture do not apply to the
Presidents detention and interrogation
of enemy combatants and goes on to
attempt to change the denition of torture.In a memo earlier that year, he called the
Geneva Conventions obsolete, writing
that because
the war on
terror is a new
kind of war,
the Geneva
Conventions do not bind the U.S. in the
war in Afghanistan (the third and fourth
Geneva Conventions initiated by the
UN and signed by the U.S. after WWII
dene the proper treatment of prisoners
and civilian populations, respectively, in political conicts). U.S. military and
government ofcials, including Colin
Powell, warned against this agrant
deance of federal and international law,
but Gonzales advised the President against
hese warnings, thus setting
he stage for Abu Ghraib.
One would assume
hat as the leading law
enforcement ofcer in
he country, the Attorney
General would actually
enforce the laws and legal
standards of the country.
lberto Gonzales has
lready proven himself
ncapable of upholding
such laws and principles.
is appointment to the
ofce of Attorney General
may be problematic and
potentially dangerous for
the country. The U.S.
cannot out international
law and then expect theworld to maintain the very
moral standards we ignore.
Physicians can play a role in
the torture of political detainees either
actively or passively. As we now know,
in Abu Ghraib and Guantanamo Bay,
U.S. military physicians were complicit
in acts of torture by denying prisoners
medications for existing medical
conditions, treating detainees so they could
return to interrogation, falsifying death
certicates to wrongly attribute prisoners
deaths to natural causes, and designing
and implementing psychologically and
physically coercive interrogations.
hysicians also play a passive role
in torture by not speaking or acting againstsuch acts. As future doctors, we are no
responsible for the exploits committed by
our military
but as a group
we will be held
accountable for
our actions or
lack thereof in condemning these methods
and deeds. The recent nomination o
Alberto Gonzales for Attorney Genera
provides each of us with such
opportunity to act against the militarys
practice of torture.
Torture, as an interrogation technique
has been shown to be ineffective in eliciting
accurate information from prisoners. As
physicians, we can work against this archaic
practice by documenting signs of torture in
our patients. More immediately, as medica
students we can actively condemn the
employment of torture by our military. A
number of people argue that writing letter
to senators and representatives is futile, and
on some issues, they would be rightbut
not on this one. The Senate will reviewGonzaless nomination to the appointmen
of Attorney General beginning in January
2005. We can, and as future physicians we
should encourage our senators to ensure
that the review of Gonzaless nomination
be thorough and fairexamining both hi
record and future plans for the Departmen
of Justice.
The following link is to a sample
etter drafted by the organization Human
Rights First. By providing your address
he letter will be sent to your senators onour behalf: http://action.humanrightsr
t.org/campaign/gonzales/
Human Rights First, Physicians fo
Human Rights, Amnesty Internationa
he AFL-CIO, the NAACP, and other
organizations have also signed a letter to
Senators Hatch and Leahy on the Senate
Judiciary Committee. The letter include
more background information on Alberto
Gonzales, and it can be found at: http
//www.phrusa.org/research/torture/pdf/
gonzales-coalition_041129.pdf
FROM NAKED STATUES TO NAKED PRISONERS
by Amber Alayyan
Political Matters
lberto Gonzalez as the Next Attorney General
Gonzalez being sworn in
as White House Council byCommander in Chief G.W. Bush
The U.S. cannot out international
aw and then expect the world to maintain
the very moral standards we ignore.
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As a member of that rebellious and
sinful 44%, Im a little sour over
he role our Church leaders may
ave played in Kerrys defeat.
by Al Garfall
S
ortly before the presidential
election, the Catholic Archbishop of
enver declared that voting for John
Kerry is a serious sin requiring confession.His exact words, as reported in the New
York Times, were: if you vote this way,
are you cooperating
with evil? And if
you know you are
cooperating with
evil, should you go
to confession? The
answer is yes. Other
bishops denied the Eucharist to Kerry and
other democratic politicians in their
dioceses. In Catholic dioceses throughout
the country, bishops spoke passionatelyabout the primacy of abortion and stem-cell
research, essentially instructing Catholics
to be single-issue voters on these so-called
life issues.
Its not surprising, therefore, that
Kerry, a Catholic himself, lost the Catholic
vote 51%-48%. Among Catholics that
attend mass regularly, the split was 55%-
44%. In Ohio, where Bush won overall
by 136,000 votes, Bush received 780,000
Catholic votes, 156,000 more than Kerry.
For comparison, both Bill Clinton in 1996
and Al Gore in 2000, neither of whom are
Catholic, took 53% of the Catholic vote in
their respective elections.
As a member of that rebellious and
sinful 44%, Im a little sour over the role
our Church leaders may have played in
Kerrys defeat. My politics aside, though,
I take issue with the idea of any single-
issue endorsements from religious leaders,
particularly from Catholic bishops.
Is it ever justied for a religious
leader to speak up politically? I hope so.
Rev. Martin Luther King Jr. comes to mind.Similarly, the Catholic Church has a long
history of speaking out and acting with great
inuence against tyrants and tyrannical
ideologies. Were a candidate or ideology
so clearly a paragon of either Catholic
virtue or anti-Catholic vice, I hope that the
Church would speak out. My view is that
the bar for such an endorsement should be
pretty high, though, because unlike voters,
the Church is under no obligation to choose
sides. While politicians and political
parties cannot function without bending
their values here and there, the Church
can continue its ministry and maintain its
positions on issues without compromising
its principles to endorse a candidate on a
single-issue basis.
Was either John Kerry or GeorgeBush so in line with the Churchs ideals
so as to deserve its endorsement? Without
going into too much
detail, the answer is
clearly no. Kerry is
unabashedly in favor
of stem cell research
nd is pro-choice.
While Bush is pro-
life on stem cell research and abortion, his
other policies fall far short of the Churchs
ideals on issues like the death penalty,
economic fairness, and the integrity of the
social safety net. Interestingly, even Bushs
position on abortion is too liberal for the
Catholic Church because Bush makes
exceptions for rape and incest.
The standard explanation the Churchoffers for its endorsement is that these life
issues trump all others, which I suppose
excuses Bush voters from having to go to
confession for the evils with which they
knowingly cooperate. I question the
sincerity of this explanation, however
because it lets politicians off the hook to
engage in a patently un-Catholic mora
calculation as they stake out their positions
For example, if I were a politician and I
wanted the Churchs endorsement, how
Political Matters
When Religion Dictates Politics
Continued on page11
3
by Sayonne Thihalolipavan
What if you were stripped of every single one of your human rights?
Freedom of expression, health, maybe even your life?
Would you remain silent, or protest the strife?
Knowing that prejudices prevent breathing in the beauty of THIS room
since education is not deemed worthy as a right.
In a cloudy, sinister fog of civil unrest,
South Africans endured a life of torture, detest
In hopes of experiencing a lucid, serene night
What if YOU were stripped of every single one of your human rights?We habitually take for granted the entitlements given upon birth;
Yet human rights are violated uncaringly throughout the world
Why hate, discriminate? Because it is effortless.
We must expand energies to embrace diversities,
Become knowledgeable, celebrate human peoples, take political
Action, admit biases, and forgive. Oh lord we must forgive!
Molecularly we are 95% similar in DNA,
Realistically why must we trip over the 5 that remain.
Prejudices may lead to poverty and lack of equality,
You can take my property and privacy but you cant take away my dignity;
I will rise against your hate and use your own abhorrence to ame my retaliation
Claiming my birth right of international amnesty
Sticks and stones may break my bones,
But unsaid words will permanently disgure my soul.
Discrimination will only lead to elimination of the human race
Like a prophecy rights will unfold whether through actions mine
Or my soul reborn in future generations
ou loathe me. ove you, fellow, human brother, but despise your actions
What if I was stripped of every single one of my human rights?
I would cry...in hopes that you heard my pain and would help heal my plight
Because before race, color, religion, and everything else that separates us,
We are human.
This spoken-word piece was performed at the NYU SoM Coffeehouse Event on 12/01/04
STRIPPED
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by Varun Sharma
The most interesting thing about the American health
care system is that it is one sector of the economy whereconsumers believe they can get something for nothing.
People want health insurance, but no one wants to pay for it. While
both the AMA and AMSA pose solutions to the problem of 45
million uninsured, neither proposes truly viable options. AMSAs
proposal is too radical to garner signicant congressional support;
AMAs proposal does little to affect health insurance status and
more to cut taxes.
It is far easier to debunk the myth that Medicare for all
is the solution to the plight of the uninsured. In reality, all you
Physicians for a National Health Plan (PNHP)-junkies out there
should really advocate for Medicaid for all Medicaids benets
are far superior to medicares.
But why is AMSAs approach utterly unrealistic? On paper,a single-payer health system with basic benets guaranteed to all
Americans looks beautiful. But so too did the concept of bringing
Joe Gibbs,
B i l l
P a r c e l l s ,
and Tom
C o u g h l i n
to the NFC
East. We all
know how well that went. Although, many in DC myself included
are still pondering an 8-8 record with a potential wild card spot.
So if they get the wild card, should we consider introducing that
single-payer bill in the next Congress and see what happens?
Realistically, in order to enact such as system, you would have to
alter the anti-tax individualism of the American psyche.
The AMSA plan is basically a reiteration of the Physicians
for a National Health Plan (PNHP) strategy of 1989 and 20032.
First on this agenda is the imposition of global budgets on
hospitals. Additionally, the AMSA/PNHP plan would regulate
capital costs as a means of controlling the medical arms race
between competing hospitals. This will cut costs, but it will
introduce inequalities between facilities and may also stie further
technological advances.
AMSA/PNHP also wants to eliminate any cost sharing, i.e.
payment of some percentage of healthcare costs at the time ofservice. This is, in my view, the worst idea proposed. Cost sharing
represents one of the best means to limit health expenditures. Its
effects are also unfortunately overly oppressive to low-income
persons. But if you keep cost sharing, means test it, and cap the
amount any one person must pay out-of-pocket throughout the
course of the year, health expenditures will stay down and people
will be relieved of nancial stress.
The AMSA/PNHP plan is remarkably lenient towards
physicians: we would retain the freedom to practice fee-for-
service (which fosters over-utilization), salaried (which fosters
by Cedric Dark
Continued on page 10
I
s health care a right or a privilege? That simple question can
illicit a very passionate response from almost anyone, but really
the debate is largely irrelevant. Healthcare now takes up 15% of
our GDP and is projected to drain 30% of our GDP within the nexfew decades. At 30% of GDP, there just simply will not be enough
money to pay for healthcare regardless of how loudly we scream
nationalized or
privatized.
Bureaucracy
nd administrative
costs are commonly
targeted as the
culprits behind the
rise in healthcare costs, and rightly so. However, the true problem
s more deeply rooted. Carelessness, poor judgment and poor
treatment by doctors, combined with the inefcient managemen
of hospitals, amounts to billions in wasted dollars, and worseclose to 100,000 avoidable deaths every year.
One reason for the very sloppily-run state of health care
s due to inherent characteristics of medicine itself. Medicine
nvolves providing a service to a largely uninformed consumer
population, rendering them almost completely dependent o
their supplier. A patient has little input with regard to the tests
nd treatments he must pay for. This imbalance of power has
helped foster a culture in medicine of poor communication and a
ack of accountability. There is little way to effectively evaluate
the performance of doctors and hospitals. This has left the task
of holding doctors accountable to malpractice lawyers, a system
which in the end only serves to raise the costs for patients.
On top of all this, within the last decade, the powers doctors
did possess to order diagnostic tests and treatment options have
being transferred to the middle men. Insurance companies ar
dictating the terms under which doctors can practice medicine
by constraining the time allotted to doctors per patient, and by
imiting the diagnostic tests and treatments doctors can provide
ultimately compromising patients care. This has done nothing to
meliorate healthcare spending and has only served to aggravate
patients and undermine doctors.
Unfortunately, hundreds of thousands of avoidable deaths a
year is not enough to warrant enough panic to change the system
but the rising and unsustainable costs of healthcare will hopefully
be enough of a wake up call. This is too important of an issue to beeft to the politicians and lobbyists. It is doctors who must commi
to changing medicine from the inside. A way must be found to
bring back power to doctors so that they can practice the medicine
they deem best and patients must be empowered to choose the
best possible care for themselves and their families. The bitteres
pill will be difcult for doctors to swallow, but the time has come
to try ideas like opening up doctors records to evaluation, and
ncreasing the competitiveness between doctors and hospitals
The solution to the nations healthcare woes does not revolve
round nding ways to allocate health insurance, but in trying new
deas to radically reform the way medicine is practiced.
edical Politics
AMA AND AMSA:A Plague on Both Your Houses
4
Medical Error:The source of healhcare woes
Carelessness, poor judgement,
n poor treatment on t e part
of doctors amounts to billions in
wasted dollars.
Cost sharing represents one of the best
means to limit health expenditures. Its
e ects are a so un ortunate y over y
oppressive to low-income persons.
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prize winning Laurie Garrett devastatingly
documents in her book,Betrayal of Trust
The Collapse of Global Public Health
the American public health apparatus
s alarminglyunprepared for the
slew of dangers
e face, from
bioterrorism to th
emergence of drug
esistant HIV and
uberculosis.
ut still, we continue to do little, or
nothing.
In short, given a modicum of the
depressing images and numbers tha
inundate our airwaves, newspapers, and
medical journals, many of us cannot help but see our current course as absurd and
self-destructive. We are forced to re-ght
the battles of a hundred years ago. This
would be disheartening enough, were
not the stakes so much higher today, in
the nuclear age, in the age where human
beings are now the primary mover o
nature. The reactionary right conveniently
denies problems or our ability to solve
them, and the postmodern left all too often
forgets its priorities or loses its resolve
The opposition seems omnipotent, and so
the question remains: what can we do in
these dim days?
erhaps I have painted a picture
somewhat too dark. One could write
equally emphatically on the medica
gains of the last few decades. However, it
seems that while medicine has advanced
enormously technologically, progress
socially has simply not kept pace.
To gauge our progress, and provide
some context for our current predicament
it might be worthwhile to change gears and briey turn to history. Lets look back t
the nineteenth-century and consider the
case of one of medicines most brillian
minds, the German doctor-statesmen
Rudolf Virchow, born in 1821.
Scientically speaking, Virchows
achievements are undeniable. Three years
from medical school, Virchow had made
two of his major discoveries, the rst of
leukemia in 1845, and the second of the
processes of thrombosis and embolism
such despair, then, is a sense that almost
everywhere, the illiberal, the discredited
and the delusional are on the march.
Each day our nation seems more deeply
sucked into an imperialadventure gone awry.
We watch a US soldier
empty bullets into an
unarmed man, while
talking heads defend it.
We read about torture
at Abu Ghraib, and
then learn that a man who all but legally
approved of such actions will probably be
our next Attorney General.
With our eye xed on war, concern
for the cultivation of our childrens minds,
our environment and our public healthsuffer. Anti-evolution teaching creeps
back into public schools (Badkhen, Anna.
Anti-evolution teachings gain foothold in
U.S. schools. San Francisco Chronicle,
November 30, 2004). An overwhelming
scientic consensus on the massive dangers
of global warming is inexplicably rivaled
by those who alternately deny its existence
or would, in a single breath, agree that it
exists while assuring us of its benecence
to the world economy. Our public health
system deteriorates, while the ranks of the
uninsured continually rise. As the Pulitzer-
Physicians and Politics:Lessons from the Past
by Adam Gaffney
Continued on next page
What overwhelms so many with
uch despair, then, is a sense
hat almost everywhere, the
lliberal, the discredited and the
elusional are on the march.
edical Politics
5
The collective despair that has gripped
much of the nation since November
2 can not be wholly attributed to
electoral defeat. Elections are bought orwon and politicians rise and fall: what is
most disheartening today to progressives is
not merely the loss of a political campaign,
an experience with which they are all too
familiar, but instead a sense that they
have lost hope itself. The replacement
of the incumbent-in-chief might entail
continuities, but also unpredictability: who
knows what changes determined activism
and a more consciousness President could
bring.
Instead, the status quo has
endured, and any battle now to be fought by progressives will be one solely
of reaction and resistance. However
successful campaigns to limit healthcare
cuts, slow the rollback of constitutional
protections, or diminish the degradation
of the environment might be, our very
success will still signify an overall
failure. Depressingly, liberals are the new
conservatives (in seeking to maintain a
moderate past), for conservatives have
become revolutionaries, albeit quite
reactionary ones.
What overwhelms so many with
The Commander-in-Chief addresses the troops.
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edical Politics
Most prominently, Virchow is considered
to be the father of modern pathology. In
his day, much of disease theory was based
on Humoral Pathology, the truly ancient
concept that an imbalance of the bodys
so-called four humors was the underlyingmechanism of all disease. His actions did
much to conclusively quash this age-old
quasi-scientic quackery, and replace it
with something quite new. The cell was
to be studied as the basic unit of life and
the underlying site of disease; cellular
pathology was born.
While these scientic achievements
were certainly historic, it is his medical
philosophy and action which serve as an
example of the best of his time, and to
which we now turn. Indeed, it reects
badly on our own time that we are stilllargely outthought by Virchow and some
of his contemporaries of more than 150
years ago. Virchows political upbringing
occurred in an extraordinarily volatile time.
In 1848, the old reactionary and oppressive
European despotisms and monarchies were
swept out of power in a long-awaited and
massively popular democratic revolution,
which blazed through the continent in
a matter of weeks. One by one the old
regimes fell, with workers, students,
professionals, and scientists, including
our Virchow, manning the barricades: this
was the so-called springtime of peoples,
and hopes and dreams were soaringly high.
Virchow himself was extremely active and
optimistic with this democratic opening.
It was, however, not to last: in 1850, the
old regimes
regrouped,
m a r c h e d
and regained
p o w e r ,
those of
revolut ionw e r e
e n t i r e l y
annihilated,
and all changes and dreams with them.
Virchows involvement with the
revolution of 1848 was only part of a
lifetime of activism. Before and after,
he took part in the Medical Reform
movement which took root in his day and
sought to remake the role of the doctor
in society. Among his various proposals
aimed at improving the professionalism
of the physician, Virchow
was a visionary public
health advocate who made
associations between
socioeconomic condition
and disease that many of
his contemporaries could
not. Most famously, in 1848the Prussian government,
apparently unaware of the
politics of our doctor, naively
sent him to report on a
devastating typhoid epidemic
that was sweeping Silesia.
The government was surely
alarmed when he released his
report: not content to merely
detail the epidemiological
aspects of the epidemic,
Virchow publicly lambasted
the government: he blamedthe economic, political
and social injustice of
the Prussian despotism
for the ravages of the
epidemic. Virchow understood the social
underpinnings of disease: he wrote of what
he called articial epidemics, which
could be overcome by social change:
the improvement of medicine would
eventually prolong human life, he wrote
but improvement of social conditions
could achieve this result more rapidly and
more successfully.
Some of his positions of more than 150
years ago remain relevant today; indeed, we
have done very little to fulll them. In the
German journal edical Reform, Virchow
advocated the constitutional right of an
individual to
h e a l t h c a r e
- everyone
should receive
[healthcare]
according to
his needs- while today
healthcare is
c o n v e r s e l y
becoming a right only of wealth
(Ackernknecht, E.H. Rudolf Virchow:
Doctor, Statesman, Anthropologist.
Madison: The University of Wisconsin
Press, 1953). He favored prison reform and
saw the penitentiary system as a massive
public health failure; unfortunately, this
too remains unchanged, as documented by
Human Rights Watch among others, our
prison system remains a moral atrocity
the mentally ill are locked away in abusive
conditions, we turn a blind eye to torture
and rape, and treatment for AIDS and other
deadly ailments is often denied to inmates
In many ways he epitomized medica
humanism, and whether in his opposition
to the death penalty or the public health
absurdities of his time, he was on the
vanguard of nineteenth-century medica
thought.
Virchows advocacy was not
however, limited solely to the pen
and he continued to see his civic and
political responsibilities as inseparab
from his medical ones, even after the
failure of 1850. Following a period in
exile (after the return of the autocrats)
and an understandable period of lessened
politicization, Virchow participated in the
formation of the Progressive Party onceconditions in Germany permitted his return
to politics and Berlin. In his capacity as
a legislator and a city council member
Virchow transformed Berlin into a modern
city. In 1860 Berlins sanitation system had
undergone little evolution since the middle
ages, with sewage routinely dumped in
the streets and contaminated water widely
consumed. Through careful study and
political persistence, Virchow successfully
authored a vast public health effort that
With the political tide owing in his
direction, Virchow articulated and forwarded
he best ideas of his contemporaries. And
with the political tides running against him,
his determination did not wane, and hefought for the principled opposition.
Continued on page11
6
VirchowContinued from page 5
Virchow, the physician-advocate.
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edical Politics
Continued on page 10
I would much rather be seated next
to somebody who has a passion for
he game, than next to a raucous
drunk with a wanton disregard for the
consequences of their actions.
A little wet behind the ears, Artest?
I
t was only tting that, of all places, I
found myself at a bar while watching
the replays of the ght breaking out at
the basketball game between the DetroitPistons and Indiana Pacers. People stood,
some cheering, some speechless, while the
scene of professional athletes ghting with
spec ta tors
u n f o l d e d .
This scene
has since
b e e n
r e p l a y e d
c o u n t l e s s
times as
commentators discuss who was right andwho was wrong; who should be deemed
guilty and who spared from judgment;
and who was punished justly and who
got off too easy. As an ordinary, curious
individual (and a fourth year with, perhaps,
too much free time), I have watched
replays of this scene many times. What
strikes me each time, however, outside of
the agrant violence, is the amount of beer
that I see being poured by the fans all over
the place.
Alcohol and sporting events seem
to go hand in hand these days. Withthe amount of advertising that alcohol
companies and professional sports do
together, it is hard to imagine professional
sports existing without alcohol. Is having
the access to alcohol at sporting events a
basic right? Is it a necessity? Or should it
be banned? As a kid growing up, I recall
the joy of watching professional football
and baseball. Going to the stadium to
watch a game was such a thrill. The joy
of the sport itself was all I needed for
entertainment. Is that no longer the case?
Is it possible to enjoy watching a game ifa bottle (or several bottles) of beer cannot
be imbibed? Perhaps banning beer sales
at sporting events would cause only true
fans, who have a love of the game and
sportsmanship, to attend. Maybe the
economics of professional sports in this
era will not allow for this. But as a sports
fan, I would much rather be seated next
to somebody who has a passion for the
game, than next to a raucous drunk with
a wanton disregard for the consequences
of their actions. Make no mistake: I am in
no way defending the action of the players
(who were not drinking alcohol) involved
in this event. Nor am I saying that alcohol
is, alone, responsible for what took place.
However, alcohol undoubtedly played a
signicant role in dening the events of
that night.
The problems with alcohol that
are manifested at
sporting events are
merely a reection
of those affecting
the rest of our
society. Alcohol
burdens our society
with needless
violence, crime, and health problems. It iseasy to suggest that people be responsible
when they drink. The problem is that when
people are not responsible, it is the rest of
society that suffers the consequences. In
1998, alcohol abuse cost the country over
$180 billion. Studies in 1995 showed that
25 to 40 percent of hospital beds were used
for treating those with complications of
alcohol abuse.
And each year,
over 16,000
people are
slaughtered indrunk driving
crashesmany
of whom are
innocent victims
caught in the
wrong place at
the wrong time.
Unfortunately,
for most, the
mentality is that
alcohol abuse is
not a problem -
until something
happens to a
loved one.
As a
result, society is
too accepting of
the consequences of alcohol. Lawmakers
and alcohol companies ght to secure the
right to abuse alcohol, while the safety
for the rest of us is neglected. Back in
my home state of Maryland, where I have
testied at legislative hearings to support
stronger drunk driving laws, it was no
until the Federal Government threatened
to withhold millions of dollars per year
that the legal limit of alcohol for driving
was lowered from 0.10 to 0.08 percent
Does anybody actually think it is safe to
drive with a blood alcohol level of .08?
Say what you will about my home state
but Marylands drunk driving laws are on
par with those of the rest of the country
What is more frustrating is that there are
devices available that could stop drunk
drivers from being able to get behind the
wheel. Ignition interlock devices require
that the driver provide a breath sample
that is alcohol-free before the car can be
started. Such a device would surely save
countless lives annually. Unfortunatelysociety seems more concerned that ignition
interlock devices impinge on their civi
liberties. Protect the liberties of the
drunk drivers. Forget about my freedoms.
The fact remains that alcohol is a
drug. As such, we must respect it as a
drug, and hold it to the same scrutiny to
which we hold other drugs, by recognizing
the benets i
provides,
more importantly
by being wa
of its adverseeffects. I am in no
way advocating
turning the clock
back to the er
of prohibition
If people wan
to enjoy alcoho
responsibly, they
should be able to
do so. However
it means tha
we all have
certain societa
responsibilities.
As future
physicians,
will have the
o p p o r t u n i t y
and duty, to identify patients with risk
factors for alcohol abuse. In this role, i
is imperative that we intervene in these
situations before it is too late and make
sure that patients get the proper treatment
7
BEERS, BRAWLS, AND BASKETBALLby Jared Goldberg
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From the Halls of NYUSoM
LOCATIONS FOR LEARNINGhere do you like to study, and why?
enjamin Young, 06
Amber Wheeler, 07When Im informally
studying, Ill study
in the library by the
computers, and then,
w en t e ru er ts t e
road, I switch to AHC.
My room easier
access to snacks and
T.V. and things to help
me procrastinate.
Bo Chen, 07
Bobst 10th oor, facing
the big windows you get a
great view of the skyline.
Kira Zavilevich, 06
owntown n o st.
like to get away from
the medical center. I
like the downtown area
and the library doesnt
feel so clausterphobic
with the natural sunlight.
Clarence Lin, 08
Coles conference rooms
I think its just right: not
too noisy, not too quiet.
risty Ahrlich, 06
My room because
theres no one to drive
me crazy there. Theres
nice distractions, if
on t wanna su y, on
have to. If I get really
esperate, c ean.
Sandra Kamholz, 08Bobst for the view
of Washington Square
ark, and the distance
from the medical
school. The natural ligh
s a g p us.
oto Po Con ucte y Samant a Brenner
Cedric Dark, 05
Some place you dont falasleep. You gotta have
your creature comfor
while you study. Hence
I prefer Starbucks.
have never been a
library person. Just don
order the vanilla cream
because its warm milk
and itll put you to sleep.
8
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NYU Med Book Review
J
rgen Habermas, eminent German
social theorist, joins the contemporary
bioethics debate with a collection of
three lectures in The Future of Human
Nature. It is an interesting book, and I
have summarized
some of the main
arguments and offer
a brief response.
In it, he
argues against
liberal eugenics
the right of parents
to program the
genomic blueprints
of their children. Heregards eugenics as a potential restriction
on the unborn programmed individuals
freedom to choose their identities and their
life courses: that is to say, their status as
moral beings is in danger. And as society
is constituted by moral beings interacting
with one another, this threat deeply
challenges the liberal values of freedom
and equality, as well as the rationale for
why we should be moral at all.
In our postmetaphysical world,
persons may no longer rely exclusively
on a single ontological narrative or divine
inspiration for moral
guidance. Modern
society is constituted
as pluralistic, and a
constitutional state must
take a neutral position
towards opposing
worldviews to secure
the human right to
individual autonomy.
For Habermas, what
grounds this view
is a species-ethic,
or the ethical self-
understanding of
the species our understanding of
what it means for us to be human. A
rationality conceived from intersubjective
communication is what creates and sustains
the species ethics. But within this ethic isthe understanding that we are the authors
of our own lives, and since other people are
authors of their own lives as well, we must
treat them as equal members of society.
Therefore the underlying sustenance of
the species-ethic is our subjective ability to
view ourselves as free and self-actualized,
and thus moral, agents.
Habermas sees the contingency
of birth as a crucial element of what it
means to be moral and human. However,
advances in genetic technology will soon
remove births contingency, and parentswill have the potential to articially design
their children. Although he is in favor of
therapeutic eugenics (i.e. to treat serious
monogenetic diseases) using an argument
of future informed consent, Habermas
opposes the enhancing type of eugenics
(i.e. modifying the genome for enhancing
appearance, intelligence, musical aptitude,
etc.). He bemoans what he describes as the
instrumentalization of the species. By
allowing people to mold their children for
preferential traits, the children become the
objects of the parents preferences. This
restricts the ability of the children to develop
an individuated ethical self-understanding
Species instrumentalization also results inthe obfuscation of the subjective-objective
distinction. A human life becomes no
simply an end to itself but a product of
technology.
abermas also contends that libera
eugenics creates an intergenerationa
asymmetry that threatens the egalitarian
foundation of liberal society and the
constitutional state. How so? Mora
beings are required for a society founded
on freedom and equality. Moral beings
are presupposed as autonomous and free
and so we are required to respect theself-understanding of other moral beings
Genetic intervention leads to the creation
of people who may not be able to achieve
these prerequisites for moral determination
This disrupts our ability to see these people
as agents of moral action and judgment.
ut why is the contingency of birth a
truly necessary component for the formation
of moral individuals? Throughout history
conceptions of what constitutes a mora
individual have changed in a manner tha
by Jeffrey Shyu
Habermas: On the Instrumentalization of Species
One could argue that a parents
overzealous efforts at training his or
her children into gifted musicians or
thletes is not all that different from
modifying their genomes before birth
o give them a predisposed aptitude
for these abilities.
Continued on next page
9
The Future of Humanature
y Jurgen Habermas$49.95
Polity Press
Habermas in his study.
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laziness), or capitated (which fosters
under-utilization). If I were emperor of the
medical world, I would make primary care
physicians either capitated or salaried and
let specialists function at fee-for-service
rates. All hospitalists should be salaried.
One more thing - forget institutional long-term care. It just costs too much.
The AMA proposal has its own
problems. This is basically the GOP
viewpoint
that almost
all of us will
share once
we stop
r e c e i v i n g
loans and
climb the
tax bracket.
As nosurprise to
anyone, the AMAs big thing is tax credits.
Aside from the fact that only thirty-three
percent of the uninsured are likely to take
up any credits offered , there are other
problems lurking.
The rst major hurdle to effective
tax credits is that it comes nowhere near
covering the full cost of a health plan
in the twenty-rst century. The average
family plan costs almost $10,000 today,
and the tax credits offered (according to the
President) will pay approximately 3,0004.
Fortunately, the AMA is not as nave.
Their position clearly states that effective
tax credit policy will require signicant
subsidies to the low income earners (up to
100% of the cost).
Another criticism of the AMA
strategy is that the people who will likely
take advantage of the tax credit will
probably already have insurance. Yes,
some of the 45 million uninsured will be
covered; however, many people already
with insurance will simply receive a backdoor tax cut. The primary beneciaries of
these tax credits would still be low-income
individuals earning less than 20,000 and
families earning 30,000-40,000 per year.
Another point, which the AMA poorly
elaborates, is that these tax credits must be
received in a fashion where they are only
useful for health insurance. That is, these
tax credits cannot be used to purchase
other goods. To accomplish this, vouchers
are key.
The AMA plan also emphasizes
consumer choice in insurance companies,
which is not necessarily a good thing. In
the language of the eld, choice equals
fragmentation of the risk pool by the forces
of adverse selection. In other words,
given the opportunity, those most at risk
and those at least at risk will choose to
buy into different plans according to their
needs, thus fragmenting the risk pool.The smaller the risk pool, the larger the
costs; the larger the risk pool, the smaller
the costs. Therefore, too much choice is a
bad thing.
Ultimately, however, choice
also means that some will choose
to go without insurance. An easy
way to x this would be to mandate
insurance on the individual. We do
it for cars, why not for health?
any solutions have therefore
been offered for our patchwork
and complex healthcare system.What should be realized is that
political compromise is necessary. While
a single-payer system seems ideal to some,
signicant opposition will arise; too many
players have too much too lose. It is in the
spirit of incremental change, as the AMA
plan suggests, that real change will happen
to our healthcare system. Nevertheless
AMSA should retain single-payer as
its long term, audacious goal. AMSA
must, however, work for smaller, but stil
signicant, reforms. Before universalizing
healthcare for all, let us make it universa
for children as it is now for those above
age 65; let us make it universal for HIVpatients as it is now for those with ESRD
Most importantly, AMSA must continue to
ght for its long-term goal because many
including the AMA, will too easily be
satised with the relatively minor steps
along the way.
References1 NEJM. 1989. 320: 102-8.2 JAMA. 2003. 290: 798-805.3 Health Insurance Survey. Kaiser Family
Foundation. April 2004. Available at: http//www.kff.org/healthpollreport/archive_
April2004/12.cfm4 Ofce of the White House Press Secretary
Making Health Care More Affordable
Available at: http://www.whitehouse.gov
news/releases/2004/09/20040902.html Sep
2, 2004.
HabermasContinued from page 9has resulted in greater inclusiveness. It is
quite conceivable that our species-ethicwill change again to include those who
have their genetic codes programmed.
And have we not seen similar arguments
before, in response to test tube babies and
so on? Their unnatural origins have not
threatened the moral foundation of society.
How is preimplantation genetic diagnosis
fundamentally different?
One could argue that a parents
overzealous efforts at training his or her
children into gifted musicians or athletes
is not all that different from modifying
their genomes before birth to give them
a predisposed aptitude for these abilities.
Habermas distinguishes the two by arguing
that whereas it is possible for a child to
reject the social intervention of the parents,
the latter is irreversible. However, logically
it is possible to reverse a genetically
arranged aptitude; after all, doesnt
therapeutic gene therapy strive to correct
the genetic mistakes that otherwise result
in terrible diseases?
AlcoholContinued from page 7
Ultimately, however choice also
means that some will choose
o go without insurance. An
asy way to x this would be
o mandate insurance on the
individual. We do it for cars,
why not for health?
AMSA vs. AMAContinued from page 4
and support before they seriously hur
themselves or somebody else. At the
present time, there is still plenty that w
can do, such as setting good examples
and keeping our friends out of dangerous
situations. This responsibility may be as
simple as taking the car keys away from
a friend who has been drinking, or telling
them to refrain from that nal drink of the
night. Sometimes such simple acts that can
make a substantial difference. During thi
upcoming holiday seasons travels, I can
only hope that the other drivers with whom
I am sharing the road have had that kind ofguidance.
break?
TE F T P EX
Sub issions for the January
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remade the citys sewers, thereby greatly
reducing the transmission of infectious
disease in the rapidly growing city.
Finally, and perhaps most signicantly,
Virchow remained an opponent of the
gathering authoritarianism, imperialism
and militarism of the German government,
as a consistent foe of its archconservative
uniter, Otto van Bismarck. His biographer,
Ackernknecht, asserts that the Progressive
Partys constitutional resistance to
Bismarck, under Virchows leadership,
was the nal attempt of the German
middle class to oppose Bismark on a large-
scale in the political arena. Given the
future authoritarian plunge that Germany
would later undergo in the 1930s (withunforgettably grave ramications for the
world), this is no small thing.
I believe these to be important
considerations given our current political
predicament, with all of its ramications
for human health and well being. With
the political tide owing in his direction,
Virchow articulated and forwarded the
best ideas of his contemporaries. And
with the political tides running against
him, his determination did not wane, and
he fought for the principled opposition,
while enacting practical reforms. Despite
my uneasiness with drawing analogies
from history, we might agree that his
steadfastness provides us with a valuable
model, and a suggestion for a way out of
despair, and into the future.
This historical summation hasthree purposes: one, to present what I
consider to be an admirable gure, who
we might agree reects the potential and
responsibilities inherent in the profession
of the physician; two, to demonstrate
our failure to progress beyond what the
medically astute were demanding more
than a century and a half ago; and nally,
to again posit the inextricability of the
political/social tasks of the physician, with
his or her medical ones.
The challenges of today and
tomorrow are frighteningly immense, and
the injustices and microbes that aficted
Virchows world continue to plague our
own. Human beings greatest epidemic,
war, continues to mock our purported
advancement. And the forces of reaction
are as powerful as ever.
Informed, organized, and devoted,
American physicians might pose an
enormously powerful force in resisting the
coming regression, and then proactively
confronting the injustices of our day. We
certainly have diverse political views
something both inevitable and benecial
and doubtless there are many who disagree
with not only the propositions presented
here, but also those of Virchow himself
So be it. Let us argue and nd a common
denominator of agreement. But we must be a louder voice on the profound issue
of our day. We are unlikely to shift the
tide of history if our greatest, most urgen
and most emotional political concern is
increasing Medicare rates or establishing
malpractice caps.
There is more hope and power in
science yet to be unleashed; perhaps even as
Virchow put it, may it remain for science
to treasure and to bring to realization the
beautiful motto: Peace on Earth (Nuland
S.B. Doctors: The Biography of Medicine
New York: Vintage Books, 1995.)
Catholics & Kerry cont. from pg 3)
many mentally retarded criminals would
I be allowed to sign death warrants for if
I promised to vigorously oppose stem cell
research? If a politician wants the bishops
to call a vote for his or her opponent a sin
but also wants to launch a war that violates
the Churchs just war principles, how many
pro-life judges does he have to promise
to nominate? Answering these absurd
questions requires a messy utilitarian
worldview that the Pope has passionately
spoken and written against. Yet, these are
exactly the questions that politicians will
now ask themselves, thanks to the Churchs
posturing during the 04 campaign, as they
plan their strategy to win the Catholic
vote.
I believe the Church will eventually
pay dearly for its decision to play power
politics. First, it will soon nd that the lifeissues, which the Church hierarchy spoke
about in such simple and unequivocal
terms, are complicated. If preliminary
analyses are correct, abortion rates in many
states have risen during Bushs rst term,
reversing a ten-year declining trend. Based
on the experience of more liberal countries
with legal abortion, better social support,
and lowerper capita abortion rates than the
US, this may be
due to economic
d e t e r i o r a t i o n
during Bushs
rst term. ShouldBush voters go
to confession
for all the extra
abortions that
might take
place during
his second
term, during
which he may
i n a d e q u a t e l y
address social
conditions that
are associated with abortion? I dont think
so, but by the Churchs new spreadsheet-
style morality, wouldnt they have to?
Second, politicians are much less
likely to take the Churchs views seriously
now that it has been manipulated so easily
in the 2004 election. Democrats wil
likely consider the Church hierarchys
consideration a lost cause, and Republican
will quickly learn that some
empty pro-life or homophobic
rhetoric will evoke enough
tough talk about sinful voting
from a couple bishops to swaysome voters.
Im certainly not saying
the Church should have
endorsed John Kerry agains
its principles. Indeed, an
endorsement for John Kerry
would have been problematic
for exactly the same reasons
Rather, the Church should think
more about moral leadership
and less about maximizing its
political inuence. The Church
should have abstained from taking sidesin this election and continued to hold
both candidates feet to the re on all the
issues without reducing itself to a puppet
for either.
VirchowContinued from page 6
Plexus staff andFrom yourditors