The Doctor-Activist: Physicians Fighting for Social Change PDF
Preview The Doctor-Activist: Physicians Fighting for Social Change
THE DOCTOR-ACTIVIST Physicians Fighting for Social Change THE DOCTOR-ACTIVIST Physicians Fighting for Social Change Edited by ELLEN L. BASSUK Better Hornes Fund and Harvard Medical School Newton Center, Massachusetts With the assistance of REBECCA W. CARMAN Springer Science+Business Media, LLC Library of Congress Cataloging-in-Publication Data On file All royalties from this volume will be paid to the Better Hornes Fund © 1996 Springer Science+Business Media New York Originally published by Plenum Press, NewYork in 1996. 10 9 8 7 6 5 4 3 2 1 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher ISBN 978-0-306-45267-3 ISBN 978-1-4899-6032-0 DOI 10.1007/978-1-4899-6032-0 Softcover reprint of the hardcover 1s t edition 1996 To Fella Cederbaum. With gratitude and love for guiding me along the path to truth and freedom: The eagle will soar. FOREWORD This is a timely book for all interested in social progress. These autobiographical accounts of physicians' struggles to improve the lives of people need to be told, for we live in a time when there is considerable skepticism about the role of physicians in creating social change. Let me explain. In the United States the delivery of health services - especially the financing of these services - has been transformed. The management of much of medical care has been moved into large-scale for-profit corporate en tities. The nonprofit sector, defensively, has begun to behave like the for-profit sector. This has resulted in what has been referred to as the "corporatization" of medicine and the "proletarianization" of the medical profession. Will this leave room for the kind of social activism by physicians recorded in this volume? The organized medical profession in the United States unfortunately has not provided congenial auspices for physi cians as social activists. Justifiably or not, these organiza tions are publicly perceived as being preoccupied with their Vll viii FOREWORD self-interests rather than with the public's health. This caused one president of the American Academy of Pediatrics to state in his presidential address that "when pediatricians talk about what is good for the pediatricians, no one will lis ten. When they talk about what is good for the children, everyone will listen." But social activist physicians have been inventive. They have developed new organizations as outlets for their con cerns about the health and welfa re of people around the world. Thus, among many others, Physicians for Social Re sponsibility, Physicians for Human Rights, and the Interna tional Physicians for the Prevention of Nuclear War have become significant social forces. The last organization's con tributions were recognized with the award of the Nobel Pea ce Prize. These organizations figure prominently in the lives of this generation of doctor-activists. As one reads of the lives of these physicians, the eclectic nature of their activities is impressive. Certainly there is no cookie cutter from which they have been stamped. Yet while their activities have been very diverse, there does seem to be a core of attributes which, in my view, they share. Among these are: 1. A clear social conscience, by which I mean a deeply held commitment to helping others. While we don't know all of the roots of social conscience (indeed the literature is sparse), we do hear from each of these authors about the importance of early experiences in shaping this commitment. The roots clearly antedate embarking on a career in medicine. 2. Inventiveness in the applications of their medical knowledge in developing new ways to bring more and better services to a larger number of people. Their rootedness in medical knowledge is part of wh at makes them unique. FOREWORD ix 3. Courage. All of these authors were self-propelled to the point of pursuing their goals in the face of oppo sition and/or criticism that often caused them to be labeled impractical, or dreamers, or worse. They per severed when they were told, "it can't be done." 4. A high energy level. Clearly these activists had to function with extraordinary expenditures of energy to accomplish their goals. 5. Resourcefulness. All manifested innovative ways of bringing people and programs together in more effec tive arrangements. All of these attributes add up to creativity. Each of these people knew when to seize the initiative to implement their programs. Several authors indicate specifically that they could not plan to do what they ultimately accomplished, but they recognized when a somewhat fortuitous set of circum stances made it possible for them to act. They are examples of what Louis Pasteur recognized when he said, "chance fa vors the prepared mind." In the Overview the editor properly points to the rich history of social activism by physicians. Among these activ ists is Dr. William Henry Welch, the first dean of the Johns Hopkins School of Medicine, who played an important role in bringing together medical education, research, and service into the four-year curriculum that has come to be recognized as modern medical education. He recognized that the ad vances in the natural sciences had to be incorporated into medical education and that preceptorial teaching was no longer sufficient. In the process the teaching hospital and its outpatient services became an integral part of educating physicians. Another of Dr. Welch's contributions relates to his keen sense of history. In 1891 he arranged to honor the 70th birth day of a person who may be the model doctor-activist of all time, Dr. Rudolf Virchow. At that time Welch said, x FOREWORD To appreciate the character and extent of an advance made by scientific discovery, it is necessary to know something about the ideas which have been displaced or overthrown by the discovery. The younger generation of students are in danger of forgetting that facts which are taught to them and which seem to them the simplest and the most natural, may have cost years of patient investigation and hard controversy, and possibly have taken the place of doctrines, very different or even con tradictory, which long held sway, and which seemed to other generations equally simple and natural. Virchow is regarded as the founder of cellular pathology and as an important contributor to the establishment of sci entific medicine. He carried on his scholarly activities in pa thology while becoming an activist to promote the democratic revolutions sweeping across Europe in his time. He wrote, The democratic state desires that all its citizens enjoy a state of well-being, for it recognizes that they all have equal rights . . . it is not enough for the state to guar antee every citizen the basic necessities for existence, and to assist everyone whose labor does not suffice for hirn to acquire these necessities; the state must do more, it must assist everyone so far that he will have the con ditions necessary for a healthy existence. Dr. Virchow served on commissions to investigate epi demics and in the process virtually invented modern public health. He campaigned for compulsory meat inspection as a consequence of his studies of trichinosis. At the request of the Berlin City Council he designed and supervised asewage disposal system which was widely copied. Most of all he saw the relationship between health and social conditions and wrote of medicine as a social science. He thought of physi cians as the natural attorneys for the poor and believed that social problems fall within their jurisdiction. Dr. Welch's commitment to scholarship in medical history led hirn to lay the groundwork for an Institute on the History FOREWORD xi of Medicine at Johns Hopkins. The university had the wisdom to recruit the great physician-medical historian, Dr. Henry Sigerist from Europe. This not only brought professionalism to the study of medical history, but it brought Dr. Sigerist's social vision of medicine's responsibility to society to the uni versity. Indeed, prior to World War II, Dr. Sigerist and his historian colleague, George Rosen at Yale, not only wrote ex tensively about the history of what they called social medi cine, but in addition were themselves social activists. They advocated studies of programs for national health insurance and encouraged cross-national studies of medical care sys tems. Medical students across the country were greatly in fluenced by their teachings and writings. It is fair to say that many of the physician-activists of the last several decades were stimulated by these scholars. I am sure I would do some injustice if I attempted to list them all. Several of them are mentioned as mentors in these accounts. In reading these autobiographical accounts, one is im pressed by many insights. On a personal note, as an activist I can't help but resonate to the conclusion of Dr. Jack Geiger's chapter. He indicates the generic issue is, ''Watch for the mo ment - the opportunity - that reflects your values. Seize it." It brought back memories of 1965 when, as professor of pediatrics at the State University of New York at Syracuse, I was carrying on research with Dr. Bettye Caldwell on the development of young children growing up in poverty. We documented their decline in development; but more impor tant, we also showed that we could prevent the decline with enrollment of the children in a comprehensive child care pro gram in the preschool years. The "moment" came. As we were making our observa tions, President Johnson and the Congress established the Of fice of Economic Opportunity. The first Director, Mr. Sargent Shriver, had heard of our work and wanted to know if we could replicate our work on anational scale. Without the clini cal experience and demonstration we had made, I might have
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