In view of the devastating aerial terrorist attack on the World Trade Center and the Pentagon by Islamic fanatic followers of Osama bin Laden on September 11, 2001, we have put together a special issue of the Medical Sentinel on the threat of bioterrorism in our own backyard. I am referring to communist Cuba under tyrant Fidel Castro only ninety miles from our shores.
Osama bin Laden and Fidel Castro come from different cultures and have different ideologies --- one is a millionaire, Islamic zealot and the other an atheist, communist dictator. Yet, they have one thing in common: their deep hatred for the United States, capitalism, and our veneration for life, liberty, and the pursuit of happiness.
Afghanistan, which is ruled by the Taliban Islamic zealots, protectors of Osama bin Laden, is not the only country implicated in sponsoring international terrorism. Iran, Iraq, Syria, Libya, North Korea, Sudan, and Cuba are all designated as state sponsors of international terrorism by the U.S. State Department.
The articles that follow are timely and very relevant in view of America's war against terrorism. It is my hope that they not only are informative but useful in fighting bioterrorism within these United States.
As far as my editor's corner essay, I have chosen to proceed with exposure of the serious threat coming from within the medical profession to one of our cherished civil liberties, gun ownership.
Not only do we have to contend with medical privacy regulations enacting the complete opposite of what the government and the media say they do, but we also have to face the new public relations campaign of the AMA and organized medicine. Just when you thought talking to your doctor or psychiatrist was one of the most private and confidential things you could do...think again.(1)
In what is described as an effort to curb handgun violence, a group called Doctors Against Handgun Injury, a spin off of the AMA and organized medicine, is calling for sweeping changes in the patient-doctor relationship that would allow physicians, including psychiatrists, to pry into their patients' gun ownership.
In the past, the medical community strenuously fought against any invasion of patient privacy by the government or other third-parties. For example, the American Psychiatric Association (APA) had, in the past and for obvious reasons, been a bulwark in the defense of patient privacy and medical record confidentiality.(2)
Suddenly, events have taken a nefarious course.
The APA has regrettably joined Doctors Against Handgun Injury, the gun prohibitionist coalition.
This coalition --- which also includes the American Medical Association (AMA) and, not surprisingly, the strident (i.e., when it comes to gun control) American Academy of Pediatrics (AAP) and ten other medical organizations reportedly comprising 600,000 doctors --- has called for a variety of patient privacy-invading measures in the name of gun safety.
Don't be fooled by their innocuous-sounding name and publically stated objectives.
Through a revealing article published in the New York Observer on March 15, 2001, much information has come to light about the gun control campaign of Doctors Against Handgun Injury. They are promoting more stringent gun control measures, what they call "upstream intervention" --- that is, using regular checkups to ask patients about firearm ownership and gun storage in their homes.
Ostensibly, the report states: "To promote public safety, health professionals and health systems should ask about firearm ownership when taking a medical history or engaging in preventive counseling. Patients should be provided with information about the risks of having a firearm in the home, as well as methods to reduce the risk, should they continue to choose to keep them."(3)
The AMA and organized medicine led by the new activist president Dr. Richard Corlin in his inauguration speech on June 20, 2001, dedicated the AMA to battling gun ownership as a public health epidemic. "[Gun violence] is a battle that we cannot not take on." Dr. Corlin said that he had decided to fight gun violence against all odds and despite the risks. "People have told me that this is a dangerous path to follow. That I am crazy to do it. That I am putting our organization in jeopardy. They say we'll lose members." Indeed, Dr. Corlin has put his own personal agenda and self-aggrandizement at the expense of all physicians and the AMA, the organization that claims to represent all of us.
Moreover, he said the AMA will attack gun violence the way it has attacked other public health concerns: "What we don't know about violence and guns is literally killing us," he exclaimed. He blamed "the gun lobby" for the loss of the $2.6 million in federal funding for gun [control] research which was stripped from the CDC budget in 1996 because of biased, politicized, result-oriented research conducted by the public health establishment.
Thus, Dr. Corlin called for increased public spending to allow the government to collect data on gun violence. In other words, he made calls to resurrect the specter of the shoddy research conducted by the NCIPC of the CDC. He parroted the litany: "Gunfire kills ten children a day in America," ignoring the fact that automobile accidents, swimming pools, matches, football and bicycle injuries kill far more children. Are we going to ban them too?
Dr. Corlin continued: "If this was a virus or a defective car seat or an undercooked hamburger that was killing our children, there would be a massive uproar within a week. Instead our capacity to feel a sense of national shame has been diminished by the pervasiveness and numbing effect of all this violence." And then he concluded, "Our goal is to cure an epidemic. If removing the scourge of gun violence isn't bettering the public health --- what is?"(4)
Here Dr. Corlin propounds the erroneous notion that gun control is a public health issue and that crime is a disease, an epidemic --- rather than a major facet of criminology. He forgets that guns and bullets are inanimate objects not constrained by Koch's Postulates of Pathogenicity that prove that a microorganism is responsible for a particular disease.
Conveniently, Dr. Corlin also ignores the benefits of firearms in our society. For example, as many as 75 lives are protected by a gun for every one life lost to a gun; medical costs saved by guns in the hands of law-abiding citizens are fifteen times greater than costs incurred by criminal uses of firearms. Guns also prevent injuries to good people and protect billions of dollars of property every year.
And while Dr. Corlin preached the gospel of gun control, the AMA's spin off organization, Doctors Against Handgun Injury, called for physicians to spy on their patients. This is a regrettable and ill-conceived effort, and a violation of the Oath and tradition of Hippocrates.
This policy constitutes a breach in medical ethics, a boundary violation in reference to abuse of the patient-doctor relationship, and an egregious invasion of privacy.
A boundary violation takes place when a physician breaches the patient's trust and uses his authority to advance a political agenda.
As Dr. Timothy Wheeler explained in an article in the Medical Sentinel, "A patient who seeks medical or psychiatric treatment is often in a uniquely dependent, anxious, vulnerable, and exploitable state.
"In seeking help, patients assume positions of relative powerlessness in which they expose their dignity, and reveal intimacies of body or mind, or both. Thus, compromised, the patient relies heavily on the physician to act only in the patient's interest and not the physician's."(5)
From time immemorial, patient privacy and confidentiality have been ethical concepts that, up until now, were fundamental to all physicians and to the patient-doctor relationship.
The Oath of Hippocrates, in fact, states: "Whatever, in connection with my professional practice or not in connection with it, I may see or hear in the lives of men, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men at all times, but should I trespass and violate this oath, may the reverse be my lot."
For psychiatrists, who of necessity should be able to obtain very personal and confidential information for their patients' mental health evaluation and treatment, trust is paramount.
Understandably, psychiatrists have claimed a patient-doctor privilege similar to the attorney-client privilege that lawyers legally enjoy and which is a notch above what physicians now possess in patient-doctor confidentiality. This new policy makes a mockery of that claim.
With good reason this push by organized medicine has been received by patients with great concern and trepidation.
With this new incursion into gun politics by the medical profession, it's easy to see why patients may be more reluctant and less candid than ever with their physicians, which may, in turn, be detrimental to their medical care.
With good reason, patients may now perceive that their doctors, in asking them about guns in their homes, are acting more as an arm of the government prying into their personal lives than as their advocates in health care.
It will be easy to discern that physicians involved in this intrusion of privacy are placing the so-called good of society and the public relations goals of their professional organizations above their ethical obligation to their patients as required by the Oath of Hippocrates.
A Historic Precedent
In the momentous article "Medical Science Under Dictator-ship," Dr. Leo Alexander, the chief U.S. medical consultant at the Nuremberg War Crimes Trials, examined "the process by which the German medical profession became a willing and unquestioning collaborator with the Nazis." He noted the early changes in medical attitudes that predisposed German physicians to first collect data on their patients to conduct what today we call "cost-effective analysis," and then to use the latter information as a vehicle to commit medical genocide under the auspices of the totalitarianism of National Socialism.
Dr. Alexander warns us that "from small beginnings" the values of an entire society may be subverted, leading to the horrors of a police state.
The "small beginnings" in Nazi Germany that Dr. Alexander referred to first led the physicians to collect data from their patients and then violate their patients' privacy and medical record confidentiality by supplying the information to the state.(6)
Organizations with humanitarian-sounding names were set up in Nazi Germany to institute "health" programs, under deceptive, euphemistic terms.
For example, questionnaires collected by a "Realm's Work Committee of Institutions for Cure and Care" gathered and reported information on patients who had been ill five years or more and who were unable to work.
"On the basis of name, race, marital status, nationality, next of kin, whether regularly visited and by whom, who bore financial responsibility, and so forth," decisions were ultimately made for the patient euthanasia program heralded by the Nazi government for the good of the state and the "health of the nation."
The first steps taken toward barbarism were the result of the physicians' willingness to participate in patient data collection and the violation of medical privacy. "Corrosion," as Dr. Alexander wrote, "begins in microscopic proportions."
German physicians were, more than any other profession, heavily represented in the Nazi Party, which they joined in droves.
German psychiatrists were no exception, and they also enthusiastically supported Nazi Germany's gun control laws of 1938 that disarmed the civilian population and left a monopoly of force in the hands of the German military and the SS.
The rest, as we say, is history.
AMA Becomes Political
As to the commitment of the AMA to weakening medical privacy and individual-based ethics in favor of population-based ethics and achieve a partnership with government, there is no longer any doubt.(7,8)
In the case of the American Psychiatric Association, one only has to peruse its position statement on homicide prevention and gun control promulgated by its leadership as early as 1993: "In view of the need to reinforce individual and group sanctions against the use of violence as a social instrument, behavioral mode, or adaptorional [sic] pattern, as psychiatrists have done with drug abuse, suicidal actions, and antisocial behavior, the American Psychiatric Association recommends that strong controls be placed on the availability of all types of firearms to private citizens."(9)
Why would the AMA and organized medicine become involved in this politically expedient but potentially explosive issue of gun control and condone the systematic violation of the privacy of vulnerable patients?
The 1991 effort by the AMA to increase membership, although expensive, was highly unproductive. The AMA attempted to reverse the trend of dwindling membership and achieve at least a majority membership of American physicians, but it was utterly unsuccessful, barely keeping pace with its attrition rate and holding to only a 38 percent bare-bones membership of American physicians, down from the 75 percent supermajority decades earlier.
This continuing, thinly veiled gun control effort is also a public relations ploy to get endless, politically correct, praiseworthy media publicity and score public relations points while ingratiating organized medicine to the liberal media.
The truth, sound scholarship, free inquiry, and the free flow and exchange of information, as it regards the benefits of firearms in the hands of law-abiding citizens, be damned.
Besides, many of these groups in organized medicine have become used to receiving money from the government, taxpayers' money, for their medical politicking efforts.
For example, during the years of the Clinton administration, groups such as the American Academy of Pediatrics, the American Public Health Association, the American Medical Women's Association, the American College of Physicians and the American Academy of Family Physicians all drank heavily from the government trough to the tune of millions of dollars of taxpayers' money.
In the case of the AAP, the amount was a whopping $1.1 million of taxpayers' money at the height of the Clinton health care debate of 1993-1994!(10)
The AAP Policy Reference Guide calls for the Protection of Children from Handgun Act as model legislation. This innocuous sounding legislation propounds for State legislatures to enact that "only the prohibition of the manufacture, sale, and possession of handguns will remove handguns from the homes and streets of this State, thereby reducing the risks of injury and death to children from handguns."
Never mind the Second Amendment in the Bill of Rights.
Has organized medicine --- the AMA, the APA and their cohorts --- learned the lessons of history?
To our peril, apparently not.
When they do, I hope they will come to their senses, return to the medicine and individual-based ethics of Hippocrates, putting patients first, and forsake this utter statist, authoritarian madness.
1. Faria M.A. Jr. Doctors warn of grave risk to your medical records. AAPS: It's time to draw the line in the sand on medical privacy. NewsMax.com, March 22, 2001.
2. Testimony of the American Psychiatric Association on H.R. 4585, the Medical Financial Privacy Protection Act before the Committee on Banking and Financial Services, U.S. House of Representatives, June 14, 2000.
3. Benson J. Medical Machers ask: Should guns be part of patient profile? The New York Observer, March 15, 2001. See also AMA Joins Gun Grabbers, NewsMax.com, May 1, 2001; Time to Ban that Dangerous AMA? NewsMax.com, June 21, 2001; and AMA's New Prez Makes Gun Safety His Platform, Raising Concerns, Associated Press, June 21, 2001.
4. Susman E. AMA chief pledges fight against guns. UPI Science News, June 20, 2001.
5. Wheeler T. Boundary violation: Gun politics in the doctor's office. Medical Sentinel 1999;4(2):60-61, http://www.haciendapub.com.
6. Alexander L. Medical science under dictatorship. New England Journal of Medicine, July 14, 1949.
7. Faria M.A. Jr. The perversion of science and medicine: Parts I-IV. Medical Sentinel, Spring and Summer 1997, http:.//www.haciendapub.com.
8. Faria MA Jr. Public health and gun control a review. Part I: The benefits of firearms, and Part II: Gun violence and constitutional issues. Medical Sentinel, Spring 2001, pp. 11-18.
9. American Psychiatric Association (APA) Position Statement on Homicide Prevention and Gun Control. Am J Psychiatry 1994;151(4):630.
10. Faria M.A. Jr. To the tune of Washington's pied pipers. Medical Sentinel 1996;1(3):8-9.
Dr. Faria is Editor-in-Chief of the Medical Sentinel, the official journal of the Association of American Physicians and Surgeons (AAPS), and author of Vandals at the Gates of Medicine (1995) and Medical Warrior: Fighting Corporate Socialized Medicine (1997), and Cuba In Revolution --- Escape From a Lost Paradise (2002), http://www.haciendapub.com.
Originally published in the Medical Sentinel 2001;6(4):115-117. Copyright ©2001 Association of American Physicians and Surgeons.