French social critic Frederic Bastiat (1801-1850) once said, “The worst thing that can happen to a good cause is not to be skillfully attacked, but to be ineptly defended.”(1) During much of the history of our republic, our intellectuals and those who digest these ideas for consumption by the general public, did a poor job of defending the basic foundations of our freedom. Until the sixties, it was taken for granted that private property, absolute moral principles, and free enterprise were desirable. But, while these things were based on a foregone conclusion, few were adequately prepared to defend these ideas against the modern liberal intellectual assault.
The left saw this as a great weakness to be exploited primarily by attacking these institutions in the universities and colleges, knowing it would capture the imaginations of our youth during their formative years. Parents trusted these institutions to inculcate these basic ideas of freedom. But two events allowed the left to instill serious questions in our youth’s minds concerning these foundations: the civil rights movement and the Vietnam War.
Both of these events were couched in terms not to correct social evils or perceived errors in our leaders’ judgment, but rather, they were designed to attack the whole fabric of our social organization, especially our moral foundations, our economic system, and the rule of law based on natural law. As we shall see, this did not begin with the sixties, but in fact, began over two centuries before.
The Power of the Printing Press
It was Nicholas Bonneville in 1789 who first recognized the immense power of the printing press when he said, “the smell of the printer’s ink is the incense of modern revolutionary organization.”(2) In organizing the revolutionary elements of the French Revolution, he proclaimed his intention to provide it with a “mouth of iron,” which in his Bulletin de la Bouche de Fer, he called printing a “different, superior power,” a “fourth power” (later called the fourth estate), with a power outside and above the three branches of government.(3)
This “superior power,” had the right and obligation to “conduct censorship and denunciation in defense of the revolution. Its mission was “universal surveillance” on behalf of “that multitude of good citizens who are not yet enlightened enough to know what they desire.” This, of course, sounds quite familiar to those of us not intellectually stuporous from the vapors of socialism.
One of the earliest communist pioneers, Theophile Thore, defended himself at his trial in 1840 by saying: “Thanks to printing and the press, we have today means of intellectual propaganda that the ancients did not imagine. Without going to converse in the shops and preach in the squares, we send the radiations of our thoughts directly in the hearts of men of good will.”(4)
Since this early beginning every revolution has depended on widespread dissimulation of information to the masses in the form of carefully crafted “managed truths.” We know that propaganda not only played a vital role in our own American revolt but also in the French Revolution, the Revolution of 1848, the rise of National Socialism in Germany and Fascism in Italy, as well as in modern communist revolutions. One of the central aspects of mass propaganda is “the lie,” which is always shrouded with a modicum of truth, however small. Jean Francois Revel tells us, “All the authors who have described this immersion in falsehood — Orwell, Solzhenitsyn, Zinoviev — all have insisted that falsehood is not simply an additive but an organic component of totalitarianism, a protective carapace without which it could not survive.”(5)
We see this blatantly demonstrated in our own time. For example, while there is overwhelming evidence the Reagan tax cuts and tight money policy not only brought inflation under control but created an economic rebirth (and he did this despite the insistence of the mass media that it could not be done without precipitating a depression), today history is being rewritten for the consumption of the masses so as to imply that these tax cuts destroyed the economy. Incredibly, a majority believe this deliberate propaganda, despite having lived themselves through the greatest boon and peacetime economic expansion in American history!
In the area of medicine, despite overwhelming evidence that Soviet collectivist medicine was a dismal failure and was resulting in a state-imposed mass annihilation, the Western media unceasingly extolled the virtues of Soviet medicine. And even worse, they all but demanded the United States copy this collectivist system. Now that the truth is available for all to see, such as the widespread AIDS infection through dirty instruments, hospitals ill equipped for even the simplest procedures and large patient wards resembling the worse conditions found in Third World countries, the media suddenly takes no interest. Why? Because it might expose “the lie.”
The leftist-liberals know few individuals will take the time to seek out the truth. Most are too busy with their daily work and many have neither the ability nor desire to understand the complex issues involved. For liberty to survive, it must be defended by toil and effort on a daily basis. We have a tendency in this country to let someone else bother with such matters.
In his book, The Flight from Truth: The Reign of Deceit in the Age of Information, Revel tells us, “For let us be honest in facing this fundamental fact: Those who cultivate competence, accuracy, and intellectual honesty tend to be the smallest segment of the journalistic community, their audience the smallest sector of the public.”(6)
The theme of his book is that a democracy cannot survive without a general access to truthful information. Without access to the truth the voting majority are easily deceived into supporting the most nefarious of collectivist schemes. One need only witness the acceptance of Social Security, Medicare/Medicaid, managed care, and the progressive tax code to understand this truth.
There exists an interesting psychology in the artful dissimulation of “managed truth.” What we hear and see from the media during the course of our lives commingles with our consciousness in subtle ways so that eventually we come to believe these ideas and impressions originated with us, something that has been referred to as the foregone conclusion. For example, when we say the United States has the best medical care system in the world, the leftists retort, “but everyone knows we have the highest infant mortality rate of any industrialized nation.” To refute this “fact” makes one an obvious idiot and a fool. This social pressure keeps most from challenging “accepted truths.” The liberals take full advantage of this social pressure in all spheres of life to keep the silent majority silent.
Role of the Intellectuals
Erick von Kuehnelt-Leddihn, Ludwig von Mises, F.A. Hayek, Christopher Dawson, and many other intellectuals have noted that no revolution in modern history ever originated with the supposedly exploited masses. Instead, it was a handful of intellectuals who designed and initiated these revolutions. F.A. Hayek crystallized their role when he said:
“It is the intellectual in this sense who decides what views and opinions are to reach us, which facts are important enough to be told to us, and what form and from what angle they are to be presented....
“It is no exaggeration to say that once the more active part of the intellectual has been converted to a set of beliefs, the process by which these become generally accepted is almost automatic and irresistible. It is their convictions and opinions that operate as the sieve through which all new conceptions must pass before they can reach the masses.”(7)
We see this in operation not only as it regards the media but also in the adoption of social policy and in the process of reaching judicial decisions. It is the “expert” to whom we defer in such cases, despite often overwhelming evidence of the errors in their thinking. But the impact of their pronouncements and opinions can mean the difference between freedom and slavery and between life and death. Witness the effects of such intellectuals as Count (Joseph Arthur) Gobineau who preached the idea of biologic racism that led eventually to the gas chambers of Auschwitz and Buchenwald.(8)
It was the Fabian socialists of England who demonstrated that without a violent revolution, a handful of cultural elites could transform a country from a free society to a collectivist one. On one evening in 1883 (the year of Marx’s death), nine young British intellectuals met and founded the Fabian Society of London with the idea of transforming the world through a species of propaganda that they termed “education.”(9) Within a short period of time, they reached their goal in England and brought her to the verge of economic collapse, destroying a system of individual freedom that had evolved over centuries.
How were such a small number of intellectuals able to wrest control of the British government? It was done through a system of gradualism that involved attracting and utilizing university professors, playwrights, writers, social dignitaries, and politicians. Special efforts were made to recruit the young. Their most powerful weapon was in controlling the “truth” and the dissimulation of information — managed truth.
For example, using monies from the tax-free foundations in America, they were able to form one of the most prestigious economic schools in the world, the London School of Economics, which attracted such luminaries as John Maynard Keynes (1883-1946), Joseph Kennedy, Jr, and John F. Kennedy.(10) This one institution changed the entire financial system of the Western world for over fifty years, mainly through a carefully orchestrated system of propaganda. Similar results have occurred in the areas of revisionist history, language, sociology and social policymaking.
The Fabians Come to America
In 1895, the Fabian Society of England came to the United States and helped establish an American society of intellectuals. Some of America’s most influential writers, playwrights, authors, poets, industrialists, labor leaders, and politicians flocked to the new society. Such dignitaries as Jack London, Upton Sinclair, Felix Frankfurter, Walter Lippmann, and Louis Brandeis were members and dedicated followers. The new society in 1905 changed its name to the Intercollegiate Socialist Society. By 1921, because of the unpopularity of the name “socialist,” they once again changed their name to the League for Industrial Democracy.
The first issue of their official magazine, The American Fabian, printed by the budding society in February 1895, outlined its objectives in America. On the top of their list was to effect a series of basic changes in the Constitution itself “that would make possible the introduction of state socialism step by step in the United States.”(11) In this same issue, they observed that England’s (unwritten) constitution readily allows changes so that England can move into socialism almost imperceptibly, but that, “our constitution, being largely individualistic, must be changed to admit socialism, and each change necessitates a political crisis.”
Even a brief review of American history, since the time these words were printed, will attest to the brilliance of this plan. Collectivism has made tremendous strides as a result of a series of contrived as well as real crises: World War I, the stock market crash of 1929 and the subsequent Great Depression of the 1930s, World War II, on and on. Today, we are told of a persistent crisis in health care delivery that acts as a political impetus for the establishment of universal health care coverage, in effect, a socialist, national, health care plan.
Three years after the new party was established, British Fabian socialist, Ramsey MacDonald, on a return visit to the United States said, “The great bar to socialist progress in the United States is the written constitution, federal and state, which gives ultimate power to a law court.”(12) As we shall see, much attention has been given to correcting this “problem.”
Judicial Activism: Socialism with Teeth
It was Felix Frankfurter (1882-1965), before his elevation to the Supreme Court(1932-1962), who advocated the concept of judicial activism. This idea transformed the intended purpose of the court from interpretation of the law to creation of new laws through leftist interpretation. This, of course, was one of the early goals of the Fabians, to break down the separation of powers. Judicial activism gives the courts the traditional judicial power as well as the new power to legislate, all the while separated from the voter. This new judicial power did not go unrecognized. In his 1967 Carpentier lecture at Columbia University, Justice Adolph A. Berle opened by saying: “The thesis can be briefly stated. Ultimate legislative power in the United States has come to rest in the Supreme Court of the United States....This is...a revolution. The unique fact is that the revolutionary committee is the Supreme Court of the United States.”(13)
One of President Woodrow Wilson’s closest friends was the Harvard law professor and later Supreme Court justice (1916-1939), Louis D. Brandeis (1856-1941). Brandeis, a supporter of the idea of a sociological interpretation of the Constitution, was the justice who, interestingly, solved the Fabians’ biggest dilemma — how to fund their massive new social programs? In a conversation with Associate Justice Benjamin Cardozo (1870-1938) on how to fund social insurance he whispered, “The taxing power of the federal government, my dear; the taxing power is sufficient for everything you want and need.”(14) The rest is history.
President Wilson’s closest advisor, Colonel Edward Mandell House (1858-1938), was a Fabian Society member and it was Colonel House’s opinion that the “United States Constitution, a creation of eighteenth century minds, was not only outmoded, but grotesque and ought to be scrapped or rewritten.”(15) The British socialist Harold Laski tells us why they feared the Constitution when he stated it was “capitalism’s strongest safeguard on earth today.”(16) He also called for all liberal, socialist, and communist groups to advance democratic socialism.
In 1920, the Fabians formed the American Civil Liberties Union (ACLU) primarily to combat arrest and deportation of communists but also to promote leftist, judicial activism. One of its founders was Supreme Court justice and Fabian socialist Felix Frankfurter. I wrote an article for the Greensboro News on the history of the ACLU including its early domination by communist board members. The newspaper would not print the article until it had been approved by the national headquarters of the ACLU. It was approved.
Philip Kurland, in an article for Modern Age, summarized the problem of judicial activism when he said, “Essentially the problem is that we have become a society overburdened by laws, whether they be statues, or executive orders, or regulations, or guidelines, or judicial decrees.”
It has been observed that today most laws are not made by the legislature but rather by bureaucracies. Hundreds of thousands of pages of laws are written every day by an army of unaccountable bureaucrats who are, in essence, destroying our freedom.
Educating the New Socialist
Recognizing the importance of education, by 1888, the Fabians formed the Nationalist Clubs whose purpose it was to “educate” the masses in socialist thought via lectures, books, and other publications.(17) By 1890, there were 158 such clubs throughout the United States. Some 50 newspapers supported the clubs, including major papers in Boston, New York, and Philadelphia. That same year they published the Literary Digest, edited by many respected luminaries, including poets, writers, bankers, clergy, and of course lawyers, primarily to give legitimacy to its collectivist ideas.
The American Fabians used as their model the Society for Socialist Inquiry and Propaganda (changed to the New Fabian Research Bureau in 1931) that was created by G.D.H. and Margaret Cole, the latter being a tutor at Oxford and the London School of Economics. This group included some of the most outstanding figures in British society, which gave them much prestige and enhanced their ability to permeate all aspects of society. This organization literally flooded British society with a multitude of publications on virtually every socialist subject under the sun. But more importantly, the usual outlets of information dissemination, newspapers, writers and politicians, turned to these socialist intellectuals for answers, just as we see in America today.
The Fabians played a large part in organizing the major teacher unions, including the National Education Association (NEA), the American Federation of Teachers, and the American Association of University Professors. Interestingly, it was one of the most ardent Fabians, Jack London (1876-1916), who started the idea of speaking tours among the many college and university campuses for the specific purpose of promoting Fabian socialist ideas.(18) Philosopher Sidney Hook tells us that it was the writings of Jack London which attracted him to socialism.
Sidney Hook, an early disciple of socialism, saw the importance of democracy in promoting socialism when he wrote, “The task of the socialist in such a situation is to work to introduce the conditions under which democracy can develop, and to carry on intense educational activity on behalf of socialism.”(19)
By 1933, the Student League for Industrial Democracy merged openly with many pro-communist groups to form the American Student Union, which continued to be deeply infiltrated with communists. Sidney Hook, in his important autobiography, Out of Step, states that “his picture of communist influence, so strong that it amounted to domination of key areas of American cultural life, in literature, art and movies, may appear incredible to those who were not involved at the time, but the evidence, although often ignored today, is available and overwhelming.”(20)
The Fabian socialists received a tremendous boost from the tax-exempt foundations. During the course of the hearings on the tax-exempt foundations before the Carrol B. Reese Committee, which examined the records of the Ford Foundation, the Rockefeller Foundation and the Carnegie Foundation, they discovered that these multi-billion dollar foundations were directing enormous amounts of money and influence into changing American education so that students would accept a new world dominated by Fabian socialist ideas.(21)
The committee found the foundations had created an “extremely powerful propaganda machine” that produced masses of material for distribution in educational institutions, underwrote textbooks to be used in schools, created political clubs, and established professorships at colleges for training and indoctrinating teachers, all with a leftist slant. In fact, one of the common themes they found in the foundation literature was a call to alter the American Constitution so as to facilitate the introduction of collectivist programs, something, as we have seen, that has always been a dream of the Fabians. The committee concluded one thing was utterly clear, “No private group should have the power or right to decide what should be read and taught in our schools and colleges”; yet, this is exactly what the endowment sought to do in “educating public opinion.”(22)
We see this pattern continued in foundation support of radical environmentalism, moral relativism, disarmament propaganda, and the Goals 2000 education scheme in our schools. They have also supported propaganda designed to alter our ideas concerning private property, medical care delivery, and the desirability of “economic democracy” (democratic socialism) worldwide. As has been reported in the Medical Sentinel, the Robert Wood Johnson Foundation has been a major force behind state initiatives forcing managed care on whole populations. Many of these foundations interlock, so that hidden contributions may come from each other.
Over the past twenty years, we have witnessed an all-out assault on our values and beliefs by the education establishment designed to alter our American system of government so as to accept collectivism on a grand scale. Knowing that the universities are the centers of collectivist activism, the left is ever seeking to enroll more and more youth in these universities. This may be why President Clinton has publically announced that all children deserve a college education in America. He knows that even though in reality not all students will need a college education to pursue their life-long careers and attain their place in society, it is in the university that they will receive their leftist indoctrination, just as with the sixties generation.
Following a backlash against socialist governments in the aftermath of World War II, it was suggested that the Fabians drop the word “socialist” and substitute instead the term “economic democracy.” This term has been used repeatedly throughout the latter part of the twentieth century by gradualist socialists and the new left. It was soon after the turn of the century, in fact, the socialists pulled their most brilliant coup. This occurred when they appropriated the label “liberal.” They were well aware that classical liberal principles were opposite theirs, but that made the theft even more exciting.
It was John Maynard Keynes (1883-1946), a product of the London School of Economics, who expressed the idea society should be a form of socialism ruled by elites.23 And, it was also Keynes who first advocated the abandonment of the gold standard by England and the shifting of defense funds for social programs — something the American, modern liberals learned well.
In his General Theory of Employment, Interest, and Money (1936), Keynes advocated the planning of a nation’s economic life, political supervision of private industry, and manipulation of the currency, that is, a massive increase in the size and scope of government. The first enthusiastic review of Keynes’ General Theory by a professional economist was by G.D.H. Cole, an avowed Marxist and founding member of the Fabian Society. Two of the strongest proponents in America were government officials in Franklin D. Roosevelt’s administration, Lauchlin Currie and Harry Dexter White, both proven communists. Keynes himself was quoted as saying, “The Republic of my imagination lies on the extreme left of celestial space.”(24) Despite this, Keynesian economics dominated the American economy until the election of Ronald Reagan, after which it was declared dead. Unfortunately, the corpse continues to convulse.
Second on a list of methods Marx and Engles proposed to create a socialist system was a steeply graduated (progressive) income tax.(25) Early writings of the American Fabians also insisted on a severely graduated income tax system and a heavy and graduated inheritance tax, as well as a tax on land value. Later, Supreme Court Justice Louis Brandeis also proposed the use of taxes to fund the growth of socialism in the U.S. during the New Deal.
It seems obvious the primary purpose of taxation is not to collect revenues, but rather to punish the wealthy individualist. It has been demonstrated no less than three times in our history that to collect more revenues you simply cut the tax rate. Yet the leftists in this country continue to rail against tax cuts. You would think they would be overjoyed to have more money to fund their programs. But they don’t because it flies in the face of a more important principle of leftism — egalitarianism.
The centerpiece of the collectivist state is the welfare establishment. People must be made dependent on government. In the beginning, this dependence centered on housing, food, and special benefits (unemployment and worker’s compensation insurance). But what better way to make people dependent than to be the only source of health care? In The Law (1850), Frederic Bastiat captures the essence of socialism: “In all of them, you will probably find this idea that mankind is merely inert matter, receiving life, organization, morality, and prosperity from the power of the state.”(26)
The greatest strides in American socialism occurred under Presidents Woodrow Wilson, Franklin D. Roosevelt, Lyndon Johnson, and Bill Clinton, but each president in between has played a role. At no time since F.D.R. have so many dedicated socialists entered government in the United States. It was Clinton’s economic advisor, Derek Shearer who, like his Fabian predecessors, in 1970 advocated a change in the name “socialism” to “economic democracy,” because the word socialism scared people. Economic democracy has also been the clarion call of Vietnam War protestor Tom Hayden. It was Shearer who once said Marxism “is an attempt to humanize economic and social life.”
Ira Magaziner, the architect of the Clinton health care plan, and former labor secretary Robert Reich lamented that we lack a “centralized government agency responsible for devising a rational ‘industrial policy.’ ” The concept of an “industrial policy” is another code word for socialism (like that of Marxist Antonio Gramsci, Fascist Italy, National Socialist Germany, and the Anglo-American Fabians).
But once again, socialism has changed its stripes. Achille Occhetto, General Secretary of the Italian Communist Party, stated, “Our objective is no longer the socialist system achieved by democratic means, but democracy guided by socialist ideas.”(27) One of the most common words used by the Marxist and Leninist has been the term “democracy.” They love democracy, but only as long as they are able to control the public perception of “truth.” For over two centuries they have understood that freedom under democracies is directly dependent on access to the “truth.” When they control the “truth,” democracy allows them to progressively increase the power of the state until it is all-powerful. The lure of socialism is that it tells the people there is nothing they cannot have and that all social evils will be redressed by the state.
This essay was designed to give the reader a better idea as to how we have arrived where we are today in American society. It is difficult,
if not impossible, to understand contemporary events without understanding the forces that have motivated our society and the ideologies that have captivated the minds of the intellectuals.
The transformation of American society, from a society of defenders of freedom to one of collectivist thinking, grew out of a small network of influential Fabian intellectuals meeting at the Hull House in Chicago at the turn of the century. By using their prestige, power, and influence and by utilizing the enormous wealth of the tax-exempt foundations, they have been able to challenge the concept of the separation of powers of our government, alter our economic system, violate our Constitution via judicial activism, and alter our perceptions on national sovereignty. Private property, for the first time in our history, is being directly challenged. Our children are being taught to ignore moral principles, accept relativism, and abandon the concept of individual liberty in exchange for collectivist ideas of “the village.”
V.I. Lenin said, “It is true that liberty is precious, so precious that it must be rationed.” The rationing of liberty has taken many forms; economic liberty is controlled by the welfare state for some, and social security and federal health care by others. Hundreds of thousands of pages of bureaucratic rules and regulations further ration our liberties. And should a national health care system be ultimately instituted, the elimination of our liberties will be near completion.
In his book Theory and History, Ludwig von Mises states, “The collective creed is by necessity exclusive and totalitarian...There is, of course, but one way to make one’s own judgments of value supreme. One must beat into submission all those dissenting. ...Collectivism is a doctrine of war, intolerance, and persecution.”(2)8 And Nathaniel Weyl notes, “Communist society needs the sort of subject who can accept regimentation and authority without questioning it. The individualist — and therefore, the intellectually superior elements — are a security risk.”(29)
The principles of classical liberalism are being assaulted daily, not only in our universities, public schools, news media, television programming, movies, books and novels, but also by a whole generation of professionals in private society who were convinced of the desirability of egalitarian collectivism during the sixties. Most shockingly, this also includes our churches. The foundation upon which Western civilization was built was religion, and hence it has been one of the main targets of the modern liberals. They not only seek to destroy Christian beliefs but they are aggressively altering the church from inside so that it too becomes a voice of the “new age” egalitarian collectivism.
Those of us who read history repeat incessantly, “You cannot understand contemporary events without knowing the past.” Too many naively assume all of these social programs arise de novo from the minds of honest reformers, rather than the truth, that they were formulated in the minds of intellectuals dedicated to the collectivization of the world. The process by which they convince the masses to accept self-enslavement is by managing the truth. So, in essence, in our naiveté and acquiescence, in being blinded to the truth, we are building the gallows of our own civilization.
1. Bastiat F. The Law. Foundation for Economic Education, Inc., Irvington-on-Hudson, New York, 1974.
2. Billington JH. Fire in the Minds of Men. Origins of the Revolutionary Faith. Basic Books, Inc., New York, 1980, p. 35.
3. Ibid., p. 36.
4. Ibid., p. 317.
5. Revel JF. The Flight From Truth. The Reign of Deceit in the Age of Information. Random House, New York, 1991, p. 28.
6. Ibid., p. 6.
7. Hayek FA. The Road to Serfdom. University of Chicago Press, Chicago, IL, 1975.
8. Mises L. Omnipotent Government. The Rise of Total State and Total War. Libertarian Press, Spring Mills, PA, 1985, p. 169-192.
9. MacKenzie N. and MacKenzie J. The Fabians. Simon & Schuster, New York, 1977, pp. 15-29.
10. Martin RL. Fabian Freeway, High Road to Socialism in the U.S.A. Western Islands, Belmont, Ma, 1966, p. 25.
11. Ibid., p. 136.
12. Ibid., p. 136.
13. Kurland PB. Government by Judiciary. Modern Age, Fall 1976, p. 363.
14. Martin, op.cit., p. 278.
15. Ibid., p. 157.
16. Ibid., p. 314.
17. Ibid., p. 132.
18. Ibid., p. 183.
19. Bernstein E. Evolutionary Socialism. The Classic Statement of Democratic Socialism. Schocken Books, New York, 1975, p. xix.
20. Hook S. Out of Step. An Unquiet Life in the 20th Century. Harper& Row, New York, 1987, p.30.
21. Wormser R. Foundations, Their Power and Influence. Devin-Adair Co, New York, 1958.
22. Ibid., p. 206.
23. Martin, op.cit., p. 335.
24. Ibid., p. 335.
25. Marx K and Engels F. Manifesto of the Communist Party. Foreign Languages Press, Peking, 1977, p. 60.
26. Bastiat, op.cit., p. 36.
27. Revel. JF. Democracy Against Itself. The Future of the Democratic Impulse. The Free Press, 1993, p. 4.
28. Mises L. Theory and History. An Interpretation of Social and Economic Evolution. Ludwig von Mises Institute, Auburn University, Alabama, 1985, pp. 60-61.
29. Weyl N. Aristocide Under Fuehrers and Commissars. Modern Age, Summer 1975, pp. 285-294.
Dr. Blaylock is a neurological surgeon in Jackson, Mississippi, and a member of the Editorial Board of the Medical Sentinel. His address is 9 Lakeland Circle, Jackson, MS 39216. (601) 982-1175, Fax (601) 982-0652.
Originally published in the Medical Sentinel 1998;3(6):92-93. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).