Editorial

The Good, the Bad and the Ugly

Niranjan Kissoon, M.D., Editor

 
A quick study of history reveals vividly that medicine does not exist in a vacuum. It is subject to the same historical and political influences with any other elements of society. These influences sometimes converge to alter the practice of medicine grotesquely in ways that can sometimes be beyond our comprehension. While medicine's dark side is no more evident that during Germany's third Reich, there are events that are occurring even today that should make us wary of adopting a defensive and comforting attitude that "it cannot happen here."

A recent example was unearthed by the South Africa's Truth and Reconciliation Commission in which Dr. Wouter Basson, an imminent cardiologist, was noted to be the founder and leader of Project COAST, a top secret chemical and biological welfare program that Bishop Desmond Tutu has called "the most diabolical aspect of apartheid." Project COAST, it was determined, was involved in research into a race-specific bacterial weapon, a project to find ways to sterilize the country's black population, discussion of deliberate spreading of cholera through the water supply, large scale production of dangerous drugs, fatal poisoning of anti-apartheid leaders, and even a plot to slip thallium, a toxic heavy metal that can permanently impair brain function into Nelson Mandela's medication before his release from prison in 1990.

A recent report from the Washington Post alleges that in 1996 Pfizer, Inc. conducted drug experiments on desperately ill children in Nigeria and then created back dated ethics approval documents in order to satisfy U.S. Regulators and to justify it's conduct of the human testing. Charges against Pfizer are currently under investigation, with evidence from several sources indicating less than ethical conduct in the treatment of these children and casting a dark shadow across the ethics and practice of some of our colleagues.

Objectionable actions like these are the tip of the iceberg and can do and will occur now in our society. While they are extremely discomforting, it is important that we face their existence. We cannot afford to take the comfort of time, space and distance from our immediate environs to deny their potency and ugliness. Acceptance of their presence and vocal and active efforts are required to keep these ugly intrusions into our professional life at bay.

However, medicine like society also has shining examples of great moral courage and good deeds. These should give cause for pride in our profession. For instance, in 1995 the German Society of Pediatrics and Adolescent Medicine undertook an initiative to document publicly the suffering that was endured by German-Jewish pediatric colleagues from 1933 to 1945. At this society's annual meeting in the Fall of 1998, the society's president, Lothar Pelz, acknowledged the society's collective guilt, both as an active participant in the national socialist policies of racial purification and it's failure to stand and speak for German-Jewish colleagues who were being persecuted. Another recent report, which made me feel proud of our profession, was the response to the devastating earthquake in San Salvador in which medical teams and equipment from many parts of the world responded promptly and with generosity and compassion.

Fortunately, "the good" outweighs the "bad and the ugly" by a tremendous margin. The world had certainly become accessible and smaller with access to technology and air travel. While this has made it easier to offer help to others and uncover unfair medical practices, technology has also increased advantages for some and widened the disparities of the rich and poor. Our proximity increases the vulnerability of many but also increases opportunities to be charitable.

Jacksonville Medicine / February, 2001