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CONFESSIONS OF A MEDICAL HERETIC
By Robert S. Mendelsohn, M.D.
Chapter 7
pp. 123-140
The Devil’s Priests
I always laugh when someone from the American Medical Association or some other doctors’ organization claims that doctors have no special powers over people. After I finish laughing, I always ask how many people can tell you to take off your clothes and you’ll do it.
Because doctors are really the priests of the Church of Modern Medicine, most people don’t deny them their extra influence over our lives. After all, most doctors are honest, dedicated, intelligent, committed, healthy, educated, and capable, aren’t they? The doctor is the rock upon which Modern Medicine’s Church is built, isn’t he?
Not by a long shot. Doctors are only human — in the worst ways. You can’t assume your doctor is any of the nice things listed above, because doctors turn out to be dishonest, corrupt, unethical, sick, poorly educated, and downright stupid more often than the rest of society.
My favorite example of how doctors can be less intelligent than the situation calls for is a matter of public record. As part of the hearings before the Senate Health Subcommittee, Senator Edward Kennedy recalled a skiing injury to his shoulder, suffered when he was a young man. His father called in four specialists to examine the boy and recommend treatment. Three recommended surgery. The advice of the fourth doctor, who did not recommend surgery, was followed, however. He had just as many degrees as the others. The injury healed. Senator Kennedy’s colleagues then proceeded to question Dr. Lawrence Weed, Professor of Medicine at the University of Vermont and originator of a highly popular patient record system for hospitals. Dr. Weed’s reply was that the “senator’s shoulder probably would have healed as satisfactorily if the operation hadn’t been performed.”
When doctors are formally tested, the results are less than encouraging. In a recent test involving the prescribing of antibiotics half of the doctors who voluntarily took the test scored sixty-eight percent or lower. We’ve already seen in the previous chapters how dangerous it is to have a doctor work on you. All of that danger doesn’t necessarily derive from the inherent risks of the treatment itself. Doctors simply botch some of those procedures. When I meet a doctor, I generally figure I’m meeting a person who is narrow minded, prejudiced, and fairly incapable of reasoning and deliberation. Few of the doctors I meet prove my prediction wrong.
Doctors can’t be counted on to be entirely ethical, either. The dean of Harvard Medical School, Dr. Robert H. Ebert, and the dean of the Yale Medical School, Dr. Lewis Thomas, acted as paid consultants to the Squibb Corporation at the same time they were trying to persuade the Food and Drug Administration to lift the ban on Mysteclin, one of Squibb’s biggest moneymakers. Dr. Ebert that he “gave the best advice I could. These were honest opinions.” But he also declined to specify the amount of the “modest retainer” Squibb Vice-President Norman R. Ritter admitted paying him and Dr. Thomas. Dr. Ebert later became a paid director of the drug company and admitted to owning stock valued at $15,000.
In 1972, Dr. Samuel S. Epstein, then of Case-Western Reserve University, one of the world’s authorities on chemical causes of cancer and birth defects, told the Senate Select Committee on Nutrition and Human Needs that “the National Academy of Sciences is rid*dled with conflict of interest.” He reported that panels that decide on crucial issues such as safety of food additives frequently are dominated by friends or direct associates of the interests that are supposed to be regulated. “In this country you can buy the data you require to support your case,” he said.
Fraud in scientific research is commonplace enough to keep it off the front pages. The Food and Drug Administration has uncovered such niceties as overdosing and underdosing of patients, fabrication of records, and drug dumping when they investigate experimental drug trials. Of course, in these instances, doctors working for drug companies have as their goal producing results that will convince the FDA to approve the drug. Sometimes, with competition for grant money getting more and more fierce, doctors simply want to produce results that will keep the funding lines open. Since all the “good ol’ boy” researchers are in the same boat, there seems to be a great tolerance for sloppy experiments, unconfirmable results, and carelessness in interpreting results.
Dr. Ernest Borek, a University of Colorado microbiologist, said that “increasing amounts of faked data or, less flagrantly, data with body English put on them, make their way into scientific journals.” Nobel Prize winner Salvadore E. Luria, a biologist at the Massachusetts Institute of Technology, said “I know of at least two cases in which highly respected scientists had to retract findings re*ported from their laboratories, because they discovered that these findings had been manufactured by one of their collaborators.”
Another now classic example of fraud occurred in the Sloane-Kettering Institute where investigator Dr. William Summerlin admitted painting mice to make them look as though successful skin grafts had been done. A predecessor to Dr. Summerlin in the field of painting animals was Paul Kammerer, the Austrian geneticist, who early in the twentieth century painted the foot of a toad in order to prove the Lamarckian theory of transmission of acquired traits. When he was later exposed in Arthur Koessler’s book, The Case of the Midwife Toad, Kammerer shot himself.
Dr. Richard W. Roberts, director of the National Bureau of Standards, said that “half or more of the numerical data published by scientists in their journal articles is unusable because there is no evidence that the researcher accurately measured what he thought he was measuring or no evidence that possible sources of error eliminated or accounted for.” Since it is almost impossible for the average reader of scientific journals to determine which half of the article is usable and which is not, you have to wonder whether the medical journals serve as avenues of communication or confusion.
One method of judging the validity of a scientific article is to examine the footnote for the source of funding. Drug companies’ records regarding integrity of research are not sparkling enough to warrant much trust. Doctors have been shown not to be above fudging and even fabricating research results when the stakes were high enough. Dr. Leroy Wolins, a psychologist at Iowa State University, had a student write to thirty-seven authors of scientific reports asking for the raw data on which they based their conclusions. Of the thirty-two who replied, twenty-one said their data either been lost or accidentally destroyed. Dr. Wolins analyzed seven sets of data that did come in and found errors in three significant enough to invalidate what had been passed off as scientific fact.
Of course, research fraud is nothing new. Cyril Burt, the late British psychologist who became famous for his claims most human intelligence is determined by heredity, was exposed as a fraud by Leon Kamin, a Princeton psychologist. It seems that the “coworkers” responsible for Burt’s research findings could not be found to have actually existed! There is even evidence that Gregor Mendel, father of the gene theory of heredity, may have doctored the results of his pea-breeding experiments to make them conform more perfectly to his theory. Mendel’s conclusions were correct, but a statistical analysis of his published data shows that the odds were 10,000 to one against their having been obtained through experiments such as Mendel performed.
Doctors’ unethical behavior is not limited to the medical business. A doctor whose name is practically synonymous with development of a major surgical procedure was convicted of five counts of income tax evasion for omitting more than $250,000 from returns for 1964 through 1968. A few years ago the chairman of the Board of the American Medical Association was indicted, convicted, and sentenced to eighteen months in jail after pleading guilty to participating in a conspiracy to misuse $1.8 million in bank funds. According to the FBI, he and his codefendants had conspired to “obtain unsound indirect loans for their own interest. . .paying bank funds on checks which had insufficient funds to back them. . .and defrauding the government. . .”
Keep in mind that these shenanigans are going on at the highest levels of the medical profession. If this kind of dishonesty, fraud, and thievery is going on among the bishops and cardinals of Modern Medicine at Yale and Harvard and the National Academy of Sci*ences and the AMA, imagine what is going on among the parish priests at the other medical schools and medical societies!
Perhaps the most telling characteristic of the profession that is supposed to deliver health care is that doctors, as a group, appear to be sicker than the rest of society. Conservative counts peg the number of psychiatrically disturbed physicians in the U.S. at 17,000 or one in twenty, the number of alcoholics at more than 30,000, and the number of narcotics addicts at 3,500 or one per*cent. A thirty-year study comparing doctors with professionals of similar socio-economic and intellectual status found that by the end of the study nearly half the doctors were divorced or unhappily mar*ried, more than a third used drugs such as amphetamines, barbitu*rates, or other narcotics, and a third had suffered emotional prob*lems severe enough to require at least ten trips to a psychiatrist. The control group of non-doctors didn’t fare nearly as badly.
Doctors are from thirty to one hundred times more likely than lay people to abuse narcotics, depending on the particular drug. At a semiannual meeting of the American Medical Association in 1972, surveys cited showed that nearly two percent of the doctors practic*ing in Oregon and Arizona had been disciplined by state licensing authorities for drug abuse. An even larger percentage got into trou*ble for excessive drinking. Even the AMA admits that one and one-half percent of the doctors in the United States abuse drugs. Various reform and rehabilitation measures over the years have not changed these percentages. Keep in mind that these figures repre*sent only the identified cases. In Illinois, for example, Dr. James West, chairman of the Illinois Medical Society’s Panel for the Im*paired Physician, reported that four percent rather than two percent of Illinois doctors are narcotics addicts. He further estimated that eleven-and-one-half percent were alcoholics - one in nine.
Suicide accounts for more deaths among doctors than car and plane crashes, drownings, and homicides combined. Doctors’ suicide rate is twice the average for all white Americans. Every year, about 100 doctors commit suicide, a number equal to the graduating class of the average medical school. Furthermore, the suicide rate among female physicians is neatly four times higher than that for other women over age twenty-five.
Apologists for the medical profession cite several reasons for doctors’ high rate of sickness. The drugs are easily available to them; they must work long hours under severe stress; their background and psychological makeup predisposes them to stretch their powers to the limits; and their patients and the community make excessive demands on them. Of course, whether or not you accept these reasons, they don’t explain away the fact that doctors are a very sick group of people.
Nonetheless, I prefer to look for more reasons. Fraud and corruption in the research process comes as no surprise to anyone who witnesses the lengths to which drug and formula companies go to doctors to their way of thinking. Free dinners, cocktails, conventions, and subsidized research fellowships still are only superficial explanations. When you examine the psychological and moral climate of Modern Medicine, you begin to get closer to understanding why doctors are so unhealthy.
Medical politics, for example, is a cutthroat power game of the most primitive sort. I much prefer political politics, because there you have the art of the possible, which means you have to compromise. Medical politics is the art of sheer power. There is no compromise: you go right for the jugular vein before your own is torn out. There’s no room for compromise because churches never compromise on canon law. Instead of a relatively open process in which people with different interests get together to try to get the most out of the situation that they can, in medical politics there is a rigid authoritarian power structure which can be moved only through winner-take-all power plays. Historically, doctors who have dared to change things significantly have been ostracized and have had to sacrifice their careers in order to hold to their ideas. Few doctors are willing to do either.
Another reason why doctors are less prone to compromise is because doctors tend to restrict their friendships to other doctors. Close friendships between doctors and non-doctors are nowhere near as frequent as among other professions. Consequently, doctors rarely have to defend their opinions among people who don’t share their background and who might offer a different point of view. Doctors can develop their philosophy in relative privacy, foray at intervals into the public scene to promote these ideas, and then rapidly re*treat to the security of other doctors who support the views of the in-group. This luxury is not available to others in influential posi*tions in public life.
Of course, doctors do see their patients. But they don’t see them as people. The doctor-patient relationship is more like that between the master and the slave, since the doctor depends on the complete submission of the patient. In this kind of climate, ideas can hardly be interchanged with any hope of the doctor’s being affected. Pro*fessional detachment boils down to the doctor rendering the entire relationship devoid of human influences or values. Doctors rarely rub elbows with non-doctors in any other posture but the professional.
Furthermore, since the doctor’s ambitions project him into the upper classes, that’s where his sympathies lie. Doctors identify with the upper class and beyond, even. They view themselves as the true elite class in society. The doctor’s lifestyle and professional behavior encourage autocratic thinking, so his conservative politics and economics are predictable. Most doctors are white, male, and rich—hardly in a position to relate effectively with the poor, the non-white, and females. Even doctors who come from these groups rarely return to serve and “be with” them. They, too, become white, male, and rich for all practical purposes and treat their fel*lows with all the paternalistic contempt other doctors do.
When asked where doctors learn these bad habits, I used to reply that doctors learned them in medical school. Now I realize they learn them much earlier than that. By the time they get to pre*medical training, they’ve picked up the cheating, the competition, the vying for position — all the tricks they know they need if they want to get into medical school. After all, our university system is modeled after the medical schools, and our high schools are modeled after our universities.
The admissions tests and policies of medical schools virtually guarantee that the students who get in will make poor doctors. The quantitative tests, the Medical College Admission Test, and the re*liance on grade point averages funnel through a certain type of per*sonality who is unable and unwilling to communicate with people. Those who are chosen are the ones most subject to the authoritarian influences of the priests of Modern Medicine. They have the com*pulsion to succeed, but not the will or the integrity to rebel. The hierarchy in control wants students who will go through school pas*sively and ask only those questions the professors can answer com*fortably. That usually means they want only one question at a time. One of the things I advise my students to do in order to survive medical school is to ask one question but never ask two.
Medical school does its best to turn smart students stupid, honest students corrupt, and healthy students sick. It isn’t very hard to turn a smart student into a stupid one. First of all, the admissions people make sure the professors will get weak-willed, authority-abiding students to work on. Then they give them a curriculum that is absolutely meaningless as far as healing or health are con*cerned. The best medical educators themselves say that the half-life of medical education is four years. In four years half of what a medical student has learned is wrong. Within four years of that, half again is wrong, and so on. The only problem is that the students aren’t told which half is wrong! They’re forced to learn it all. Super*vision can be very close. There is no school in the country where the student-teacher ratio is as low as it is in medical school. During the last couple of years of medical school, you frequently find classes of only two or three students to one doctor. That doctor has tremen*dous influence over those students, through both his proximity and his life-and-death power over their careers.
Medical students are further softened up by being maliciously fatigued. The way to weaken a person’s will in order to mold him to suit your purposes is to make him work hard, especially at night, and never give him a chance to recover. You teach the rat to race. The result is a person too weak to resist the most debilitating in*strument medical school uses on its students: fear.
If I had to characterize doctors, I would say their major psychological attribute is fear. They have a drive to achieve security-plus that’s never satisfied because of all the fear that’s drummed into them in medical school: fear of failure, fear of missing a diagnosis, fear of malpractice, fear of remarks by their peers, fear that they’ll have to find honest work. There was a movie some time ago that opened with a marathon dance contest. After a certain length of time all the contestants were eliminated except one. Everybody had to fail except the winner. That’s what medical school has become. Since everybody can’t win, everybody suffers from a loss of self-esteem. Everybody comes out of medical school feeling bad.
Doctors are given one reward for swallowing the fear pill so will*ingly and for sacrificing the healing instincts and human emotions that might help their practice: arrogance. To hide their fear, they’re taught to adopt the authoritarian attitude and demeanor of their professors. With all this pushing at one end and pulling at the other, it’s no wonder that doctors are the major sources of illness in our society. The process that begins with cheating on a biology exam by moving the microscope slide so that the next student views the wrong specimen, that continues with dropping sugar into a urine sample to change the results for those who follow, with hiring others to write papers and take exams, and with “dry labbing” ex*periments by fabricating results, ends with falsifying research reports in order to get a drug approved. What begins with fear and fatigue over exams and grades ends with a drug or alcohol problem. And what begins with arrogance towards others ends up as a doctor pre*scribing deadly procedures with little regard for the life and health of the patient.
My advice to medical students is always to get out as soon as pos*sible and as easily as possible. The first two years of medical school are survivable because the students are relatively anonymous. The student should try his or her best to remain so, since if the professors don’t know him they can’t get to him. The last two years are more personal, but the student has more time off to recover from the as*saults. If a student simply does enough work to pass and doesn’t get all wrapped up in the roller derby mentality, he or she can make it to the finish line relatively unscathed. Then, as soon as the student is eligible for a state license, I advise him to quit. Forget residency and specialty training because there the professionals have the stu*dent day and night, and he can really be brainwashed. That’s when the real making of the Devil’s priests occurs.
Doctors are only human. But so are the rest of us, and sometimes we need the services of all-too-human doctors. Because the doctor-priest acts as a mediator or a conduit between the individual and the powerful forces the individual feels he cannot face alone, a faulty conduit can result in some very powerful energy flowing into the wrong places. For example, when doctors are compared with other people in evaluating retarded and other handicapped persons, those who always give the most dismal predictions and the lowest evalua*tions are the doctors. Nurses are next lowest, followed by psychologists. The group that always gives the most optimistic evaluation is the parents. When I’m faced with a doctor who tells me a child can’t do certain things and parents who tell me that the child can do them, I always listen to the parents. I really don’t care which group is right or wrong. It’s the attitude that counts. What*ever attitude is reinforced and encouraged will prove true. I know doctors are prejudiced against cripples and retarded people because of their education — which teaches that anyone who is handicapped is a failure and is better off dead — so I can protect my patients myself against the doctors’ self-fulfilling prophecies of doom.
Yet doctors continue to get away with their attitude and their self-serving practices. Even though doctors derive a great deal of their economic status and power from insurance companies, the doc*tors are in control. So much in control, in fact, that insurance com*panies generally act against their own interests when the choice is that or weaken the power of doctors. Blue Cross and Blue Shield and other insurers logically should be searching for methods of de*creasing unnecessary utilization of medical services. Occasionally, we see half-hearted attempts in this direction, such as the flurry of rules requiring second opinions before elective surgery, or the every-so-often policy of discontinuing reimbursement for procedures long fallen into oblivion. These efforts are more window dressing than anything else. They are introduced with considerable fanfare, rapidly generate a groundswell of controversy, and then quietly slip away. Regardless of how well-intentioned they are, they still address them*selves only to the peripheral aspects of medical care and not to the areas where real money is to be saved. If insurance companies really wanted to cut costs, they would promote reimbursement for a wide range of simpler, more effective, cheaper procedures — such as home birth. And they would allow reimbursement for measures that re*store and maintain health without drugs or surgery — such as diet therapy and exercise.
One of the most fascinating statistics I’ve ever run across is one that was reported by the Medical Economics Company, the publishers of the Physician’s Desk Reference. Among other questions, they asked a representative sampling of more than 1,700 people, “If you learned that your doctor had lost a malpractice suit, would it alter your opinion of him?” What amazes me is that seventy-seven percent of the people said NO!
Now I don’t really know if that means that people expect their doctors to commit malpractice or if they don’t care whether he does or not!
I do know that the insurance companies are bamboozled by the doctors into spending more money than they have to. I also know that only about seventy doctors lose their licenses every year — despite all the obvious corruption, sickness, and dangerous malprac*tice. Here we come to one of the truly wondrous mysteries of Modern *Medicine. Despite (or because of?) all that fear and compe*tition among medical students, doctors are extremely reluctant to report incompetent work or behavior on the part of their colleagues. If a hospital, for example, discovers malpractice by one of its doc*tors, the most that will happen is the doctor will be asked to resign. He won’t be reported to state medical authorities. When he seeks employment elsewhere, the hospital will most likely give him a shining recommendation.
When the famous Marcus twin-brother team of gynecologists were found dead of narcotics withdrawal during the summer of 1975, the news that the doctors were addicts came as a surprise to everyone but their colleagues. When the brothers’ “problems” were noticed the year before by the hospital staff, the twins were asked to take a leave of absence to seek medical care. When they returned to New York Hospital-Cornell Medical Center, they were watched for signs that they had improved. They had not. Were they then whisked off the staff and kept out of touch with patients before any*one was seriously harmed? Were they reported to state licensing au*thorities? No. They were told in May that as of July 1, they would not be allowed to work in the hospital. They were found to have died within days after they lost the privilege to admit patients to the hospital.
Another favorite example of doctors allowing their colleagues to commit mayhem on unsuspecting patients occurred in New Mexico. A surgeon tied off the wrong duct in a gall bladder opera*tion and the patient died. Although the error was discovered at au*topsy, the doctor was not disciplined. Apparently, he wasn’t taught the right way to do the operation, because a few months later he performed it again, wrong — and another patient died. Again, no punishment and no surgery lesson. Only after the doctor performed the operation a third time and killed another person was there an investigation resulting in the loss of his license.
[To be continued]
CONFESSIONS OF A MEDICAL HERETIC
By Robert S. Mendelsohn, M.D.
Published by Contemporary Books
ISBN Number 0-8092-4131-5
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