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by Congressman Ron Paul,
MD
Note: Dr.
Ron Paul was the June 2001 commencement speaker at the
University of Texas-Houston Medical School.
Being invited to address you today is
indeed a particular honor for me. In seeking advice about
my speech I was told to observe three things:
1)
Be brief; no one remembers graduation speeches and too often
they are boring. Being brief is not the easiest request
for a politician to fulfill. But I did decide not to read
the 80-page speech I'd written.
2)
Be positive; don't dwell on the problems medicine faces;
this is to be an upbeat event. Now that's a little more
difficult for one who titles his weekly legislative report:
"Texas Straight Talk."
3)
Be non-controversial; well, that's just asking too much
of a politician.
My task today is to remark on the relationship
of medicine to society from my perspective as a physician
and legislator. To me this is a very interesting task, but
difficult to accomplish in a short period.
Before I begin, let me reassure you that
I will try hard not to offend anyone, but that's probably
not completely possible. If I do offend, I apologize.
But you need not worry too much about
a disagreement you might have with what I say, because I'm
an advocate of a political philosophy that believes social
and economic problems should not be solved by passing more
laws and using force, but instead, solutions
should come through freedom and persuasion.
The same events that early on motivated
me to go to medical school later motivated me to participate
in politics. Clear memories of the horrors of World War II
and the Korean War and the reports of loss of life of family,
friends, and neighbors had an impact on me.
I knew very early on I never wanted to
carry a gun in a war and, with the draft in place, I realized
the odds were overwhelming that I would be called up to serve.
I definitely knew at an early age that I preferred a medical
bag to a gun, healing to maiming, life to death.
I'm sure all of your reasons to become
physicians vary, but most young people deciding on the medical
profession share the noble goals of promoting health, healing,
and life.
There are two short stories I want to
tell, one medical, the other political and economic.
First, when George Washington got a serious
illness, the best physicians in the country were called in.
Three of the best consulted and agreed that bloodletting was
the treatment of choice, and the leeches were put in place.
Washington's weakened condition that
was the result of a serious respiratory infection promptly
worsened and he soon died. (There was no malpractice lawsuit
filed.)
Good intentions and conventional wisdom
were not helpful in saving the life of the father of our country.
Medical
care involves more than good intentions.
Second, in 1620 the Pilgrims, under the
guidance of Governor Radford, landed at Plymouth Rock. For
the first two years the guiding principle was "from each
according to ability, to each according to need - and by force."
Starvation ensued and the colony neared
extinction. However, in the third year, Radford, in consultation
with the adults of the community, agreed on a system of private
plots and self-reliance. Results the next summer were astounding.
Productivity shot up, and a community spirit of voluntary
sharing replaced the harsh laws that guided the first two
years.
Freedom solved
the problem of starvation.
The second story reminds me of one of
my early lectures in medical school. We were told that Kwashiorkor
was the most common illness in the world, killing more persons
than any other. Immediately, with delusions of grandeur, I
dreamed of being the physician to find a cure for this devastating
malady.
But later in the lecture I learned that
Kwashiorkor was a different kind of illness - it is the end
result of starvation. Later it dawned on me that the solution
to this problem was more political than medical.
Because we in this country have enjoyed
the benefits of the freest society ever known, true famine
has never existed here. But a headline a few weeks ago read:
"Rickets on the rise in the U.S." I wondered at
the time, could this be an early sign that something is wrong?
Have we undergone a reversal back toward the philosophy that
nearly destroyed the Plymouth colony?
Currently the method of distribution of
medical care in the United States is coming under attack by
politicians, bureaucrats, hospitals, labs, service providers,
doctors, and patients. More laws and more money are demanded
from all quarters.
But could it be possible that distribution
of medical care is now being criticized because of a return
to a system of government similar to the early rules of the
Plymouth colony?
Or is it possible that freedom combined
with self-reliance no longer works? A basic understanding
of economics helps one to understand
why distribution of medical care today is becoming
more difficult; quality is down while costs
are rising; and everyone seems dissatisfied.
We have, unfortunately, at least for medicine,
accepted the rules used in the Plymouth colonies for the first
two years ... "from each according to his ability, to
each according to his needs by force."
I'm not convinced that more regulations
and government laws - which are demanded on a daily basis
- will solve this problem any better than Congress' similar
attempts to deal with most other problems.
Managed care is not market-driven, it's
government-mandated.
It has driven
charity out of the system.
No more church-financed hospitals and
free care for the indigent. Everyone is charged the maximum,
and no test is left undone for fear attorneys will be ridiculing
us in court alleging our negligence.
And if it's not the attorneys, it's the
HCFA [Health Care Finance Administration] agents threatening
us with fines and prison if we misinterpret any of the 132,000
pages of regulations. This system artificially pushes costs
up, bringing calls for price controls, which only mean rationing
and shortages.
Greater understanding of freedom and economics
by the next generation of doctors would go a long way toward
heading off the approaching crisis: the day when the taxpayer
has been bled dry and no funds are available.
Even during the Great Depression, most
people received medical care because of the system. Today
that system won't function without taxpayers' money and can't
function very well even with it.
The medical degree you receive today makes
you a medical doctor. A state license will legally permit
you to practice. However, it takes a lot more to be a caring
physician to your patients. There are several challenges to
the practice of medicine that you, the graduating class, will
have to face in the 21st Century to achieve this goal.
Big Challenges
Ahead
Managed care is the accepted method of
delivering medical care today - to the frustration of many.
Read up!
There are 132,000
pages of Medicare regulations, compared with only
17,000 pages of the tax
code.
A compliance plan to guard against mistakes
in filing government forms is offered by your friendly attorney
for a mere $7,000.
Additional employees are needed to file
insurance forms and keep up with regulations in operating
laboratories. Even more employees will soon be needed to implement
the 1,500 pages of regulations protecting patient privacy
- regulations that in reality turn control of all our medical
records over to the US government and establish a national
medical data bank.
Fines of up to $25,000 and 10 years imprisonment
are possible for fraud and for mistakes that are hard to distinguish
from fraud.
Capitation depersonalizes medicine. FDA
regulations, though designed to help, often delay the arrival
and raise the cost of new drugs. An average new drug now requires
15 years of testing and
$500 million in costs. Many question whether or
not this process is cost-effective. A more liberalized approach
to allowing patients and doctors to use experimental medicines
could speed up the process and lower costs.
Medical privacy rules are expected to
cost $22 billion over 4 years to implement - costs that must
be passed on to the taxpayer or to the patient.
HCFA has actually requested authority
to carry guns on their audits.
Another challenge to personalized care
is the continued influence
of technology and super specialization. It's easy
for the patient to be lost in the process and become only
an object in a scientific whirlwind. This challenge is not
new, but it will continue to affect the practice of medicine
to an even greater extent.
Legal challenges through lawyer-driven
lawsuits are of epidemic proportion and will continue to plague
our profession, thus driving up costs while prompting unnecessary
testing. Threats of an actual lawsuit do affect the way we
all practice.
The National Practitioners Data Bank has
been set up to keep all the records of doctors' misconduct,
which is also subject to the errors of politicians, bureaucrats
and spiteful lawyers. Rectifying errors and avoiding misinterpretations
in this process are difficult, if not impossible tasks. Centralized
government bureaucracy won't solve the problems of ethics
and measuring ability in medicine.
The Drug War
The drug war will continue to affect the
way we practice medicine. Law enforcement pesters us to be
their assistants in turning over to them patients who break
the drug laws.
This encourages
patients to hide rather than reveal vital information to their
physicians.
Drug laws have also caused many physicians
to inadequately treat the pain of the dying patient out of
fear of the law. Nursing care has been affected as well.
Some day, hopefully, all drug addiction
will be treated more like we treat alcoholism; as a disease
or social aberration rather than as a crime. The drug war
has done more harm to our society than the drugs themselves.
The medical community should help to reeducate the public
on this serious problem.
Life and Death
The greatest challenge young doctors face
today in their journey to becoming caring physicians is dealing
with the new attitude of our profession toward
life and our closer alliance with death. Thirty years ago,
taking early life was not a routine medical procedure; today
it is. Many believe this has coarsened society's attitude
toward life.
The changes regarding abortion have occurred
in my generation and not without a lot of heated disagreements.
The debate will continue until your generation answers a perplexing
question.
Let me state it: If a woman in an automobile
on her way to have an abortion is hit by another vehicle which
causes the death of her fetus, does she have the moral right
to sue and win a million dollar judgment in a "wrongful
death" suit?
This is not meant to be a legal question
but one pertaining only to our understanding of life
and morality. An acceptable answer to this question
on both sides of the abortion argument must be found if we
ever expect the sharp debate on this crucial issue to mellow.
In the last 30 years, the medical profession
has allowed itself to get closer to the implementation of
the death penalty than previously. In the 1880s, technology
was available to implement the death penalty by injection
and was seriously considered.
Organized medicine at that time, however,
strongly objected to even the principle - believing needles
and syringes would portray medicine as a participant - and
it wanted no part of it.
With the advent of electricity, the electric
chair was chosen over lethal injections. Since the resumption
of the death penalty in 1977, lethal injection has been commonly
used to carry out the death penalty, with the advice and even
the presence of physicians. The strong objections expressed
by the medical community a century ago are no
longer heard.
Euthanasia
Your generation will deal with euthanasia
as we have dealt with abortion. I predict a major and heated
debate will occur in the next 30 years. Already one state
has legalized "doctor-assisted suicides." I'm not
talking about reasoned restraints of heroic measures for the
terminally ill at the patient's request. Euthanasia laws as
they have progressed in some European nations permit active
euthanasia.
We already have the Dr. Kevorkians and
angels of death leading the charge in a dangerous and illegal
fashion in this country. It's interesting that the promoters
of euthanasia always want the doctors involved.
This is for a precise purpose, and that
is to gain moral sanction not otherwise available. You never
hear about having attorney or judge-assisted suicides, but
they can figure out the details as well as the medical profession.
This trend is fraught with great danger.
Once
physicians embark on making decisions over death, rather than
always opting for life, they invite too many mistakes.
Subjugation to social pressure and family
squabbles can affect decisions.
The government now assumes nearly a complete
role in regulating and paying for health care; economic factors
will surely play a role in this decision-making as time goes
on. Already we have seen managed care and government regulations
dictate rules that are not always fair as to who gets the
organ transplant or some other expensive treatment.
Regardless of the law in dealing with
these issues, I see no reason why the medical profession has
to grant moral approval to the process. Let someone else deal
with it and carry out the deed. It’s surely not an issue
of know-how, and we need not give it credibility by pretending
it’s part of our responsibility to heal.
Society needs and demands our endorsement
to make it a medical procedure, which it is not. Our endorsement
only prevents others from considering the morality of the
issue.
Already a well-known former governor is
strongly advocating active euthanasia, saying "the elderly
have an obligation to die" and should not hang on to
life that offers little.
The US Congress, although technically
it has no jurisdiction to do so, has tried to undermine the
Oregon law (the first state to pass a law that permits physician-assisted
suicide) with proposed legislation that would severely micromanage
the care of dying patients.
This attempt to do what some see as "the
right thing to do" will only cause more problems by intimidating
physicians in their efforts to relieve the pain of dying patients.
New restraints by government on prescribing for the dying
will prove to be an unnecessary aggravation. This is not the
answer to a society moving toward euthanasia.
This subject will be with us for a long
while. Your generation of physicians will have no choice but
to deal with it one way or another. You can’t escape
it -- even total non-participation in the debate is taking
a position.
Obviously, problems do exist in medicine,
but the profession you have chosen is the best of all. It
is a noble calling to enter medicine. You have learned the
science, you will get your license, and the only task left
before you is to become a caring physician. I am sure that
nearly every one of you thought of service to your fellow
man when deciding on a medical career. And that’s a noble
ambition that should never be forgotten.
The true physician draws on this and must
be reminded of it throughout his or her life. This is what
makes us approach our patients with kindness, gentleness,
caring, and concern. Being a good listener is essential. Someday,
a sincere thank you or a small gift will remind you of this,
and at times it will even surpass in value the fee that you
have received for your services.
Good intentions can kill any patient,
just as they did George Washington. Good science, without
compassion and understanding,will not allow you to practice
great medicine. Compassion and care and good science will
make you become the physician you dreamed of being. This will
require tolerance for alternative medical options -- since
some may actually work -- and a recognition that faith and
prayer have a healing quality. Intolerance of this view will
not enhance a physician’s ability to heal.
Carry These
Thoughts With You
A few simple but important reminders are
in order. Always remain inquisitive, studying and keeping
up with new medical knowledge. This is your easiest task.
You have proven your ability just by being here today.
But also be inquisitive in other areas.
Economics, politics, and the arts (that you so far have had
little time for) are vital subjects that can provide satisfaction
and challenge us.
Remain productive. Medicine has discouraged
many in the past years and too many are retiring in their
prime -- that’s disappointing. It’s expected that
one-third of all the nurses are likely to quit practicing
in the next year due to problems in medicine.
But regardless of the system, a physician
should always be willing to practice the art of medicine for
as long as possible in some capacity. We have all heard about
the "greatest generation." You are joining the "greatest
profession."
There can be no better job than being
a physician in that it’s always possible and easier for
you and others to follow the adage "it is better to light
a candle than curse the darkness." Every patient facing
illness, death, or stress deserves your lighting a candle.
I’m convinced that the freer the
society is the better this job can be done, and that can only
be achieved through education and political action. Freedom
is never automatic. Without due vigilance, the only thing
that is automatic is that the good intentions of the politicians,
like the good intentions of George Washington’s doctors,
will not suffice -- they will only make our problems worse.
In politics, always opt for freedom. Today,
this country is starved for a greater faith in freedom and
less dependency on government and management of our lives
and our medical system.
LewRockwell.com
August, 16, 2001
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