All posts by David Penner

Health Care Imperialism: Looting The World’s Doctors

To poach and rely on highly skilled foreign workers from poor countries in the public sector is akin to the crime of theft.

—  “Migration of Health Workers: An Unmanaged Crisis,” The Lancet, May 28, 2005

What is striking about the tyranny of the medical industrial complex is not only its unconscionable oppression of the American working class, but also its assault on the health care systems of other countries. These acts of barbarity and pillage allow the Anglo-American elites to keep the countries of the global south in a state of backwardness and dependency, and one of the ways this is done is by enticing doctors from developing nations to abandon their countries and practice in the West.

One such example is India, a country with horrendous unmet health care needs. Snakebites are a serious problem and lead to the deaths of over 45,000 Indians each year, the overwhelming majority of whom are villagers in isolated rural communities. Following a snakebite, the afflicted person often has to travel vast distances to reach a medical facility, typically battling poor roads in the process. An unreliable power grid results in these remote areas having intermittent access to electricity, which exacerbates the problem as the anti-venom must be refrigerated.

So lax are India’s ethics laws that her destitute masses are frequently used as clinical guinea pigs by powerful pharmaceutical companies in the testing of new drugs, which has resulted in tens of thousands of adverse reactions and thousands of fatalities. The number of clinical trials has risen dramatically following a relaxing of drug testing laws that was implemented in 2005, and many of these patients are unable to read the consent forms which are printed in English. India also has an egregious doctor-patient ratio, with less than one doctor for every thousand patients.

Speaking on the troubled state of Indian health care, Tatyarao P. Lahane, MD, said in an interview with The Times of India:

A skewed doctor-patient ratio in our country is the major cause of trouble. In almost all leading countries of the world a doctor in a government hospital checks a maximum of 30 patients a day. In India, any doctor on an average checks at least 150 patients a day.

Inadequate environmental regulations have led to extremely poor air quality, which has likewise contributed to unsatisfactory health outcomes. Furthermore, India’s downtrodden masses continue to be oppressed by an inhuman multi-tier system. In an article titled “More Indians die of treatable diseases than lack of access to healthcare,”  Swagata Yadavar writes:

Poor care quality leads to more deaths than insufficient access to healthcare –1.6 million Indians died due to poor quality of care in 2016, nearly twice as many as due to non-utilisation of healthcare services (838,000 persons).

In addition to these problems that are a pox on Indian society, there are over 59,000 Indian physicians working in the United States, the United Kingdom, Canada and Australia, countries which have the resources to easily train their own doctors. Two thirds of that number work in the US. Lamenting the staggering number of Indian doctors that go abroad in “Doctors For The World: Indian Physician Emigration,” Fitzhugh Mullan writes “that their clinical and political energies will never address the improvement of health care in India.”

In an ironic twist, private hospitals that cater to affluent Indians are turning a profit through the peculiar phenomenon of “medical tourism,” whereby uninsured and underinsured Americans can receive medical care for a minuscule fraction of what they would be billed in the US.

Significant numbers of African doctors, virtually all coming from countries with poor doctor-patient ratios, are lured to practice in the US, and are also beguiled by false promises of excellent training and superior working conditions. Many hail from countries with poor health indicators, such as Ghana, where life expectancy is 63. Moreover, as Jonathan Wolff writes in “Why America Steals Doctors From Poorer Countries“:

If a doctor from Ghana is recruited to the US, not only does Ghana lose its doctor, it loses the money paid for the training. It may be that the doctor is likely to send a portion of earnings back home (known in the development business as “remittances”). But this is scant compensation. In sum, the US is receiving a massive subsidy from the developing world in training its medical staff.

Nigeria has a doctor-patient ratio of one doctor for every five thousand of her citizens, a life expectancy of 55 for men and 56 for women, and a maternal mortality rate of over 800 deaths per 100,000 live births. Over half of Nigeria’s doctors practice abroad.

International medical graduates (IMGs) that hail from developing countries are often sent to work in rural areas where American physicians are reluctant to practice, and yet many never return to their native lands. In an article titled “U.S. Recruiting Africa’s Doctors for Placements No One Wants,” by Austin Drake Bryan, the author writes:

The United States is recruiting the world’s doctors — and from the very places that need MDs the most. Dubbed the “international brain drain,” the United States leads the way in attracting international doctors, especially those from Africa.

The United States, with its high salaries, attracts more international doctors every year than Britain, Canada and Australia combined. However, for every 1000 people, Africa has only 2.3 health care workers, while the United States has almost 25.

IMGs are frequently brought into the US on guest worker visas, and can have their visa revoked if they complain. This bolsters the stranglehold of the health insurance companies, hospital executives, and pharmaceutical companies, and exacerbates the challenges of unionizing a newly proletarianized and increasingly dehumanized workforce. Indeed, foreign doctors on the J-1 visa are particularly vulnerable to abusive and exploitative working conditions. Decrying the exploitation of IMGs in Australia, Sue Douglas, MD, writes in The Australian “that international medical graduates are a vulnerable group that have been exploited by the government, abused by their own profession and ignored by the public.”

In an interview with Pamela Wible, MD, and Corina Fratila, MD, Fratila, who is from Romania, speaks of training in the US and being forced to work 126 hours a week with minimal supervision, while also struggling with the danger of fatal miscommunications that can easily occur between doctors and nurses who are coming from different countries and do not share English as their native language.

Another disturbing trend is the growing number of American medical graduates that do not match into a residency position. In an article published on April 16th, 2019, titled “The National Resident Matching Program No Longer Meets Doctor Needs,” Joe Guzzardi writes:

In the most recent match, which happened last month, 1,162 U.S. medical school seniors and 811 previous U.S. graduates did not match to a residency at a teaching hospital, so nearly 2,000 U.S. grads did not get residency. Without fulfilling residency requirements, doctors can’t practice medicine. In last month’s match as well, 4,028 non-U.S. citizen students/IMGs matched and were granted residency, bringing the total number of IMGs placed in U.S. residencies since 2011 to 31,894.

It is important to remember that residency positions are subsidized through Medicare funds, which are in turn subsidized by the American taxpayer. Passed over for a residency position and often saddled with terrible student loans, some unmatched medical school graduates have even taken their own lives, as exemplified by the tragedy of Robert Chu. The increasing reliance on foreign doctors is also curious, in light of the fact that vast numbers of American high school students are not receiving an education in basic math and science.

A ruthless war is being waged against universal health care, both at home and abroad. US military interventions in Iraq, Libya, Afghanistan (under the communists), and Yugoslavia brought about the destruction of comprehensive (and in the case of Afghanistan, burgeoning), single-payer health care systems. Juan Orlando Hernández, the US puppet overseeing the Honduran junta following the putsch that ousted the progressive government of Manuel Zelaya, has taken measures to privatize that country’s health care system. Hence, “democracy has been restored.”

The progressive governments in Cuba and Venezuela both offer free health care to their citizens. Consequently, they are “rogue” states. Syria has been ravaged by the US-NATO-Israel bombing campaigns and the “international community’s” support for a generous array of barbarians and religious fanatics, yet still offers free health care to her citizens. This is also the case with the rebel government in the Donbass which even gives free health care to captured neo-Nazis.

The poaching of foreign doctors is consistent with the desire of the Western elites to keep the global south under the iron heel of subservience and destitution. This devilry has also played a role in transforming the American medical profession into a diabolical sweatshop devoid of unions and labor laws, with the deteriorating rates of infant mortality, life expectancy and maternal mortality that have inexorably followed. To borrow a phrase from Yeats: “anarchy is loosed upon the world.” Unless we find a way to disenthrall ourselves from the despotism of the medical industrial complex, the health care oligarchs will continue to enslave us all.

The Doctor-Patient Relationship Can be Found in the Graveyard of Informed Consent

My master that was thrall to Love
Is become thrall to Death.

— “A Ballad of Death,” by Algernon Charles Swinburne, Poems and Ballads, First Series, 1866

The 21st century is only in its infancy, and the United States has revealed itself to be a truly remarkable country. We have imaginary jobs, an imaginary middle class, imaginary checks and balances, and an imaginary society. We even have imaginary bioethics. At the root of this new and exciting phenomenon is the dismantling of informed consent and the disintegration of the doctor-patient relationship that has followed in its wake.

The privatization of health care has contributed to the weakening of the physician-patient bond, as health care has largely been taken over by the gangster capitalists of the pharmaceutical industry, the health insurance companies, device manufacturers, and hospital administrators. In a KevinMD article titled “The Self-Inflicted Death of the Physician,” an anonymous doctor writes, “For certainly we, as a profession, have handed over our authority to others, not all at once, but slowly, inexorably, over decades. We are just a shadow of our former selves.” Mirroring these sentiments, Linda Girgis, MD, writes in Physician’s Weekly, “The doctor is no longer center stage, unless you are watching a puppet show.”

In what will inevitably foment more unscrupulous behavior, MD/MBA programs are teaching doctors to think like businessmen, an irreconcilable contradiction. Hospital administrators are pressuring doctors to see increasing numbers of patients each day, while the health insurance companies continue to play a major role in stripping doctors of their autonomy by regularly countermanding doctor’s orders. This corporate coup d’état, rooted in avarice, callousness, and sociopathy has caused many clinicians to become unmoored from their traditional moral compass.

Physicians are now compelled to use electronic medical records (EMRs), which force them to waste countless hours doing mind-numbing data entry. If an attending physician decides to employ a medical scribe, nurse, or medical student to assume responsibility for this onerous task, it means that a third party will be in the examination room during patients’ office visits, which if done without the patient’s permission, constitutes an egregious violation of informed consent. It is also common for businesses to change the health insurance plans of their employees each year, which invariably results in many patients having to leave doctors that they have established long-standing relationships with, and who may be critically important to their physical and emotional well-being.

In addition to seeking assistance with EMRs, many physicians opt to bring interlopers into patients’ office visits, either because they prioritize teaching trainees to establishing a sound physician-patient rapport, or because they have figured out that it is much harder to be sued if there is a chaperone present in the examination room. Unsurprisingly, the medical institutions that spend the most money on glossy advertisements boasting of their boundless magnanimity and benevolence are frequently the institutions that are the most eager to bully patients into accepting a culture anchored in authoritarianism and absolute contempt for the rights of the patient.

In a KevinMD article titled “Electronic Health Records Cannot Replace a Doctor Who Knows You,” the authors write: “Ensuring the best medical care is not primarily a technical challenge. It is a human challenge, which requires patients and doctors to be able to form deep and long-standing relationships.” And yet American teaching hospitals are churning out delusional and hubristic creatures who have not been inculcated with a respect for patient privacy and informed consent, and who are incognizant of the fact that once these principles have been jettisoned the majority of their patients will neither trust, nor respect, nor confide in them. The deterioration of this vitally important relationship has resulted in a situation where it is increasingly common for patients to fail to disclose pertinent medical information. The deplorable state of the humanities and the rise of subspecialization have undoubtedly  contributed to this scourge of blindness in American health care.

Commenting on the dangers posed by medical scribes, Ami Schattner, MD, of the Hadassah Medical Center in Jerusalem, said in an interview with The Medical Bag:

I have serious concerns about the impact of scribes on the tender dynamic and intimacy of the physician-patient encounter. Perhaps the word ‘sanctity’ is not too strong when talking about the physician-patient relationship.

In an article titled “Shining a Light on Shadowing,” by Elizabeth A. Kitsis, MD, the author warns of the ethical ramifications of imposing pre-med students on patients during their doctor visits:

Physician shadowing by college students…may involve subtle coercion of the patient. To maintain his or her rapport with the physician, a patient may feel compelled to allow students into the examination room if his or her physician makes the request. However, the patient may resent the intrusion, and feel uncomfortable during the interaction.

Indeed, Kitsis’ words are also applicable with regard to nurses, medical students, residents, and fellows observing office visits. In an article in Medscape titled “What is Medical Ethics, and Why is it Important?” the authors write: “Ethical decisions cannot be avoided. Whenever doctors make a clinical decision, they are almost always making an ethical decision, consciously or not.” It is not even unusual for attending physicians to inform patients of ominous test results with their entourage in tow. While this may be very exciting for medical students it can be perceived as callous, degrading, and inhuman from the standpoint of the patient.

In “Stop the Anti-Doctor Media Bias,” by Rebekah Bernard, MD, the author writes that “Most physicians are dedicated individuals who hold patient care as sacrosanct.” I saw more doctors from 2016 to 2018 than a person would typically work with if they lived to a hundred, and have yet to see a single doctor’s office present me with a choice regarding the presence of observers during my office visits. In what could form the basis of a Kafka story, I had to voice my objections to the same institution and the same departments over and over again ad infinitum. Is this indicative of holding patient care as sacrosanct?

Jeremy Brown, MD, has proposed that doctors be equipped with body cameras, and Myles Riner, MD, supports the recording of physician-patient encounters, arguing in “Should Physicians Record and Share Conversations with Patients?” that “One thing is certain, this approach is certainly indicative of patient-centered care, and I think many patients would greatly appreciate the effort.” Not to be outdone, The New York Times has waxed glowingly on the subject of group doctor visits. Virtual office visits and doctor visits at work also pose a serious threat to confidentiality. So little value is placed on patient privacy that hospitals have even allowed television crews into emergency rooms, resulting in one New York widow turning on the television one evening, only to watch her husband die before her very eyes. Even if medical students attend a few decent lectures on bioethics, this is frequently negated by what they see their attending doing on a daily basis.

When the time comes for doctors to be patients, they often take for granted having the finest insurance plans which permit them to see any doctor without restrictions. This is in contrast with the majority of patients, who are increasingly restricted to narrow networks.

In a KevinMD article titled “Please, be kind to your doctor. We need it.,” Sara R Ahronheim, MD, writes: “But when I go home, I am alone; no one knows your stories, no one sees the tears you cried when I told you the awful things I had to tell you.” No one, that is, except the nurse, medical student, and resident who also happened to be hanging out in the room at the time.

What will become of the younger generation, being mentored as they so often are, in an environment where degradation is professionalism, indifference is empathy, and the most sordid behavior is hailed as “patient-centered care.” Indeed, this practice embodies everything base, ignoble, and treacherous in contemporary American health care. So relentlessly are patients besieged by these indignities, that there are times when I cannot help but wonder if these are really accidents and misunderstandings or the result of knavery and villainy. Teaching hospitals have a sacred duty to inculcate their trainees with a comprehensive understanding of, and respect for, medical ethics. All too often they are derelict in this duty. That so many attendings and their charges are indifferent to the physical, psychological, and emotional vulnerability of their patients underscores the fact that doctors and patients often speak in completely different languages.

This imposition of interlopers during physician office visits — a depraved reality show euphemistically called “team-based care” — constitutes a violation of every foundational tenet of medical ethics: informed consent, confidentiality, patient privacy, patient dignity, patient trust, and the oath to do no harm. Moreover, once trainees have learned to disregard informed consent with regard to nonconsensual physician shadowing, it is highly probable that they will do so again when the opportunity presents itself.

For instance, it is common for medical students and residents to be instructed to do practice pelvic exams on anesthetized patients, and the practice is legal in 45 states. A 2007 study done in Canada — a country with a comprehensive single-payer system — revealed that over 70 percent of medical students had done practice pelvic exams on anesthetized patients, and women have reported pain and bruising from these unauthorized exams.

Teaching hospitals frequently regard their patients, especially those who lack the best commercial plans, as their property. In an online forum on The Student Doctor Network where the ethics of having trainees perform practice pelvic exams on anesthetized patients is debated, AmoryBlaine writes:

It’s surprising how worked up some people get over the issue. You will be naked on a brightly lit table for all to see. A medical student will put a tube into your bladder. We’re about to flay your belly open and remove your uterus and ovaries. But to do a pelvic exam! What a violation! If you get into this habit of being deathly afraid of the patient’s feelings about an internal exam you will never learn how.

Glorytaker writes:

When I was doing OB/GYN as a med student, the attending would have me do a pelvic right after the patient was under and before we started surgery. Of course, we were doing GYN-related surgery and he wanted me to note the difference before and after a cystocele or rectocele repair. We didn’t exactly get permission but it was for teaching purposes.

Any rational layperson would be able to tell you that this is unethical, and yet many medical students and residents would disagree. What does that say about our education system? Perhaps it is this sort of degenerate thinking that led The Stanford Encyclopedia of Philosophy to nonchalantly point out that “The turn of the 21st century has seen doubts surfacing about informed consent.” The fighter pilot that bombs wedding parties in Afghanistan and the impressionable trainee who is taught that it is acceptable to do practice pelvic exams on anesthetized patients have much in common. For they have both been inculcated with a profound sense of blind obedience.

It is common for doctors to do nonconsensual episiotomies and pelvic exams on women in labor, and women are frequently coerced into having pelvic exams in exchange for birth control prescriptions. This is an example of how, with a medical degree and some mental gymnastics, blackmail and rape can be transformed into cod liver oil and brussel sprouts. Writing about the lack of informed consent with regard to Pap smears and testing for cervical cancer, Joel Sherman, MD, has pointed out that cervical cancer is very rare in the United States. In Finland women are given the option of being tested for cervical cancer once every five years. And in an article that appeared in The Milbank Quarterly titled “Cervical Cancer Screening in the United States and the Netherlands: A Tale of Two Countries,” the authors write, “Even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries’ mortality trends were quite similar.” Perhaps this egregious lack of ethics in obstetrics and gynecology should come as no surprise, considering the fact that James Marion Sims, who invented the speculum and who is widely regarded as the founder of modern gynecology, performed experiments on black slave girls.

Will a 25-year-old woman continue to trust her oncologist should she go into permanent early menopause following chemotherapy, and her oncologist failed to disclose this as a common side effect associated with her chemotherapy regimen? What is the likelihood that a cancer patient will continue to trust their doctors should they experience long-term chemotherapy-induced cognitive dysfunction, they are unable to continue with their career, and this too was not disclosed? Indeed, failure to disclose common long-term chemotherapy side effects is standard practice in many American cancer centers. It is also common for school districts to force high school students to undergo genital exams as a requirement to play sports, despite the fact that the scientific rationale behind the practice remains murky at best. And there are medical institutions, such as Memorial Sloan Kettering Cancer Center in New York City, that do not allow patients to change from one doctor to another within any given department, which can leave a patient torn between seeking care at an inferior facility or being the slave of an overbearing scoundrel.

Informed consent is absent in routine mammography screening, as no evidence exists that mammograms provide any benefit, whereas evidence exists that they have caused considerable harm. Obstetrics and gynecology aside, in no other specialty is there greater contempt for informed consent than in psychiatry, where dangerous side effects from psychiatric drugs are regularly withheld from patients and these drugs are even being prescribed for children. Psychiatrist Lawrence Kelmenson writes in “The Three Types of Psychiatric Drugs – A Doctor’s Guide for Consumers:”

Psychiatrists are seen as hard-working, caring, understanding healers, but they’re really snake-oil salesmen, drug-dealers, and master-sedaters. What they do should be illegal. Someday everyone will realize that not only do psychiatrists not heal anything, they’re a major contributor to the recent rise in suicides and overdoses.

Dr. Peter Breggin has echoed these sentiments, and actually specializes in getting people off these drugs.

It is common for patients who are perceived as “anti-authoritarians” to be diagnosed as “mentally ill,” and a number of school shooters were found to be taking powerful psychiatric drugs at the time they unleashed a fusillade of bullets on their classmates and teachers. Informed consent is frequently absent in the treatment of prostate cancer, and tens of thousands of American men have their prostates removed unnecessarily each year, only to fully understand the dire consequences after the damage is irreversible. (Consider the words of Atul Gawande, MD, in “Overkill:” “The forces that have led to a global epidemic of overtesting, overdiagnosis, and overtreatment are easy to grasp. Doctors get paid for doing more, not less.”) These are all examples of how informed consent is routinely disregarded in an unconscionable manner. The Tuskegee Alabama syphilis experiments, as well as medical experiments conducted on the downtrodden of IndiaAmerican prisoners, and on prisoners in Guantanamo are emblematic of the barbarities that can be unleashed when the celestial temple of informed consent lies in ruins.

After undergoing a surgical procedure in the summer of 2016, I was given a prescription for oxycodone, a semisynthetic opioid. Never was the highly addictive nature of this drug disclosed to me. Thankfully, Dr. Google informed me that oxycodone posed a “high risk for addiction and dependence.” Perhaps this might explain why, according to the CDC, “On average, 130 Americans die every day from an opioid overdose.” Many medical blogs delight in reminding us of the fact that the doctor-patient relationship is foundational to sound health care, and yet narcissism, moral bankruptcy, and careerism are endemic to our health care system. The erosion of trust that has followed this satanic cult of medical coercion has led to a situation where it has become harder for physicians to get patients to follow through with their treatment protocols.

The hazing and bullying commonly experienced by many trainees can cause medical students and residents to become jaded, and to lose their sense of empathy. Residents are often so exploited that many suffer from depression and are chronically sleep-deprived, and the brutal military-style training they are forced to endure can lead to many trainees forgetting that “gall bladder in Room 213” is a human being with a name. It is incontrovertible that corporations have undermined the doctor-patient relationship and inflicted catastrophic damage to our health care system. And while doctors must support the fight for single-payer, they must also acknowledge the fact that the cavalier attitude towards informed consent on the part of many American physicians has played a critical role in the dissolution of the public’s trust. Inexperienced patients naively assume that every doctor will have their best interests at heart. All too often, this is sadly not the case. Moreover, once this trust has been violated, it can result in grievous and long-lasting emotional harm. A clinician that is indifferent to the doctor-patient relationship, and who is only interested in scans, pathology reports, and blood tests has been infected with the virus of technocracy and fallen into a morass of charlatanism.

In the Charmides Plato wrote that “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” Medical students and residents may learn how to diagnose and treat different diseases, yet are seldom inculcated with an understanding of medical ethics and why it is so indispensable. In “Bringing Hospitality Back to the Hospital: Lessons From a Bartender,” by Cory Michael, MD, the author writes: “People remember how you make them feel. They don’t care how much you know unless they know how much you care.” Medical terrorism and corporatization are the Goneril and Regan of medical sacrilege. Perpetually locked in a deadly embrace, they fuel one another’s nefarious designs. The tragedy is that so many medical students and residents are being seduced, not by the voice of truth, but by the voice of damnation. Let us recall the chilling words of Iago: “When devils will the blackest sins put on / They do suggest at first with heavenly shows / As I do now.” (Othello II.iii.)

Informed consent is a river that separates the consecrated light of morality from the profane and blasphemous abyss of amorality. Once this Rubicon has been crossed, there is no turning back. Those who have strayed from their sacred oath will find absolution not in the ways of the wicked, but in a return to the path of compassion, integrity, and righteousness. Indeed, dignity for the patient and dignity for the physician are mutually interdependent.

The doctor-patient relationship now lies buried in the unhallowed primeval ground; a cemetery where broken tombstones litter the earth with thorns and broken bottles, the land is barren and no flowers grow, and a once-proud beating heart beats no more. Only with a return to this inviolable bedrock of medical ethics can we embrace its resurrection.

The Doctor-Patient Relationship Can be Found in the Graveyard of Informed Consent

My master that was thrall to Love
Is become thrall to Death.

— “A Ballad of Death,” by Algernon Charles Swinburne, Poems and Ballads, First Series, 1866

The 21st century is only in its infancy, and the United States has revealed itself to be a truly remarkable country. We have imaginary jobs, an imaginary middle class, imaginary checks and balances, and an imaginary society. We even have imaginary bioethics. At the root of this new and exciting phenomenon is the dismantling of informed consent and the disintegration of the doctor-patient relationship that has followed in its wake.

The privatization of health care has contributed to the weakening of the physician-patient bond, as health care has largely been taken over by the gangster capitalists of the pharmaceutical industry, the health insurance companies, device manufacturers, and hospital administrators. In a KevinMD article titled “The Self-Inflicted Death of the Physician,” an anonymous doctor writes, “For certainly we, as a profession, have handed over our authority to others, not all at once, but slowly, inexorably, over decades. We are just a shadow of our former selves.” Mirroring these sentiments, Linda Girgis, MD, writes in Physician’s Weekly, “The doctor is no longer center stage, unless you are watching a puppet show.”

In what will inevitably foment more unscrupulous behavior, MD/MBA programs are teaching doctors to think like businessmen, an irreconcilable contradiction. Hospital administrators are pressuring doctors to see increasing numbers of patients each day, while the health insurance companies continue to play a major role in stripping doctors of their autonomy by regularly countermanding doctor’s orders. This corporate coup d’état, rooted in avarice, callousness, and sociopathy has caused many clinicians to become unmoored from their traditional moral compass.

Physicians are now compelled to use electronic medical records (EMRs), which force them to waste countless hours doing mind-numbing data entry. If an attending physician decides to employ a medical scribe, nurse, or medical student to assume responsibility for this onerous task, it means that a third party will be in the examination room during patients’ office visits, which if done without the patient’s permission, constitutes an egregious violation of informed consent. It is also common for businesses to change the health insurance plans of their employees each year, which invariably results in many patients having to leave doctors that they have established long-standing relationships with, and who may be critically important to their physical and emotional well-being.

In addition to seeking assistance with EMRs, many physicians opt to bring interlopers into patients’ office visits, either because they prioritize teaching trainees to establishing a sound physician-patient rapport, or because they have figured out that it is much harder to be sued if there is a chaperone present in the examination room. Unsurprisingly, the medical institutions that spend the most money on glossy advertisements boasting of their boundless magnanimity and benevolence are frequently the institutions that are the most eager to bully patients into accepting a culture anchored in authoritarianism and absolute contempt for the rights of the patient.

In a KevinMD article titled “Electronic Health Records Cannot Replace a Doctor Who Knows You,” the authors write: “Ensuring the best medical care is not primarily a technical challenge. It is a human challenge, which requires patients and doctors to be able to form deep and long-standing relationships.” And yet American teaching hospitals are churning out delusional and hubristic creatures who have not been inculcated with a respect for patient privacy and informed consent, and who are incognizant of the fact that once these principles have been jettisoned the majority of their patients will neither trust, nor respect, nor confide in them. The deterioration of this vitally important relationship has resulted in a situation where it is increasingly common for patients to fail to disclose pertinent medical information. The deplorable state of the humanities and the rise of subspecialization have undoubtedly  contributed to this scourge of blindness in American health care.

Commenting on the dangers posed by medical scribes, Ami Schattner, MD, of the Hadassah Medical Center in Jerusalem, said in an interview with The Medical Bag:

I have serious concerns about the impact of scribes on the tender dynamic and intimacy of the physician-patient encounter. Perhaps the word ‘sanctity’ is not too strong when talking about the physician-patient relationship.

In an article titled “Shining a Light on Shadowing,” by Elizabeth A. Kitsis, MD, the author warns of the ethical ramifications of imposing pre-med students on patients during their doctor visits:

Physician shadowing by college students…may involve subtle coercion of the patient. To maintain his or her rapport with the physician, a patient may feel compelled to allow students into the examination room if his or her physician makes the request. However, the patient may resent the intrusion, and feel uncomfortable during the interaction.

Indeed, Kitsis’ words are also applicable with regard to nurses, medical students, residents, and fellows observing office visits. In an article in Medscape titled “What is Medical Ethics, and Why is it Important?” the authors write: “Ethical decisions cannot be avoided. Whenever doctors make a clinical decision, they are almost always making an ethical decision, consciously or not.” It is not even unusual for attending physicians to inform patients of ominous test results with their entourage in tow. While this may be very exciting for medical students it can be perceived as callous, degrading, and inhuman from the standpoint of the patient.

In “Stop the Anti-Doctor Media Bias,” by Rebekah Bernard, MD, the author writes that “Most physicians are dedicated individuals who hold patient care as sacrosanct.” I saw more doctors from 2016 to 2018 than a person would typically work with if they lived to a hundred, and have yet to see a single doctor’s office present me with a choice regarding the presence of observers during my office visits. In what could form the basis of a Kafka story, I had to voice my objections to the same institution and the same departments over and over again ad infinitum. Is this indicative of holding patient care as sacrosanct?

Jeremy Brown, MD, has proposed that doctors be equipped with body cameras, and Myles Riner, MD, supports the recording of physician-patient encounters, arguing in “Should Physicians Record and Share Conversations with Patients?” that “One thing is certain, this approach is certainly indicative of patient-centered care, and I think many patients would greatly appreciate the effort.” Not to be outdone, The New York Times has waxed glowingly on the subject of group doctor visits. Virtual office visits and doctor visits at work also pose a serious threat to confidentiality. So little value is placed on patient privacy that hospitals have even allowed television crews into emergency rooms, resulting in one New York widow turning on the television one evening, only to watch her husband die before her very eyes. Even if medical students attend a few decent lectures on bioethics, this is frequently negated by what they see their attending doing on a daily basis.

When the time comes for doctors to be patients, they often take for granted having the finest insurance plans which permit them to see any doctor without restrictions. This is in contrast with the majority of patients, who are increasingly restricted to narrow networks.

In a KevinMD article titled “Please, be kind to your doctor. We need it.,” Sara R Ahronheim, MD, writes: “But when I go home, I am alone; no one knows your stories, no one sees the tears you cried when I told you the awful things I had to tell you.” No one, that is, except the nurse, medical student, and resident who also happened to be hanging out in the room at the time.

What will become of the younger generation, being mentored as they so often are, in an environment where degradation is professionalism, indifference is empathy, and the most sordid behavior is hailed as “patient-centered care.” Indeed, this practice embodies everything base, ignoble, and treacherous in contemporary American health care. So relentlessly are patients besieged by these indignities, that there are times when I cannot help but wonder if these are really accidents and misunderstandings or the result of knavery and villainy. Teaching hospitals have a sacred duty to inculcate their trainees with a comprehensive understanding of, and respect for, medical ethics. All too often they are derelict in this duty. That so many attendings and their charges are indifferent to the physical, psychological, and emotional vulnerability of their patients underscores the fact that doctors and patients often speak in completely different languages.

This imposition of interlopers during physician office visits — a depraved reality show euphemistically called “team-based care” — constitutes a violation of every foundational tenet of medical ethics: informed consent, confidentiality, patient privacy, patient dignity, patient trust, and the oath to do no harm. Moreover, once trainees have learned to disregard informed consent with regard to nonconsensual physician shadowing, it is highly probable that they will do so again when the opportunity presents itself.

For instance, it is common for medical students and residents to be instructed to do practice pelvic exams on anesthetized patients, and the practice is legal in 45 states. A 2007 study done in Canada — a country with a comprehensive single-payer system — revealed that over 70 percent of medical students had done practice pelvic exams on anesthetized patients, and women have reported pain and bruising from these unauthorized exams.

Teaching hospitals frequently regard their patients, especially those who lack the best commercial plans, as their property. In an online forum on The Student Doctor Network where the ethics of having trainees perform practice pelvic exams on anesthetized patients is debated, AmoryBlaine writes:

It’s surprising how worked up some people get over the issue. You will be naked on a brightly lit table for all to see. A medical student will put a tube into your bladder. We’re about to flay your belly open and remove your uterus and ovaries. But to do a pelvic exam! What a violation! If you get into this habit of being deathly afraid of the patient’s feelings about an internal exam you will never learn how.

Glorytaker writes:

When I was doing OB/GYN as a med student, the attending would have me do a pelvic right after the patient was under and before we started surgery. Of course, we were doing GYN-related surgery and he wanted me to note the difference before and after a cystocele or rectocele repair. We didn’t exactly get permission but it was for teaching purposes.

Any rational layperson would be able to tell you that this is unethical, and yet many medical students and residents would disagree. What does that say about our education system? Perhaps it is this sort of degenerate thinking that led The Stanford Encyclopedia of Philosophy to nonchalantly point out that “The turn of the 21st century has seen doubts surfacing about informed consent.” The fighter pilot that bombs wedding parties in Afghanistan and the impressionable trainee who is taught that it is acceptable to do practice pelvic exams on anesthetized patients have much in common. For they have both been inculcated with a profound sense of blind obedience.

It is common for doctors to do nonconsensual episiotomies and pelvic exams on women in labor, and women are frequently coerced into having pelvic exams in exchange for birth control prescriptions. This is an example of how, with a medical degree and some mental gymnastics, blackmail and rape can be transformed into cod liver oil and brussel sprouts. Writing about the lack of informed consent with regard to Pap smears and testing for cervical cancer, Joel Sherman, MD, has pointed out that cervical cancer is very rare in the United States. In Finland women are given the option of being tested for cervical cancer once every five years. And in an article that appeared in The Milbank Quarterly titled “Cervical Cancer Screening in the United States and the Netherlands: A Tale of Two Countries,” the authors write, “Even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries’ mortality trends were quite similar.” Perhaps this egregious lack of ethics in obstetrics and gynecology should come as no surprise, considering the fact that James Marion Sims, who invented the speculum and who is widely regarded as the founder of modern gynecology, performed experiments on black slave girls.

Will a 25-year-old woman continue to trust her oncologist should she go into permanent early menopause following chemotherapy, and her oncologist failed to disclose this as a common side effect associated with her chemotherapy regimen? What is the likelihood that a cancer patient will continue to trust their doctors should they experience long-term chemotherapy-induced cognitive dysfunction, they are unable to continue with their career, and this too was not disclosed? Indeed, failure to disclose common long-term chemotherapy side effects is standard practice in many American cancer centers. It is also common for school districts to force high school students to undergo genital exams as a requirement to play sports, despite the fact that the scientific rationale behind the practice remains murky at best. And there are medical institutions, such as Memorial Sloan Kettering Cancer Center in New York City, that do not allow patients to change from one doctor to another within any given department, which can leave a patient torn between seeking care at an inferior facility or being the slave of an overbearing scoundrel.

Informed consent is absent in routine mammography screening, as no evidence exists that mammograms provide any benefit, whereas evidence exists that they have caused considerable harm. Obstetrics and gynecology aside, in no other specialty is there greater contempt for informed consent than in psychiatry, where dangerous side effects from psychiatric drugs are regularly withheld from patients and these drugs are even being prescribed for children. Psychiatrist Lawrence Kelmenson writes in “The Three Types of Psychiatric Drugs – A Doctor’s Guide for Consumers:”

Psychiatrists are seen as hard-working, caring, understanding healers, but they’re really snake-oil salesmen, drug-dealers, and master-sedaters. What they do should be illegal. Someday everyone will realize that not only do psychiatrists not heal anything, they’re a major contributor to the recent rise in suicides and overdoses.

Dr. Peter Breggin has echoed these sentiments, and actually specializes in getting people off these drugs.

It is common for patients who are perceived as “anti-authoritarians” to be diagnosed as “mentally ill,” and a number of school shooters were found to be taking powerful psychiatric drugs at the time they unleashed a fusillade of bullets on their classmates and teachers. Informed consent is frequently absent in the treatment of prostate cancer, and tens of thousands of American men have their prostates removed unnecessarily each year, only to fully understand the dire consequences after the damage is irreversible. (Consider the words of Atul Gawande, MD, in “Overkill:” “The forces that have led to a global epidemic of overtesting, overdiagnosis, and overtreatment are easy to grasp. Doctors get paid for doing more, not less.”) These are all examples of how informed consent is routinely disregarded in an unconscionable manner. The Tuskegee Alabama syphilis experiments, as well as medical experiments conducted on the downtrodden of IndiaAmerican prisoners, and on prisoners in Guantanamo are emblematic of the barbarities that can be unleashed when the celestial temple of informed consent lies in ruins.

After undergoing a surgical procedure in the summer of 2016, I was given a prescription for oxycodone, a semisynthetic opioid. Never was the highly addictive nature of this drug disclosed to me. Thankfully, Dr. Google informed me that oxycodone posed a “high risk for addiction and dependence.” Perhaps this might explain why, according to the CDC, “On average, 130 Americans die every day from an opioid overdose.” Many medical blogs delight in reminding us of the fact that the doctor-patient relationship is foundational to sound health care, and yet narcissism, moral bankruptcy, and careerism are endemic to our health care system. The erosion of trust that has followed this satanic cult of medical coercion has led to a situation where it has become harder for physicians to get patients to follow through with their treatment protocols.

The hazing and bullying commonly experienced by many trainees can cause medical students and residents to become jaded, and to lose their sense of empathy. Residents are often so exploited that many suffer from depression and are chronically sleep-deprived, and the brutal military-style training they are forced to endure can lead to many trainees forgetting that “gall bladder in Room 213” is a human being with a name. It is incontrovertible that corporations have undermined the doctor-patient relationship and inflicted catastrophic damage to our health care system. And while doctors must support the fight for single-payer, they must also acknowledge the fact that the cavalier attitude towards informed consent on the part of many American physicians has played a critical role in the dissolution of the public’s trust. Inexperienced patients naively assume that every doctor will have their best interests at heart. All too often, this is sadly not the case. Moreover, once this trust has been violated, it can result in grievous and long-lasting emotional harm. A clinician that is indifferent to the doctor-patient relationship, and who is only interested in scans, pathology reports, and blood tests has been infected with the virus of technocracy and fallen into a morass of charlatanism.

In the Charmides Plato wrote that “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” Medical students and residents may learn how to diagnose and treat different diseases, yet are seldom inculcated with an understanding of medical ethics and why it is so indispensable. In “Bringing Hospitality Back to the Hospital: Lessons From a Bartender,” by Cory Michael, MD, the author writes: “People remember how you make them feel. They don’t care how much you know unless they know how much you care.” Medical terrorism and corporatization are the Goneril and Regan of medical sacrilege. Perpetually locked in a deadly embrace, they fuel one another’s nefarious designs. The tragedy is that so many medical students and residents are being seduced, not by the voice of truth, but by the voice of damnation. Let us recall the chilling words of Iago: “When devils will the blackest sins put on / They do suggest at first with heavenly shows / As I do now.” (Othello II.iii.)

Informed consent is a river that separates the consecrated light of morality from the profane and blasphemous abyss of amorality. Once this Rubicon has been crossed, there is no turning back. Those who have strayed from their sacred oath will find absolution not in the ways of the wicked, but in a return to the path of compassion, integrity, and righteousness. Indeed, dignity for the patient and dignity for the physician are mutually interdependent.

The doctor-patient relationship now lies buried in the unhallowed primeval ground; a cemetery where broken tombstones litter the earth with thorns and broken bottles, the land is barren and no flowers grow, and a once-proud beating heart beats no more. Only with a return to this inviolable bedrock of medical ethics can we embrace its resurrection.

Medical Ethics Can Only Be Restored With a Single-Payer System

It is the year 2019, and American health care is in a state of profound crisis. While oligarchic parasites from the pharmaceutical industry and health insurance companies make enormous profits, bankruptcy and the fear of being denied care hang over the American people like a sword of Damocles. This diabolical order, predicated on greed and placing profit-making over human life, has stripped doctors of their autonomy and given birth to an inhuman and deeply unjust multi-tier system.

Unless we are able to disenthrall ourselves from the tyranny of privatized health care, Americans will continue to die as a result of avaricious insurance companies denying coverage for needed drugs and procedures, and from treatment which is delayed due to requests for “prior authorizations.” Moreover, medical students and residents are being taught that good health care is a privilege and not a right, and that the oath to do no harm applies, but only to a privileged few. In a world turned upside down, doctors in training are being inculcated with the pernicious notion that the job of a doctor is not to listen to the patient, perform a comprehensive physical, respect the patient’s privacy, get an accurate history, diagnose, treat, and follow up; but rather to help their employer maximize the greatest possible profit. Indeed, the number of patients doctors are expected to see each day has become increasingly unwieldy, and this has gravely undermined their ability to practice good medicine.

Are we to continue to buy and sell health care as if it were a consumer good? The wealthiest can buy a Ferrari, the upper middle class a Lexus, the working class a Toyota, and the poor a used car. The very destitute cannot afford a car at all and have to take the bus. Clearly, it is barbaric to run a health care system in such a manner, and yet this is precisely what we are doing.

From their very first day of residency, doctors in training are being indoctrinated with the following code of dishonor: “This patient has a right to privacy, while this patient doesn’t. This patient has a right to informed consent, while this patient doesn’t. This patient has a right to linger following their surgery, while this patient has to leave immediately following their procedure. This patient has a right to their own room with a view, while this patient will be crammed into a room with a stranger.” The idea that medical ethics can coexist with such an ideology is inane and deeply delusional.

Many institutions have established multi-tier systems which are so egregious that it has resulted in the implementation of a Jim Crow health care system. Indeed, these institutions often place the “humans” and the “subhumans” in physically separate facilities. In this internationalization of the third world model, patients with inferior insurance are regularly arm-twisted into being clinical guinea pigs and used as laboratory animals with which to teach impressionable residents and fellows. This railroading of the “losers” into resident clinics magnifies the innate power imbalance inherent in the doctor-patient relationship a hundredfold, and constitutes a violation of patient privacy, informed consent, confidentiality, and patient dignity all of which fall under the umbrella of the physician’s oath to do no harm.

In an article in Annals of Emergency Medicine titled “Observers in The Medical Setting”, by Joel M. Geiderman, MD, the author posits that:

Privacy is treasured by citizens in free societies around the world, and any infringement on it is considered by many to be an affront to personhood. In the United States, the right to privacy runs deep in the American soul.

Residents that have no qualms about observing office visits without the patient’s consent are likely to go on to violate the privacy of their patients as attendings, and may very well spend their careers mindlessly violating and debasing their fellow human beings, only to periodically vent their frustrations on the Internet over all the “self-entitled” patients that don’t appreciate their diligence and divine wisdom. And while there are undoubtedly some residents that may have misgivings over participating in a clinic which coerces patients with unglamorous insurance plans into being medical models, as we have largely become a nation of careerists, the apelike majority will blindly follow orders.

Geiderman writes:

In addition to informational privacy, or protection of their personal health information, patients are also entitled to physical privacy, that is, a zone of personal space where access is under the patient’s autonomous control. Closely linked is the right to one’s modesty, a human value that is expressed in the Bible in Genesis, as Adam and Eve wished to shield their nakedness even from their Creator.

Should a physician order countless tests and prescriptions which are subsequently vetoed by the insurance companies, assuming they are not vehemently opposed to single-payer, they are unequivocally not to blame for this. However, once a doctor has knowingly participated in a clinic which is predicated on coercing patients with inferior insurance into being clinical guinea pigs for residents and fellows to practice on, they have stepped into a void beyond which lies a wasteland devoid of honor, dignity, integrity and morality. Any participation in such an egregious multi-tier system on the part of a physician threatens the survival of the doctor-patient relationship and constitutes unbridled and unmitigated heresy.

This descent into barbarism is glaringly on display in many dermatology departments, which are able to choose from the crème de la crème of our nation’s medical graduates, dermatology being one of the most competitive and sought-after specialties. These departments often assign patients with inferior insurance to a resident, who in turn has to be supervised. And so through artifice and trickery, the patient is duped and arm-twisted into being a medical model without their consent. The attending arrives and spews platitudes such as “The more eyes the better,” “There’s nothing we’ve never seen before,” and “We’re all professionals here” as if this can mitigate the fact that they are teaching their residents that the have-nots deserve neither privacy nor respectful care. That neither the attending nor the resident would even think of seeking care in such a clinic underscores the fact that in the innermost recesses of their addled brains they are cognizant of the fact that what they do is unethical. To gain admission into MS-13 one would likely have to commit murder. When doing a dermatology residency at an elite Manhattan medical institution, violating the privacy of hundreds of patients is the price of admission into this rather alarming society.

In conjunction with this uncivilized behavior, doctors in training are duly inculcated with the idea that informed consent is a privilege and not a right. Many of these creatures will go on to do practice pelvic exams on anesthetized patients, or even perform forced cavity searches at the request of law enforcement. Indeed, doctors that have no respect for informed consent are a danger to themselves, and a danger to those who place their trust in their care.

Reactionary physicians at elite institutions take for granted having the finest insurance, and delude themselves into thinking that patients go to resident clinics of their own volition, and not because their insurance dictates that they go there. Few realize that if a Medicaid patient sees a doctor out of network they can actually lose their insurance. Restoring physician choice to the American patient is absolutely vital if we are to restore any semblance of democracy to our health care system. For as long as a vast swath of American society is forced to work with doctors that they do not wish to work with, all talk of “patient-centered care” is farcical and absurd.

If a woman with good insurance needs a prescription for birth control, she can leave a doctor who insists on doing a pelvic exam prior to ordering the prescription, whereas a patient with inferior insurance can be bullied into submitting to the unnecessary exam due to the lack of gynecologists that take their insurance. While the pharmaceutical companies, health insurance companies, and hospitals grow fat with the lucre sucked from the blood of their patients, not a day goes by when the underinsured do not experience such indignities. And while the government continues to abrogate its social responsibility to implement a single-payer system, many patients that do have good insurance are a cancer diagnosis or car accident away from losing their job and their superior insurance along with it.

In non-union jobs employers often change insurance plans every year, perpetually searching for the plan which is most affordable. This in turn forces patients to constantly change doctors, and if a patient has a complex medical condition, the consequences of perpetually denying such an individual continuity of care can have disastrous consequences. Indeed, even if a patient is healthy, this can result in reduced health care outcomes over the long-term. And just as the multi-tier education system has come to be accepted without question by millions of our countrymen, the multi-tier health care system has likewise left its mark on the consciousness of millions of Americans, and is increasingly accepted as “normal” by the insouciant and the knavish alike.

Patients that freelance can also see their insurance change while their income fluctuates, and this can likewise force a patient to change doctors. Like a marriage, the doctor-patient relationship is predicated on a sacred trust, and being forced to constantly change doctors disrupts, destabilizes, and destroys these relationships.

The takeover of the medical decision-making process by insurance companies – essentially criminal gangs – has stripped doctors of their autonomy and is a driving force behind physician burnout. For after every treatment plan agreed upon between a doctor and a patient, doctors’ orders are increasingly countermanded by the patient’s insurance company. Not a day goes by without a doctor prescribing a drug which a patient’s insurance refuses to cover. The doctor then calls in a second drug – a variation on the first – and the insurance company may refuse coverage for this as well. Then a third drug is called in – perhaps not even of the same class – and this too may be rejected. Meanwhile, the patient has been examined by their doctor, not by an MD working for the insurance company. Should a physician order a PET or CT scan to determine whether a patient has metastatic cancer following a needle biopsy that has revealed a mass to be malignant, it is not uncommon for the patient’s insurance to declare this request as requiring “prior authorization.” This pervasive undermining of a doctor’s authority is without precedent in American health care, and these delays have caused people to die.

In addition to living paycheck to paycheck, millions of Americans are under the illusion that their health insurance plan is much better than it is, incognizant of the fact that they are a health problem away from financial ruin. The insouciant among us who ask where the money is going to come from should consider why they failed to ask this question prior to the invasions of Iraq and Afghanistan. The money will come from demilitarizing our society and transferring to a peacetime economy. Are the underinsured not victims of terrorism?

As their entire raison d’être is anchored in maximizing the greatest possible profit, hospitals ruthlessly exploit their residents, many of whom work eighty hours a week or more. In an article on KevinMD titled “The secret horrors of sleep-deprived doctors,” by Pamela Wible, MD, a doctor speaks of their training:

I did my internship in internal medicine and residency in neurology before laws existed to regulate resident hours. My first two years were extremely brutal, working 110 to 120 hours/week, and up to 40 hours straight. I got to witness colleagues collapse unconscious in the hallway during rounds, and I recall once falling asleep in the bed of an elderly comatose woman while trying to start an IV on her in the wee hours of the morning.

It is not uncommon for young doctors to accidentally kill patients as a result of being so exploited and sleep deprived, and this has undoubtedly played a role in making hospital errors the third leading cause of death in this country. Wible quotes another physician:

I have made numerous medication errors from being over tired [sic]. I also more recently misread an EKG because I was so tired I literally couldn’t see straight. She actually had a subarachnoid hemorrhage, and by misreading the EKG, I spent too much time on her heart and didn’t whisk her back to CT when she came in code blue. She died.

This is the inevitable result of exploiting residents as if they were fast food workers. Moreover, as has transpired with education, health care is simply becoming unaffordable. In an article for KevinMD titled “The demonization of socialized medicine,” by Matthew Hahn, MD, the author writes, “It’s almost become a ritual now where a patient (who usually has health insurance) is diagnosed with cancer, and then we attend their community fundraiser to help them with the costs of their care.”

Many doctors are compelled to spend countless hours each month filling out electronic medical records which have been foisted on them by the insurance companies. To assist with this onerous task, doctors increasingly employ a nurse or medical scribe to type the required information into the computer during a patient’s office visit. This destroys any semblance of confidentiality and undermines the physician-patient bond. It can also result in the doctor failing to obtain a comprehensive history.

Some physicians feel that the way to regain autonomy is to not take insurance at all, but by doing this they are denying care to patients with low income; i.e., the majority of the country. In theory, doctors take an oath to do no harm. In reality, they are in thrall to rapacious corporate power and are more likely to spend a lot of time violating patients’ privacy, doing mind-numbing data entry, and failing to disclose the risks of extremely dangerous drugs such as opioids and psychiatric medications.

Liberal saints Obama and Hillary had an opportunity to make a push for single-payer, but instead chose to spend trillions of dollars murdering large numbers of people in Ukraine, Iraq, Afghanistan, Yemen, Libya, Honduras and Syria while maintaining nearly a thousand bases all around the world. How many more patients will be forced into bankruptcy? How many more souls will be debased and defiled? How many more human lives will be lost?

Black Sun Over Kiev

The conflict in Ukraine has been a war of seemingly endless violence and brutality. This cataclysmic conflict, which has pitted Ukrainian against Ukrainian, marks a restoration of the fighting that took place between Nazi collaborators and partisans during the Second World War. Perhaps unsurprisingly, the coverage from what Paul Craig Roberts is fond of calling “the presstitutes,” has been a deranged combination of liberal schizophrenia, outright lies, and neo-Nazi propaganda.

As noted in The Washington Times, the decision on the part of the Trump administration to give Kiev an additional 200 million dollars in military aid, brings the total amount of US military aid sent to Kiev since the Maidan coup to a billion dollars. This war has pitted the Armed Forces of Ukraine (AFU) and its affiliated paramilitary organizations, against the Armed Forces of Novorossiya which are defending their homes, villages, and cities from a ruthless genocidal onslaught. The former are getting the military assistance. Rest assured, it is for “defensive purposes,” and needed to defend Ukraine from “Russian-backed separatists.”

In an article in The New York Times titled “After Initial Triumph, Ukraine’s Leaders Face Battle For Credibility,” by Steven Erlanger, the author writes of the Maidan coup: “The United States and the European Union have embraced the revolution here as another flowering of democracy, a blow to authoritarianism and kleptocracy in the former Soviet space.” While some of the initial Maidan protests may have been peaceful, the actual change of government – the “flowering of democracy” – was, in fact, a violent coup that brought to power in Kiev the descendants of the Organization of Ukrainian Nationalists (OUN) and its military wing, The Ukrainian Insurgent Army, ultra-nationalists that collaborated with the Nazis and carried out genocidal massacres of Jews, Poles, and communists during the Second World War.

The author continues: “As Russian forces appear to be establishing their control of Crimea in the name of a seemingly manufactured local cry for aid, Ukraine today is a good example of how deep, domestic, centrifugal forces can be easily manipulated from the outside to keep a new, inexperienced government shaken and destabilized.” That the new regime is “shaken and destabilized” should come as no surprise, as it took power through a Western-backed coup, and in violation of the country’s constitution. It is also important to remember that Moscow permitted the reunification of Germany on the condition that NATO would not expand, and it has been expanding and expanding ever since – even to the point where Nato troops can now march right through downtown Kiev. NATO is at Russia’s doorstep, and while the insouciant West sleeps, Russians are increasingly alarmed.

While there are undoubtedly some Russian volunteers that have gone to the Donbass to defend their brothers from fascism, the idea that “Russia invaded Ukraine” is unmitigated propaganda. If this were, in fact, the case, the Russian air force would have destroyed the Ukrainian units besieging the Donbass in a matter of days, effectively ending the war. The Novorossians would also not have lost strategically important cities such as Slovyansk and Mariupol which are located within the Donetsk Oblast. Moreover, if the Russian military had truly taken control of the Donbass, it is inconceivable that so many key Novorussiyan leaders would have fallen victim to assassination. And lastly, if Russia had invaded Ukraine, why would hundreds of thousands of Ukrainians have sought refuge, not in the West, but in Russia?

In an article in The Guardian titled “On the Frontline of Europe’s Forgotten War in Ukraine,” Julian Coman reiterates the mass media’s obsession with blaming all things wrong with the world on Vladimir Putin: “In February it will be four years since Russia’s president, Vladimir Putin, annexed Crimea and helped foment a rebellion in Ukraine’s industrial east. Since then about 10,000 people have died, including 3,000 civilians, and more than 1.7 million have been displaced.” Crimea was integrated into Russia by Catherine the Great in 1783. It was, under legally dubious circumstances, gifted to Ukraine in 1954 by Khrushchev. The idea that Crimea is under a Russian military occupation is patently absurd, as the Russian Black Sea Fleet was already based in the city of Sevastopol. In other words, there were Russian soldiers in Crimea prior to the putsch. Following the Maidan coup, the overwhelming majority of Crimeans voted in a referendum to be reunited with Russia. The use of the word “annexation” is designed to draw parallels with the Nazi annexation of Austria and the Sudetenland. Lamentably, this crude propaganda actually works. The Russian invasion of Crimea may have taken place – but only in the deranged fantasyland of the mass media – as Miguel Francis’ humorous reportage in “Crimea for Dummies” offers many examples of.

That Banderites and neo-Nazis seized power in a coup d’état appears to give the author great joy, as he refers to them as “Euromaidan revolutionaries.” And why is this a “forgotten war?” Have the journalists of major Western newspapers such as The Guardian not played a critical role in bringing about this very thing?

The mainstream press regularly attempts to portray civilians as being shelled by “Russian-backed terrorists” and “Russian-backed separatists,” when it is the AFU which indiscriminately shells residential areas in Donetsk and Lugansk. In actuality, we should be talking about the NATO-backed Banderites, as it was the coup that destabilized the country and instigated the civil war. The Stalker Zone article titled “I Would Whack Volker With a Stick For Telling Such a Lie!”, offers a good example of this propaganda. The excellent RT documentaries “Facing The War,” “Ukrainian Refugees,” and “Trauma” also provide countless examples of how ordinary Ukrainians are suffering at the hands of the Banderite junta. The automatons of the mass media seem to think they know a lot about what is going on in the Donbass, but how many foreign correspondents do they have there?

As Stephen Cohen and others have noted, the coup that ousted Viktor Yanukovych was ultimately brought to fruition by sniper fire, which took the lives of police and protesters alike, and it is highly probable that this massacre was carried out by members of the neo-fascist group Right Sector. In an article in RT titled “Kiev Snipers Shooting From Bldg Controlled by Maidan Forces – Ex-Ukraine Security Chief,” the author writes, “Former chief [sic] of Ukraine’s Security Service has confirmed allegations that snipers who killed dozens of people during the violent unrest in Kiev operated from a building controlled by the opposition on Maidan square.” The Odessa massacre on May 2nd, 2014, where anywhere from forty to several hundred anti-Maidan activists lost their lives when they were trapped in Odessa’s House of Trade Unions, which was then pelted with Molotov cocktails by a mob of bloodthirsty Banderites, symbolized the neo-fascist nature of the coup. Pogroms have likewise been carried out against Ukrainians for wearing the ribbon of Saint George, worn to commemorate the victory of the Soviet people over fascism, and more recently, to protest the Banderite regime. Ominously, the Odessa massacre was a harbinger to the brutal military assault on the inhabitants of the Donbass that would follow.

Granted, many in the western part of the country wish to join the EU, while the ethnic Russians in the East prefer to maintain close economic ties to Russia. However, this is also a conflict between Ukrainians that have diametrically opposed views of the Second World War – between a Banderite regime that glorifies and extols the Ukrainians who collaborated with the Nazis – and the descendants of the Ukrainians that triumphed over Nazism, who regard the new regime as illegitimate and deeply repugnant.

The Banderite junta is also implementing draconian changes to Ukraine’s education system, making education in minority languages such as Russian, Hungarian, Romanian and Polish forbidden beyond primary school, and this is dismantling the entire foundation upon which the modern Ukrainian state is based.

The massacres of Poles in Volhynia and Eastern Galicia, which began in 1943, and which were perpetrated by the Bandera faction of the OUN and the Ukrainian Insurgent Army, resulted in the deaths of approximately 100,000 people, many of whom were also tortured. Under the Poroshenko government Stepan Bandera has been hailed as a national hero. As statues of Lenin are torn down, and monuments commemorating the Soviet victory over fascism are defaced, monuments of Bandera are erected in their stead as the monster of Ukrainian nationalism eviscerates its own heritage. October 14th, the day the Ukrainian Insurgent Army was founded, is now a national holiday. General Vatutin Avenue in Kiev, named after the Red Army commander that liberated Kiev from the Nazis, has been renamed Roman Shukhevych Avenue, after a commander of the Nachtigall Battalion, which was comprised of Ukrainians that fought under the command of Abwehr special operations during the Second World War. On April 28th, marches are now held in honor of the founding of the SS Galicia Division, which was also comprised of Ukrainians that collaborated with the Third Reich.

Contrast this mass hysteria with a day of mourning held in the Donbass on August 31st, where school bells ring out in honor of the children who lost their lives to the “Anti-Terrorist Operation,” and who won’t be able to join their classmates at the start of the school year. And while Donetsk and Lugansk are engaged in a war where their very survival is at stake, the authorities still manage to provide free medical care – not only to their own citizens – but even to captured soldiers of the AFU.

The OUN chant “Glory to Ukraine! Glory to the heroes!” can be heard once more in areas of the country under the sway of the Banderite junta. The Svoboda Party and other ultra-nationalist groups regularly engage in torchlit rallies that are eerily reminiscent of the torchlit rallies common during Nazi Germany. Indeed, the flag of the Right Sector is almost identical to the flag of the Ukrainian Insurgent Army.

Fighting with the AFU are various punitive battalions, all of which share a loathing of Russians, and some of which are driven by an unmistakable neo-Nazi ideology. As discussed in Fort Russ News and Global Research, the Azov Battalion has been accused of committing atrocities against those resisting the new regime, such as the rape and torture of prisoners. The insignia of the Azov Battalion includes a black sun and an inverted Wolfsangel. The later was used by a number of Waffen-SS units, notably the Das Reich Division, which participated in the Nazi invasion of the USSR. The black sun remains a cryptic symbol and was likewise popular with the SS. Azov also runs summer camps, where children are taught to embrace militarism, handle weapons, and chant “Glory to the nation! Death to enemies!” and “Ukraine above all!” Vadim Troyan, a deputy commander of the Azov Battalion, went on to become the chief of police for Kiev.

Another punitive battalion, the Aidar Battalion, was accused of war crimes in an Amnesty International report titled “Ukraine: Abuses and war crimes by the Aidar Volunteer Battalion in the north Luhansk region.” In what underscores the fascistic mentality of these battalions, the report quotes an Aidar commander, who told an Amnesty International investigator:

It’s not Europe. It’s a bit different… There is a war here. The law has changed, procedures have been simplified… If I choose to, I can have you arrested right now, put a bag over your head and lock you up in a cellar for 30 days on suspicion of aiding separatists.

Some of these paramilitary formations, such as the Tornado Battalion, resisted efforts to be integrated into the AFU, resulting in the dissolution of the unit and even the arrest of some of their members. When the phones of several Tornado commanders were seized by the authorities, it was revealed that they had raped girls in the Donbass and recorded it on their phones. Punitive battalions that agreed to be integrated into the military chain of command were, like rampaging savages, unleashed on those resisting the regime, and permitted – indeed, even encouraged – to commit atrocities and terrorize the local population at will.

In an article in Fort Russ News titled “Ukraine: Where Rape Is ‘Patriotic’ And Worth 100 Euros,” Svyatoslav Knyazev writes of the new Ukraine:

Ukraine, of course, is Europe. But it is medieval Europe in its worst aspects – executions and incarcerations in dungeons for irreverent criticisms of kings and dukes, the looting and plunder of residential areas by troops, torture for slander, and the right of the “nobility” to kill, maim, and rape “commoners” with impunity.

The insouciance on the part of most Americans regarding this barbarous regime that has murdered thousands of its own people, is tied to our morally bankrupt press and the jettisoning of history from the public schools. Indeed, if the only thing one can say about the Nazis is that they murdered Jews in death camps, it is impossible to understand the current conflict. Nazism is anchored in many repugnant things, anti-Semitism being one of them. A virulent Russophobia, a belief that Slavs are inferior to “Aryans,” a hatred of Gypsies, and a virulent anti-communism are also significant tenets of Nazi ideology.

Towards the end of the Second World War, the Allies began to cultivate relationships with Nazis and Nazi collaborators that could be used against the Soviets in the burgeoning Cold War. Of particular historic significance was Wehrmacht General    Reinhard Gehlen, who was in charge of Foreign Armies East, which oversaw military intelligence operations in Eastern Europe and the Soviet Union. Utilizing his contacts within US Army Intelligence, and later the CIA, Gehlen managed not only to escape prosecution, but went on to found the Gehlen Organization, which would eventually become the precursor to West Germany’s federal intelligence agency, the BND. Gehlen would also go on to become the first president of the BND, where he proceeded to hire many Nazi war criminals that he had formerly worked with. (Today, the BND is one of the most powerful intelligence agencies in the world, and like the CIA, is sometimes referred to as “a state within a state.”) Gehlen possessed a wealth of information regarding fascist collaborators in Eastern Europe, including OUN and Ukrainian Insurgent Army members, some of whom went on to work for the CIA.

In an article in The Nation titled “The Silence of American Hawks About Kiev’s Atrocities,” Stephen Cohen writes, “The entire Maidan episode, it will be recalled, had Washington’s enthusiastic political, and perhaps more tangible, support.” Indeed, the Obama administration’s support for the coup was the culmination of an alliance with the OUN that stretches back to the end of the Second World War. Moreover, the decision on the part of Washington to commence with the training of Ukraine’s National Guard on April 20th, 2015, was not lost on Ukrainians. For as neo-Nazis are well aware, this also happens to be Hitler’s birthday.

Throughout the conflict the AFU has repeatedly and deliberately shelled residential areas in the Donbass, thereby committing war crimes. On Kiev’s assault on Donetsk and Lugansk, Cohen writes:

Kiev has repeatedly carried out artillery and air attacks on city centers that have struck residential buildings, shopping malls, parks, schools, kindergartens, hospitals, even orphanages. More and more urban areas, neighboring towns and villages now look and sound like war zones, with telltale rubble, destroyed and pockmarked buildings, mangled vehicles, the dead and wounded in streets [sic], wailing mourners and crying children.

In an article in Foreign Policy titled “Yes, There Are Bad Guys in the Ukrainian Government,” the author, after taking some obligatory shots at Putin, sheepishly acknowledges that, “The uncomfortable truth is that a sizeable portion of Kiev’s current government — and the protesters who brought it to power — are, indeed, fascists.” Oleh Tyahnybok, leader of the Svoboda Party, and a fanatical Banderite and demagogue, rails not only against Russians, Jews, and communists, but also against Poles, Hungarians and Czechs. Enemies help keep the people frightened and compliant, and so the more the merrier. Svoboda Party deputy Iryna Farion, when asked about the people in the Donbass protesting the regime, said they should be shot. Russians still living in Ukraine following the putsch, said that they should be killed with nuclear weapons. Thankfully, these lunatics don’t have any.

These are some of the people for whom John McCain and Victoria Nuland gave their unequivocal support to during the bloody coup, romanticized ad nauseam by the mass media as a grassroots democratic uprising. Nuland, the Assistant Secretary of State for European and Eurasian Affairs under Obama, and a driving force behind the coup, openly boasted that over five billion dollars had been invested in helping to bring about a pro-Western government in Kiev, and was caught in a taped conversation plotting the coup with Geoffrey Pyatt, the US ambassador to Ukraine at the time.

Indeed, the Russophobia of Washington and the Russophobia of the Banderites appear to have found common cause. Anne Applebaum, in an article for The New Republic titled “Nationalism Is Exactly What Ukraine Needs,” writes of the ethnic Russians in the Donbass: “For this—Donetsk, Slavyansk, Kramatorsk—is what a land without nationalism actually looks like: corrupt, anarchic, full of rent-a-mobs and mercenaries.” In an article in The Atlantic titled “Russia’s Strength Is Its Weakness,” the author informs us that, “Russia takes advantage of the divisions within the West—and within the United States—by driving wedges between its opponents, using psychological warfare, propaganda, and cyberwar.” Substitute “Russia” with “the Jews,” and this could have been written by Goebbels.

The assassinations of the prime minister of the Donetsk People’s Republic, Alexander Zakharchenko, along with charismatic rebel commanders Givi, Motorola, and socialist Aleksey Mozgovoy failed to break the spirit of those resisting the Banderite regime. Nevertheless, these assassinations did succeed in irrevocably destroying the Minsk Agreements, rendering dialogue and a diplomatic solution impossible for the foreseeable future. The mass media vilifies those resisting the Poroshenko government as separatists and terrorists, but the reality is that these four men are hailed as heroes in the Donbass for protecting the people from fascism and Banderite death squads. You can watch Givi’s funeral here:

Installing a gang of thugs and con artists in Kiev is an echo of the same bloody scenario that has played out with dozens of other countries around the world. Indeed, this has become the time-honored method with which Washington has been able to implement puppet regimes, as neo-Nazis and Banderites could no more win a fair election than ISIS would be able to, just as both would be unable to survive without foreign support.

And while the Western elites have imposed multiculturalism and identity politics at home, they have simultaneously fomented a resurgence of Nazism in Eastern Europe. If these two ideologies are diametrically opposed to one another, how is it that they came to be supported by the exact same people?

Following the initial clashes between the AFU and the self-defense militias, the Ukrainian army was so poorly officered and equipped that the war would have ended in a matter of months, were it not for the military aid provided by Washington and other NATO countries. Should the AFU threaten to overrun Donetsk and Lugansk with its new revamped military, there will be tremendous pressure on Putin to intervene. And as is also the case in Syria, there is a danger that these tensions could spill over into a direct military confrontation between the two nuclear powers.

In a speech given at the Odessa Opera House on October 23rd, 2014, Poroshenko said of the people in the Donbass: “We will have our jobs. They will not. We will have our pensions. They will not…. Our children will go to schools and kindergartens. Theirs will be holed up in basements.” The Ukrainian nationalist dream of an ethnically pure state has, like a resurrected demon, once more set fire to this ancient land, as the black sun of violation spreads its wings over the ravaged earth, enveloping the bestial, the brave and the innocent alike.

Racism, Sexism, and Homophobia: The Father, The Son, and The Holy Spirit of American Liberalism

The Russians have an expression: words are deeds. Indeed, words contain a mesmeric power, and while this power can be used for good, it can also be used to harness dark and pernicious forces. For as Orwell understood all too well, words can be hijacked by a corrupt ruling class and used to indoctrinate, manipulate, and deceive.

In order to understand how the liberal class has come to be so beguiled by the forces of reaction, one must take note of the unprecedented liberal hysteria over racism, sexism, and homophobia. Indeed, the more liberals remain transfixed with this unholy trinity, the more indifferent they become to the terrible suffering inflicted by capitalism, as they are drawn further and further to the right, and pulled ever more deeply into a vortex of amorality.

This is not to suggest that racism, sexism, and homophobia do not exist, but rather, that these words have been co-opted by a ruling establishment which has succeeded in duping the faux-left into embracing policies that are deeply antithetical to the interests of American workers, patients, and students.

In politics either one believes in unions, single-payer, and public education or one doesn’t. Either one opposes imperialism, or one does not. The problem with anchoring a political discourse around who opposes racism, sexism, and homophobia and who (allegedly) doesn’t, is that these words are inherently ambiguous to the point where they can be manipulated to mean almost anything. All too often, the racists, sexists, and homophobes can simply comprise anybody who has the temerity to challenge liberal orthodoxy.

In an article in U.S. News and World Report titled “The Problem with Hillary-Hate,” Joanne Cronrath Bamberger bemoans the criticism of her hero, arguing that, “Pundits and journalists alike continually refer to her as corrupt and untrustworthy, even though the things people point to for support either are false or they can’t say why they use those words because, well, it’s just a feeling they have”. “We came, we saw, he died,” Hillary famously blurted out when asked about the brutal murder of Gaddafi. While this may never be mentioned on CNN, Libya was a country that had a high standard of living, and had attained a sound nationalization of its health care and education systems. Gaddafi infuriated the Western elites by attempting to establish a gold-backed dinar, leading NATO to unleash a barrage of merciless savagery and violence on a country that is now in a state of complete and utter lawlessness, yet this fails to elicit even so much as a shrug from the sanctimonious imaginary left. For these acts of barbarity pale in the decaying liberal mind with an accusation of sexism.

Bamberger continues:

Disagree with her policies all you want. Propose different plans that are better. But continuing hate-based commentary about Clinton implicitly says to us all that it will also be acceptable to throw the next woman presidential candidate – viable or not – under the bus with detestable accusations and made-up charges. To let that kind of hateful disrespect for any woman continue allows it to become our cultural norm.

This lamentable mentality is illustrative of how the sexism card can be used to stifle criticism – not only of an extremely corrupt politician – but of foreign policies that are nothing short of genocidal.

In an equally inane article in the HuffPost by Maya Dusenbery, titled “Medicine has a Sexism Problem, and it’s Making Women Sicker,” the author (who has rheumatoid arthritis and a female rheumatologist), writes:

While I’ve been a feminist writer for years, before I got sick, I hadn’t given much thought to how sex and gender bias has skewed what we know and don’t know about health and disease and how it affects the quality of medical care that patients receive. But after my brush with the autoimmune epidemic – an epidemic that seemed strangely off the radar of both the public and the medical system – I started to explore it. What I’ve discovered is that a lack of knowledge about women’s health, and a lack of trust in their reports of their symptoms – entwined problems that have become remarkably entrenched in the American medical system – conspire to leave many women misdiagnosed, dismissed and sick.

Hospital errors are the third leading cause of death in this country, and thousands of Americans continue to file for bankruptcy due to medical bills they cannot pay, while little Cuba has had constitutionally mandated single-payer since 1959, yet these are mere trivialities. The real problem with our health care system is that it is sexist.

If sexism is the son, racism is the father, and no one loves talking about racism more than liberals. Regrettably, they know nothing whatsoever about it. Last April, Milo Yiannopoulos was driven out of a New York bar by a pack of vituperative liberals who repeatedly yelled “Nazi scum get out.” That Milo is a flamboyant homosexual, married to a black man, and has a Jewish maternal grandmother surely makes him the strangest Nazi that ever lived. Whether one agrees with what he says or not, is neither here nor there. The point is that it is simply far too common for anyone who disagrees with fundamentalist liberal dogma to be beaten with the truncheons of racism and sexism. That the real Nazis are in Kiev, and that they violently seized power in a coup which was wholeheartedly backed by the Obama administration is, to quote John Pilger, beyond irony.

In an article in The Washington Post titled “The Racist Backlash Obama Has Faced During His Presidency,” by Terence Samuel, the author writes, “From the very beginning, Obama’s ascendance produced a huge backlash that was undeniably racist in nature….” This was an administration that destroyed Libya, Yemen, Ukraine, supported death squads in Syria that led to the destruction of over half the country, slaughtered thousands in Iraq and Afghanistan, passed the National Defense Authorization Act, set aside a trillion dollars to modernize our nuclear weapons arsenal and brought relations with Moscow to their nadir. Moreover, these genocidal polices were paid for with trillions of dollars, while a vast swath of American society is either uneducated, unemployed, or without decent health insurance. Yet these acts of brazen criminality and barbarity are incidental. So let’s ignore the content of Obama’s character, and just talk about the color of his skin.

At a lecture at Trinity College Dublin in June, Hillary said, “Vladimir Putin has positioned himself as the leader of an authoritarian, white-supremacist and xenophobic movement….” What is striking about these remarks is that much of Hillary’s presidential campaign was anchored in Russophobia – undeniably one of the most dangerous forms of racism – and which contributed to an ideology that led to the murder of twenty-seven million Russians during the Second World War.

Liberals wield an extraordinary amount of power in the public schools, and regard themselves as valiant crusaders against racism. Yet while they repeatedly and vociferously maintain that the ethnic studies programs and the multicultural curriculum are the antithesis of racism, they are actually the quintessence of it. For these policies have fomented an unprecedented degree of segregation in our schools and in our society. Indeed, virtually any attempt at elevating the level of education for poor students of color – especially in the humanities – will invariably land a public school teacher in the doghouse with a liberal administrator. In this schizophrenic order that would make Orwell blush, the real racists are now holier-than-thou anti-racists.

Accusations of homophobia have also become quite useful when it comes to duping insouciant liberals into embracing reactionary policies. In an article in The Guardian titled “Iranian Human Rights Official Describes Homosexuality as an Illness,” the author bemoans the fact that, “An Iranian official whose job is to protect human rights has described homosexuality as an illness, after a UN special rapporteur expressed concerns about the systematic persecution of Iran’s gay, lesbian, bisexual and transgender community.”

What a pity that the editors of a once respectable newspaper are happy to print anti-Iranian propaganda, so as to foment liberal bloodlust for yet another regime change. The author also fails to question why one of Washington’s best friends in the Middle East, the Saudi monarchy, a regime that delights in decapitating people as punishment for “sorcery and witchcraft,” is permitted to impose a theocracy infinitely more reactionary and medieval than the one in Iran, and can do so without even the faintest trace of rebuke from the Western media. And what of the Washington-backed jihadi death squads in Syria and Libya? What is their record on gay rights? Indeed, the same question could be raised regarding the rights of women living under the yoke of these barbarians. But they are “the good terrorists,” and so all is forgiven.

In an article in The Guardian by Peter Tatchell, titled “World Cup Fever, Gay Rights Abuses and War Crimes – It’s an Ugly Mix,” the author writes, “I’m here for the World Cup – but unlike thousands of fans, I won’t be cheering on this festival of football. LGBT+ people and many other Russians suffer state-sanctioned persecution and far-right violence. These abuses need to be challenged.” The decision of Washington to unleash Neo-Nazi and other far-right paramilitaries on the Donbass that have murdered thousands of ethnic Russians, Moscow’s military intervention in Syria that saved the country from the fate of Libya, and the fact that Russians enjoy free health care and superior education, are of no interest to Western propagandists. Russians are simply terrible people, and what better way to get liberals to embrace Russophobia (not to mention the annihilation of the planet), than to talk about the country’s lack of gay rights?

This is not to say that identity politics and multiculturalism have been a failure. On the contrary, they have been a resounding success. However, contrary to fundamentalist liberal dogma this success lies not unto the heart of the left, but under the iron heel of the right. Increasingly, those who have been indoctrinated to view the world through the warped prism of identity politics are incapable of seeing political reality for what it is, but for what the ruling establishment desires it to be. For they have been enshrouded in a veil of blindness.

That liberals have severed all ties with The Civil Rights Movement, unions, intellectual inquiry, and anti-imperialist sentiment is incontrovertible. The ongoing fervor and cultlike zealotry over racism, sexism, and homophobia has ushered in a new era of witch-hunts, and is indicative of a liberal class that is increasingly unmoored and unhinged. The psychosis of contemporary liberalism has defiled and contaminated our very language, and caused the national discourse to be paralyzed by a deranged political philosophy that has fomented a war of all against all, while allowing the elite to use liberals as attack dogs to vilify, intimidate, and silence all who oppose the machinations of capitalist power both at home and abroad

When Health Care is a Privilege and Physician Shadowing is a Right

As it is presently constructed, the American health care system is predicated on the pernicious idea that good health care is a privilege. Meanwhile, medical students, residents, and other interlopers regard observing patients’ doctor’s visits to be their right, regardless of whether or not the patient’s consent has been obtained. This dichotomy embodies the egregious inequality inherent in the two-tier system, and is indicative of a complete inversion of the way any humane health care system must be ideologically oriented.

The subject of physician shadowing is inextricably linked with unfettered capitalism and the neoliberal project, where the privileged few have a vast array of options in regards to where and with whom they can seek care, while the under-insured masses can spend countless hours – sometimes in vain – searching for the appropriate specialist that takes their insurance. If an under-insured patient is able to find a specialist that takes their insurance, they often fall prey to the scourge of nonconsensual physician shadowing, as they can be coerced into becoming a medical model and teaching tool without their consent.

Physician shadowing must never be done without the patient’s consent, as this constitutes an egregious violation of medical ethics, patient privacy, and the patient’s moral right to meet with a physician in private should they choose to do so. Moreover, once a patient feels that their trust in the system has been violated, it will be extremely difficult, if not impossible, to ever fully restore it.

While a great deal of lip service is paid to “privacy,” “consent,” and “the doctor–patient relationship” in American teaching hospitals, all of these things are summarily jettisoned once medical students and residents get inculcated with the idea that it is acceptable to shadow a physician regardless of whether or not the patient’s consent has been obtained. In actuality, physician shadowing is a privilege that can be granted by one person, and one person only: the patient.

Under the neoliberal project, many physicians have been pulled inexorably into a vortex of amorality. This is because they are trained in an environment whereby the scourge of free market ideology has distorted their thinking and debased any sense of morality. Indeed, many young physicians are inculcated with the shameful idea that unless a patient has an excellent commercial plan privacy, consent, and confidentiality should have no bearing on the care they will receive.

Medical schools compel undergraduate pre-med majors to shadow a physician for a significant number of hours. This practice should be banned, as these students are not officially medical students. Consequently, they are totally unvetted. Allowing high school students to shadow a physician, or observe medical personnel at work in an emergency room or operating room, is an outrage. Having a secretary serve as a “chaperone” – deemed desirable by some physicians, as this can protect them from lawsuits – is likewise unethical and thoroughly repugnant.

The dismantling of the humanities has played a significant role in fomenting dehumanization and moral bankruptcy in health care, because without the humanities, many health care professionals have lost their ability to be compassionate and empathetic. Indeed, without a humanities education, what separates a urologist from a plumber, or an auto mechanic from a gastroenterologist?

In an online discussion on forums.studentdoctor.net titled “Isn’t Shadowing Intrusive?” doctors and medical students nonchalantly discuss physician shadowing. One philistine writes, “If you agree to the student being in the room, how is your privacy being violated? Everyone should stop being so hysterical – if the patients don’t like something, they can speak up.”

While another defends the right of undergraduates to shadow: “Medical training has to start somewhere. There is not (or shouldn’t be) a glaring divide between premedical and medical education. Better to make sure our students are better prepared for medical school and know what they are getting themselves into. And if anything, many patients are happy to have someone else to talk to. It never was a problem when I shadowed.”

Actually, many patients are interested in talking with a physician in private – and without interlopers barbarically violating their privacy. In all the many times I have experienced this at Weill Cornell and Sloan Kettering, never was my consent first obtained. In fact, at Memorial I had to complain dozens of times before my request to meet with my various doctors in private was finally granted. There are certain departments at Cornell where you can issue complaints ad nauseam, yet they will still not allow a patient with inferior insurance to meet with an attending physician in private.

Another morally bankrupt knave writes: “I’ve seen at least 100 patients in shadowing experiences. Not one asked me to leave. If you’re at a teaching hospital, and the patient has been there before, they know the deal.”

“The deal” is that there is a crisis in American health care, where all too often patient privacy is nonexistent. Also, the notion that patients can easily object is deeply fallacious. Would this hold true with the under-insured, who are acutely aware of how limited their options are? Even a patient with the finest insurance may have a hard time objecting to unwanted observers at Sloan Kettering, as Memorial has a policy of denying patients the right to change from one oncologist to another within whatever department they are ensconced in. Moreover, as these comments demonstrate, the cavalier dismissal on the part of many medical students, residents, and attending physicians that nonconsensual physician shadowing could leave patients with real emotional scars, is indicative of an extraordinary degree of insouciance regarding the delicate nature of the doctor-patient relationship, as well as a deep-seated callousness and moral bankruptcy that has metastasized throughout our entire health care system like a cancer.

Once the callow are inculcated with the idea that nonconsensual physician shadowing is an acceptable and everyday part of learning how to be a doctor, what follows? Catheterizing anesthetized patients without their knowledge? Having medical students do practice pelvic and rectal exams on anesthetized patients? Willful nondisclosure of long-term chemotherapy side effects, such as cognitive difficulties and early menopause? Over-prescribing opioids? Psychiatrists overprescribing psychotropic drugs? Indeed, these are things that have already come to pass.

It is unequivocally true that the principal devils in the American health care crisis are the private insurance companies, the pharmaceutical industry, and the hospital administrators. Yet throughout my many long and arduous years as a patient, I have witnessed medical students, residents, and fellows instructed by attending physicians to do things that are undeniably unethical. All too often their medical training is corrupted by the two-tier system and the moral bankruptcy that this spawns.

What kind of doctors will medical students and residents become, when every day they are immersed in an environment where do no harm applies to a privileged few? Where the haves are endowed with an endless array of good options, and the have nots are commodified and railroaded into resident clinics which prey on the under-insured, and which coerce patients into surrendering all vestiges of privacy? Privacy, confidentiality, and consent are foundational to any humane health care system, and once they become a privilege for the few, the very basis of medical ethics is torn asunder.

Capitalism has distorted and inverted our sense of morality – so that rights such as good health care, a good education, equality under the law, safe drinking water, affordable housing, etc. – have become privileges, whereas privileges, paradoxically, have become rights.

Once at Cornell Dermatology, I was subjected to an examination with a resident present and a nurse going in and out of the room, despite my requests to meet with a dermatologist in private. As I am at risk for melanoma and was overdue for a checkup, I deemed the visit to be medically necessary. Moreover, had I elected to go somewhere else (a specious argument frequently posited by anti-privacy ideologues), the other dermatology departments in Manhattan that take my insurance are run in a similar fashion. This is not a coincidence, as those who manage resident clinics are acutely aware of the fact that many of the under-insured who walk through their doors have few if any options.

I often think about this resident, and whether she was cognizant of the fact that she played a role in egregiously violating my privacy, as well as the oath that she took to do no harm. Did she fail to see the double standard – that she was participating in an assault on a patient’s privacy that she would vehemently object to – indeed be mortified by, herself? She has since completed her residency at Cornell, and is now ensconced at the dermatology department at The University of Pennsylvania. While these things may look nice on one’s resume, I can’t help but wonder how many hours she had to spend shadowing, and how much of this shadowing was done without the patients’ consent. I can only hope that now that she is an attending physician, she can use her influence to give patients a choice in regards to whether observers are present during their doctor’s visits, and that this will be done regardless of what type of insurance these patients may have. It is regrettable that for many ambitious young doctors privacy and consent matter little in the face of blind obedience, authoritarianism, and careerism.

Doctors know much more today than they’ve ever known before. Yet ironically, they are trusted and respected less than was the case in the 50’s and 60’s. Losing their autonomy to the private insurance companies, as well as being forced to see an increasing number of patients each day, have undoubtedly played a role in the diminishing of the doctor’s prestige. However, a growing number of patients are acutely aware of how morally compromised many doctors have become, as unfettered capitalism and the profit motive have come to permeate and defile the very soul of our society. Indeed, many physicians that ardently defend nonconsensual physician shadowing, are the first to use their superior health insurance plans to avoid this very thing when it is time to see a doctor themselves.

It is deeply disturbing watching medical students and residents being instructed to obey unethical orders from an attending physician. Only with a single-payer system will we disenthrall ourselves from the barbarism of the two-tier system – a system which destroys the souls of doctors and patients alike.

Without Single-Payer American Health Care is Doomed

Of all the forms of inequality, injustice in health is the most shocking and inhuman.

— Dr. Martin Luther King, Jr., Second National Convention of the Medical Committee for Human Rights, Chicago, March 25, 1966.

It is the year 2018, and yet not a day goes by when a patient is unable to receive good care or a doctor questions their career choice.  How have we arrived at this tragic state of affairs? The answer is that our for-profit health care system is the principal cause, not only of poor patient care, but also of physician burnout. Only with a single-payer system, anchored not in the mores of capitalist plunder, but with the understanding that quality government-funded health care is an inalienable right, can both doctors and patients extricate themselves from this suffering.

Even amongst patients that are insured, restrictive health care plans force millions of Americans to work with doctors that they do not wish to work with. No less disconcerting is the fact that Americans are often compelled to stop working with doctors that they have known for years and do not wish to leave. In conjunction with a complicated health condition I have seen dozens of different doctors over the past two years. Should my insurance suddenly change, this painstakingly constructed system of specialists could come crashing to the ground. Moreover, being forced to leave a doctor that you have known for years is a shame, not only because no one will know your medical problems quite like they do, but because once a good doctor-patient relationship is lost it is gone forever.

This revolving door is also very harmful for physicians, because if a doctor has a practice with patients incessantly coming and going, this will invariably foment alienation which can be a driving force behind physician burnout.

The argument that a single-payer system would be impossible to implement in practice, is contradicted by the fact that the overwhelming majority of countries in the West from Vancouver to Vladivostok, have nationalized health care systems that guarantee universal coverage for all of their citizens. The GDP of Cuba is mere pennies compared to that of the United States, and yet all of their citizens enjoy excellent free health care, with an infant mortality rate lower than that of the United States. (They also enjoy superior literacy rates). How can we call ourselves a civilized nation when millions of Americans with serious illnesses are more fearful of bankruptcy and losing their insurance, than they are of death from widespread disease?

A single-payer system recognizes that it is deeply immoral and inhumane to give superior care to the upper middle class and affluent, while denying good care to vast segments of the population. In the absence of a nationalized health care system, do no harm will continue to be applied increasingly to the haves – and not to the have nots.

Liberals have embraced the Affordable Care Act (the very name of which would make Orwell blush) as if it brought about the successful implementation of a single-payer system, when the power of the private insurance companies has, in fact, been bolstered. Moreover, the premiums and deductibles of the new plans are often considerably higher than the plans they replaced, and the number of doctors that take these plans extremely limited. Obamacare also failed to address the sinister problem whereby health insurance is tied to one’s job, as many Americans have found themselves in the Kafkaesque predicament of having good insurance when they are well, but not when they are unwell. This barbarous state of affairs underscores the fact that this inhumane for-profit system is more entrenched than ever before.

This two-tier system also results in preposterous and inane contradictions, such as when I once asked the chair of Dermatology at a prestigious Manhattan teaching hospital whether there were certain situations where he would object to observers being present during any of his doctor’s appointments, to which he replied without hesitation, “Of course!” Yet patients that have Medicaid and community health plans are denied this right when they seek treatment at his very department, and are quite willfully treated as second-class citizens. A morally bankrupt physician that supports privatization and the two-tier system would argue that if a patient is dissatisfied with a particular physician or department they should simply seek care at another clinic. However, the under-insured invariably have extremely limited options – hence they are often at the mercy of such loutishness and knavery.

There is no logical reason why a New Yorker should be denied the right to see any doctor that they wish at Lenox Hill, Mount Sinai, Weill Cornell, Columbia, NYU or Sloan Kettering. Is it not preposterous that millions of Americans live either within walking distance or a reasonable subway ride from these renowned medical institutions, and yet their health insurance prevents them from seeing the majority of physicians that actually work at these institutions? As is the case with the Manhattan rentals market, there is no shortage of five thousand dollar one bedrooms, yet they are accessible to only a small fraction of the population.

The question of who will foot the bill should be asked, not in regards to who will pay for single-payer, but in regards to how we can continue to maintain a system of nine hundred military bases all across the globe. According to that great bastion of Marxist heresy The Washington Post, “The U.S. wars in Afghanistan and Iraq will cost taxpayers $4 trillion to $6 trillion.” And this was written in March 28, 2013. How many hundreds of billions of taxpayer dollars have we spent on sustaining this bloated empire over the past four years? Instead of using this money to establish a health care system that we can be proud of the great beacon of liberty and freedom is arming death squads, and dropping depleted uranium, cluster munitions, and white phosphorus on mostly defenseless human beings. Think about that, the next time someone says we can’t afford a single-payer health care system.

The astounding waste that can be associated with just one new (and deeply flawed) fighter aircraft can boggle the mind, as Mike Fredenburg writes in the curiously subversive July, 2015 issue of National Review:

Indeed, it could be argued that the biggest threat the U.S. military faces over the next few decades is not the carrier-killing Chinese anti-ship ballistic missile, or the proliferation of inexpensive quiet diesel-electric attack subs, or even Chinese and Russian anti-satellite programs. The biggest threat comes from the F-35 — a plane that is being projected to suck up 1.5 trillion precious defense dollars. For this trillion-dollar-plus investment we get a plane far slower than a 1970s F-14 Tomcat, a plane with less than half the range of a 40-year-old A-6 Intruder, a plane whose sustained-turn performance is that of a 1960s F-4 Phantom, and a plane that had its head handed to it by an F-16 during a recent dogfight competition. The problem is not just hundreds of billions of dollars being wasted on the F-35; it is also about not having that money to spend on programs that would give us a far bigger bang for the buck.

Such as a single-payer health care system, for instance. That would give us a nice bang for the buck!

Lamentably, the most pressing problem in this debate is the fact that millions of Americans insist on looking at health care as yet another business. Moreover, the extreme inequality that is glaringly on display in education, where our public schools continue to churn out some of the most illiterate and dehumanized creatures ever to walk the face of the earth, in contrast with the outrageously expensive and infinitely more rigorous prep schools that the affluent are sending their children (granted, not without their own problems), may one day be the destiny of our privatized health care system.

The astronomical cost of college tuition has resulted in over a trillion dollars in student loan debt, while the quality of education has been steadily deteriorating since the end of the 1960’s. As with education, we can either choose to have a good health care system, or we can continue to allow a corrupt few to make staggering amounts of money while generating the most abject misery and suffering for millions of their fellow countrymen.

Tying health insurance to one’s job constitutes one of the most diabolical abuses of corporate power, as the overwhelming majority of Americans with full-time jobs can be fired at the drop of a hat, should they be compelled to take a significant amount of time off from work due to illness. Moreover, primary care physicians that elect not to take insurance at all will neither be able to provide patients with critical in-network referrals, nor will they be able to write prescriptions that will be covered by any health insurance plan.

How can do no harm be implemented in practice when vitally important health care decisions are routinely made by hospital administrators, pharmaceutical CEOs, and insurance executives whose only reason for getting involved in health care in the first place was to maximize the greatest possible profit? Remove the profit motive and compassion, logic, and dignity will be reclaimed. Indeed, no less than our very humanity will be restored.

Why must we continue to allow charlatans and con artists to dictate to doctors how they can treat patients, dictate to patients which doctors they can and cannot see, while also using health care as a financial weapon to wage war on the poor and what is left of our country’s once formidable middle class? Good doctors that are forced by hospital administrators and soul-obliterating insurance companies to provide under-insured patients with inferior care will be prone to feelings of guilt, shame, remorse and depression. Some have even taken their own lives. Indeed, this barbarous and unconscionable state of affairs is indefensible, and cannot hold water in any rational or civilized conversation.

The time has come for Americans to put an end to this foolishness, and to disenthrall themselves from these corrupt elements, that straitjacket and humiliate both doctors and patients alike.

The Exploitation of Medical Students and Residents is a Metaphor for the Post-New Deal Barbarism

I was happy, secure, and mostly unafraid until med school. I recall in vivid detail the first orientation day. Our anatomy professor stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: ‘If you decide to commit suicide, do it right so you do not become a burden to society.’ He then described in anatomical detail how to commit suicide.

— “Why Doctors Kill Themselves”, by Pamela Wible, KevinMD.com, March 23, 2016

The exploitation and bullying of medical students and residents is pervasive, and stories of the most egregious and diabolical hazing are not uncommon. So oppressive are these working conditions, that each year approximately four hundred medical students and doctors take their own lives. Indeed, with the betrayal of the American worker by the liberal class, which is too busy chasing Russian spies to notice that our once proud middle class lies in ruins, the decimation of unionization continues unabated. Compelled to work outrageously long hours by corrupt hospital administrators, while also forced to negotiate a landscape of diminished autonomy due to the takeover of the medical profession by private insurance companies, a young doctor’s ability to help their patients can be steadily degraded over time, and their spirit broken.

This abuse and exploitation of medical students and residents is something that we cannot afford to ignore, for these inhumane working conditions place both the lives of these young doctors as well as the lives of their patients in grave jeopardy.

In “Medical Residents are Abused More Than Chinese Factory Workers”, an anonymous physician writes on KevinMD.com:

I began my internship…and worked up to 160 hours per week, though I only reported 80 hours of my time due to the pressure by hospital administration and fellow residents. That year, a fellow intern, Tony, a compassionate doctor, was killed in a single car accident when he fell asleep at the wheel after working too many consecutive hours without sleep. I too have fallen asleep post-call at the wheel when paused at a stop light, only to be startled awake by blaring horns indicating the light change.

These exploitative working conditions are emblematic of the authoritarian nature of post-New Deal America, where much of the increasingly debt-ridden workforce has been reduced to the status of serfs and indentured servants. This absence of democracy in the workplace is inextricably linked with the fact that there are at present approximately a hundred million unemployed Americans of working age, along with massive numbers of Americans working very low-paying jobs that do not support an independent existence. Consequently, conditions are ripe for corrupt employers to engage in ruthless forms of exploitation, and young people that enter fields where they seek to help others are marked for particularly heinous forms of abuse.

In “The Secret Horrors of Sleep-Deprived Doctors”, written for KevinMD.com, an anonymous physician writes:

During intern year at a program with a nominal 80-hour work week, I worked 100 hours per week for most of a month. I was interviewing a patient when I suddenly realized that I could not remember what I had just asked. I excused myself abruptly and rushed down the hall where I collapsed on the bathroom floor. I leaned against the wall and felt relaxed for the first time in weeks. My face was wet, and I realized I was sobbing. I was so unaware of how exhausted and impaired I had become. I cried because I was tired, and also because the patient I was seeing deserved better attention and care than I was capable of providing. I couldn’t remember any details of his chest pain or risk factors for heart attack. I couldn’t even remember his name or his face. Only that he was friendly and he trusted me. I felt intensely guilty for not being able to stay awake, let alone think like a doctor. I nodded off while crying, propped up against the wall. I woke up and forgave myself. I think I was away from him for less than 10 minutes. I walked back into his exam room and said, ‘Where were we? Let’s start at the beginning to make sure I get this right. Because what you are saying is really important.’ That month during my evaluation, my program director told me that my total number of work hours was a sign of inefficiency.

Medical students and residents that suffer from anxiety, either due to being bullied or as a result of being forced to work outrageously long shifts, sometimes feel the need to see a psychiatrist and yet are fearful of doing so. This is because if a physician is treated for depression or anxiety, the stigma that follows can have a deleterious impact on their ability to maintain and renew their medical license.

Tragically, abused medical students and residents may go on to lose their sense of empathy and compassion, which can result in their becoming callous or even abusive towards their patients.

Some residents are indoctrinated into believing that this exploitation is for their own good, as if this will somehow make them a better doctor. Residents are also indoctrinated into believing that this exploitation is necessary “in the quest for perfection.” In-hospital medical errors are presently the third leading cause of death in the United States. Indeed, this is the “perfection” that hospital administrators and health insurance companies have blessed us with.

There are also significant parallels between the exploitation of young doctors with the exploitation of teachers, for the exploitation of the former is analogous to giving a high school English teacher hundreds of students per semester, which puts them in the impossible position of being unable to make detailed corrections to these essays. The loss of autonomy so acutely felt by doctors, where they are now forced to spend countless hours each week requesting permission from insurance companies so as to be able to prescribe a particular drug or order a particular test, again finds its mirror image in education, where a similar loss of autonomy has resulted in classic works of literature being jettisoned by book burning administrators, and replaced with teaching to standardized tests.

The grade inflation game that many teachers are forced to play can be no less soul-destroying, and undermines high school teachers and professors in many ways. Adjunct professors are easily fired at the drop of a hat should they receive negative evaluations from their students at the end of the semester, as the student is now regarded as a customer, and the professor as a disposable fool that has been hired to dumb down to the lowest possible level. How does one receive negative evaluations? Not giving enough A’s is indeed an excellent method of attaining such a result. This is not unlike a doctor receiving a negative online review for failing to prescribe opioids or antibiotics to a patient that simply doesn’t need it.

The brutality of neoliberalism cannot abide the altruistic. Capital is in the driver’s seat, and those who refuse to swear obedience at the Altar of Profit must be destroyed. Hence, gratuitous savagery and barbarism are unleashed on the kind, the generous, the merciful, and the idealistic. Public school teachers, professors, medical students, idealistic young doctors, nurses, social workers, and public defenders must be relentlessly tormented for their refusal to turn their backs on their fellow human beings. They must be punished without mercy for the crime of altruism.

As we have lost real communities in this country, and many Americans consequently identify with nothing other than their jobs, a career that does not come to fruition as it had when the New Deal was still in effect can be taken as incontrovertible proof that one is a failure, and this can have a devastating impact on one’s mind and spirit.

No amount of yoga, meditation, or Prozac is going to help a suffering resident or medical student. Only with a restoration of the humanities and solidarity will the soulful triumph over the soulless. And it is only then that compassion and empathy will triumph over alienation, hopelessness, and despair.

In “A Tragic Physician Story The Match Doesn’t Want You To Hear About”, published with KevinMD.com, an anonymous physician describes his first days of residency:

It did not take long for my excitement to wane. Within only a few days of starting my residency, I was called ‘retarded’ and referred to with homophobic slurs. Women were commonly referred to with misogynistic labels. I was given no organized instruction on how to perform my duties…. There came a time in which a patient of mine died as a result of a procedure I’d performed. I was told that I needed to lie to the risk managers and make it look like my supervising attending physician was in the room even though he was nowhere to be found, and while I personally didn’t do anything wrong, it would just look bad if I was unsupervised. It became clear that the people I was working for did not live in a world in which accountability existed.

Crushed under the iron heel of the new untrammeled barbarism, the dream of helping others can fade into the night. This inhumane treatment places both young doctors and their patients in extremely grave danger. Caught in the diabolical machinery of merciless plunder, a sleep-deprived resident may even accidentally kill a patient – a mistake they will likely never forgive themselves for.

American Teaching Hospitals: Where Pelvic Exams Under Anesthesia Happen

Before undergoing a liver biopsy at Memorial Sloan Kettering Cancer Center in New York City, I asked my surgeon’s nurse whether I was to be catheterized for the procedure. In response to this perfectly legitimate question the knave sardonically replied: “I’m really not supposed to say this, but what difference does it make? You’re going to be under general anesthesia.”

It was at that moment that I started to wonder: With an attitude like that, what do they really do to us when we are under anesthesia? And thus a little Internet surfing was most certainly in order.

In my journey into the subterranean depths of cyberspace, I was startled to come across a most terrifying sea monster indeed: a disturbing discussion where medical students debate, often favorably, the ethics of doing practice pelvic exams on anesthetized women undergoing surgery. The thread is here.

Apparently, there is no shortage of medical students, interns, residents, and attending physicians who feel they are entitled to penetrate the vaginas and anuses of anesthetized patients that lie paralyzed and helpless on the operating table, and who feel that they have the right to do this without first obtaining the patient’s consent. This naked display of barbarism and sociopathic behavior speaks volumes about the moral unraveling that is so glaringly on display in the West today.

This scandalous practice is evidently not uncommon in Australia, as this article attests.

The forum is fascinating in that it allows the reader to be a fly on the wall, giving one a glimpse into how many American medical students think – if that is, in fact, the appropriate word. (Some spelling corrections have been made in the following quotations. Hopefully, these Ivy League superstars will take more care in looking after their patients than they do with the written word. Considering the attitudes on display here, I am not optimistic).

The discussion opens with a medical student named Unregistered Abuser, who, like a kind of postmodern Socrates struggling with an existential conundrum, puts forth the following question:

Let me pose a question. I am on gynecological surgery and several different residents and attendings have told me that prior to surgery it is a great idea to perform a pelvic exam on the anesthetized woman in order to get practice. Many have said it is not traumatic to the patient and you get a more technically adequate exam since the patient is not guarding. Sure enough, before every procedure the attending and resident…perform a quick pelvic exam. Is this wrong? The attending does it for one last chance to feel for any previously undiagnosed masses or other abnormalities, but the resident and student do it primarily for educational purposes. The patient has consented to the surgery, but not for the pelvic exam. Does consent to surgery of the uterus, vagina, vulva, ovaries, etc. also imply consent to manual palpation of these structures during the surgery?

A medical student named Starayamoskva comments: “It is standard procedure. How else do you think the residents and students are going to learn?” A student named Gauss replies: “Pelvics on anesthesized women prior to surgery is routine – informed consent was obtained as part of the surgical consent.”

Doc Ivy chimes in, “As a woman I have to say that I really don’t have a problem with this. If I am at a teaching hospital it’s what I would expect.” A medical student named tupac_don flippantly remarks, “Been there done that, it’s A okay.” And not to be outdone, one student who could be the very devil himself says, “Patients…have rights? This phrase is thrown around by every damn idiot…but where does it come from? Hey Mr. lawyer, does the Bill of Rights say ‘Medical students shall not examine a patient’s vagina prior to vaginal surgery?’ This patient’s have rights bull**** came from lawyers…. Healthcare isn’t even a right.”

So how did we arrive at this cesspit of degeneracy and the most abject moral bankruptcy? And where did these despicable monsters come from?

They came from our schools, our press, and our mass media. They came from our consumerism, our materialism, our barbarism abroad, and the totalitarianism of our prison system. They were born out of the ashes of post-New Deal America, where our nation’s once proud middle class now lies in ruins, and we are increasingly trapped in a world of the affluent living in their gated communities on one side, and the miserable wretched masses – the oppressed, the destitute, and the debt-ridden on the other.

The dismantling of the humanities has also played a significant role in fomenting this dehumanization. This is because most colleges and universities presently exist for only two reasons: to maximize the greatest possible profit, while also serving as vocational institutes that mold young people into becoming automatons trained to perform increasingly specialized jobs. (Jobs which, particularly outside of health care, do not even exist).

This absence of a proper humanities education has undoubtedly contributed to the inculcation of many medical students with the pernicious idea that patients are mere objects and teaching tools. And the danger of significant numbers of young people receiving an advanced scientific and technical education that is utterly devoid of any foundation in the humanities, lies in the fact that the soullessness and amorality that follow will inevitably usher in an age of authoritarianism and absolute unchecked barbarism.

Many medical students are also made acutely aware of which patients have money and good health care plans, and which don’t. This two-tier system is well on display in many medical institutions across the country, as patients are separated into the haves and the have nots. (And lest we forget, there are also the “have mores,” as George W Bush was once kind enough to point out). One student writes on this thread: “At my school, the rule is that it’s ok to do [pelvic exams on anesthetized women] on welfare patients but not on private patients.”

The oligarchy’s mass media brainwashing apparatus has been relentless in spreading the virus of neoliberal free market dogma. And this has also exacerbated commodification, dehumanization, desensitization, as well as contributing to a profound loss of compassion, empathy, and a sense of self.

The attitude of the attending physician will unequivocally have a profound impact on the behavior and thinking of the medical students, interns, and residents that they mentor. And their philosophy and approach to patient care will shape and mold the moral character (or lack thereof) of their charges in profound ways, and for many years to come.

The physician Peter Ubel writes on the website kevinmd.com:

Moral attitudes are often a function more of our experience than of our training. When some colleagues and I surveyed medical students and asked them how important it was to ask permission before conducting a pelvic exam on an anesthetized woman, brand new medical students almost universally stated that permission was vital but by the time the students finished their OB/GYN rotations three years later, they didn’t see permission as being important anymore. Despite the lectures they’d received about ‘informed consent’ during the first two years of medical school, six weeks of an OB/GYN rotation was enough to change their moral attitudes.

Men under anesthesia are not immune to this barbarous practice, as the attending physician can order medical students to line up and perform practice prostate exams on anesthetized male patients.

How ironic, that if a student passes out while intoxicated at a party and their body is vaginally or anally penetrated while they are unconscious, the law states unequivocally that this is illegal. However, if a student gets a 4.0 GPA, aces the MCAT, and goes to medical school they can actually do this all day long and to their heart’s content.

Many medical students will feel in their heart that this practice is unethical, yet proceed with the unauthorized exam as they wish to get a good grade and don’t want to anger their attending physician. And like soldiers in the military, the pressure to conform will be overwhelming. It will take great courage to say no.

There is also an inextricable connection between nonconsensual physician shadowing and nonconsensual rectal and pelvic exams performed on anesthetized patients. With the former, once this Rubicon has been crossed it becomes ingrained in the minds of everyone on the medical “team” that the patient is more of a primate than a human being, and is consequently undeserving of any right to privacy whatsoever. Moreover, once these civilized norms of morality and ethics have been breached, it will be easy for a medical student to take things just one step further, and violate a patient’s body on the operating table “for practice.”

It is vitally important that medical students, residents, and fellows be inculcated with an understanding that both observing a patient’s session with their doctor as well as examining a patient’s body, constitute a privilege and not a right. And they must be made to understand that this privilege can only be granted when both the attending physician  and the patient sign off on it.

There may be some medical students who are angrily reading this, and who have concluded that I am somehow attempting to sabotage their efforts at becoming doctors. As one who has taken a lot of photographic portraits on the streets of New York City, never have I taken someone’s portrait without first obtaining their consent. If a photographer makes the case that there is an ethical and an unethical way of taking portraits, does it then somehow follow that they are of the opinion that photographic portraiture should be banned altogether?

Every teaching hospital in this country has a website where they speak ad nauseam of their profound respect for patient privacy. The problem is that their conception of the term applies only to protecting the digitalization of your medical records.

It is noteworthy that not all the medical students who participated in this discussion were in favor of this practice. Souljah1 says: “Lining up 4-6 medical students to do pelvics on anesthetized women is totally ****ed up in my opinion. Not giving clear information regarding students lining up to examine their genitalia and reproductive organs is incredibly unethical in my opinion.”

And one brave medical student going by the name Mumpu argues, “Think about the absolute trust the patient places in your skills and professionalism when they go under anesthesia. They are paralyzed and unconscious and it is grossly unprofessional of you to violate that trust by violating their body. There’s no ‘greater good’ clause here. To do an unconsented exam is assault (any firefighter/EMT who ever worked on the streets knows this), to do an unconsented pelvic is sexual assault.”

And so perhaps we can take heart in knowing that even in this dark age of book burning and the most appalling ignorance, there are still those who live their lives with a powerful sense of morality and ethics, who have retained their humanity in the face of stifling reactionary dogmas, and who have resisted the call of dark forces that lie in wait behind every shadow and every unlocked door.