Category Archives: medical ethics

The American Teaching Hospital: School for Psychopaths

Medicine has changed. We used to be a calling that catered to the public welfare, and our prime consideration was the patient. Now we are a business, and some of us practice as impersonal corporations, with the bottom line the profits, not the well-being of the patient.”

— From The Doctor, by Dr. Edward E. Rosenbaum, 1991

The most shocking thing about the neoliberal health care model is not that it bankrupts and murders hundreds of thousands of Americans each year, but that vast numbers of physicians continue to support it. The insatiable depravity of the anti-single-payer virus has metastasized throughout every organ of the American teaching hospital, an institution which has betrayed its sacrosanct purpose, and which increasingly inculcates residents with the pernicious idea that good health care is a privilege and not a right.

The teaching hospital has become a dangerous place, not only for patients, but also for trainees, who are being forged into physicians without having been inculcated with a respect for basic principles of medical ethics. In this way have American physicians largely been reduced to an army of automatons trained to make money for the medical industrial complex. Indeed, it should come as no surprise that many residents lose themselves in a pitiless sea of soulless careerism, as they are immersed for years in an environment where they are beholden to, and at the mercy of, rapacious interests that place profit-making over all other considerations.

The teaching hospital is to health care what the ballet academy is to ballet and the music conservatory is to the symphony orchestra. All who covet this career must pass through its gates, and the values it imparts to its pupils form the basis of the light — or the inexorable darkness — that will assuredly follow.

Knowing that patients are often confined to extremely narrow networks, it is standard practice for teaching hospitals to arm-twist patients with inferior insurance into being medical models during physician office visits. This underscores the sociopathy of the contemporary teaching hospital, and serves as a metaphor for how these institutions have become inhuman machines that harm patients and sully the souls of their trainees. Cornell Dermatology, a department that could win an award for teaching residents how to coerce patients with inferior insurance into being clinical teaching tools, takes great pride in their villainy, writing on their website:

In addition to basic and clinical dermatology training, we strive to instill ethical behavior, compassion, communication and the recognition that we are here to serve our patients.

Residents that are the most amenable to the dictates of unscrupulous attendings position themselves to become chief resident or to be awarded a prestigious fellowship. In the American teaching hospital, this is the only thing on the mind of most trainees.

It is incontrovertible that the multi-tier system, the spawn of privatized health care, is incompatible with the oath to do no harm. Cornell Oncology, which once assigned me to a fellow due to my unglamorous insurance, writes on their website that “We care for the whole person and put the needs of our patients at the center of everything that we do.” Despite a blatant predilection for medical Jim Crow, Weill Cornell claims in their literature to have “a legacy of putting patients first.” In actuality, American teaching hospitals put profit-making first, research second, the attending’s comfort (vis-à-vis their desire to have a medical scribe or chaperone present in the examination room) third, the teaching of the trainee fourth, and the patient last.

In “I am a physician and I am not your enemy,” by Megan Gray, MD, the author laments the fact that her patients are wary of doctors. “I am asking you to trust that every day I put your needs above my own,” she writes entreatingly. It is possible that Dr. Gray does, in fact, put the needs of her patients above her own. Regrettably, this is often not the case, as evidenced by the fact that American physicians wrote over two hundred million prescriptions for opioids each year from 2006 – 2016, millions of our countrymen have been made addicted to psychotropic drugs, while Vioxx took the lives of roughly the same number of Americans as died in the Vietnam War.

It is clear that the physician-patient bond, regarded as inviolable for millennia, cannot coexist within the mores of privatized health care. Yet many doctors would argue otherwise. In “Being a doctor is not what it used to be,” by Raviraj Patel, MD, the author writes that “in my humble opinion, the patient-physician relationship is sacred, and the entire system is designed to facilitate that relationship.” In “To combat COVID-19, we endanger our doctors in training,” Gali Hashmonay, MD, writes of our uniquely dysfunctional for-profit apparatus, that “This system attracts doctors in training who are eager to put a patient’s well-being in front of their own.” Indeed, accepting gifts from pharmaceutical companies, performing practice pelvic exams on anesthetized patients, not disclosing long-term chemotherapy side effects, getting patients addicted to drugs (formerly benzodiazepines and barbiturates), imposing unwanted observers on patients during their physician office visits, pushing unnecessary surgeries, and ignoring do not resuscitate orders are some of the many things that residents have to look forward to when training at our esteemed teaching hospitals. After the corporate lexicon of “humanism,” “patient-centered care,” and “compassion” are stripped away, blind obedience is the attribute most coveted by teaching hospitals when interviewing prospective residents.

By refusing to acknowledge that corporatization has been a catastrophe, anti-single-payer physicians have sacrificed their autonomy to the devilish whims of the private health insurance companies, which have usurped the medical decision-making process. They have also sold their souls to the pharmaceutical companies, which continue to corrupt medical knowledge and foment quackery; and to hospital executives, who treat doctors as if they were employees at an investment bank.

The successful Cuban response to the pandemic underscores the fact that money and technology are useless when profits are placed over human lives. Vietnam, also a poor country with limited resources, has likewise mustered a stronger defense against the virus than the Beacon of Liberty. Cuba’s health care system is so robust that they have continued to send teams of doctors abroad, even in the midst of the pandemic.

Successfully completing a residency is analogous to being awarded a black belt in karate. Without a sense of compassion and virtue, such an individual is destined to become a danger to themselves, and a danger to others. As profiteering and the multi-tier system have become normalized in the American teaching hospital, this can only result in the commodification of the patient in the mind of the debased trainee.

In “5 things that make U.S. health care great,” by Suneel Dhand, MD, the author posits, without satire, that “A homeless American entering the doors of a hospital with an acute medical issue — be it sepsis, a myocardial infarction, or a stroke — will get better care than a rich person almost anywhere else in the world.” Writing for KevinMD, Kent Holtorf, MD, concedes that “The U.S. far exceeds any nation in expenditures for insurance administration, where the essential means of cost control is denial of service and rationing of care via ever increasing complex treatment approval systems, resulting in spiraling costs.” He then concludes:

A free-market system is shown to be the only reasonable method of reform that addresses the true underlying problems of the U.S. health care system and effectively lowers health care costs, allowing for universal insurance coverage for most everyone so any reasonable person — doctor, patient, Republican or Democrat — could support.

Not to be outdone, Kevin Tolliver, MD, asks In “A framework to understand universal health care:”

At its core, universal health care forces healthy people to pay for others’ medical care. Is this fair? Why should an active, healthy-eating, non-smoker pay for health care for an obese, sedentary diabetic who chain smokes all day?

In “Corporate games have ruined the health care system,” Osmund Agbo, MD, acknowledges that “When an insurance executive is making a seven-figure bonus, it’s very clear his loyalty lies somewhere else outside the interest of regular Americans struggling to pay an infinitely rising monthly premium.”  He then informs us that “I am not a fan of socialist medicine. On the contrary, I am a firm believer in the free market enterprise system.”

Where does all of this irrationality and deranged thinking come from? Surely, the media has played a role. And yet we cannot discount the deleterious influence of the teaching hospital, which far more than medical school, profoundly shapes an impressionable trainee’s sense of right and wrong. Polluted and defiled by the pathogen of amorality, the fallen wallow in the plague wards of neoliberalism, banished from the world of compassion and rationality, and forever condemned to live out their days enveloped by a shroud of blindness.

Let us recall Pope’s haunting words in An Essay on Man: Epistle II:

Vice is a monster of so frightful mien,
As, to be hated, needs but to be seen;
Yet seen too oft, familiar with her face,
We first endure, then pity, then embrace.

Only by collectively acknowledging that health care cannot be sold as cars, kitchen appliances, and soap are sold; that it is the doctor’s sacred duty to treat all patients equally, regardless of their ability to pay; and that medical ethics can only flourish in a nonprofit socialized system, can we take this desperately needed step in reclaiming our humanity. For too long have American teaching hospitals been bastions for every form of knavery, perfidy, and skulduggery. These institutions must cast off their shackles of corporate thralldom, and join the fight to restore dignity and honor to American health care.

My Experience with Hospice, Inc.

One nurse told Clay, “I’ve given him the highest dosage I can. It’s enough to kill a horse. Most hospice patients die from morphine, but I can only OD him within an acceptable margin of error.”

— From Christopher Bollen,  A Beautiful Crime, 2020

In this age of coronavirus, it has become abundantly clear that Western culture has little respect or reverence for its elders.  Deaths of the elderly seem of no account and only to be taken in stride. Such an attitude has increased the opportunities for the hospice/medical industry as it profits off the expendable bodies of older, vulnerable human beings. For me, that expendability was brought abruptly into focus when my mother, aided and abetted by my siblings, was quickly dispatched by large doses of morphine:  even at 93-years-old, way ahead of her time to die. My brother and sister-in-law had prominently displayed her “Do Not Resuscitate Form” on the front of her refrigerator for months—and Hospice Inc. efficiently obliged them.

The hospice movement had some thought-provoking beginnings, at least the modern version.  Of course, the good offices of monks and nuns had cared for the dying in medieval times and before. In the modern version, Dame Cicely Saunders is credited with beginning the movement with her London hospice in 1967. She was nurse, social worker and doctor, and dedicated her (much-decorated) life to helping the terminally ill. Saunders brought compassionate (“palliative”) care to patients’ last days, advocating they die in their own time, and “naturally.” She did, however, introduce the use of morphine to ease pain. Her philosophy was somewhat different from America’s hospice pioneer, Florence Wald, dean of Yale nursing. Wald, in 1974, brought “assisted suicide” and “euthanasia” to her Connecticut hospice. What has evolved in the American hospice industry seems to be a very successful melding of the image of Dame Saunders’ “compassionate” care with the use and apparent abuse of assisted suicide and what author and former hospice nurse Roger Gantz calls “stealth euthanasia.”

A 2014 Huffington Post study found that once Medicare introduced a hospice benefit in 1983, the hospice industry burgeoned into (by 2014) a $17 billion industry. In that year, one million died under hospice “care,” and nearly half of all Medicare patients died as home or institutional hospice patients. The study reported hospice “marketers, doctors, [and] rehab centers” trolling for ill (enough) patients for their purposes. The now for-profit business is publicly traded and receives little government oversight, regulation, or inspection. The industry is also rarely punished when lawsuits or investigations claiming wrongdoing are brought. Many patients and their families never complain—but a 2017 Kaiser News study analyzing 3200 complaints filed against hospice companies over five years, found that with 75% of companies who did receive complaints, none suffered punishment.

There is definitely a host of problems that could bring complaints. In 2014, a Washington Post report found that hundreds of hospices did not provide promised care; and in 2012, at least one in six had not. In 2019 the Office of the Inspector General found millions of dollars of hospice Medicare fraud, and a “task force” was formed. Also on the federal level, US Health and Human Services did a study showing that between 2012 and 2016, 80% of hospices had “deficiencies,” with 20% having “serious” deficiencies. And in 2018, statnews.com found that in 2006 Medicare had paid out $9.2 billion for one million hospice beneficiaries, and in 2016, that grew to $16.7 billion for 1.4 million beneficiaries. They cited a Texas nurse in their report who gave “high doses of morphine” whether “a patient needed it or not,” to justify getting “higher hospice payments.”  And they reported the case of a woman with dementia being signed up a year before her scheduled demise. For that, in a rare outcome, the head of the hospice got six and a half years in federal prison—for her treatment, and for his $20 million scheme to sign up people who were not dying.  Most complaints made to or about hospice are ignored. That would certainly be my experience:  my complaint was met with denials, lies, and offers of bereavement counselors.

In looking through the hospice patient cases presented on hospicepatients.org, collected by Roger Krantz, it’s clear that there is a definite pattern to how hospice operates in securing and then “treating” their patients. One case I read involved a woman professional whose 60-year-old boyfriend was basically hijacked by his sister and her husband, apparently so they could have access to his money. It began by the man needing rehab, and then changed to his health care providers declaring him “terminal” and placing him in hospice. A health care provider, under today’s protocols, identifies you as terminal if they decide you have six months or fewer to live (a very iffy determination). He had trusted his sister with his power of attorney after he had experienced a “depressive episode” and was placed back in hospice after having been upgraded to rehab for a time. His sister placed him in hospice, where, to his girlfriend’s dismay, he was given zyprexa—a stroke inducer. His girlfriend was kept away from him as his condition worsened, and she was told he had “dementia” (a typical hospice move). When the girlfriend succeeded in getting him back to rehab, he improved, but his sister was furious.

The sister was able to suddenly move her brother to a hospice house, where the girlfriend was told he had eight days to live. The hospice nurses stopped his IV, and told the girlfriend he would now receive only “comfort [palliative] care.” The nurses also had been “warned” by his sister about the girlfriend, and said she “was in denial” (another hospice bullet point).  When she pressed on and was able to get him to eat and drink, his sister was furious, and said the girlfriend got him “agitated”—causing hospice to re-drug him.  The girlfriend’s questions were met by “blank stares.” He was given meds for pain, although he was not in pain.  The girlfriend told the doctor the man should not be there, and the sister “flew out of the room in rage!” At that point, they upped the morphine he was being given.  The girlfriend was told without holding his POA (power of attorney), there was nothing she could do.  She tried reasoning with his sister, and soon thereafter got a “vicious letter” from the sister’s husband which said she was “venomonous” and “in denial.” The sister sent her an email informing her of his death.

The experience of this woman is not at all unique. Time and time again, hospice agencies exploit vulnerable patients and ignores any protest they might get from concerned family and friends. My experience with hospice was a nightmare. It was not an anomaly. After I discovered that was the case, it was a comfort, (“I’m not crazy!”) but also a horror to find a very widespread pattern and problem. My mother was a very independent and feisty lady—in very good health for most of her life. At 91, she fell in her kitchen, breaking a finger and shattering her pelvis. She was hospitalized and then placed in rehab in a nursing home where she successfully recovered her mobility and went home.  I gradually became aware that my brother and sister-in-law, visibly upset when my mother left the nursing home, had developed a long-range plan not atypical of many children of elderly parents, not for control of her money really, but apparently for the convenience of not having to deal with their elderly mother.  My brother had my mother’s POA and was the sole executor of her will, and thus was able to solidify his control over family decisions.  He and his wife, a 22-year volunteer for hospice, also secured the loyalty of my two sisters, who stopped questioning any of his decisions, particularly about my mother’s health care.

The problem was that I had been her primary caregiver for over a year and a half, there every day, taking care of most of her needs—eye drops, pills, errands, meals usually, and also taking her to doctor appointments, etc.  When I questioned my (younger) brother’s decisions, he began a campaign to separate me from my mother’s care.  This was done by not so subtle assertions to my family, and beyond, that she was not “safe” with me at home, that I was “over my head.” My input into my mother’s care was shut off—my brother and sister-in-law refused to speak to me—and it was easy for them to solve any of my mother’s objections by drugging or ignoring her.  This was especially true once my brother and his wife instituted their new, long-term “palliative” medical regime for my mother.  My hospice veteran sister-in-law told the family that “palliative care” would “mean no change in her care,“ and “assure Mom’s remaining days are comfortable.”   When it was apparent she was developing difficulty bathing and cooking for herself, and had to take two trips to the hospital to treat anemia resulting from the blood disorder myelodysplasia, I began to think of ways to get help to improve her home care.  But I was pre-empted.  My sister-in-law had already arranged a hospital-style bed for my mother, something my mother (who was fully coherent and lucid right up until her death—unless heavily drugged) repeatedly and emphatically said she did not want.  The day it was delivered she was heavily dosed with lorazepam and morphine in case she got “agitated.”

The new regime for my mother included hiring numerous home health aides, done without my prior knowledge much less consent. Her doctor, who had spent little time examining my mother, signed onto the new plan. I questioned the need for what they called her new palliative care regime, which had my mother receiving no showers or baths, sitting in unclean clothes, having an unhealthy diet, being drugged into very long periods of sleep, and receiving no treatment for her urinary infections. All the aides were required to sign a letter promising to speak only to my brother and his wife and not to me, about any aspect of her care.  One of the health aides, a woman with 26 years’ experience, told me my mother’s health was not bad enough to require palliative (hospice) care. She also warned me that if hospice came in, she’d be dead within a week. My mother was almost always alert, and her diagnosis of myelodysplasia was not necessarily dire. My observation was that she was still as active as she could be, cheerful and not in much pain. When that experienced aide who objected to her palliative care would not sign my brother’s letter, he fired her.

According to hospice care reformer and author Roger Krantz, for patients under hospice care, the line between so-called palliative care—“pain relief, symptoms management”—and “imposed death” has blurred as hospice and palliative care groups became “heavily funded.”  Palliative care is supposedly a “niche” in medicine for treatment of pain.  But, as with my mother, when every patient is sedated because they’re defined as “agitated,” that’s not what palliative care is supposed to be.  Krantz asks, “Is it ‘palliative’ to refuse to treat treatable medical problems?”  And then just “anaesthetize and kill—?”  In some cases, families are led to expect palliative care, but get no treatment at all.  A woman in New York City who recounted her experience in a 2018 New York Times article, said their family was promised 24/7 oversight by a doctor and 24-hour service by a nurse by hospice, for their father, but were not told it depended on “staffing levels” whether or not her father got “palliative care.”  He slipped into a coma before they could say goodbye.

According to author/reformer Roger Krantz, there are apparently thousands of patients being cheated of competent and humane treatment.  A father of two daughters died under hospice care because his regular lung medication was refused him against his stated wishes.  He was given no food or water—just morphine—killing him in a few days. Another man had heart problems, but not life-threatening.  After being taken to a hospice facility, he gradually diminished, and died in a few days, after being given morphine every 15 minutes. [!]  And in the account referred to earlier, a 60-year-old man in rehab became deathly ill in a hospice institution after being given dangerous amounts of morphine instead of treating his actual medical condition.

It is an all too common experience for families of hospice-bound patients to be misled and given misinformation at all points of the process. It is also common to be treated with coercion, hostility and intimidation. For my mother’s admissions/information visit by Hospice Inc., my sister-in-law announced that a “palliative care nurse” would be coming to my mother’s house (September 19, 2019) to “check over” my mother, answer our questions about hospice and discuss whether or not my mother should become a hospice patient. The hospice nurse began by explaining the Hospice Inc. program, with heavy emphasis—and a handout—on the drugs they administer via visiting nurses: Tylenol, prochoropenzine (for vomiting and psychosis), lorazepam (for anxiety), and most especially, morphine. I learned that day that my mother had already been taking morphine for some time, presumably part of her “palliative” care.  My questions about how things worked, who made the decision to have Hospice Inc. come in, and so on, were answered politely by the admissions nurse, at first, with her stressing that they would work “hand-in-hand” with her doctor to have treatment “pain-free and with dignity.” But she also said there would be no (more) palliative care.  My mother was “with Hospice, when no treatment is done.”

My sister-in-law punctuated my questions with sighs and groans and throwing up her hands, along with comments like, “Oh, she’s just a distraction.” My mother was there at this meeting, heavily drugged with lorazepam (and maybe morphine), and half-dozing, but awake.  She and I exchanged grimaces a few times, because she had made it clear to me on a number of occasions—when she was fully cognizant and coherent—that she didn’t think hospice coming in was necessary.  When I asked who made the decision for her to become a Hospice Inc. patient, the nurse said “the patient—the family—her health proxy.” My older sister held the health proxy, but my brother said he was her advocate. And when I asked what if some of the family disagrees?  At that point, the nurse turned her back on me, and related only to the people who were busy yelling at me that I knew nothing and “lived in my own world.”

The nurse suggested a “family meeting” to work the whole thing out. My sister seemed dazed and kept saying she just wanted information. I told my brother and his wife that I was opposed to Hospice Inc. coming in at that time.  When I told the two of them they do not control everything, my brother said, “Yes, I do,” and moved as if to strike me, putting a fist up to my face. His wife told him “no.” But then she stood up, went behind my chair, and using both hands, shoved me forcibly into it. Beyond disgusted, I told my mother goodbye and left. I encountered the nurse outside, and told her the situation “was not over.” She said nothing. She did not tell me that the Hospice Inc. admittance papers were already prepared, and that within minutes after I left, my confused sister, my mother’s health proxy, had signed them all. The “admissions” procedure, characterized by lies, misrepresentation and coercion, was accomplished.

Hospice agencies have become notorious for misrepresenting what’s to come, to patients, and to family. As noted earlier, in the case of the woman with a boyfriend in rehab, she was totally misled about what would happen with hospice, and more importantly, she was totally helpless to remove him when she saw what was happening. In another case, a daughter thought her father’s heart problems were treatable, but he “diminished” when placed in a hospice facility, a place one doctor had warned her had a “license to kill.” After morphine doses, he died after a few days there. The 2018 Times article cited earlier, writing of “not the good death we were promised,” makes clear that the woman’s father did not receive anywhere near the care hospice promised with a resulting nightmare for her as he went into a coma. And in 2014, the Huffington Post reported on what happened to Evelyn Maples, whose family was horrified to watch her “overmedicated.” She had not given her consent, although capable of doing so—her family was misled about her treatment, and they were unable to get her out of hospice “care.”

After I found out my mother was officially a patient of Hospice, Inc., I checked the medical notations done by the aides, and found my mother was being given 0.25 ml of morphine three times a day, by Friday the 21st. Shortly after that, Nurse “Naomi” was administering 0.5 ml every two hours, with doses of prochloropenzine. (My brother’s home health aides also gave her morphine.) My mother’s condition very quickly deteriorated from being alert and seeming fine, when she was allowed to be awake, to just weeks later, being a vegetable lying with her mouth open—, and given no food, bathing, and little water. Just the morphine. I was alarmed at her rapid downhill slide. She and I had had no time to talk, to say goodbye. On Monday the 24th, I finally convinced my older sister that we should call Hospice Inc. and see if they would ease up on the morphine. (My younger sister refused to believe me when I appealed to her.) We spoke to a nurse on phone duty there, and she was incredibly rude. When I said I’d like to call my mother’s doctor (her original one, back from leave) about it—she became very angry. “They’d tell you the same!” When I went to see my mother after that call, I said, out loud: “It’s way too late.” She looked barely alive.  She died two days later.

It was too late to save her from the “morphine cocktail.” As in the opening quote, as part of popular culture, it is known that morphine is hospice’s weapon of choice. “Most hospice patients die from morphine, but I can only OD him within an acceptable margin of error.”  An RN told the hospice patients organization that when her mother was given over to hospice, both her own and her mother’s wishes were ignored. The RN told the hospice nurses they should not give her mother morphine, but she was ignored. Her mother quickly began to show signs of “poisoning” as a result of the morphine. The hospice nurses told her—as Hospice Inc. told me, using almost the exact same language—that her mother “didn’t want to eat,” “would be sleeping more,” and would begin to “have trouble breathing.” When the RN objected to the morphine, the nurse turned her back on her and yelled at her, and then security took her away. [!] The RN said hospice gave her mother “a death cocktail,” and echoing my sentiments, said she “looked like a euthanized animal” when she died. Evelyn Maples, mentioned above, was over-medicated, including with morphine, even though she was “full code resuscitate.” They ignored that since hospice patients are assumed to have a DNR form.

Case after case reveals the same deadly prescription: a father died when his lung medicine was replaced by morphine; as noted, another father died in a few days after being given morphine every 15 minutes! A woman with COPD (chronic obstructive pulmonary disease) had a cut left untreated, medicine denied and died, according to her autopsy, of “morphine intoxication.” The study on statnews.com cited earlier found a North Texas nurse giving “high doses of morphine” whether “a patient needed it or not” to get higher payments from Medicare. And Huffington Post reported a former hospice doctor in Atlanta saying hospice nurses gave morphine against a patient’s will and doctor’s orders. The world of hospice continues unabated in the coronavirus pandemic. In a pbs news report, a hospice institutional manager laments that hospice patients were tending to not go to a hospice facility, but to just stay at home. Those patients could go to a hospice facility and “be comfortable with morphine and attentive nurses and sparing community exposure.”  Attentive nurses who will gladly give a death cocktail.

When I sent Hospice & Palliative Care, Inc. my formal complaint in January of this year, the CEO gave me her “deepest condolences” in her reply, and assured me she did a “full investigation.” Of course, that investigation did not include speaking to me, or to the veteran home health aide who voiced grave reservations about their treatment. She also, unsurprisingly, put all the responsibility on my mother’s physician and refused to reveal any medical records.  She also said my brother had my mother’s health care proxy; something easily disproven by the fact it was my older sister who signed the admission forms.  He did not have it, but since according to her he did, she said she therefore considered him the one who was supposedly the “point person” in charge of giving me information.  Unfortunately, he had not been really speaking to me in some time. All the wonderful written information that she told me Hospice provides, I never saw. She also lied about their 24/7 availability for families, although they were available to be hostile to questions.  She was sorry if I “felt the Admissions Nurse did not include me”; she denied that was her intent.  Oh?  Turning her back on me?  Not speaking to me? Lying to me?  And the CEO (so appropriate, a CEO!) insisted “the patient,” my mother, “received a gradual dose change of ‘pain management medication’ based on her physician’s recommendation.” This was a lie—I saw the aides’ notes on the rapid increase of morphine and could also see the results. My response to her response addressed the above, and was, of course, never answered.

She obviously thought I could be fobbed off with her assurance she would use “my concerns” “in staff training … so no one will feel left out.” And the kicker: “I hope you will consider using our bereavement services that are available to family members of all Hospice patients.” Yes, that would do it. “Bereavement” doesn’t begin to touch my feelings towards Hospice Inc. and their part in killing my mother with morphine, with my siblings’ compliance. I knew that my protest would not result in any satisfactory action, but as I said in that complaint, I wanted them to know “that not everyone will simply accept the sort of cruel, callous and incompetent treatment” that my mother received. And, of course, it’s evidence for this article.

Hospice Inc. deals in lies, coercion, manipulation and greed. And they get away with it. As noted, Kaiser News reported in 2017 that a five-year study found 3200 complaints filed against various hospice organizations which were rarely punished. Police, prosecutors, county and state health officials, the DEA—complain all you want, they refuse to go there.  And a wrongful death suit is very difficult to win: you have to show how you suffered a loss of income (!), among other requirements. There are privacy laws. The media is very hospice-positive: “They do much more good than bad.” Most victimized family members just stay silent, and if they do speak up, they get nowhere. In California, in 2019, Steve Lopez’ mother Grace died after neither her medications nor her hospice nurse showed up from the hospice agency.  The California Public Health Department “could not validate his complaints,” nor did they get around to, as promised, investigating further. A Kentucky man who complained about his wife’s death being caused by “suspicious use of a drug [morphine] pump” was told by hospice lawyers that his “trauma had colored his perception.”  In case after case investigated by Roger Krantz, complaining family members are told they are “not able to deal with death.” This is what Hospice Inc. told me in suggesting their bereavement counselors. My younger sister has repeatedly said to me that I obviously have a hard time dealing with death.  Yes, I do.  Especially when, for my mother it was unnecessary, premature and made possible by her own children.

The elderly are not revered in Western society. Oxford economist Jeremy Warner finds the virus beneficial for “culling elderly dependents.” Scotland’s George Galloway writes scathingly of British treatment of old people which, in the midst of the pandemic, is encouraging an increase in “Do Not Resuscitate” orders. “Euthanasia by stealth and contrary to law, has washed up on our shores.” And our own local Hospice Inc. is eagerly seeking new patients. The CEO says her staff “performs like true angels,” providing bedside care, social work and “spiritual care” (bereavement).  She says Hospice Inc. reduces the strain on the healthcare system.  She then tells us it is important people know Hospice is there: “We’re still taking care of people at home so they don’t have to go to the hospital to die.” They can die by morphine overdose in the comfort of their own home. They do not resuscitate.

Orwellian Lockstep and a Loaded Syringe

Some years ago, the then vice-president of Monsanto Robert T Fraley asked, “Why do people doubt science”. He posed the question partly because he had difficulty in believing that some people had valid concerns about the use of genetically modified organisms (GMOs) in agriculture.

Critics were questioning the science behind GM technology and the impacts of GMOs because they could see how science is used, corrupted and manipulated by powerful corporations to serve their own ends. And it was also because they regard these conglomerates as largely unaccountable and unregulated.

We need look no further than the current coronavirus issue to understand how vested interests are set to profit by spinning the crisis a certain way and how questionable science is being used to pursue policies that are essentially illogical or ‘unscientific’. Politicians refer to ‘science’ and expect the public to defer to the authority of science without questioning the legitimacy of scientific modelling or data.

Although this legitimacy is being questioned on various levels, arguments challenging the official line are being sidelined. Governments, the police and the corporate media have become the arbiters of truth even if ‘the truth’ does not correspond with expert opinion or rational thought which challenges the mainstream narrative.

For instance, testing for coronavirus could be flawed (producing a majority of ‘false positives’) and the processes involved in determining death rates could be inflating the numbers: for example, dying ‘with’ coronavirus’ is different to dying ‘due to’ coronavirus: a serious distinction given that up to 98 per cent of people (according to official sources) who may be dying with it have at least one serious life-threatening condition. Moreover, the case-fatality ratio could be so low as to make the lockdown response appear wholly disproportionate. Yet we are asked to accept statistics at face value – and by implication, the policies based on them.

Indeed, documentary maker and author David Cayley addresses this last point by saying that modern society is hyper-scientific but radically unscientific as it has no standard against which it can measure or assess what it has done: that we must at all costs ‘save lives’ is not questioned, but this makes it very easy to start a stampede. Making an entire country go home and stay home has immense, incalculable costs in terms of well-being and livelihoods. Cayley argues that this itself has created a pervasive sense of panic and crisis and is largely a result of the measures taken against the pandemic and not of the pandemic itself.

He argues that the declaration by the World Health Organization that a pandemic (at the time based on a suspected 150 deaths globally) was now officially in progress did not change anyone’s health status, but it dramatically changed the public atmosphere. Moreover, the measures mandated have involved a remarkable curtailing of civil liberty.

One of the hallmarks of the current situation, he stresses, is that some think that ‘science’ knows more than it does and therefore they – especially politicians – know more than they do. Although certain epidemiologists may say frankly that there is very little sturdy evidence to base policies on, this has not prevented politicians from acting as if everything they say or do is based on solid science.

The current paradigm – with its rhetoric of physical distancing, flattening the curve and saving lives – could be difficult to escape from. Cayley says either we call it off soon and face the possibility that it was all misguided (referring to the policies adopted in Sweden to make his point), or we extend it and create harms that may be worse than the casualties we may have averted.

The lockdown may not be merited if we were to genuinely adopt a knowledge-based approach. For instance, if we look at early projections by Neil Ferguson of Imperial College in the UK, he had grossly overstated the number of possible deaths resulting from the coronavirus and has now backtracked substantially. Ferguson has a chequered track record, which led UK newspaper The Telegraph to run a piece entitled ‘How accurate was the science that led to lockdown?’ The article outlines Ferguson’s previous flawed predictions about infectious diseases and a number of experts raise serious questions about the modelling that led to lockdown in the UK.

It is worth noting that the lockdown policies we now see are remarkably similar to the disturbing Orwellian ‘Lock Step’ future scenario that was set out in 2010 by the Rockefeller Foundation report ‘Scenarios for the Future of Technology and International Development’. The report foresaw a future situation where freedoms are curtailed and draconian high-tech surveillance measures are rolled out under the ongoing pretexts of impending pandemics. Is this the type of technology use we can expect to see as hundreds of millions are marginalized and pushed into joblessness?

Instead of encouraging more diverse, informed and objective opinions in the mainstream, we too often see money and power forcing the issue, not least in the form of Bill Gates who tells the world ‘normality’ may not return for another 18 months – until he and his close associates in the pharmaceuticals industry find a vaccine and we are all vaccinated.

US attorney Robert F Kennedy Jr says that top Trump advisor Stephen Fauci has made the reckless choice to fast track vaccines, partially funded by Gates, without critical animal studies. Gates is so worried about the danger of adverse events that he says vaccines shouldn’t be distributed until governments agree to indemnity against lawsuits.

But this should come as little surprise. Kennedy notes that the Gates Foundation and its global vaccine agenda already has much to answer for. For example, Indian doctors blame the Gates Foundation for paralysing 490,000 children. And in 2009, the Gates Foundation funded tests of experimental vaccines, developed by Glaxo Smith Kline (GSK) and Merck, on 23,000 girls. About 1,200 suffered severe side effects and seven died. Indian government investigations charged that Gates-funded researchers committed pervasive ethical violations.

Kennedy adds that in 2010 the Gates Foundation funded a trial of GSK’s experimental malaria vaccine, killing 151 African infants and causing serious adverse effects to 1,048 of the 5,949 children. In 2002, Gates’ operatives forcibly vaccinated thousands of African children against meningitis. Approximately 50 of the 500 children vaccinated developed paralysis.

Bill Gates committed $10 billion to the WHO in 2010. In 2014, Kenya’s Catholic Doctors Association accused the WHO of chemically sterilising millions of unwilling Kenyan women with a  ‘tetanus’ vaccine campaign. Independent labs found a sterility formula in every vaccine tested.

Instead of prioritising projects that are proven to curb infectious diseases and improve health — clean water, hygiene, nutrition and economic development — the Gates Foundation spends only about $650 million of its $5 billion budget on these areas.

Despite all of this, Gates appears on prime-time TV news shows in the US and the UK pushing his undemocratic and unaccountable pro-big pharma vaccination and surveillance agendas and is afforded deference by presenters who dare not mention any of what Kennedy outlines. Quite the opposite – he is treated like royalty.

In the meantime, an open Letter from Dr. Sucharit Bhakdi, emeritus professor of medical microbiology at the Johannes Gutenberg University Mainz, to Angela Merkel has called for an urgent reassessment of Germany’s lockdown. Dr Ioannidis, a professor of medicine and professor of epidemiology and population health at Stanford University, argues that we have made such decisions on the basis of unreliable data. In addition, numerous articles have recently appeared online which present the views of dozens of experts who question policies and the data being cited about the coronavirus.

While it is not the intention to dismiss the dangers of Covid-19, responses to those dangers must be proportionate to actual risks. And perspective is everything.

Millions die each year due to unnecessary conflicts, malnutrition and hunger, a range of preventative diseases (often far outweighing the apparent impact of Covid-19), environmental pollution and economic plunder which deprives poor countries of their natural wealth. Neoliberal reforms have pushed millions of farmers and poor people in India and elsewhere to the brink of joblessness and despair, while our food is being contaminated with toxic chemicals and the global ecosystem faces an apocalyptic breakdown.

Much of the above is being driven by an inherently predatory economic system and facilitated by those who now say they want to ‘save lives’ by implementing devastating lockdowns. Yet, for the media and the political class, the public’s attention should not be allowed to dwell on such things.

And that has easily been taken care of.

In the UK, the population is constantly subjected via their TV screens to clap for NHS workers, support the NHS and to stay home and save lives on the basis of questionable data and policies. It’s emotive stuff taking place under a ruling Conservative Party that has cut thousands of hospital beds, frozen staff pay and demonised junior doctors.

As people passively accept the stripping of their fundamental rights, Lionel Shriver, writing in The Spectator, says that the supine capitulation to a de facto police state has been one of the most depressing spectacles he has ever witnessed.

It’s a point of view that will resonate with many.

In the meantime, Bill Gates awaits as the saviour of humanity — with a loaded syringe.

Socialism at Its Finest after Fed’s Bazooka Fails

In what is being called the worst financial crisis since 1929, the US stock market has lost a third of its value in the space of a month, wiping out all of its gains of the last three years. When the Federal Reserve tried to ride to the rescue, it only succeeded in making matters worse. The government then pulled out all the stops. To our staunchly capitalist leaders, socialism is suddenly looking good.  

The financial crisis began in late February, when the World Health Organization announced that it was time to prepare for a global pandemic. The Russia-Saudi oil price war added fuel to the flames, causing all three Wall Street indices to fall more than 7 percent on March 9. It was called Black Monday, the worst drop since the Great Recession in 2008; but it would get worse. 

On March 12, the Fed announced new capital injections totaling an unprecedented $1.5 trillion in the repo market, where banks now borrow to stay afloat. The market responded by driving stocks 8% lower.

On Sunday, March 15, the Fed emptied its bazooka by lowering the fed funds rate nearly to zero and announcing that it would be purchasing $700 billion in assets, including federal securities of all maturities, restarting its quantitative easing program. It also eliminated bank reserve requirements and slashed Interest on Excess Reserves (the interest it pays to banks for parking their cash at the Fed) to 0.10%. The result was to cause the stock market to open on Monday nearly 10% lower. Rather than projecting confidence, the Fed’s measures were generating panic.

As financial analyst George Gammon observes, the Fed’s massive $1.5 trillion in expanded repo operations had few takers. Why? He says the shortage in the repo market was not in “liquidity” (money available to lend) but in “pristine collateral” (the securities that must be put up for the loans). Pristine collateral consists mainly of short-term Treasury bills. The Fed can inject as much liquidity as it likes, but it cannot create T-bills, something only the Treasury can do. That means the government (which is already $23 trillion in debt) must add yet more debt to its balance sheet in order to rescue the repo market that now funds the banks.

The Fed’s tools alone are obviously incapable of stemming the bloodletting from the forced shutdown of businesses across the country. Fed chair Jerome Powell admitted as much at his March 15 press conference, stating, “[W]e don’t have the tools to reach individuals and particularly small businesses and other businesses and people who may be out of work …. We do think fiscal response is critical.” “Fiscal policy” means the administration and Congress must step up to the plate.

What about using the Fed’s “nuclear option” – a “helicopter drop” of money to support people directly? A March 16 article in Axios quoted former Fed senior economist Claudia Sahm:

The political ramifications of the Fed essentially printing money and giving it to people – there are ways to do it, but the problem is if the Fed does this and Congress still has not passed anything … that would mean the Fed has stepped in and done something that Congress didn’t want to do. If they did helicopter money without congressional approval, Congress could, and rightly so, end the Fed.

The government must act first, before the Fed can use its money-printing machine to benefit the people and the economy directly.

The Fed, Congress and the Administration Need to Work as a Team 

On March 13, President Trump did act, declaring a national emergency that opened access to as much as $50 billion “for states and territories and localities in our shared fight against this disease.” The Dow Jones Industrial Average responded by ending the day up nearly 2,000 points, or 9.4 percent.

The same day, Democratic presidential candidate Rep. Tulsi Gabbard proposed a universal basic income of $1,000 per month for every American for the duration of the crisis. She said, “Too much attention has been focused here in Washington on bailing out Wall Street banks and corporate industries as people are making the same old tired argument of how trickle-down economics will eventually help the American people.” Meanwhile the American taxpayer “gets left holding the bag, struggling and getting no help during a time of crisis.” H.R. 897, her bill for an emergency UBI, she said was the most simple, direct form of assistance to help weather the storm.

Democratic presidential candidate Andrew Yang, who made a universal basic income the basis of his platform, would go further and continue the monthly payments after the coronavirus threat was over.

CNBC financial analyst Jim Cramer also had expansive ideas. He said on March 12:

How about a $500 billion Treasury issue … [at] almost no interest cost, to make sure that when people are sick they don’t have to go to work, and companies that are in trouble because of that can still make their payroll. How about a credit line backstopped by … the Federal Reserve. I know the Federal Reserve is going to say they can’t do that, Congress is going to say they can’t do that, everyone is going to say what they said in 2007, they can’t do that, they can’t do that — until they did it. … [W]e heard all that in 2007 and they ended up doing everything.

And that looks like what will happen this time around. On March 18, as the stock market continued to plummet, the administration released an outline for a $1 trillion stimulus bill, including $500 billion in direct payments to Americans, along with bailouts and loans for the airline industry, small businesses, and other “critical” sectors of the U.S. economy.

But the details needed to be hammered out, and even that whopping package buoyed the markets only briefly. In the bond market, yields shot up and values went down, on fears that the flood of government bonds needed to finance this giant stimulus would cause bond values to plummet and the government’s funding costs to shoot up.

Extraordinary Measures for Extraordinary Times

There is a way around that problem. To avoid driving the federal debt into the stratosphere, the Treasury could borrow directly from the central bank interest-free, with an agreement that the debt would remain on the Fed’s books indefinitely. That approach has been tested in Japan, where it has not generated price inflation as austerity hawks have insisted it would. The Bank of Japan has purchased nearly 50 percent of the government’s debt, yet consumer price inflation remains below the BOJ’s 2 percent target.

Virtually all money today is simply “monetized” debt – debt turned by banks into something that can be spent in the marketplace – and the ultimate backstop for this sleight of hand is the central bank and the government, which means the taxpayers. To equalize our very unequal system, the central bank and the government need to work together. The Fed needs to be “de-privatized” – turned into a public utility that serves the taxpayers and the economy. As Eric Striker observed in The Unz Review on March 13:

The US government’s lack of direct control over the nation’s central bank and the plutocratic nature of our weak state means that common sense solutions are off the table. Why doesn’t the state buy up majority shares in large corporations (or outright nationalize them, as happened with the short successful experiment with General Motors in 2009) and use the $1.5 trillion at low interest to develop American industrial independence?

Interestingly, that too could be on the table in these extraordinary times. Bloomberg reported on March 19 that Larry Kudlow, the White House’s top economic adviser, says the administration may ask for an equity stake (an ownership interest) in corporations that want coronavirus aid from taxpayers. Kudlow noted that when this was done with General Motors in 2008, it turned out to be a good deal for the federal government.

While traditionally considered “anti-capitalist,” the government taking an ownership interest in bailed out companies may be the only way the proposed bailouts will get approval. There is little sentiment today for the sort of no-strings-attached “socialism for the rich” that the taxpayers shouldered in 2008 without reaping the benefits. Bloomberg quotes Jeffrey Gundlach, chief executive officer at DoubleLine Capital:

I don’t think government bailouts of over-leveraged companies that got over-leveraged by share buybacks at all-time highs, enriching executives and hedge fund investors, will sit well with the American people.

The Bloomberg article concludes with a quote from another chief investment officer, Chris Zaccarelli of Independent Advisor Alliance:

I like how [the administration is] thinking a little bit outside of the box. Something big and bold like that could potentially be what turns the market around ….

Long-term Solutions

Rather than just a stake in the profits, the government could think a bit further outside the box and turn insolvent airlines, oil companies, and banks into public utilities. It could require them to serve the people and the economy rather than just maximizing the short-term profits of their shareholders.

Concerning the banks, the Fed could do as the People’s Bank of China is doing in this crisis. The state-run PBoC is giving regional banks $79 billion in stimulus money, but it is on condition that they lend it to small and medium enterprises and forgive late payments, so that economic damage is reversed and production can recover quickly.

Another model worth studying is that of Germany, which also has a strong public banking system. As part of a package for coronavirus aid that the German finance minister calls its “big bazooka,” the government is offering immediate access to loans up to €500,000 for small businesses through its public bank, the KfW (Kreditanstalt fuer Wiederaufbau), administered through the publicly-owned Sparkassen and other local banks. The loans are being made available at an interest rate as low as 1%, with interest only for the first two years.

Contrast that to the aid package President Trump announced last week, which will authorize the Small Business Administration to offer business loans. After a lengthy process of approval by state authorities, the loans can be obtained at an interest rate of 3.75% – nearly 4 times the KfW rate. German and Chinese public banks are able to offer rock-bottom interest rates because they have cut out private middlemen and are not driven by the insatiable demand for shareholder profits. They can lend countercyclically to avoid booms and busts while supporting the economy as a whole.

The U.S., too, could create a network of publicly-owned banks backed by the central bank, which could lend into their communities at below-market rates. And this is the time to do it. Times of crisis are when change happens. When the Covid-19 scare has passed, we will have a different government, a different economy and a different financial system. We need to make sure that what we get is an upgrade that works for everyone.

Drug Dealers, Polluters and Sex Traffickers: Welcome to Oligarch Cloud Cuckoo Land

Men’s evil manners live in brass; their virtues
We write in water.
Henry VIII (IV.ii.)

The notion that American oligarchs amass great wealth due to their extraordinary intelligence has become a deeply engrained tenet of liberal fundamentalist dogma. For in order for neoliberalism to maintain popular support it is necessary that the media relentlessly extol the virtues of the new robber barons. This myth of the meritocracy is sustained with fawning from the presstitutes, but also from the dubious practice of philanthrocapitalism. And yet cracks have appeared in the meritocratic facade which even the mass media has not been able to conceal.

From Andrew Carnegie to Henry Clay Frick, from John D. Rockefeller to Cornelius Vanderbilt, American capitalists have long embraced philanthropy as a means with which to not only deify themselves, but to also glorify and perpetuate a system anchored in authoritarianism, cruelty, and the impoverishment of millions.

Jeffrey Epstein hails from this blood-soaked lineage, as his rise was inextricably linked with a culture in thrall to the lie that those who are the most virtuous acquire the most wealth. A sex trafficker, who for decades managed to maintain a carefully cultivated image of an urbane and munificent New Yorker, Epstein had become a magnet for careerists, opportunists, and fellow con artists alike.

Helaine Olen writes in The Washington Post:

The major lie of the age of wealth inequality is that the moneyed are somehow better than the rest of us day-to-day working schlubs. The aristocracy of prewar Europe had their bloodlines. Our latter-day meritocratic aristocrats, we are told, possess the modern equivalent, which is extraordinary intelligence. The slothful working class are slaves to short-term pleasure. The rich, on the other hand, are disciplined. They wake up early, and they refuse to live beyond their means.

This is a lie. The Epstein scandal proves it.

Epstein preyed not only on destitute American girls from broken homes, but also on foreign girls, some of whom did not speak English, making them even more vulnerable to abuse and exploitation. Writing in The Miami Herald, Julie K. Brown writes that “after the FBI case was closed in 2008, witnesses and alleged victims testified in civil court that there were hundreds of girls who were brought to Epstein’s homes, including girls from Europe, Latin America and former Soviet Republic countries.”

The suspicious deal worked out a little over a decade ago by Epstein’s high powered legal team allowed their client to get off with incredibly lenient sentencing terms, and served to protect other creatures of dubious repute who may have been involved in a vast criminal network. Brown continues: “The deal, called a federal non-prosecution agreement, was sealed so that no one — not even his victims — could know the full scope of Epstein’s crimes and who else was involved.”

Epstein’s “black book” contained personal phone numbers belonging to such “masters of the universe” as Donald Trump, Prince Bandar of Saudi Arabia, Tony Blair, Bill Clinton, Senator Ted Kennedy, Henry Kissinger, David Koch, Ehud Barak, John Kerry, David Rockefeller, Michael Bloomfield, Leslie Wexner, Prince Andrew, Queen Elizabeth, Saudi King Salman and Edward de Rothschild. Irregardless of whether these plutocrats were involved in the abuse of minors, the fact that Epstein was permitted to inhabit this peculiar parallel legal system for so many years signifies the degradation of checks and balances which has opened up the floodgates of the West to barbarism.

Ghislaine Maxwell, who allegedly procured underage girls for Epstein, founded the TerraMar Project in 2012, a nonprofit ostensibly devoted to protecting the world’s oceans. Ghislaine’s father, Robert Maxwell, was a Mossad agent, and some have speculated that she may have introduced her boyfriend to the Israeli intelligence services.

There is a high degree of probability that Epstein was running a blackmail operation in conjunction with an intelligence agency (or agencies), as he had hidden cameras scattered throughout the rooms of his many residences, and appeared to be filming his guests as they were “getting a massage.” Epstein also had an Austrian passport, coveted by spies, due to Austria’s neutrality.

Chicago criminal defense attorney Leonard C. Goodman writes in the Chicago Reader:

A public criminal trial would have made it very hard to cover up Epstein’s relationship to intelligence agencies. These are the agencies that tell our presidents which countries to bomb, what leaders to depose, and which terrorists to assassinate by drone.

Frequently referred to by the presstitutes as a “disgraced financier,” despite the fact that no one has seen a website for the firm which he allegedly operated; and often referred to as “pedophile Jeffrey Epstein,” as if he were a lone villain acting all by himself, Epstein’s life personifies the depravity of contemporary American society. Moreover, this “financial genius” was somehow able to acquire one of the most luxurious residences in Manhattan (21,000-square-feet, and steps from Central Park), a 10,000 acre ranch in New Mexico, an apartment in Paris, a luxury villa in Palm Beach; and two islands in the U.S. Virgin Islands, Little Saint James and Great Saint James.

Epstein’s charitable donations were clearly a smokescreen designed to disguise extremely nefarious activities. The mega-rich in other countries may be crooks (consider Pablo Escobar, described by Wikipedia as a “narcoterrorist”), but not wealthy Americans, who are simply smarter than everyone else. That Epstein came from a working class family, and that his father, Seymour Epstein, worked for the New York Parks Department as a groundskeeper, only deepens the mystery of where this money really came from.

Ever the debonair cool guy of Manhattan’s in-crowd, Epstein donated to the Independent Filmmaker Project, the Film Society of Lincoln Center, the Metropolitan Opera Orchestra, Interlochen Center for the Arts, Ballet Palm Beach, the Icahn School of Medicine at Mt. Sinai, the Leukemia & Lymphoma Society, the Cancer Research Wellness Institute and the Melanoma Research Alliance. In May of 2012, PR Newswire ran an article titled “The Largest Private Funder of Melanoma Research Receives Vital Support From Activist Jeffrey Epstein.”

One of Epstein’s favorite places to donate was Harvard, as this allowed him to hobnob with a variety of influential academics and scientists. As John Patrick writes in The Washington Examiner:

The disgraced finance mogul donated millions to Harvard endeavors from the late 1990s throughout the 2000s, including a $6.5 million donation to Harvard’s Program for Evolutionary Dynamics, and a $2 million pledged donation for Harvard’s Jewish organization Hillel. Plus, Epstein contributed more than $100,000 to a Harvard performing arts organization, and gave a gift of more than $100,000 to a non-profit run by Elsa New, wife of former Harvard president and Clinton administration member Larry Summers.

Epstein also donated $2.5 million to Ohio State University and $800,000 to MIT. Taking hypocrisy to new heights, he even donated to the Women Global Cancer Initiative, the Mount Sinai Breast Health Resource Program; and to The Hewitt School, a prep school for girls on Manhattan’s Upper East Side. Underscoring the netherworld of imaginary morality that our plutocrats inhabit, Epstein told the New York Post that “I’m not a sexual predator, I’m an ‘offender.’ It’s the difference between a murderer and a person who steals a bagel.”

Bernie Madoff, another exhilarating New York success story, was managing – at least according to his computer printouts – the astronomical sum of $50 billion, and was equally fond of donating to charitable causes. Yeshiva University, The Ramaz School, Maimonides School, and the Hadassah Women’s Organization were some of the institutions that suffered serious losses when Madoff’s firm revealed itself to be the biggest Ponzi scheme in history.

Cousins of human traffickers, polluters also need to unwind from time to time, and what better way to bask in the grandeurs of perdition than donate to the arts? The New York State Theater, an important performing arts space within Lincoln Center and home to the New York City Ballet, was renamed the David H. Koch Theater in 2008; while the Metropolitan Museum of Art now offers the David H. Koch Plaza, whose namesake paid $65 million to have the new plaza built in his name. The Koch Institute for Integrative Cancer Research at MIT is another child born of Koch philanthropy.

The Charles Koch Foundation has donated enormous sums of money to hundreds of universities with the aim of inculcating impressionable young minds with their reactionary ethos, which is anchored in the idea that all attempts at corporate regulation and maintaining a public sector should be jettisoned. The Koch brothers donated over $95 million to George Mason University, which is a public university, and this led to the Charles Koch Foundation being granted a significant amount of leverage with regard to the hiring and firing of faculty.

Steven Pearlstein writes in The Washington Post:

When someone gives $10 million to an engineering school rather than the college of humanities, it changes the university’s priorities. When someone endows a center to study the causes and consequences of climate change, it affects who is hired and what is taught and researched. When someone gives enough to name a school after a public figure, it shapes a school’s ideological profile. It would be great if all donations were unrestricted, but they aren’t. Many donors have agendas. The Kochs are just an extreme example.

The Koch brothers have left behind a toxic legacy from Corpus Christi, Texas; to Chicago and Detroit; to Crossett, Arkansas; to New Delhi, India, and beyond. Greenpeace posits that “Koch Industries is a major polluter, with ongoing incidents and violations of environmental laws.” Tim Dickinson writes in Rolling Stone that “Thanks in part to its 2005 purchase of paper-mill giant Georgia-Pacific, Koch Industries dumps more pollutants into the nation’s waterways than General Electric and International Paper combined.” He goes on to point out that “Koch generates 24 million metric tons of greenhouse gases a year.” Together, Charles and David Koch accumulated around $100 billion.

The Sackler Family, which owns Purdue Pharma and made billions off of the opioid crisis, deceived doctors about the highly addictive nature of OxyContin. This particularly dangerous opioid was promoted in part through dishonest advertising, but also though manipulating physicians into believing the drug was safe. Patrick Radden Keefe writes in The New Yorker that “The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.” The Sackler family is now attempting to sell the drug abroad through Mundipharma, a Purdue subsidiary, and is marketing OxyContin in Asia, South America and the Middle East.

It is noteworthy that Arthur Sackler aggressively marketed Librium and Valium in the 1960s, which earned tremendous profits for Hoffmann-La Roche, and also led many Americans down a path towards abuse and addiction. Judith Warner writes in Time:

Valium has long served extremely well as a vehicle for proving the perfidy of psychiatrists and the drug companies behind them. It was indeed dispensed in outrageous-seeming numbers in the 1960s and early 1970s. It did indeed lead to tragic levels of abuse and addiction.

The Sacklers are now one of our richest families. Like Epstein, the Sackler family sought to cultivate a worldly image anchored in their patronage of education and the arts, and some of the most prestigious museums in the Western world have galleries and wings named after them.

At the Guggenheim, there is the Sackler Center for Arts Education; at the Metropolitan Museum of Art, there is the Sackler Wing; and at the American Museum of Natural History, there is the Sackler Educational Laboratory. At Harvard, there is the Arthur M. Sackler Museum; in Washington DC, the Sackler Gallery; and at the Brooklyn Museum, the Elizabeth A. Sackler Center for Feminist Art. Moreover, there are Sackler wings and educational institutions at renowned British museums such as the Ashmolean Museum of Art and Archeology, the British Museum, the Dulwich Picture Gallery, the National Gallery, the Victoria and Albert Museum and at the Tate Modern. The Sacklers have also donated to the Royal Ballet School, the Royal Botanic Gardens, and the Royal Opera. Perhaps the Whitney Museum of American Art, which has a board run largely by war profiteers, could receive the funds accumulated from the many lawsuits arrayed against Purdue and be renamed the Sackler.

Not content with defiling artistic institutions with their blood money, the Sacklers have donated to educational institutions. At Columbia, there is the Sackler Institute for Developmental Psychobiology; and at Oxford, the Sackler Library; at Yale, there is the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences.

Particularly egregious conflicts of interest are the Sackler Brain and Spine Institute at NewYork–Presbyterian Hospital, the Raymond and Beverly Sackler Center for Biomedical and Physical Sciences at Weill Cornell, and the Sackler School of Graduate Biomedical Sciences at Tufts. No less disturbing, in the winter of 2010 Thomas J. Lynch Jr., MD, was named Richard Sackler and Jonathan Sackler Professor of Medicine and Director of the Yale Cancer Center. The Sacklers have also donated millions to Massachusetts General Hospital, Harvard’s oldest teaching hospital. Andrew Joseph writes in “Purdue Cemented Ties with Universities and Hospitals to Expand Opioid Sales, Documents Contend,” that “At Mass. General, the agreement with Purdue allowed the company to suggest curriculum for pain education.” No less outrageous, in Israel there is the Sackler School of Medicine at Tel Aviv University. Emblazoned in its lobby are the words “Dedicated to Mankind for the Health of All People.”

Some arts institutions have disassociated themselves from the Sacklers, such as the Louvre, which took down the Sackler name from its Wing of Oriental Antiquities. A number of prominent museums, such as the Guggenheim, the Met, and the Tate galleries have refused to accept further donations from the Sacklers, although the name continues to sully their august halls.

Teva Pharmaceuticals has likewise played a role in the opioid crisis, and partners with Mount Sinai, a blatant conflict of interest. Ostensibly, they will treat “multiple chronic conditions” together. Teva has donated to a wide variety of health care organizations and gave $2.5 million to the Franklin Institute in Philadelphia. In an article in The Times of Israel titled “Federal Data Reveals Extent of Teva’s Role in Fueling US Opioid Crisis,” the authors write that between 2006 and 2012 “Teva Pharmaceuticals USA produced 690 million opioid pills.”

When not getting Americans addicted to opioids and psychotropic drugs, Johnson and Johnson delights in donating to Johnson & Johnson Vision and the Himalayan Cataract Project (HCP), both of which make endearing videos replete with cute kids and teary-eyed grandparents.

Indeed, this was how some of the most diabolical drug dealers in America, were, at least for a time, able to convey an image of benevolence, munificence and altruism. Keefe writes that “Over time, the origins of a clan’s largesse are largely forgotten, and we recall only the philanthropic legacy, prompted by the name on the building.”

Where are our heroes, America? Our novelists, labor leaders, artists and intellectuals? What would Thoreau, Frederick Douglass, or Mark Twain say about these soulless creatures who sought to use their lucre to envelop themselves in a halo of veneration and hagiography? A society that prostrates itself at the altar of depravity is a society of death.

Let us disenthrall ourselves from the shackles of materialism and careerism. Let us cast the false idol of avarice from the tallest cliffs, and from its ashes embrace a phoenix reborn, a harbinger of compassion, altruism and justice.

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?

Capitalism Is Killing Patients… And Their Physicians

Photo Greanville Post

Physician burnout, depression, and suicide increasingly invade discussions within the medical field. Depression and suicide are more common among male and female physicians, with suicide rates 1.41 and 2.27 times greater than that of the general male and female populations, respectively. Though, the insults to the mental health of physicians begins much earlier in their career.

While the numbers may vary from study to study, some 28 percent of medical residents experience a major depressive episode during their training compared to 6 to 8 percent of the general population. These numbers are important, not only because suffering physicians are suffering humans in their own right, but also because this epidemic leads to poor patient care.

As a recent study out of the Stanford School of Medicine suggests, burnout and depression in physicians can lead to medical error and death. Many have tried to explain the causes of the epidemic, referencing everything from unmanageable workloads and work inefficiency, to lack of meaning in work and lack of work-life balance. Films are now being produced to shine light on the issue. In her TED talk “Why Doctors Kill Themselves,” Pamela Wible points to a medical school culture of hazing and bullying that continues into residency, along with a professional culture that hinders physicians from obtaining mental health treatment.

These factors certainly contribute to the epidemic, but when discussing physician suicide, we ignore the elephant in the room: capitalism. We are unable to recognize how the exploitation and alienation of physicians is integrally connected to this dominant economic system, but nothing could be more poignant, given in the state of the world today.

Ironically, the same destructive system that is driving physicians to extremes is also the main driver of the deterioration of health of the patients and populations, requiring patients to see physicians in the first place. The sooner we realize and confront our own exploitation, the sooner we can join in the fight to address the real driver of disease that is plaguing physicians and patients.

The System Outlined

Busy physicians may not have time to study how the world’s prevailing economic system functions, but doing so could benefit both our profession and the patients with whom we work. To briefly discuss, inside this system the working class that does not own the means of production is forced to sell its labor to an employer to survive.

A few corporations control most of the market for each of the commodities they produce. In these corporations, a very small sector of a board of directors and majority shareholders makes essentially all of the decisions on what to produce, where to produce and how to distribute profits. This puts the working class in a vulnerable position.  With the ultimate goal of profit maximization, decisions are often made by the corporate class which are not in the best interest of workers and negatively affect the health of entire communities.

Outsourcing work, closing factories, creating poor working conditions to cut costs, polluting waterways and the environment–decision after decision may initially increase profits, but in the long term harms health. This harm to health can be more obvious, as when air and water are polluted, or more subtle, for example, when families are put under chronic stress–which eventually leads to various forms of illness– from poor workplace conditions or income insecurity secondary to factory closure and outsourcing.

In this system, certain “costs”–the health of families, and entire communities being destroyed–are “externalized.” This means the business itself does not pay for these costs of poor societal health, which are created secondary to decisions made by business executives to increase profits. Such decisions are made by a small number of wealthy, powerful individuals pursuing their interests for greater wealth and power accumulation at expense of all else.

As economists such as Thomas Piketty have shown by combing through economic records from as far back as the 18th century, capitalism inherently generates inequality, concentrating wealth into the hands of the few at expense of everyone else. Study after study shows us that socioeconomic inequality itself is detrimental to patient health and actually increases morbidity and mortality.

Despite the negative effects, the working class today is more productive than ever, while wages remain flat (or are sometimes even lower) and work hours continue to increase. Workers struggle to put food on the table and meet basic needs, while the ownership class continues to become richer. Workers are exploited and reduced to tools for industry, many times forced to do mundane tasks or assignments over and over. They are alienated, or separated from the control and the product of their labor, each day they go to work. Inside this system workers are ultimately reduced to mechanistic cogs producing profit for large corporations.

This combination of being overworked and lacking true meaning and fulfillment in the work being done, drives more and more throughout both the white and blue collar sectors into despair. As Johan Hari, shows in his recent work Lost Connections: Uncovering the Real Causes of Depression and Unexpected Solutions, workers become separated from loved ones and from things that bring them joy as they work multiple jobs for longer hours as they struggle to make ends meet.

This constant stress leads to anxiety, depression, and various other forms of disease. Meanwhile, all medicine has to offer for them are at best poor attempts–many times with questionable supporting data demonstrating efficacy– to numb the pain that much larger systemic structures continue to create.

Unfortunately, the corporate elite know no limits in this system. They continue to exploit the masses and drive more and more into poverty and desperation while concentrating wealth in ever fewer hands. In America today, the three wealthiest individuals own the same wealth as the entire bottom half of the population, more than 160 million individuals. In order to maintain this system, the elite must ensure that the members of the working class fight amongst themselves rather than direct their rage toward those who are benefiting off of the oppression of the masses.

The capitalist system, born from racism and white supremacy as highlighted in studies such as Edward Baptist’s The Half That Has Never Been Told: Slavery and the Making of American Capitalism, continues to separate members of the working class based on social constructs such as race. At the same time, through a multitude of mechanisms, the system creates a self-loathing, insecure public, driven to constant consumption, leading to the pollution of the earth and poisoning of community after community.

These various forms of structural violence are the true drivers of disease and suffering, of which the health care system sees the results, but has little to no ability to truly address. The health of the majority of the population deteriorates and the elites benefit. Capitalism’s need to endlessly expand and its effect on the earth, has literally lead some scientists to call for the designation of a new geologic era called the anthropocene to describe the effect humans have had on the earth.

Scientists now warn we have moved into the sixth great mass extinction of species seen in our world’s history. A new report by the World Wildlife Fund (WWF) suggests, “Humanity has wiped out 60% of mammals, birds, fish and reptiles since 1970, leading the world’s foremost experts to warn that the annihilation of wildlife is now an emergency that threatens civilisation.” Meanwhile, a new U.N. Intergovernmental Panel on Climate Change (IPCC) report warns us that humanity has only a dozen years to address global warming to avoid increasing droughts, floods, etc., which will inevitably lead to more poverty and illness.

Capitalism does not just threaten the health and well being of every human, but life on this earth as we know it. Capitalism operates as a terminal cancer, knowing no limits to its endless growth and consumption, destroying systems necessary to survival and threatening the continued existence of its host.

Medicine Has Not Escaped

What is outlined above are the underlying causes of the majority of disease and suffering. The prevailing economic system in the world today commodifies every aspect of life including health care. As a result, the health of the public, especially the US public, is subjected to a barrage of market mechanisms.

US medical professionals, while often paid more than the typical member of the working class, are still forced to operate inside of this system that places profits above patient health. We see how this system harms our patients, limiting availability of the care they need, but we tend to miss that we also are damaged by this same system.

As Howard Waitzkin and the “Working Group on Health Beyond Capitalism” state in the book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health,” until the 1980s, doctors, for the most part, owned and/or controlled their means of production and conditions of practice.” This allowed them to have control over things such as their work hours and how much time to spend with patients. As the Working Group references, “loss of control over the conditions of work has caused much unhappiness and burnout in the profession”.

As other members of the proletariat, or working class, have experienced for years, doctors now no longer have control over their labor. Now corporations or other large institutions control such decisions. Physicians have become “proletarianized” and while not members of the traditional working class, they have become tools in the corporate wheel of profit production. This has left us with a health system parasitized by the capitalism that cares more about profit production than it does the care of human beings.

The medical industrial complex, made of a multitude of different institutions–hospital corporations, large insurance companies, or pharmaceutical and device corporations and, more specifically the corporate elite who control these corporations–ultimately governs a majority of the large scale, structural decisions that affect patient care. The elite in these institutions, just like other capitalist organizations, make decisions that affect the lives of the majority with little to no input from those who are affected by these decisions.

They govern the prices of drugs–often leading to the obscene drug prices–and how long a physician should be spending with his or her patients in the clinic. These organizations have the primary goal of maximizing profit (regardless of whether they bear the title of “for profit” or “non-profit”) above all else. Consequently, patient health really becomes secondary in this system.

The metastasis of capitalism’s perverse incentives to even the sector that claims to care for the health of human beings, has given us the ineffective, damaging system we have today. Since profit production is of prime importance, physicians–and really health care providers in general–must be trained to be efficient tools for profit, seeing more patients more quickly, knowing how to bill appropriately, etc.

These incentives limit a physician’s ability to do what he or she actually went into medicine (or should have) for: to help people. Physicians want to help their patients, but are simply not able to truly address patient suffering because addressing the causes, as highlighted above, are outside the scope of a profit based medical system.

To understand how exactly this system creates human tools for health care profit while in the process leaving them physically and mentally broken, we must delve into the medical education and training structure and analyze how medical providers are conditioned to accept their own exploitation.

Training in the Art of Being Exploited

Step 1: Medical School

Medical trainees in the US enter medical school at least generally claiming they have some interest in caring for other human beings. Unfortunately, little do they know they are entering a system designed to prime them for their own exploitation from the second their training begins—one could argue even well before that point–and subsequently throughout their residency training.

During medical school, students are forced to study innumerable hours while being told they have to “lay a good foundation” of knowledge for their future practice. The first 2 years in most medical schools are classroom based, where insurmountable amounts of information are thrown at students as they are told “this is just the way medicine is, get used to it.”

Unfortunately though, much of the information students spend their time studying–or more often mindlessly memorizing–will never be used when caring for patients. This information is absorbed, regurgitated on an exam, and then often forgotten. One thing students do begin to learn–if they hadn’t already through their undergraduate education or their grade school education prior–is to listen to authority figures’ demands if they would like to succeed.

Students have little influence on what they are being taught. Instead, they must accept what they are being told or they may not pass their next exam. Students who entered medicine eager and idealistic, hoping to help others, begin to slowly withdraw from their individual passions and interests simply because tests, rotation evaluations determined by the opinions of supervising providers students must impress, and board exams are deemed more important. They are taught that listening to authority figures at the expense of their own interests and passions, comes first and then they can try to pursue their interests if they have time. This obviously can affect the mood and morale of a training physician.

During their third year, medical students are forced to spend numerous hours in the hospital. They are also required to take “shelf exams” at the end of each rotation, which can often have a large impact on their overall rotation grade. Because slight differences in grades can affect residency opportunities, students spend free-time studying for these exams instead of participating in activities to maintain their own mental and physical well being. While the exam scores offer little insight into the type of a physician the student will become, they serve to add extra pressure on students and ensure that they spend little time actually thinking for themselves while they are out of the hospital.

During fourth year many students are expected to complete sub-internships in the fields they are are interested in going into for residency training. These sub-internships normally require students to work near their 80 hour work limit, congruous to work limits of residents (more on that shortly). Medical students often carry their own patient panels, write notes that can be co-signed, and can even pend medication orders to be approved. The main difference between them and an actual paid intern is that they do not get paid. Instead they must work to “impress” their superiors in hopes of obtaining a positive evaluation. Once again, students are taught that listening to and striving to impress authority is their ultimate goal.

After four years of indoctrination, in addition to a medical degree, most medical students are given one final parting gift on their way into residency: hundreds of thousands of dollars of debt. This debt serves as a convenient way of pushing newly minted doctors into financial constriction when entering their residency.

No matter how they view their new employer or the field they have chosen, they know that they now have hundreds of thousands of dollars that they must find some way to pay back. This makes them much less likely to question or challenge authority in their new positions because doing so could impede completion of their training, sabotaging their career and only chance to escape debt. Along, with the inherent emotional stress of caring for sick patients, these financial difficulties can lead to depression, anxiety and a host of mental health issues in the newly minted physician.

Step 2: Residency

Once medical school graduates enter residency, they have already been primed for their inevitable exploitation, understanding that they need to take direction from authority, curtail their passions to make them more palatable to superiors, and most importantly, suppress any depression or anxiety they feel secondary to an ineffective, exploitative system. They now have few options–or are at least told so–other than to continue through residency. They know that to find themselves at this stage, they have made significant financial and emotional sacrifices, often losing connection with the people and things they love in order to fulfill education requirements.

Unfortunately, the exploitation of these newly minted doctors is just beginning.  During training, residents are forced to work often 80 hours per week doing a large portion of the patient care in hospitals (not to mention the additional hours of preparation outside of hospital or clinic, which are not counted toward this 80 hour limit). Residents are salaried, so they provide a cheap, efficient source of labor for hospitals and clinics. Residents become physically and emotionally exhausted trying to care for maxed out patient loads effectively in understaffed hospitals. Work hours become normalized over time and residents simply expect to be working an unhealthy amount of time in the hospital or at least convince themselves that it is normal to maintain their own sanity. It is no wonder this situation plunges many, who are already at risk, into burnout and depression.

Throughout residency, residents do, admittedly, grow exponentially in their ability to care for patients and become independently functioning physicians. Though, there is another type of growth that occurs during these years, which is seldom discussed.

Residents are groomed to be efficient, effective profit producers once they enter the workforce. For example, over their time in residency, a large degree of emphasis is placed on residents meeting particular “quality measures” for the clinic or hospital settings. Training after training is spent ensuring residents understand how to properly bill and submit insurance claims. Residents learn how to see patients extremely quickly and complete entire patient visits within 15 minutes. As anyone who has even interacted with a health care provider can attest, this is not enough time to actually make any significant interpersonal connection with a patient.

Either during this visit or after, residents must also learn to input information into whichever electronic medical record their training center uses. As Matt Anderson notes in Health Care Under the Knife commenting on EMRs, “most were designed to capture billing and quality information, not facilitate clinical care.” Residents end up spending more time looking at a computer than they do connecting with a patient. In the inpatient setting, a hospitalized patient might only see their doctor for a few minutes each day. This is partially because the rest of the day is spent documenting a coordinating care inside of a completely nonsensical system to ensure hospitals will be able to cash in on patient hospital stays.

This puts individuals, who went into medicine to care for and make connections with patients, torn between still trying to achieve this goal and meeting designated “quality measures.” If they are not able to see patients fast enough in the clinic or inpatient hospital setting they may not be seen as “marketable” to employers. This is clearly an environment that can breed physical, mental, and emotional suffering in the exploited trainee.

Even while studies have shown these grueling hours put both patients and residents at risk, when it comes to actually addressing the problems highlighted above, the onus is consistently put on the provider to maintain “self care.” From the beginning of residency, different “mental health departments” speak with residents about the importance of maintaining self care and “balance,” while at the same time maintaining an exploitative system that overworks its employees and drives suffering. Residents are a cheap form of labor for hospitals or clinics, and actually addressing this problem at a systemic level would be too threatening to the profitable status quo.

How the system’s leaders speak about these work conditions is very telling. For example, in 2016 Dr. Janice Orlowski, the Chief Health Care Officer with the Association of American Medical Colleges (AAMC), stated:

The individual is going to go into a profession where their profession calls on them to work extended hours and to be available at unusual hours […] We need to train individuals who can learn to pace themselves, who can recognize when they have sleep deprivation or when they are stressed.

This is an interesting statement, coming from someone who should know the demands put on residents drastically limits their capacity to “pace themselves.” It is clear that there is much more concern for protecting a public image of medicine and hospital programs than there is for addressing the crisis of physician depression and suicide.

Step 3: Practicing Physicians

Finally, if not already burned out, the physician has escaped residency and now believes that he or she will be able to practice “however one wants.” Unfortunately, any overburdened physician–either fresh out of residency or seasoned–who has worked inside a busy hospital or clinic, can attest to feeling tired, overworked, and often unfulfilled, in part due to their lack of patient connection as they are rushed from patient to patient and progress note to progress note.

Again, citing Matt Anderson in the Health Care Under the Knife’s section “Becoming Employees: The Deprofessionalization and Emerging Social Class Position of Health Professionals,” concepts typically lauded again and again in the health sector–”value, efficiency, quality, and market discipline–are part of an ideology to justify corporate control over the work of physicians and other works providing health services.” He references Marx’s concept of alienation–the separation of worker’s control over his or her labor– and describes how more and more health care providers are separated from what they once truly loved about their work, and now must fill the primary role of profit producer and secondary role of health care provider. If this separation did not occur during residency, there is a good chance it will when outside of training working for an employer.

While practicing, providers are still attempting to treat patients who present with illnesses created by the much larger system of capitalist exploitation referenced above, but their training prior to starting independent practice in no way, shape, or form has actually prepared them to join the communities they serve in combating these larger oppressive systems. On the contrary, what they were taught was to keep their head down, survive, and make it through exploitative residency programs. They are in regular practice and know how to put in a billing code and attempt the near impossible task of making a true connection with someone in a 15 minute clinic visit, but have not remotely learned how to begin to resist a parasitic capitalist system damaging both their colleagues and their patients.

At the same time, even if a physician did want to step outside of traditional boundaries to help challenge the true socioeconomic and structural causes of disease highlighted above, the provider still has a massive amount of student loans constricting their decisions. They may also have started a family or accumulated other financial constraints during residency. This leaves them with few options and many find it easier to get back in the clinic, put their heads down, and tell themselves they are really helping to address patient health. When in reality, they have been indoctrinated into a system based on profit maximization and blunting of patient suffering at best.

This endless process of day after day in clinic, seeing little to no progress at a systemic level, can become frustrating and make one’s work seem futile. Imagine spending over 10 years in training–from college, through medical school, through residency–to find yourself in this position. It is no surprise that more and more physicians are burning out, and feeling so desperate, that harming oneself becomes a viable option to escape.

Recognizing One’s Exploitation and Fighting Back

Capitalism’s parasitic economic structure has infiltrated all aspects of our society, and medicine has not been spared. This results in physicians being trained and conditioned to be obedient profit producers above all else. It leads them to be alienated from their loved ones and from their true passions. Inside our healthcare system, physicians are separated from the things that truly brought them joy and fulfillment. Yet we still continue to question why physicians are killing themselves?

Some maintain hope that there will be action around these issues from residency administrations, hospital working groups, or any number of hierarchical bodies that govern medical education, graduate medical education, or our healthcare system in general. The reality is that these issues will never be solved by any large committees or “task forces” we currently have in place, which continually put the onus onto medical students, residents, and practicing physicians to develop more “resilience” inside of a system that is built to do the exact opposite.

Those who have made it to the top positions of organizations such as the Accreditation Council for Graduate Medical Education (ACGME) or the Association of American Medical Colleges (AAMC) are there because they will continue to support the status quo. As political dissident and linguist Noam Chomsky discusses in reference to elite control of institutions, “an unstated but crucial premise is that the ‘responsible men’ achieve that exalted status by their service to authentic power, a fact of life that they will discover soon enough if they try to pursue an independent path.” These institutions will never consider the best interests of physicians or the patients they serve. Their leaders have been groomed to support the status quo. It is up to us to realize our exploitation and begin to fight against it.

Realizing this fact is easier said than done, as most physicians, due to the filtering mechanisms throughout our educational system, which typically lead to those from the upper classes securing seats in medical school, come from the exploitive classes themselves. Physicians are also paid more than a majority of other employees within our healthcare system such as nurses, technicians etc. They are conditioned to believe that they are somehow different or more important than the rest of the working staff when in reality all members are important in caring for the patient and all members are overworked and exploited by the same system.

Giving one member of an exploited group–in this case the physician–more benefits than others, helps to keep the fighting going between all groups as opposed to collaboration and organizing. We will be able to begin addressing the crisis of physician suicide once we, as physicians, accept that just as this capitalist system exploits our patients and coworkers, it is also exploiting us. And then we organize against it.

Whether it is consciously recognized or not, physicians specifically are also often boosted up with a false sense of elitism from the second they step into the field. This creates a blind spot for them being able to recognize their own suffering and exploitation and organize against it. They are given special white coats, which–besides becoming completely filthy after 80 hour work weeks–distinguish them from other hospital staff and distinguish themselves by the title of “doctor.”

While other staff members, such as nurses, actually have the collectivist mindset to organize against the damage the health care industrial complex causes to the patients they care for and even strike when necessary, physicians–especially those in the US–have been conditioned to believe they are too important to the system to do the same, even while that system is actively damaging them. Their administrators and peers say, “If we aren’t caring for patients, our patients will die.”

Those with a vested interest in maintaining the business as usual hold patients as hostages inside this system, guilting providers into accepting the status quo (inadequate care, inadequate access to care, medical errors, and crushing debt) with this rhetoric. It is despite the fact that physicians around the world have been able to organize and strike effectively while also continuing to provide absolutely necessary care.

Referencing Mark Ames’s 2005 book, Going Postal: Rage, Murder, and Rebellion: From Reagan’s Workplaces to Clinton’s Columbine and Beyond is useful for understanding this current phenomenon. In the book, Ames evaluates the mental anguish caused by Reagan era policies and analyzes how our capitalist system degrades and humiliates workers until they are pushed to harm themselves and others. In the following passage he speaks of how people can often deny their own exploitation until it is too late. He notes:

The middle class persistently denies its own unique pathos, irrationally clinging to an irrational way of measuring it, perhaps because if they did validate their own pain and injustice, it would be too unsettling–it would throw the entire world order into doubt. It is more comforting to believe they aren’t really suffering, to allocate all official pathos to the misery of other socioeconomic groups, and its more comforting to accuse those who disagree of being psychologically weak whiners. Despite its several hundred million strong demographic, the white bourgeoisie’s pain doesn’t officially count–it is too ashamed of itself to sympathize with its own suffering.

Until physicians are willing to accept the fact they they are being exploited by the same system that harms their patients, there will be no progress made in addressing physician depression and suicide. At that same time, until health care providers generally accept that it is our current capitalist system which puts profit production above the well being of every living thing on this planet–including themselves–we will not be able to effectively address true social and structural causes of disease and suffering.

Capitalism exploits, damages, and destroys us all. History shows us, large scale systemic change has never come from the beneficence of those in power and, frankly, it never will. As historian Howard Zinn writes speaking about public activism, the rights of the citizenry only come when “citizens organize, protest, demonstrate, strike, boycott, rebel, and violate the law in order to uphold justice.”

As physicians, if we truly care about the well being of our coworkers and of our patients, we must begin to organize, unionize, and rebel inside our practices, residency programs, etc, resisting business as usual, and finding ways to threaten the profits of capitalists if we want to see systemic change. We must begin to organize with communities and populations resisting oppression from a parasitic capitalist system as physicians in the past have done with groups such as the Black Panthers and Young Lords.

Once physicians can begin to view the dynamics of our capitalist system more clearly–and view the dynamics of our healthcare system as just one microcosm of how capitalism harms us all–it will become clear what needs to be done. We must put down our fancy white coats and begin to organize with our fellow healthcare staff–and, more importantly, with our patients–against a system that exploits and damages us all. Only then will we be able to begin developing a new system that actually cares about both people and the planet.

• First published in Popular Resistance

Glencore and Other Mining Corporations Make Record Profits and get Away with Murder Literally

Glencore, according to statistica.com is the world’s largest mining company by revenues. As a way of introduction, here is what statistica.com has to say about Glencore.

Glencore-Xstrata is a public limited company founded in 1974 by Marc Rich whose headquarters are based in Baar, Switzerland and also has registered office based in Saint Helier, New Jersey. Glencore-Xstrata is also a mining company whose headquarters are based in the United Kingdom. On May 2nd, 2013, the current company was established through a merger between Glencore and Xstrata. Glencore-Xstrata is the third largest family owned business in the world and was ranked number 10 on the list of Fortune Global 500 in 2015. Glencore Xstrata is the leading mining company in the world with estimated revenue earned in 2017 of $205 billion, on a rebound from 2015 (US$ 147billion) and compared to the best year so far, 2012 (US$237billion). Net earnings have skyrocketed in 2017 to US$ 5.8 billion, more than 4 times higher than in 2016 (US$ 1.4 billion).

The four next mining corporations in world ranking include BHP Billiton, Australia; British-Australian Rio Tinto; China state-owned Shenhua Energy, and Vale, Brazil. Their mining practices may not differ a lot from those of Glencore’s. However, what distinguishes Glencore is its particularly aggressive business style. Aggressive from all points of views – tax avoidance, corruption, total neglect for employees as well as communities they work in, non-responsiveness to critique.

Though it looks like Glencore’s aggressive business model is paying off. Glencore’s tax rate negotiated in Switzerland is next to zero. The Canton of Zug, where the city of Baar, seat of Glencore’s headquarters (HQ) is located, is the number one tax haven in Switzerland.  Glencore pays 0.2% taxes on its net earnings.

Glencore is exploiting developing countries to the maximum, not respecting any social and environmental laws or even humanitarian standards, brushing them aside and pushing ahead – poisoning and killing people on their way with toxic effluents from their mining practices, no regard, no attention to their fate, to their families, irrespective of whether they have been working for a Glencore mine, when they are sick they are out, no compensation; or whether they are just living in the contaminated environment, in communities on their own plots, exposed on a daily basis to water-ways and soil polluted with cancer-causing deadly heavy metals. The average life expectancy in South American mines is between 32 and 40 years for mine workers. Glencore leaves hardly any tax money or royalties in the country they exploit, on average about one cent per dollar of net earnings, as their tax residence is Switzerland.

This article looks specifically at an event which I witnessed and was able to interview victims about, at Glencore’s copper mine in Espinar, near Cusco, Peru, some 4,200 m above sea-level. Gold is a side product. Where there is copper, there is almost without fail also gold to be found and vice-versa. The mining and refining of both metals is highly toxic, leaving poisonous heavy metals, such as mercury, cyanite, cadmium, arsenic, chromium, lead and many more disease-causing toxins in water, soil, and air, poisoning fauna, flora and humans.

On April 3, 2018, a dozen or so indigenous unarmed, women – the poorest of the poor –protested with their bare hands in defense of their only water way left, a small stream. Glencore wanted to deviate it – totally illegally – for Glencore’s use. The women were attacked by police in full riot gear, beaten with batons. It is openly known that Glencore, like other mining corporations, literally buys the national or local police services for this type of abject brutality.

The police were helped by Glencore’s own security forces. All this was recorded on video and in photos. Arriving the following day on location with a group of locals, we interviewed several of the victims. See also my earlier article on the subject

As the above essay went to press, I wrote directly to Glencore’s CEO, Ivan Glasenberg, suggesting a personal meeting to discuss the event and the general circumstances that led to it. Mr. Glasenberg replied promptly through his director for Sustainable Development (sic), who proposed to meet – which we did, in a neutral place, a hotel lobby in Bern. The Glencore delegation consisted of the Sustainable Development director and her lawyer.  I was alone.

What transpired during a roughly two-hour non-confrontational, rather peaceful dialogue, I recorded in an Aide-Memoire, asking for their approval, comments or suggestions for change. The answer a few days later was a full rejection, saying none of the contents of the AM reflected our conversation. This is, of course, a flagrant lie. Under the circumstances, I decided to make the gist of our two-hour conversation public, as reflected in the Aide-Mémoire.

The conversation covered three key topics

  1. Beating of unarmed indigenous women in Alta Huata, Espinar, Cusco Province, Peru, by Police and Glencore’s Security Forces on 3 April 2018;
  2. Glencore’s contamination of water, soil, air, flora, fauna and humans by toxic chemicals used in the mining process; and
  3. Blood and urine samples – people who are sick from intoxication with mine effluents, working for the mine and/or living in the close vicinity of the mine, sought testing their blood and urine for heavy metals. They were never given the results from the tests from medical doctors, clinics and laboratories. Why?

Addressing point by point, starting with the Beating of unarmed women – the dozen or two bare-handed indigenous women were protesting in defense of their water against Glencore workers, wanting to deviate, actually steal the little stream for Glencore’s own use. They were brutally beaten by national police in government issued riot gear – imagine, in riot gear! – with the help of Glencore’s own security forces. This happened around noon on 3 April, when the women were alone, even more defenseless, while village men were working at the mine or in their small agricultural plots.

According to several accounts from the local population as well as from people in the town of Espinar, Glencore intended to reroute the small stream providing the only water source for the six or so villages higher up on the mountain. This is further corroborated by the large pile of big-sized pipes, deposited on the land next to the small stream. A nearby gigantic earth moving machine and fresh tracks traversing the small water way were also clear signs that water deviation works were planned.

In the early morning hours of 4 April, we went to Glencore’s copper mine at Alta Huata, about 4,200m above sea level, to meet with the mistreated women and to interview them. Still affected by indignation and pain, some of them under tears, showed us their badly bruised body parts. Evidence of the police assault and aggression by Glencore’s security forces is available as independent testimony in the form of short videos and photographs. An elderly woman (65) was beaten so severely, she was resting and moaning in a rickety stone shack which apparently was destroyed by Glencore’s bulldozers the week before and hastily rebuilt by the local population. The woman had pain all over her body, could not move, and got no medical attention, no pain medication – nothing – she was a ‘high risk’ case. Later, we learned, she was miraculously recovering with the care of the villagers.

The villagers told us they wanted to file a complaint with the local police which did not receive them. It is clear, if Glencore hired the police to do their dirty work, they, the police, will not receive the villagers’ complaint. It’s a revolving-door corruption at every level that is being practiced. I wonder whether Glencore’s boss, Mr. Glasenberg, is aware of it. If not, then at least this article which will be sent to him should remind him that he is complicit in serious crimes of his company by letting them happen.

During our meeting, the Glencore ‘sustainable development’ people said the workers were only doing repair work when the women appeared interfering with their job. Another flagrant lie. But how could they know? They are repeating what they are told by their people on the ground. And whenever they go to visit the area, we understand, they never set foot in the affected villages, to talk to the people or to the mayor, but only talk the inside-talk to Glencore insiders, another revolving door approach to resolving problems by being blind to them and keeping perpetuating the lies. The sustainable development people of Glencore also denied that Glencore had anything to do with the beating, that Glencore could not control the police. They dismissed the assertion, against all evidence on video, that Glencore’s security forces were also involved and, of course, that they actually called and hired the police in the first place.

Later we talked to villagers who lived in the mine-surrounding areas. With anguish, sadness and even resignation, they told us that contamination of water, soil, air, flora, fauna – and humans was evident. It appeared in the water ways and was reported in soil samples. Plants adjacent to water courses, rivers and effluents from the mine, were all contaminated by heavy metals, poisoning animals, as well as humans. Farm animals became sick and often died.

Many inhabitants of the mine-surrounding communities, so we were told, including by the former mayor, were sick with cancer and other terminal diseases which were caused by contact with, or ingestion of, contaminated water or food. To purify water efficiently from heavy metals – cyanide, mercury, lead, arsenic, cadmium and more – a complex and expensive process is required. It’s called reverse osmosis. In most cases, mining companies do not use this process. In the case of Glencore and Espinar, reverse osmosis is not in use, leaving the effluent waters highly and dangerously polluted.

We talked to several people, some working for the mine, others just living in the immediate vicinity of the mine – say, in a radius of 1 to 5 km. All said, they felt sick; their bodies hurt, they had respiratory problems and many suspected having different types of cancers, mainly lung cancer. The disease rate increased the closer they lived to the mine.

One of the peasants said that young people in his neighborhood were dying “like flies” from cancer. He added that the average life expectancy of people living near the mine was drastically reduced. He also said, that most people by now are just resigned to their fate and were tired of protesting and being frustrated, because Glencore would not respond and do nothing for them. They felt helpless.

To top it off, Glencore’s Sustainable Development people said that Glencore received certification from the municipality that the effluents from their mine were clean and not contaminated by the mine, and that it was common knowledge that the water was not potable, ridiculously ascertaining that contamination occurred naturally in these mountainous streams. This abject manipulation of the truth would be laughable if it weren’t so serious. But the people have no recourses to hire lawyers, and even if they would have the money to do so, no lawyer, no judge, no court would take on a case against Glencore. They are afraid to confront the mobsters from where the money flows – corruption at infinitum! Glencore’s sustainable development representatives rejected all responsibilities for the contamination and said they had no knowledge about the disease rates reported by the local population. They were never informed.

Well, if they didn’t know, they must know now. And Mr. Glasenberg would do well sending an HONEST delegation to Espinar to verify with neutral experts on location the veracity of this account and of the account of the victims. Question is, of course, will there be uncorrupt neutral experts daring to tell Glencore the truth?  And even if that were the case, what would Glasenberg do about it? Glasenberg is the key person. It’s a family business, one of the world’s largest, so if he wants to change the way Glencore does business, he can do it.

Who manages Glencore’s mines on the ground?  Mainly locals, we were told. In Espinar, Peru, it’s a Peruvian. This has two purposes. First, a Peruvian is familiar with the local ‘habits’ of how the ‘turntable’ turns, how to buy favors and how to threaten potential adversaries; and, second, if something goes wrong – like in the present case of brutally beating of inoffensive women, deadly contamination and people dying from cancers caused by intoxication from mine effluents – they, at Swiss HQs can say, we didn’t know; nobody told us. The we didn’t know effect seems to be effective, so effective, in fact, that the entire conversation of two hours was annihilated by the sustainable Glencore people. Even though the conversation took place as recorded, the sustainable people deny its contents.

We also talked with people who lived in the vicinity of the mine, who are feeling ill for years and worsening, mostly the lungs, but also their respiratory and nervous system, yet mine management not only ignores them, but also prevents them, directly or indirectly, from getting their blood and urine samples tested, paid for by the victims themselves. We were told that many of the people living in the communities near the mine, including the people who spoke with us, consulted doctors, clinics, hospitals, laboratories on their own, to get their blood and urine tested for heavy metals. They never received the test results back from these medical establishments.

The truth is beyond suspicion. These medical facilities, are either bought by Glencore, or they fear Glencore to a point that they prefer not to hand out negative health results, of which they know from where they emanate.  The people also said that they get absolutely no medical support from Glencore. They pay their medical expenses from their own pockets and yet, they are refused to see the test results.

Diseases stemming from heavy metals have often long gestation periods; i.e., cyanide and mercury do not necessarily lead to immediate symptoms, rather the impact may be slow, because heavy metals accumulate in the body and are not evacuated as other toxins may be. They affect over time the nervous system, respiratory tracts, the heart and often cause cancer and lead to early death. It is well known that mine workers in general in developing countries have a drastically reduced life expectancy; i.e., in some parts of Peru and Bolivia an average of around 35 years.

The director of the Sustainable Development Department appeared to be shocked. She was unaware, she said, and in an outburst of good will, she offered that any of the people who were sick and concerned may call her directly. Of course, none of this was even acknowledged once they received the Aide-Mémoire.

The moral of this story is multi-fold. There is Glencore, the largest mining corporation in the world, largely a family business, with Ivan Glasenberg, main shareholder, at the helm. He could personally intervene, stop the abuse and high crime, bringing about ‘as clean mining’ as there is, respecting environmental and social ethical rules, regardless of whether the country, where they operate, in this case Peru, is corrupt and can be bought. Glasenberg, the CEO, could become a shining example for ethics in mining which would bode well for the company as well as for the host country, Peru, and not least for their country of residence, Switzerland. The cost of implementing ethical environmental and social standards would hardly make a dent in Glencore’s net earnings, but the gains in positive reputation and improved image are priceless.

On the other hand, you have Switzerland that offers this UK-Swiss mining corporation their tax haven as residency. Yet, the Swiss Government does absolutely zilch, nothing, nada to impose and enforce certain standards of ethics to Glencore and other corporate sinners enjoying the Swiss tax paradise. Talking with people from a so-called Ethics Department (sic) in the Swiss Ministry of Foreign Affairs, the hush answer was, if we are too strict with them, they will leave Switzerland – and as an after-thought, besides, they [these corporations] have their own standards of due diligence and we trust that they adhere to them. If they don’t, then it’s up to their host country; i.e., in this case Peru, to enforce their laws.

Here you have it. The Swiss Government, the paradise for banking and finance and corporate ‘well-being’, the epicenter of neoliberal economics, where privatization reigns, is knowingly and intimately complicit in the crimes committed by these corporations. No wonder the lawmakers, the Swiss parliamentarians, are entitled to sit in as many corporate boards of directors they please – against all rules of ethics and ‘conflict-of-interest’ guidelines of OECD, of which Switzerland is a member. This built-in lobby of parliamentarians is making the laws in their favor, operating on a ‘legal basis’, not unlike a white-collar mafia.