Category Archives: Patient Rights

Greece:  Suicide or Murder?

Pundits from the left, from the right and from the center cannot stop reporting about Greece’s misery. And rightly so because the vast majority of her people live in deep economic hardship. No hope. Unemployment is officially at 18%, with the real figure closer to 25% or 30%; pensions have been reduced about ten times since Syriza – the Socialist Party – took power in 2015 and loaded the country with debt and austerity. In the domain of public services, everything that has any value has been privatized and sold to foreign corporations, oligarchs, or, naturally, banks. Hospitals, schools, public transportation – even some beaches – have been privatized and made unaffordable for the common people.

While the pundits – always more or less the same – keep lamenting about the Greek conditions in one form or another, none of them dare offer the only solution that could have rescued Greece (and still could) – exiting the euro zone; return to their local currency and start rebuilding Greece with a local economy, built on local currency with local public banking and with a sovereign Greek central bank deciding the monetary policy that best suits Greece, and especially Greece’s recovery program. Why not? Why do they not talk about this obvious solution? Would they be censured in Greece, because the Greek oligarchy controls the media as oligarchs do around the (western part of the) globe?

Instead, foreign imposed (troika: IMF, European Central Bank (ECB) and European Commission (EC) — the latter mainly pushed by German and French banks and the Rothschild clan — austerity programs have literally put a halt on imports of affordable medication, such as like for cancer treatments and other potentially lethal illnesses. So, common people no longer get treatment. They die like flies; a horrible expression to be used for human beings. But that’s what it comes down to for people who simply do not get the treatment they humanely deserve and would have gotten under the rights of the Greek Constitution; however, they simply do not get treated because they can no longer afford medication and services from privatized health services. That is the sad but true story.

As a consequence, the suicide rate is up, due to foreign imposed (but Greek government accepted) debt and austerity, annihilating hope for terminally ill patients, as well as for pensioners whose pensions do no longer allow them to live a decent life and especially as there is no light at the end of the tunnel.

Now, these same pundits add a little air of optimism to their reporting, as the right wing New Democracy Party (ND Party) won with what they call a ‘landslide’ victory on the 7 July 2019 elections; gathering 39.6% of the votes, against only 31.53 for Syriza, the so-called socialist party, led by outgoing Prime Minister Alexis Tsipras, who represents a tragedy that has allowed Greece to be plunged into this hopeless desolation. The ND won an absolute majority with 158 seats in the 300-member Greek parliament. Therefore, no coalition needed, no concessions required.

The new Prime Minister, Kyriakos Mitsotakis (51), son of a former PM of the same party, in his victory speech on the evening of 7 July, vowed that Greece will “proudly” enter a post-bailout era of “jobs, security and growth”. He added that “a painful cycle has closed” and that Greece would “proudly raise its head again” on his watch.

We don’t know what this means for the average Greek citizen living a life of despair. What the “left” was unable to do – stopping the foreign imposed (but Greek accepted) bleeding of Greece; the strangulation of their country – will the right be able to reverse that trend? Does the right want to reverse that trend? Does the ND want to reverse privatization, buy back airports from Germany, water supply from the EU managed “Superfund”, and repurchase the roads from foreign concessionaires, or nationalize hospitals that were sold for a pittance and – especially – get out from austerity to allow importing crucial medication to salvage the sick and dying Greek, those who currently cannot afford treatment of their cancers and other potentially deadly diseases?

That would indeed be a step towards PM Mitsotakis’ promise to end the “painful cycle” of austerity, with import of crucial medication made affordable to those in dire need, with job creation and job security – and much more – with eventually a renewed Greek pride and Greek sovereignty. The latter would mean – finally – it’s never too late to exit the euro zone. But, that’s an illusion, a pipe-dream. Albeit  it could become a vision.

If the ND is the party of the oligarchs, the Greek oligarchs that is, those Greeks who have placed literally billions of euros outside their country in (still) secret bank accounts in Switzerland, France, Lichtenstein, Luxemburg and elsewhere, including the Cayman islands and other Caribbean tax havens, hidden not only from the Greek fiscal authorities, but also impeding that these funds could, crucially, be used for investments at home, for job creation, for creation of added value in Greece. If the ND is the party of the oligarchs, they are unlikely to make the dream of the vast majority of Greek people come true.

Worse even, these Greek oligarch-billionaires call the shots in Greece not the people, not those who according to Greek tradition and according to the Greek invention, called “democracy” (Delphi, some 2500 years ago) have democratically elected Syriza and have democratically voted against the austerity packages in July 2015. Now, that they are officially in power, they are unlikely to change their greed-driven behavior and act in favor of the Greek people. Or will they?

Because, if they do, it may eventually also benefit them, the ND Party and its adherents — a Greece that functions like a country, with happy, healthy and content people, is a Greece that retains the worldwide esteem and respect she deserves — and will, by association, develop an economy that can and will compete and trade around the world, a Greece that is an equal to others, as a sovereign nation. A dream can become a reality. It just takes visionaries.

Back to today’s reality. The Greek Bailout Referendum of July 5, 2015, was overwhelmingly rejected with 61% ‘no’ against 39% ‘yes’, meaning that almost two thirds of the Greek people would have preferred the consequences of rejecting the bailout, euphemistically called “rescue packages”, namely exiting the euro zone, and possibly, but not necessarily, the European Union.

Despite the overwhelming, democratic rejection by the people, the Tsipras government reached an agreement on 13 July 2015 – only 8 days after the vote against the bailout with the European authorities for a three-year bailout with even harsher austerity conditions than the ones rejected by voters. What went on is anybody’s guess. It looks pretty obvious, though, that “foul play” was the name of the game which could mean anything from outright and serious (life) threats to blackmail, if Tsipras would not play the game and this to the detriment of the people.

President Tsipras’ betrayal of the people resulted in three bailout packages since 2010 and up to the end of 2018, in the amount of about €310 billion (US$ 360 billion). Compare this to Hong Kong’s economy of US$ 340 billion in 2017. In that same period the Greek GDP has declined from about US$ 300 billion (€ 270 billion) in 2010 to US$ 218 billion (€ 196 billion), a reduction of 27%, hitting the middle- and lower-class people by far the hardest. This is called a rescue?

The democracy fiasco of July 2015 prompted Tsipras to call for snap elections in September 2015, hélas – he won, with a narrow margin and one of the lowest election turnouts ever in Greek postwar history; but, yes, he ‘won’. How much of it was manipulated – by now Cambridge Analytica has become a household word – so he could finish the job for the troika and the German and French banks, is pure speculation.

Today, the ND has an absolute majority in Parliament, plus the ND could ally with a number of smaller and conservative parties to pursue a “people’s dream” line policy. But they may do the opposite. Question: How much more juice is there to be sucked out of broken Greece? Of a Greece that cannot care for her people, for her desperate poor and sick, cannot provide her children with a decent education, of a Greece that belongs into the category of bankruptcy? Yes, bankruptcy, still today, after the IMF and the gnomes of the EU and the ECB predict a moderate growth rate of some 2%?  But 2% that go to whom?  Not to the people, to be sure, but to the creditors of the €310 billion.

Already in 2011, the British Lancet stated “the Greek Ministry of Health reported that the annual suicide rate has increased by 40%”, presumably since the (imposed) crisis that started in 2008. From this date forward the suicide rate must have skyrocketed, as the overall living conditions worsened exponentially. However, precise figures can no longer be easily found.

The question remains: Is the Greek population dying increasingly from diseases that could be cured, but aren’t due to austerity- and privatization-related lack of medication and health services and of suicide from desperation? Is Greece committing suicide by continuing to accept austerity and privatization of vital services, instead of liberating herself from the handcuffs of the euro and very likely the stranglehold of the EU?  Or is Greece the victim of sheer murder inflicted by a greed-driven construct of money institutions and oligarchs, who are beyond morals, beyond ethics and beyond any values of humanity? You be the judge.

• First published by the New Eastern Outlook – NEO

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.

Putting Patients Last: Corporate Capture of Doctors

Welcome to corporate healthcare, the new normal in doctors’ offices, where profits are king and patients are commodities. With government regulatory agencies essentially adopting a “hands-off” policy, the ever-inventive medical establishment has come up with a basketful of new procedures to delude the patient population into believing that more (traditional drug-and procedure-saturated medicine) is the way to go. This at a time when American health care is growing more expensive and less effective. Life expectancy in the U.S. has been dropping for two straight years, the US. has the highest maternal mortality rate among developed countries and, according to a report by the Commonwealth Fund — the U.S. fails to achieve better health outcomes than the other countries, and … is last or near last on dimensions of access, efficiency, and equity.”

The response of the medical community to the state of U.S. healthcare? General agreement that reasonably priced healthcare options are “junk science” (acupuncture, massage, chiropractic care). Even patient choice is no longer a given—

Arthur W. saw a neurologist in a big medical group affiliated with a major hospital. He decided to see another neurologist in the same practice. When he called to make the appointment, he was told that he would not be able to see the neurologist of his choice since he had already seen a neurologist in that practice. Arthur was outraged but decided against pursuing his complaint. He was afraid the medical practice would drop him. He ended up making a repeat visit to a provider he neither liked nor trusted.

What happened to Arthur happens more often these days as medical practices get bigger and scoop up more and more doctors in the same specialty. If you don’t like your doctor, the practice threatens, you can hit the road. For most Americans, particularly those millions forced into second or third jobs to pay their medical expenses or college loans, the effort required to go to another practice is not a realistic option.

The bottom line: U.S. healthcare has taken two critical components of a patient-centric system —access and choice — off the table. Like other corporations, medical practices these days slap an LLC (limited liability company) behind their names and suddenly are endowed with a lower level of liability for their actions (medical malpractice may still apply to individual doctors, but the owners of the practice have no personal legal liability). In Trump’s tax plan, LLC practices also shield their owners from some of the taxes assessed on non-LLC corporations. Another tax dodge for corporate America.

It was a nightmare scenario. Henry G. had been operated on for advanced bladder cancer and now used a catheter. Having come down with a bladder infection, he called to make an appointment with the urologist who had been taking care of him through his surgery and beyond. He was told that his doctor no longer worked at the practice and the practice would not divulge where his doctor had gone. Henry was blindsided ‘What do I do now?’”

Henry was stuck between a rock and a hard place. As it turned out, his doctor had been fired by his practice (not bringing in enough business is the usual cause for termination or violating the strict time caps —7-11 minutes —for each patient visit) and started a new urology practice with colleagues who had been similarly booted. But even if Henry had managed to find his doctor, he probably couldn’t have scheduled a visit. Under the terms of the contract his doctor signed with his former employer, he was bound by a restrictive covenant clause that barred him from treating former patients or even from practicing within thirty-five miles of his former employer.

How prevalent are these restrictive covenants? In a recent survey of two thousand PCPs (primary care physicians) in five states, 45% admitted to being bound by a non-compete clause. Wresting a doctor away from long-time patients, particularly those with chronic conditions, is devastating for patients. It happened to one long-term cancer survivor. She received a letter from her doctor’s medical practice announcing the doctor’s exit but omitting reference to his new practice. Her response— “Somehow they [the practice enforcing the non-compete clause] lost sight of patient care and were more concerned about the bottom line.

That goes for the entire healthcare industry which has steadily relegated patient care to the bottom of the priority list. On top —profits, the bigger, the better. “When doctors want to move from one practice to another, if they’ve got a good therapeutic relationship with their patients, you’d think that public policy would want them to continue to treat those patients that trust them”. (Judy Conti, National Employment Law Project).  Ah, that’s the rub, isn’t it? When “public policy” clashes with profit-driven capitalism, the pillage and plunder metrics of capitalism invariably win.

To defend the indefensible, big wigs at major healthcare practices pretend that non-compete clauses actually benefit patients — “…because they [non-compete clauses] provide stability with a practice and ensure continuity of care.” (director of a major Iowa clinic). Not convinced? Try this excuse on for size— “Patients get frustrated but what they may not understand is that this is a legal thing that we have to abide by.” (Spokesperson for the University of Wisconsin health care system). Without doubt, a major component of the success of non-compete clauses is the lack of moral courage on the part of those who feel bound to enforce them. How about the doctors’ “natural allies,” the AMA (American Medical Association)? As the official lobby for corporate medicine, not individual doctors, their allegiance is to the power brokers — in a carefully nuanced statement, Dr. Patrice Harris, President-elect dithered — “To the extent that these agreements disrupt continuity of care, this is of great concern to the AMA.”

What are the chances a group of doctors bringing a lawsuit challenging both terminations and restrictive covenant clauses in medical contracts will prevail? Very good, according to David Clark, an expert on the legality of healthcare non-compete clauses — “No court is going to deny a patient who wants to go see a doctor of her choice.”

As almost every American who has had the misfortune to be a patient knows, profit-driven healthcare is not the answer to a long, healthy life. Consider the checkered history of Electronic Health Records (EHRs), sold to the public as the one sure way for patients to receive the most effective treatments, reduce medical errors, and provide a fast and efficient way to share their medical histories with doctors and hospitals virtually anywhere in the world. These wildly exaggerated claims convinced Obama to make them part of Obamacare. So far the feds have poured $36 billion into the EHR industry and made a lot of fat cats fatter. What have patients gotten in return — an error-prone, cumbersome system whose requirements vitiate doctor-patient interactions, making them little more than a fill-in-the-blanks exercise. Here’s how one administrator at a large medical center described a typical office visit in the era of EHRs —In America, we have 11 minutes to see a patient and [our doctors have] to be empathetic, make eye contact, enter about 100 pieces of data, and never commit malpractice. It’s not possible”. (John Halamka)

But when it comes to outright larceny, “surprise billing” takes the cake. Let’s say you go to a hospital that’s part of your insurance company’s network, only to receive care without your knowledge or permission from a doctor who isn’t part of that network.

Charlotte C. was forced to have an emergency C section. Although the hospital was in her insurer’s network, an in-network anesthesiologist wasn’t available, so she was billed $15,000 for the out-of-network doctor who replaced her.

There’s an even darker side to U.S. healthcare.  “Predictive medicine” (not unlike predictive policing) helps insurers predict how likely you are to develop specific illnesses and more important, from the doctor’s point of view, how likely you are to pay what your insurer doesn’t cover. As high deductibles and co-pays force patients (both those insured by their employers and those buying insurance on the federal marketplaces) into paying a greater share of the larcenous fees doctors and hospitals charge, health providers want to know how likely they are to be paid before they treat you. A couple of companies are getting rich investigating your credit worthiness for doctors and hospitals.

There was a time when healthcare was exactly that. Fifty-eight years ago, this dedication celebrating the commitment of the U.S. medical system to the welfare of patients appeared at the end of the movie The Young Doctors “This film is dedicated to the medical profession for its constant devoted service to mankind.”

Little more than a half century later, it’s hard to imagine that U.S. medicine ever operated that way.

What will it take to unseat the power brokers who control healthcare in America? Lots of us united around one goal — single payer universal healthcare. “Small acts, when multiplied by millions of people, can quietly become a power no government can suppress, a power that can transform the world.” (Howard Zinn)

Putting Patients Last: Corporate Capture of Doctors

Welcome to corporate healthcare, the new normal in doctors’ offices, where profits are king and patients are commodities. With government regulatory agencies essentially adopting a “hands-off” policy, the ever-inventive medical establishment has come up with a basketful of new procedures to delude the patient population into believing that more (traditional drug-and procedure-saturated medicine) is the way to go. This at a time when American health care is growing more expensive and less effective. Life expectancy in the U.S. has been dropping for two straight years, the US. has the highest maternal mortality rate among developed countries and, according to a report by the Commonwealth Fund — the U.S. fails to achieve better health outcomes than the other countries, and … is last or near last on dimensions of access, efficiency, and equity.”

The response of the medical community to the state of U.S. healthcare? General agreement that reasonably priced healthcare options are “junk science” (acupuncture, massage, chiropractic care). Even patient choice is no longer a given—

Arthur W. saw a neurologist in a big medical group affiliated with a major hospital. He decided to see another neurologist in the same practice. When he called to make the appointment, he was told that he would not be able to see the neurologist of his choice since he had already seen a neurologist in that practice. Arthur was outraged but decided against pursuing his complaint. He was afraid the medical practice would drop him. He ended up making a repeat visit to a provider he neither liked nor trusted.

What happened to Arthur happens more often these days as medical practices get bigger and scoop up more and more doctors in the same specialty. If you don’t like your doctor, the practice threatens, you can hit the road. For most Americans, particularly those millions forced into second or third jobs to pay their medical expenses or college loans, the effort required to go to another practice is not a realistic option.

The bottom line: U.S. healthcare has taken two critical components of a patient-centric system —access and choice — off the table. Like other corporations, medical practices these days slap an LLC (limited liability company) behind their names and suddenly are endowed with a lower level of liability for their actions (medical malpractice may still apply to individual doctors, but the owners of the practice have no personal legal liability). In Trump’s tax plan, LLC practices also shield their owners from some of the taxes assessed on non-LLC corporations. Another tax dodge for corporate America.

It was a nightmare scenario. Henry G. had been operated on for advanced bladder cancer and now used a catheter. Having come down with a bladder infection, he called to make an appointment with the urologist who had been taking care of him through his surgery and beyond. He was told that his doctor no longer worked at the practice and the practice would not divulge where his doctor had gone. Henry was blindsided ‘What do I do now?’”

Henry was stuck between a rock and a hard place. As it turned out, his doctor had been fired by his practice (not bringing in enough business is the usual cause for termination or violating the strict time caps —7-11 minutes —for each patient visit) and started a new urology practice with colleagues who had been similarly booted. But even if Henry had managed to find his doctor, he probably couldn’t have scheduled a visit. Under the terms of the contract his doctor signed with his former employer, he was bound by a restrictive covenant clause that barred him from treating former patients or even from practicing within thirty-five miles of his former employer.

How prevalent are these restrictive covenants? In a recent survey of two thousand PCPs (primary care physicians) in five states, 45% admitted to being bound by a non-compete clause. Wresting a doctor away from long-time patients, particularly those with chronic conditions, is devastating for patients. It happened to one long-term cancer survivor. She received a letter from her doctor’s medical practice announcing the doctor’s exit but omitting reference to his new practice. Her response— “Somehow they [the practice enforcing the non-compete clause] lost sight of patient care and were more concerned about the bottom line.

That goes for the entire healthcare industry which has steadily relegated patient care to the bottom of the priority list. On top —profits, the bigger, the better. “When doctors want to move from one practice to another, if they’ve got a good therapeutic relationship with their patients, you’d think that public policy would want them to continue to treat those patients that trust them”. (Judy Conti, National Employment Law Project).  Ah, that’s the rub, isn’t it? When “public policy” clashes with profit-driven capitalism, the pillage and plunder metrics of capitalism invariably win.

To defend the indefensible, big wigs at major healthcare practices pretend that non-compete clauses actually benefit patients — “…because they [non-compete clauses] provide stability with a practice and ensure continuity of care.” (director of a major Iowa clinic). Not convinced? Try this excuse on for size— “Patients get frustrated but what they may not understand is that this is a legal thing that we have to abide by.” (Spokesperson for the University of Wisconsin health care system). Without doubt, a major component of the success of non-compete clauses is the lack of moral courage on the part of those who feel bound to enforce them. How about the doctors’ “natural allies,” the AMA (American Medical Association)? As the official lobby for corporate medicine, not individual doctors, their allegiance is to the power brokers — in a carefully nuanced statement, Dr. Patrice Harris, President-elect dithered — “To the extent that these agreements disrupt continuity of care, this is of great concern to the AMA.”

What are the chances a group of doctors bringing a lawsuit challenging both terminations and restrictive covenant clauses in medical contracts will prevail? Very good, according to David Clark, an expert on the legality of healthcare non-compete clauses — “No court is going to deny a patient who wants to go see a doctor of her choice.”

As almost every American who has had the misfortune to be a patient knows, profit-driven healthcare is not the answer to a long, healthy life. Consider the checkered history of Electronic Health Records (EHRs), sold to the public as the one sure way for patients to receive the most effective treatments, reduce medical errors, and provide a fast and efficient way to share their medical histories with doctors and hospitals virtually anywhere in the world. These wildly exaggerated claims convinced Obama to make them part of Obamacare. So far the feds have poured $36 billion into the EHR industry and made a lot of fat cats fatter. What have patients gotten in return — an error-prone, cumbersome system whose requirements vitiate doctor-patient interactions, making them little more than a fill-in-the-blanks exercise. Here’s how one administrator at a large medical center described a typical office visit in the era of EHRs —In America, we have 11 minutes to see a patient and [our doctors have] to be empathetic, make eye contact, enter about 100 pieces of data, and never commit malpractice. It’s not possible”. (John Halamka)

But when it comes to outright larceny, “surprise billing” takes the cake. Let’s say you go to a hospital that’s part of your insurance company’s network, only to receive care without your knowledge or permission from a doctor who isn’t part of that network.

Charlotte C. was forced to have an emergency C section. Although the hospital was in her insurer’s network, an in-network anesthesiologist wasn’t available, so she was billed $15,000 for the out-of-network doctor who replaced her.

There’s an even darker side to U.S. healthcare.  “Predictive medicine” (not unlike predictive policing) helps insurers predict how likely you are to develop specific illnesses and more important, from the doctor’s point of view, how likely you are to pay what your insurer doesn’t cover. As high deductibles and co-pays force patients (both those insured by their employers and those buying insurance on the federal marketplaces) into paying a greater share of the larcenous fees doctors and hospitals charge, health providers want to know how likely they are to be paid before they treat you. A couple of companies are getting rich investigating your credit worthiness for doctors and hospitals.

There was a time when healthcare was exactly that. Fifty-eight years ago, this dedication celebrating the commitment of the U.S. medical system to the welfare of patients appeared at the end of the movie The Young Doctors “This film is dedicated to the medical profession for its constant devoted service to mankind.”

Little more than a half century later, it’s hard to imagine that U.S. medicine ever operated that way.

What will it take to unseat the power brokers who control healthcare in America? Lots of us united around one goal — single payer universal healthcare. “Small acts, when multiplied by millions of people, can quietly become a power no government can suppress, a power that can transform the world.” (Howard Zinn)

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.

Thriving on Dark Web: The My Health Record and Data Insecurity

Data is rarely inert.  It moves, finds itself diverting, adjusting and adapting to users and distributors. Ultimately, as unspectacular and banal as it might be, data sells, pushing the price in various markets whoever wishes to access it.  Medical data, given its abundance, can do very nicely in such domains as the Dark Web.  With governments attempting to find the optimum level of storing, monitoring and identifying the medical health of citizens, the issue of security has become pressingly urgent.

Britain’s National Health Service is a case in point.  Last year, that venerable, perennially criticised body of health provision, received the full attention of the WananCry virus. Much of this was occasioned by carelessness: a good number of organisations were running on out-of-date Windows XP software.  The principle of insecurity was, however, affirmed.

Last month, the Singaporean government faced the grim reality that 1.5 million health records had been accessed by hackers including, audaciously, the records of Prime Minister Lee Hsien Loong. This well landed blow riled all the more for that state’s heralded insistence on the merits of its own cybersecurity.  In the words of the government statement, “Investigations by the Cyber Security Agency of Singapore (CSA) and the Integrated Health Information System (IHiS) confirmed that this was a deliberate, targeted and well-planned cyberattack.”

Lee, in an obvious effort to reassure, perhaps more himself than anybody else, claimed that his data had nothing of value.  (If a thief takes your goods, make sure they are worthless.)  “My medication data is not something I would ordinarily tell people about, but there is nothing alarming in it.”

Obtaining medical data enables a stealthy plotting for the attacker, hoarding information clandestinely then deploying it with maximum effect.  “Patients who have had their medical information stolen,” goes Aatif Sulleyman for The Independent, “might not realise it’s even happened until the attackers have already set their plans in motion.”

Patient profiles can be built, with credentials mustered for reasons of impersonation to obtain health services.  Medical equipment and drugs can be duly purchased, and claims with insurers lodged.  That prospect is somewhat bleaker than one whose credit card details have been pinched; the bank, at the very least, might be able to put a halt on transactions with immediate effect.

Such excitement turns in anticipation and worried focus to the My Health Record proposition of the Australian government, which, it must be said, belies the usual blissful ignorance about what such an invitation tends to be.  Here, information utopia is paraded and extolled: to have such material in one spot, rather than diffused and intangible; to have the picture of one’s medical being in one location for those providing health care services.

Australia’s political representatives and bureaucrats have assumed a certain cockiness far exceeding health providers in other jurisdictions, making the My Health Record scheme a pinnacle of insecurity in medical care.  A pervasive sense exists that privacy concerns will simply vanish in a bout of extended apathy.  The scheme is astounding for the scope it enables prying of medical data that would otherwise be deemed private.

Deficiencies were spotted early on.  Far from being clinically-reliable as a record, it is dated and far from comprehensive.  Any such record would be, at worse, a distraction in an emergency.  Nor is there a track on who has seen it, except institutions en bloc.

If Australians do not opt out of the centralised medical scheme by October 15, a record by default will be created, stored and used.  This will mean that those in the healthcare provision business, be it pharmacists, nurses or podiatrists, not to mention a whole string of unknown providers, will have automatic access to the medical record without patient consent.  The notions of express and fully informed consent have been given a dramatic, contemptuous heave ho, with a focus on the patient’s volition to avoid the scheme altogether. The Australian government’s refusal to engage the public in any meaningful way, be it through a sustained advertising or information campaign, has been patchy, and, in some instances, entirely absent.

Such an approach flies in the face of such recommendations as those made by the UK Information Governance Review from 2013 acknowledging “an appropriate balance between the protection of the patient user’s information, and the use and sharing of such information to improve care”.  This balance was struck on principles derived in the 1997 Review of the Uses of Patient-Identifiable Information, chaired by Dame Fiona Caldicott. While admitting that information governance might at stages have to give way to sharing confidential patient information for the sake of that patient’s welfare, the principles of data security remain fundamental.

A skirt through the My Health Record system yields the extent of its shabbiness, and the level of its aspiration.  The My Health Record privacy policy is hardly glowing, acknowledging the problems with having such a database in the first place. “In any online platform, including the My Health Record system, there are inherent risks when transmitting and storing personal information.” Then comes the mandatory, if hollow, reassurance: “Despite this, we are committed to protecting your personal information, and ensuring its privacy, accuracy and security.”  A rich opportunity for the prying and the pilfering await.