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Keeping values alive
in the marketplace
Most social institutions,
according to Samuel O. Thier, M.D., former chair of the Department
of Medicine and now CEO of the Harvard-affiliated Partners HealthCare,
have failed to keep pace with the transition from the Industrial Age to
the Information Age. “Medicine,” he said, “is perhaps as
complicated as any social system we have. Doing anything to change it
is going to create major problems.
“Nonetheless, if it continues
to change in the fashion it is changing now, which is by chaos in the
marketplace, without values driving that change, I fear for what might
come out at the other end,” Thier said, as he delivered the Department
of Medicine’s fifth annual Samuel O. Thier Lecture, named in his honor,
on September 20.
Partners, founded in 1994
by Massachusetts General Hospital and Brigham and Women’s Hospital, has
used the strength of its affiliations to preserve its values in an increasingly
competitive marketplace. “Academic medicine,” Thier said, “provides
not just the intellectual base, it provides social values, it provides
education, it provides research, it advances care and it has been the
safety net for the indigent and the people who are uncovered. The number
of uninsured is still an embarrassment in this country. If those [academic]
institutions are injured, then we have a major problem.”
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Getting
it right for The Times, and in a hurry
Journalists who cover medicine
must do so under severe time constraints and often under pressure from
people hoping to exact commercial or political profit, said Gina Kolata,
a medical reporter at The New York Times who gave the first Margaret
Roth-Glynis McKiernan Annual Lecture during dermatology grand rounds in
September. Typically, she said, publicists swamp her with letters, e-mails,
faxes and phone calls, all touting a real or perceived advance in medical
care. “One of the things you start to ask yourself is, ‘What
am I supposed to believe and how am I supposed to believe it?’ ”
she said. Her skepticism about a press release promoting an exercise regimen
led her to a physician who had lost his license in New York for fraud
and mistreatment of patients. “The onus in medical reporting is really
on the reporter. You have to get it right. Sometimes you have to get it
right in a very short time. It’s an imperfect system. I don’t
know if there’s a better one.”
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“On
the threshold of a gigantic new technology”
“One can be sobered by
the realization that virtually all the earlier technologies of our species—stonework,
metallurgy, internal combustion, electronics—have been used for peaceful
purposes, but all have also been exploited vigorously for hostile ones,”
said Matthew Meselson, Ph.D., a microbiologist and expert in biological
weapons. In a talk on October 23 sponsored by the Institute for Social
and Policy Studies, “Averting Hostile Exploitation of Biotechnology,”
he noted that with the unlocking of the human genome the stakes are even
greater. “We are on the threshold of a gigantic new technology,”
said Meselson, Cabot Professor of the Natural Sciences at Harvard. “It
is totally different from all the previous technologies because it has
the potential to change what it means to be human.” Controlling this
new technology, he said, requires an international norm that would bar
its hostile use.
Production and use of biological
weapons, Meselson believes, should rank with aircraft hijacking and state-sponsored
torture as an international crime with universal jurisdiction. He used
the example of former Chilean president Augusto Pinochet, who was arrested
in England after a judge in Spain filed charges against him for the torture
of dissidents in Chile. “The development, production and use of biological
weapons is the result of decisions made by individuals,” Meselson
said. “Why not hold individuals responsible?”
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With
global health, “There is no them, only us”
When anthrax scares put Americans
on edge last fall, public health took center stage as a national security
matter, said Nils Daulaire, M.D., M.P.H., the CEO of the Global
Health Council, an organization that identifies and reports on world health
problems. To be sure, noted Daulaire, health issues have always mattered
in some security contexts, including the work of the CIA, which uses infant
mortality rates as a measure of a country’s stability.
In a talk sponsored by the
School of Medicine and the Department of Epidemiology and Public Health
in October, “Fighting Terror with Hope: Global Health in the New
Reality,” Daulaire placed post-September 11 health issues in a context
of globalization, security and justice. “It is fundamentally unjust
that a child born in Afghanistan has a chance of dying in childhood that
is 30 times greater than that of a child born in Fairfield, Conn.,”
he said of statistics that predate the bombing campaign that began October
7. “Focusing on global health is an appropriate rejoinder to what
happened on September 11. It is something we need to do for the good of
our own security. We need it for a global sense of justice. Ultimately,
we need it for our souls. When it comes to global health, there is no
them, there is only us.”
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Originally published in Yale Medicine,
Winter 2002.