Friday, November 12, 2004
Medicine is Politics
In 1847 Rudolf Virchow , the renowned pathologist was only 26 years of
age, but he was already one of Germany's greatest scientists. In that
year, the Berlin City Council asked Virchow to investigate an epidemic
of typhus which had broken out in upper Silesia (currently located in
Poland). Virchow concluded that the cause of the epidemic was
"mismanagement of the region by the Berlin government". Virchow's
recommendations included full democracy for Silesia, allowing
Polish as the official language of the region, the separation of
church and state, shifting the burden of taxation from the poor to the
rich, a program for road construction, the improvement of agriculture,
and the establishment of farming cooperatives. The Berlin Council was
very unhappy with Virchow's report. The
Council criticized Virchow for producing a political document rather
than the scientific report which they thought they had commissioned.
Virchow then made his famous statement which still resonates 155 years
later:
"Medicine is a social science and politics is nothing but medicine writ large!"
Virchow further claimed that if medicine were to be successful then it
must enter political and social life because diseases were caused by
defects in society. He claimed that,"If disease is an expression of
individual life under unfavourable circumstances, then epidemics must
be indicative of mass disturbances."
Bloggers get their topics just by chance. I thought of the topic when
I came across the editorial titled "Should journals mix medicine and
politics?" which appeared in BMJ of 6th Nov. 2004. But when I
decided to write about that and quote Virchow the great visionary who
first said it as early as 150 years ago, I was
not knowing that my blog is going to coincide with the exit of the
giant figure of middle east that is Yasar Arafat.
British Medical Journal ( BMJ ) was actually publishing a selection
of responses to Derek Summerfield's personal view on public health
effects of Israel's security wall in the West Bank ( BMJ 2004;329:
924, 16 Oct), a view that immediately lead to arguments on either side
with highly polarised opinions.As the editor points out, BMJ differs
from many medical journals in that it offers a diverse mixture of
articles. Many sections are rigorously peer reviewed purely scientific
,medical articles
while the journal also carries more journalistic pieces as well - as
in its news and reviews sections.
Kamran Abbasi, the acting editor (kabbasi@bmj.com) further adds :
" Most of our readers understand and value this dichotomy.Most of
our readers also want us to reflect the entanglement of medicine
and politics, according to a survey we conducted on bmj.com in
2002 http://bmj.com/misc/politics.shtml). And the BMJ has
traditionally published on broader social and political issues
that affect health care.Indeed, a logical extension of the report
by the Commission on Macroeconomics and Health in 2001 is that
any issue has a health angle in the same way that the Economist
has shown that any issue has an economic one. The BMJ will not shy
away from difficult issues that impinge on health care. More so,
medical journals have a duty to highlight concerns about abuses of
state power--be they by the
government of the United Kingdom, United States, China, Israel,
or the Palestinian Authority. Medicine cannot exist in a
political void."
One can go to the prestigious free website of BMJ ( www.bmj.com ) and
read the full text of the article by Derek Summerfield of Institute of
psychiatry of London (BMJ, 16 Oct 2004; 329: 924). Let me just quote
excerpts from that article to initiate you to the full text :
"Israeli military reoccupation of the West Bank and Gazaâa system of
military checkpoints splitting towns and villages into ghettos,
curfews, closures, raids, mass demolition and destruction of houses
(more than 60 000), and land expropriationsâhas made ordinary life
impossible for everyone, and is driving Palestinian society and its
institutions towards destitution. Moreover, Israel has been
constructing a grotesque barrier that, when completed, will total over
400 milesâfour times longer than the Berlin Wall. Extending up to 15
miles into Palestinian territory, the real purpose of the wall is
permanently to lock more than 50 illegal Israeli settlements into
Israel proper. This is expansive, aggressive colonisation, in defiance
of the International Court of Justice in The Hague and the United
Nations General Assembly resolution of last July.
Last year a UN rapporteur concluded that Gaza and the West Bank were
"on the brink of a humanitarian catastrophe." The World Bank estimates
that 60% of the population are subsisting at poverty level (£1.12; $2;
1.6 per day), a tripling in only three years. Half a million people
are now completely dependent upon food aid, and Amnesty International
has expressed concern that the Israeli army has been hampering
distribution in Gaza. Over half of all households are eating only one
meal per day. A study by Johns Hopkins and Al Quds universities found
that 20% of children under 5 years old were anaemic, 9.3% were acutely
malnourished, and a further 13.2% chronically malnourished. The
doctors I met on a professional visit in March pointed to a rising
prevalence of anaemia in pregnant women and low birthweight babies.
The coherence of the Palestinian health system is being destroyed. The
wall will isolate 97 primary health clinics and 11 hospitals from the
populations they serve. Qalqilya hospital, which primarily serves
refugees, has seen a 40% fall in follow up appointments because
patients cannot enter the city. There have been at least 87 documented
cases (including 30 children) in which denial of access to medical
treatment has led directly to deaths, including those of babies born
while women were held up at checkpoints. The checkpoint at the
entrance to some villages closes at 7 pm and not even ambulances can
pass after this time. As a recent example, a man in a now fenced in
village near Qalqilya approached the gate with his seriously ill
daughter in his arms, and begged the soldiers on duty to let him pass
so that he could take her to hospital. The soldiers refused, and a
Palestinian doctor summoned from the other side was also refused
access to the child. The doctor was obliged to attempt a physical
examination, and to give the girl an injection, through the wire.2
Don't you think what Virchow said is more true in current world,than
ever before?
"Medicine is a social science and politics is nothing but medicine writ large!"
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