If a Tree Falls, Ch 1
Posted on December 2, 2009 with 0 comments
If a Tree Falls: If a Patient is Assaulted Under Anesthesia Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. One is Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is literally subcontracted out (with kickback and all) to another surgeon and the surgeon you thought was operating has moved on to a higher paying patient/procedure. Other times your surgery is handed over to interns and residents to whom you have never been introduced. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency. Once under anesthesia for surgery or colonoscopies physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. 1. Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions and intimate practice exams for the sake of education rather than patient health. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms allowing the switch, when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. “Gurney consenting” is a method often used on patients who staff has reason to think will not consent to substitutions, video tapping, many spectators, or multiple pelvic exams by teams of students lined up 8 and even 12 deep…, adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern. As patients, we are lead to believe that patients have rights, and physicians respect our rights as a matter of practice and oath. We are further lead to believe that there are laws protecting these rights, and physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. The World Medical Association Declaration of Helsinki 2000 declared that, “The well-being of the human subject be given the highest priority and accorded precedence over the interests of science and society.“ This is not medical education and research as it is practice, more propaganda than reflective of practice. Many common practices among practitioners, hospitals, drug companies, imaging companies, and labs prove this declaration hollow. In addition to these Ghost surgeries, and gang bang intimate student exams, kickback driven medicine, unnecessary surgeries and other harmful procedures, are all common practices that prove the WMA declaration to be no more than propaganda. An overwhelming number of physicians get kickbacks and other economic incentives from pharmaceutical companies, not only for being willing to prescribe a drug, or implant a devise, but also for research. Often, physicians also get kickbacks from other Physicians, hospitals, and imaging facilities to which they refer patients. Physicians even get kickbacks for implant devises. Influenced by a greed for these kickbacks, many physicians prescribe medications and procedures they know are NOT the most effective response to your medical condition or may not even be indicated in your case, but you have become part of a side effects study. 2. In one study one third of the Doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest.” 3. Physicians promote unnecessary surgeries and other risky procedures, often failing to tell a patient of less radical alternatives, to disclose and even mislead patients about risks, and encourage a patient to elect procedures that are not good for their health. “While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates4. Breast implants are just one example. Implants are never permanent. Most will require another surgery within five years, virtually 100% fail within 10 years. 5. Reconstruction after a mastectomy requires multiple surgeries (including one on the healthy breast), and thus provides a whole string of opportunities for surgeons to make big bucks. For women with cancer this is particularly cruel even murderous as evidence put the latter at 2.5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors.” indicates that physical trauma the like of multiple surgeries can encourage the spread of cancer. 6. Surgeons virtually never reveal this trauma induced cancer growth risk. Even women’s magazines have described new “perky” breasts, and perhaps even a tummy tuck, as a couple among ten reasons to “be glad you have breast cancer.” 7. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern. One would think we would hear from our better, more ethical physicians, if such violations were common, that medical boards would act to remedy the situation. It is harder to understand the silence of more ethical less greedy physicians, or nurses for that matter. There is, however, one violation practiced by physicians historically and today that provides us with an insight, a perspective, from which to think of these violations by many physicians, and silence by others, that leads us to a deeper understanding of how medical culture is literally constructed one generation after another to an end conductive of such patient abuse. Unnecessary exams and tests are harmful to patient health, medical radiation cumulative and a proven source of cancer, medications often dangerous. Currently, however, I want to address a practice that physicians claim carries NO risk of harm to patients, serves only to benefit ALL members of society, and are willing to VIOLENTLY defend the practice over all claims to patient autonomy, all reasonable notions of informed consent. I chose this practice because I think it ultimately is very informative and insightful perspective to take a look at in terms of medical staff attitudes towards patients and patient’s rights. This is the practice of “medical rape”. Manifest in various forms, medical rape is essentially a non-consensual, non-emergency, intimate exam (pelvic, breast, or rectal) or procedure. Students are inducted into the culture of disrespect for patient autonomy, dignity, privacy, and yes, even health, through medical rape in the form of lines of students, interns and residents, six, eight, or more (many reports have been in the double digits), performing practice pelvic, rectal, and breast exams on manipulated young clinic patients or uninformed sedated patients waiting for surgery. Many intersexuals are traumatized by medical staff forcing apart their legs for gangs of students to inspect their genitals. Now medical culture resists “medical procedures” being referred to as “rape”, regardless of lack of consent, use of chemical force and restraint, lies and manipulation, and the employment of methods they are very well aware patients would not tolerate were they informed. My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected non-consensual non-emergency, non-medically indicated pelvic exams, and more. If we are to understand this medical culture of patient violation, it is insightful to approach the subject from the direction of historical practice, in conjunction with the rationalizations of apologists that refer to themselves as medial ethicists. This is a sort of “People’s History” of Allopathic Medicine. With no intent to go into the detail Howard Zenn has in his books, I want to take a critical look at medical practices as they relate to violations of patient’s autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, the philosophical and pragmatic weaknesses of such rationalizations, and what needs to be done to ensure patient autonomy, dignity, and rights are respected. The History: We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,…; from it’s inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 8 At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued patients who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving. Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice,“to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 9. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for- profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.
One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.
In the late 1700s a Mr. Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 10. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)
Physicians not eager to give up their God like position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 11.
With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.
The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, …, was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims’ experiments. Anarcha’s condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims’ inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 12. There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.
Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) , Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 13. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.
Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman’s Hospital Sims help found were so critical of Sims’ unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 14. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.
Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women’s medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims’ experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent; they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health. Contemporary acts of medical violence are rationalized in the same manor Sims’ experiments employing medical rape of the slave women has been rationalized and re-rationalized by some physicians and medical (anti) ethicists. The fact that in spite of criticism in his own day, today Physicians’ rewrite history not only in overwhelming defense, but worship of Dr. Sims is very telling. In fact, to this day people are often reduced to captive patients, not as much through slavery as through force, physical and chemical.
To be Continued: To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.
1. Not Rape, but Still Not Right: Hospitals Should Get Clearer
Consent Before Med Students Probe Anesthetized Women, Evan Schulz, LEGAL TIMES, Mar. 17, 2003, 54;
Also see,
Using tort law to secure patient dignity, by
JOHN DUNCAN
Independent
ROBIN FRETWELL WILSON
Washington and Lee University - School of Law
DAN LUGINBILL
Ness, Jett & Tanner, LLC
MATTHEW RICHARDSON
Wyche, Burgess, Freeman & Parham, PA
U of Maryland Legal Studies Paper No. 2004-24
Training Intrusive and Needs Patient Consent, Activists Say, WASH. POST, May 10,
2003, at A1; Darin L. Passer, Medical Students Respect Their Patients, THE STATE,
July 19, 2003
Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?, by Melissa Waters, Concurring Opinions, July 24, 2007
2. Prescription Drug Scams, by Dean Baker, Thruthout, June 29, 2006
Drug Trials Hide Conflicts for Doctors , by KURT EICHENWALD and GINA KOLATA, May 16, 1999
Insurers Pay Doctors to Switch to Generics, by Joe Mantone, The Wall Street Journal Health Blog, Jan 24, 2008.
Med-tech perks for doctors questioned, by JANET MOORE, Star Tribune, Feb 28, 2008
Is Something Rotten in the State of Radiology?, by Leonard Berlin, MD, FACR, Imaging Economics, March 2007
3.Phoenix Doctor's Picture Taking Latest Sad Tale of Medical Malpractice, |by Parker Waichman Alonso LLP
4. Profit-Seekers, by Payne Hertz, Wednesday, August 29, 2007
Also see,
Needless Surgery, Reprinted from Consumer Reports on Health (March 1998)
© 1998 Consumers Union*
To Go Under the Knife--or Not?, by Kate Murphy, Business Week, July 7 2003
Health Department Fines Parkway Hospital $32,000 for Performing Unnecessary Surgeries on Patients from Leben Home, state of New York Department of Health, 7/16/01 Blue Cross and Blue Shield Plans File $30 Million Lawsuit Alleging "Rent a Patient" Fraud in Southern California, Summary by Blue Cross Blue Shield Association, BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.
Laparoscopic Cholecystectomy Atrocity, Elizabeth Eugenia James-LaBozetta
Central Ohio Patient's-rights Service (C.O.P.S.) and Citizens for Medical Safety
5.High Rate of Failure Estimated for Silicone Breast Implants, by GARDINER HARRIS, New York Times, Published: April 7, 2005 6.Breast surgery accelerates recurrences in some women., Heatlh Facts, Nov 5, 200 Trauma-associated growth of suspected dormant micrometastasis, Nagi S El Saghir,1 Ihab I Elhajj,1 Fady B Geara,2 and Mukbil H Hourani3 BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.
STRESS HORMONES MAY PLAY NEW ROLE IN SPEEDING UP CANCER GROWTH, Cancer Research, Nov. 1, 2006 republished OHSU Research News
Tumor dormancy: not so sleepy after all, by Cliff Murray, Nature Medicine, 1, 117 - 118 (1995)
Does surgery unfavorably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases?,European Journal of Cancer, Volume 41, Issue 4, Pages 508-515 M. Baum, R. Demicheli, W. Hrushesky, M. Retsky
Wounding from Biopsy and Breast cancer progression, Ritsky etal, The Lancet, Vol 357, March 31, 2001
HOW SCIENTIFIC ARE ORTHODOX CANCER TREATMENTS?, by Walter Last
7. Top 10 Reasons to Be Glad You Have Breast Cancer, by PJ Hamel
Monday, May 7, 2007
8. Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor
BITTER PILL : Disseminating Truth And Fighting Tyranny
http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html
9/9/2008 - (NaturalNews) Race, Health Care and the Law Speaking Truth to Power! Basis of Distrust http://academic.udayton.edu/health/05bioethics/slavery02.htm
Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)
Toxins in the Bodies of Newborns Lead to a Contaminated Generation Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)
10. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)
12. (James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)
McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)
13. Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.
Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.
14. Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)