Letters to the Editor

How can Physicians Not Speak Out?

Re: "Physicians Make Lousy Advocates," David J. Gibson's rebuttal to my article "Physicians as Activists" in the September/October issue of SSV Medicine, I stand by my original comments. In a democracy of, by and for the people, there is no justification for anyone - including members of the medical profession - to remain silent when government policies are harming the health and safety of individuals here and abroad.

Society does grant physicians a level of credibility that affords us with the opportunity to make a difference if we act responsibly. We lose this credibility, however, if we remain silent or collaborate with governments when they torture or kill.

A perfect example of action benefiting the public good is the "heavy lifting" by individual members of Physicians for Social Responsibility (PSR) in the early 1960s that galvanized public opinion to oppose atmospheric nuclear testing. Rejecting government statements about the safety of over 200 nuclear tests that had taken place, PSR physicians throughout the country collected children's deciduous teeth that were then tested and found to contain radioactive strontium 90, a byproduct of nuclear fission. This led to passage of the Limited Test Ban Treaty of 1963 and the end of above ground nuclear testing.

Now leaders of our government, the only country that has ever used the atomic bomb, are threatening peoples and countries such as Iran with possible pre-emptive nuclear strikes using warheads many times the size of the Hiroshima bomb. How can physicians not speak out, when the health and humanitarian consequences of such action would be so catastrophic?

- Harry Wang, MD

As a lay member of Physicians for Social Responsibility, I read with great interest the article by Dr. Harry Wang setting forth the role of physicians as social activists. First of all, we are citizens living in a democracy, where almost by definition, we have responsibilities beyond earning a living to support ourselves and our families.

Whether we are physicians, architects, school teachers, nurses, writers, factory workers, street cleaners--you name it--we are all concerned, or should be, to assure that our democracy continues in a livable world.

In this process, inevitably, most people whatever their interests and skills, will want to use them, in greater or lesser measure, toward achieving the goals of a peaceful society with social justice and the elimination of war as major objectives.

Physicians have much to contribute, along with other professions, at this time in human history when our technology, especially nuclear weapons, can bring about a world holocaust that staggers the imagination. In such an event, doctors, if there are any left, will be at the front lines in dealing with the casualties--if there are any left.

So yes, in my view, there is a definite role for physicians as activists, especially from a preventive perspective, in working with organizations and institutions, political and otherwise, to help forestall the destruction of our beautiful planet which all signs point to as a real, not imaginary, possibility for the reasons noted above.

Dr. Wang should be praised, rather than criticized, for bringing his scholarly approach to this critical issue.

- Leon Lefson

This is in response to Dr. David Gibson's article "Physicians Make Lousy Advocates" triggered by Dr. Harry Wang's article "Physicians As Activists" published in the September\October issue of Sierra Sacramento Valley Medicine. Dr. Gibson's major arguments warrant rebuttal.

Dr Gibson first argues that "individual physicians seek unearned credibility by attaching their academic title to public statements". He urges that they omit their titles in public statements. This injunction, if followed, would apply equally to economists, lawyers, sociologists, geologists, physicists, and PHD's, all of whom have a degree of prestige attached to their degrees. Worse yet, members of the public who read or heard the opinions and information communicated by these unidentified professionals would be unable to take the opinion maker's area of expertise into account in evaluating the validity or credibility of what was communicated. Dr. Gibson has apparently forgotten the axiom that an informed citizenry requires the disclosure of more, not less, information. As the misleading run up to the war in Iraq (and the current misleading run up to an attack on Iran) demonstrate, bad things happen when information is not disclosed and when members of the public (including professionals) fail to stand up and voice their concerns. To quote another letter writer, Dr. John McCarthy, "The problem [in this country] is not activism, but lack of enough activism like Dr. Harry Wang's."

Dr. Gibson also claims that physicians have a nasty record on public policy issues, citing examples of infamous physicians who espoused or carried out inhumane practices. Most Dr. Gibson's examples involve physicians who influenced , supported, or executed the inhumane practices of dictatorships or terrorist organizations. The others involved physicians who were mentally 'unhinged', radically extreme or both. It is inconceivable that organizations like Physicians for Social Responsibility or Doctors Without Borders--which are devoted to promoting peace, opposing brutality and alleviating suffering- would go off 'the deep end' in any manner. All professions and enterprises have their 'bad apples'. The bad apples cannot be allowed to discourage public policy participation by a member of any profession.

Dr Gibson claims that physicians are absolutists who deal poorly with nuance and competing interests, values and truths. Judging by the sound bite political discourse that politicians and journalists regularly (with some exceptions) dish up, this is not a trait confined to physicians. I have met many doctors, Dr Wang included, who are well educated, have a variety of interests and a sophisticated and nuanced approach to thinking about issues. They should participate in public discourse with MD title attached.

Sincerely
Jan Rein (dare I say Professor of Law, Emiritus?)

The rebuttal, "Physicians Make Lousy Advocates" by David J. Gibson, MD, criticizing Dr. Harry Wang's article, misses its mark in three ways:

(1) The fact that doctors have not been good politicians is completely irrelevant to the discrediting of Dr. Wang's article. Dr. Gibson wasted most of his article (and associated good research) making assertions about doctors that are perhaps accurate but that have no bearing whatsoever on Dr. Wang's message.

(2) The implication that Dr. Wang is presuming to speak for him or all physicians is way out in left field. Where in the world did Dr. Gibson even get that idea.

(3) Dr. Gibson is totally wrong about using the "Dr." title as a "short-cut...to credibility" and his comments are an insult to Dr. Wang's intentions. Physicians are known to be intelligent, they are known to care about human health and welfare. Any thinking reader or listener who hears a physician speak out on war would rightfully give it much more weight than, for example, the words of some politician.

Dr. (not the "lousy advocate" type, but a Ph.D.) Chris S. Tomine

Dear Editor:

This is to respond to several articles and letters to the editor which appear in your September/October 2007 issue of Sierra Sacramento Valley Medicine. A very well written and intentioned article by Harry Wang MD entitled "Physicians as Activists", and a counter point article by David I. Gibson MD entitled "Physicians Make Lousy Advocates", cause me great concern.

First, I am surprised to find that you published Dr. Gibson's rather poorly researched personal attack against Dr. Wang. I must say Dr. Gibson well demonstrates his points and makes his case that some unprofessional members of your profession should stay focused on medical issues, and not on political and policy issues that are basically over their head from an intellectual standpoint.

Dr. Gibson rambles on in some detail as to all the physicians who have made poor decisions and conducted themselves an unethical manner over time. Much of his ramblings seem to strongly argue against physicians running for public office, an issue not even addressed by Dr. Wang. Further, Dr. Gibson states that "physicians do not represent the norm in any society. We are highly selected for intelligence, work ethic and commitment." As if those select attributes are exclusive to physicians! I'm not a physician, but I am a well educated professional. I recently retired from a profession where I demonstrated these aforementioned attributes for 31 years of federal public service. Dr. Gibson further states that "Our temperament and training ill prepares us to accommodate the strongly held views of those with whom we disagree." Then as if to make his own point he closes with an unethical and undeserved personal attack target at an individual with which he disagrees. He was provided Dr. Wang's article prior to publication. A courtesy not afforded to Dr. Wang.* I agree that some physicians are intelligent and ethical. Others should give serious consideration to not quitting their "day job".

I have only met Dr. Wang twice, and spoken with him for about five minutes. Who in the medical profession, with any intelligence whatsoever, can not hold their head up high in opposition to war, genocide, torture, weapons of mass destruction, and capital punishment? I thought you were the folks that spend your life's work healing the sick and notably putting our boys and girls back together again, as they flood our institutions with the horrific physical and mental wounds of yet another totally unnecessary war.

- Howard K. Stark

Dear Editor

I was pleased to read Dr. Wang's remarks as published in the recent edition of SSV Medicine, and the lively debate that ensued-hardly boring I would say!

Dr. Wang's thoughtful , beautifully reasoned, historically nuanced analysis reminds us all that howsover we might wish to just be left alone to practice Medicine as we were trained to , we are among and part of messy human affairs that demand our legitimate medical attention. The antidote-the Primary Prevention if you will- to the physical and emotional injuries of war is to not have any war. Dr. Wang aptly notes what happened when physicians did not involve themselves in important "social" issues. Maybe we should have had more exposure to medical hisotry and public health in our medical school training.

That this point of view seems new , or unusual, or "out of the box" for some , just makes it new or unusual; it doesn't make it an illegitimate area of interest or involvement.

We are fortunate to have so caring and concerned a doctor as Dr. Wang in our community. Whether agree with him or not, those of us who know him and have worked with him, are familiar with his integrity, intelligence and humanity to the everlasting credit of the name "Physician".

Very truly yours.
Harvey Tullin, M.D.
Child and Adolescent Psychiatrist