Friday, 21 August 2009

The State as Doctor: Prescription for Atrocities

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No wonder politicians applaud medical Marxism, a.k.a. Obamacare: it increases their power over us. Ditto for special interests and their profits. But astoundingly, many ordinary Americans whom the system will badly hurt — figuratively and literally — also clamor for it. Learning some history might temper their enthusiasm.

Most folks probably know about the atrocities the Nazis and the Soviet Union paid doctors to commit on prisoners. But they may not realize that American governments have long meddled in medicine as well, and their record isn’t pretty. Among the horrors is the unconscionable research the U.S. Public Health Service (PHS) conducted for decades in Tuskegee, Alabama.

From 1932 to 1972, federally employed and empowered doctors experimented on poor, uneducated black men suffering from syphilis. Like the politicians touting Obamacare, the PHS’s bureaucrats professed noble intentions: they wanted to study and treat indigent syphilitics in five of Alabama's poorest counties.

But because the PHS rather than patients paid the piper, the government called the tune. The PHS decided soon after beginning its campaign that studying syphilis was more valuable to "public health" than curing the 399 participants it had recruited.

And for the next 40 years, PHS did precisely that. It withheld treatment and monitored the disease's progress while pretending to doctor the men.

This became even more reprehensible in the 1940s after the discovery of penicillin. Treating syphilis before that time required “highly toxic arsenic and mercury compounds,” according to the Center for Ethics and Humanities in the Life Sciences at Michigan State University — somewhat like fighting cancer with chemotherapy. Penicillin was far safer and more effective.

But the PHS continued dispensing placebos to its unwitting victims. Ironically, though the doctors published their findings internationally and openly discussed their callous investigation with colleagues, none of the patients knew what was afoot nor why the PHS had recruited them. The PHS ensured their ignorance by alternately bribing them and lying to them. Among other goodies, it fed them on examination days — a huge incentive during the Great Depression. And it billed painful research like spinal taps as “special free treatment[s].” By the time the Depression eased, the PHS’s personnel and procedures had become not only familiar but trusted.

The brutality ended in 1972 when a whistle-blower alerted the press. But by then, just 74 of the study's subjects still survived. Syphilis or related problems had killed 128 of the men and infected forty wives. Congenital syphilis afflicted nineteen of the children born to these couples.

Even bureaucrats ought to blush at such evil. But the PHS's Dr. John Heller vehemently defended it instead: "The men's status did not warrant ethical debate," he insisted. "They were subjects, not patients; clinical material, not sick people." Chillingly, he added, "For the most part, doctors and civil servants simply did their jobs. Some merely followed orders, others worked for the glory of science."

Congress rewarded the PHS’s barbarity with its usual prize: it created a commission to study the study and passed the National Research Act. Let’s hope the latter restrains Leviathan’s lackeys better than has legislation to prevent other governmental sins: those that were supposed to curb its extravagance, for example — the Gramm-Rudman Acts of 1985 and 1987, the Budget Enforcement Act of 1990, or the Balanced Budget Act of 1997 — have failed miserably.

Because the PHS’s victims were black and its personnel mostly white, historians usually blame the study’s villainy on racism. But the actual culprit is government. By nature, it wages interminable war against everyone (black, white or polka-dotted) under its thumb.

The PHS’s study isn’t the only time an American government has played doctor and practiced inhumanity. In the early 20th century, New York City’s Board of Health kidnapped a woman for allegedly spreading illness. “Typhoid Mary” Mallon bitterly denied their accusations and fought for her freedom.

An unmarried Irish immigrant, Mary worked as a cook for wealthy families who sickened one after another with typhoid. Mary herself never did. (Medical historians theorize she either inherited bacteria from her mother or suffered a bout of illness as a baby. If so, she was among the 3-5 percent of typhoid’s survivors who carry the germs all their lives, infecting others while remaining healthy themselves.) She deeply resented officials’ insistance she was the source of her employers’ misfortune at a time when outbreaks of typhoid were common, and she defied their orders to quit work. The health department arrested her, dragged her kicking and screaming to a hospital, and then exiled her to an islet in the East River.

The State imprisoned Mary there until she died in 1938, nor did its minions treat her kindly. The Board of Health humiliated her by repeatedly collecting her urine and stool; at least 25 percent of the tests they ran discovered no typhoid. Mary cannily sent samples to an independent lab as well: not a single one ever tested positive. When she sued for her release, she presented those findings to the court. So did the Board. Not surprisingly, a judge on Leviathan’s payroll chose to believe bureaucrats who were also sponging off the taxpayers rather than a private lab.

Meanwhile, Mary charged her captors with ignoring the other, very real ailments afflicting her in favor of the typhoid that obsessed them: “My eyes began to twitch, and the left eyelid became paralyzed ... for six months. There was an eye specialist [who] visited the island three and four times a week. He was never asked to visit me.” They also pressured her to agree to an unethical bargain: “Dr. Studdiford said to this man ‘Go and ask Mary Mallon and enveigle her to have … her gallbladder removed.’” (Typhoid can infect that organ, but extracting it doesn’t always rid the carrier of the germs.) “’I'll have the best surgeon in town to do the cutting.’” Rightly fearing the primitive and often fatal procedures of that time, Mary refused.

Mixing the State’s power with the healing arts lets compulsion trump compassion every time. Americans hoping to live — or, more likely, die — at their neighbors’ expense should understand that Obamacare will cost far more than they ever imagined.

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