Beginning in the second half of the 20th century, physicians were taught not to mix politics and medicine. This arose when physicians became aware of the atrocities committed by Nazi doctors as detailed during the first of the Doctors’ Trials held at Nuremberg in 1946. This awareness led the World Medical Association to “modernize” the Oath of Hippocrates in 1948. Specifically, the WMA voted to forbid physicians to discriminate on the basis of “age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor.” In 2009, the WMA took additional action when they passed the Preservation of International Standards of Medical Neutrality resolution that commits physicians to provide healthcare in times of conflict without a pre‐condition of the achievement of peace, thereby separating the delivery of care from the causative politics. Implicit in these resolutions was the concept that politics and medicine should be kept separate.
The covid-19 pandemic has created an inextricable clash between American politics and medicine. Even decisions such as whether to open schools or the utility of wearing masks have pitted conservatives against liberals, fraying the fabric of American democracy. Into this cauldron stepped Anthony Fauci, a physician-scientist and director of the National Institute of Allergy and Infectious Diseases. He has stood his ground and, in my view, has tried to bring science, clarity, and good common sense to the ongoing discussions.
American politicians invariably find support for their views in the writing of the founding fathers: Jefferson, Hamilton and Adams. But did William Osler, the founding father of modern medicine provide guideposts that might prove helpful in charting a path forward in these difficult times? I think, he did. At the turn of the 20th century, healthcare was marked by common outbreaks of bacterial epidemics. These could be mitigated by relatively simple steps: purification of water systems and the detection and quarantine of the infected. However, political leaders lacked the financial means or the will to fix the problem, and disease continued unfettered. William Osler, the Chair of Medicine at the new Johns Hopkins School of Medicine, was unwilling to acquiesce to the politicians. In a lecture to the Medical Society of the State of New York in 1882, he provided an unrestrained view of the etiology of the epidemics. He noted that people were: “not killed by any pestilence that walked in darkness, but by a preventable sickness that destroyed in the noon-day of the intelligence of a civilized people.” [1] He went on to say that America “displays in matters of public sanitation a carelessness which is criminal.”
Osler also used the bully pulpit to skewer elected officials. [1] Concerned that Baltimore’s political leadership lacked insight regarding the causes of and care for patients with tuberculosis, he organized a public meeting in 1902 to which he invited several distinguished scientists and the Mayor of Baltimore. The last to speak, Osler asked: “Now, what is our condition in this city, and what are we doing for the 10,000 consumptives who are living today in our midst? We are doing, Mr. Mayor and fellow-citizens, not a thing that a modern civilized community should do.” He went on to note that it: “is a disgrace to us as a city of 500,000 and of hopeless imbecility in everything that should be in our civic relation to the care of this disease.” [1]
American physicians now encounter a group of problems no less burdensome than those faced by Osler over a century ago—the worst pandemic in recent history, a national leadership that has done nothing to mitigate the disease, an absence of Federal policy, a lack of protective equipment, the inexplicable failure of industry to create a workable diagnostic kit, bickering between State and local governments regarding everything from wearing of masks to opening of schools, the fear that new vaccines will be evaluated without the normal levels of regulatory oversight, and a level of mendacity never before seen in American politics. [2]
So what should the medical community do? A 20th century “founding father” has given us the same answer as Osler. In a letter to the nation that was published upon his death last month, the civil rights leader Congressman John R. Lewis wrote: “When you see something that is not right, you must say something. You must do something. Democracy is not a state. It is an act and each generation must do its part.” [3] As physicians we need to take Congressman Lewis’ advice and we must not lack courage. We face an existential threat and have a responsibility not just to the US but to the world. It is time for us to speak out both as individuals and as groups—whether to patients, to colleagues, to friends or to those that impede our efforts. We must patiently and effectively explain what must be done to stop the death and destruction we are currently witnessing as a result of this pandemic and we should hold those that impede this process publicly accountable. Osler would have expected no less.
Arthur M Feldman is the Laura H. Carnell Professor of Medicine (cardiology) and former Executive Dean of the Lewis Katz School of Medicine at Temple University. He studies the use of viral vectors to treat patients with monogenic dilated cardiomyopathy.
Competing Interests: I declare that that I have read and understood the BMJ Group policy on declarations of interest and have no competing interests to declare.
References:
- Cushing H. The Life of Sir William Osler, Oxford, U.K., Oxford Press, 1925.
- Shearer MD, Weiland N, Lipton E, Haberman M, Sanger DE. Inside Trump’s failure: The Rush to abandon leadership role on the virus. New York Times, July 28, 2020. https://www.nytimes.com/2020/07/18/us/politics/trump-coronavirus-response-failure-leadership.html
- Lewis J. Together you can redeem the soul of our nation. New York Times, July 30, 2020. https://www.nytimes.com/2020/07/30/opinion/john-lewis-civil-rights-america.html