by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
“The Great Lion” ...................................................................................... 131
14 Trading Treatment for Terror ................................................................ 135
Physicians on the Front Lines ................................................................... 136
The Fort Hood Massacre ........................................................................... 139
Doctors as Terrorist Leaders ..................................................................... 145
15 Guilty Until Proven Innocent ................................................................. 149
Katrina and Dr. Pou ................................................................................... 149
The Benghazi Six ...................................................................................... 153
Section 5 What Now?
16 Euthanasia, and Assisted Suicide: What Would
Hippocrates Do? ...................................................................................... 159
A Short History of Suicide ........................................................................ 159
The Physician and Suicide ........................................................................ 160
Physician-Assisted Suicide ....................................................................... 162
Legal Assisted-Suicide .............................................................................. 164
“Excursional” Suicide ............................................................................... 164
Euthanasia ................................................................................................. 165
Karen and Terri ......................................................................................... 167
Karen Ann Quinlan ................................................................................... 168
Terri Schiavo ............................................................................................. 169
What Is Right? .......................................................................................... 172
17 Malpractice or Murder? ......................................................................... 173
The Current Problem ................................................................................. 174
Medical Errors by Individual Physicians .................................................. 174
Murder Versus Malpractice ....................................................................... 176
18 It’s All Natural! ....................................................................................... 179
Alternative and Complementary Medicine ............................................... 179
Alternative Medicine Gone Bad ............................................................... 182
Attachment Therapy .................................................................................. 184
xvi
Contents
19 Contagious Caregivers ............................................................................ 187
The Sad Story of Kimberly Bergalis ......................................................... 188
Blood Money ............................................................................................ 190
Honesty is the Best Medical Policy .......................................................... 190
The Last Word ........................................................................................... 191
20 Fictitious Physicians: Where Has Marcus Welby Gone? .................... 193
Off the Pedestal ......................................................................................... 194
The Characters .......................................................................................... 194
“Dr.” Victor Frankenstein ...................................................................... 194
Dr. Hannibal “the Cannibal” Lecter ...................................................... 195
Dr. Henry Jekyll .................................................................................... 196
Dr. Christian Szell ................................................................................. 196
Dr. Josef Mengele ................................................................................. 197
Dr. Evil (a.k.a. Dougie Powers) ............................................................ 197
Dr. Richard Kimble ............................................................................... 198
Dr. Remy Hadley (a.k.a. “Thirteen”) .................................................... 198
Dr. Alice Krippen .................................................................................. 199
Is Reality Really Stranger Than Fiction? .................................................. 199
21 Doctors to the Stars ................................................................................. 201
Dr. Feelgood .............................................................................................. 201
Celebrities and Abuse of Prescription Drugs ............................................ 202
Somewhere Under the Rainbow................................................................ 205
Long Live the King – Or Not .................................................................... 209
Anna Nicole Smith .................................................................................... 214
Moonwalk ................................................................................................. 218
Shooting Stars ........................................................................................... 226
Can It Be Stopped? ................................................................................... 227
Suggested Reading .......................................................................................... 229
Index ................................................................................................................. 243
Section 1
Ethics and the Physician
Chapter 1
In the Beginning
I am the Lord your physician!
– Exodus 15:26
From the dawn of history, humankind has been awed by the power of healing.
To restore the rosy color of health to skin bleached by illness and misery; to quiet a bone-rattling, hacking cough; to morph the gasps of suffocation into refreshing breath; to quench the fires of burning fever; and to return a soul on the threshold of another world back to life, certainly appeared to be mighty magic. And to many, it still does.
Therefore, it is no wonder that from the earliest times man has believed that the power to heal is, in truth, a Godly power that only supernatural beings can possess.
Many early polytheistic religions have anthropomorphic Gods of Healing or Medicine. According to the more than 6,000 year-old Hindu mythology, Brahma, the creator of the Universe, was the first to make a compilation of Ayurvedic texts of medicine and surgery – secrets of healing known only to Gods. The name “Ayurvedic”
is derived from the title of the ancient Veda writings which espouses this method of healing. Ayurvedic medicine is the Indian traditional medicine that forms the basis of Tibetan healing practices. It includes the use of various herbal medicines and cures as well as a holistic approach to health. Another major Hindu deity, Lord Vishnu, is also believed to be associated with medicine. He ordered the “churning of the ocean of milk” from which Dhanvantari, the God of Medicine, was said to have been born.
In Egyptian mythology, the Goddess Isis (1,500 BC) was considered the
“Divinity of Medicine” and her name was invoked again
st all kind of diseases.
Imhotep, the first recorded celebrity physician (who incidentally also designed the first pyramid of Sakara for King Zoser of the third dynasty (cca. 2800 BC)), was considered a demigod a hundred years after his death. By 525 BC this pre-Renaissance, “Renaissance man” was elevated to the status of God of Healing. His mythical prowess extended beyond Egypt. Even the rival Greeks worshipped him as a God.
This is not to say that the Greeks were devoid of their own deities with respect to medicine. Apollo was considered the earliest God of Medicine and it was he who taught the healing arts to the centaur Chiron. Asclepius, the most famous of the Greek physicians and a pupil of Chiron, cured many patients of a variety of ailments around 130–40 BC. The myth of Asclepius is particularly interesting because it highlights both the benefits and risks associated with the magical art of J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 3
DOI 10.1007/978-1-4419-1369-2_1, © Springer Science+Business Media, LLC 2010
4
1 In the Beginning
healing. It also foretells the hubris that continues to afflict many physicians to this day. Asclepius was said to be Apollo’s offspring from his union with Coronis, the daughter of the king of the Lapiths. While she was pregnant by Apollo, however, Coronis fell in love with a mortal. Enraged that Coronis preferred a mortal to a God (not unlike preferring a ditch digger to a neurosurgeon – if you ask a neurosurgeon), Apollo sent his twin sister Artemis to kill and burn Coronis. Before the body was totally consumed by fire, Apollo rescued the infant child from the flames and took him to Chiron who raised him. Athena, the Goddess of wisdom, also helped Asclepius by giving him two samples of the magical blood of the Gorgon Medusa, one containing blood from her right veins that could heal sickness and even reverse death and the other from her left veins, which was a lethal poison. Asclepius became a great healer but his ego took over. He had the audacity to resurrect Hyppolytus, the son of Theseus, as well as other warriors clearly stepping over the line that separated Man from God. An angry Zeus smote him with a thunderbolt, perhaps as a warning to other healers that Nature has borders that cannot be crossed. Nonetheless, the Gods and men alike eventually recognized his profound skills and he was eventually deified.
In Buddhism, Buddha as a Healer is portrayed as the Lapis Lazuli Buddha with his hand extended, palm outward in a generous gesture, holding a magical fruit that can heal any disease. Buddhist teachings claim that merely seeing an image or a statue of the Medicine Buddha or hearing or saying His name is greatly beneficial to physical and mental health. Tibetan Buddhist leaders such a Lama Tashi Namgyal, the founder of the Victoria Buddhist Dharma Center believe that “If one meditates on the Medicine Buddha, one will eventually attain enlightenment, but in the meantime one will experience an increase in healing powers both for oneself and others and a decrease in physical and mental illness and suffering.” Perhaps this approach has been worked into the new Healthcare Reform Law (it may be necessary as there may not be many doctors around in a few years).
In Judaism God is also seen as the ultimate healer. In the Torah (the Old Testament) God states about himself: “I am the Lord your physician” (Exod.
15:26). In Genesis, the tale of the patriarch Abraham and his wife Sarah positions God as both causing illness as a punishment and curing it upon repentance.
The story relates that God (Yahweh) directed Abraham and Sarah to migrate and settle in Gerar (the southern Negev area of the Land of Israel). Sarah was very beautiful and when Abraham introduced Sarah to the local king, Avimelech, he presented her as his sister. King Avimelech was struck by her beauty and took her into his harem. God was angered at this indiscretion and struck Avimelech and his servants with impotence. Clearly, the Lord knows how to hurt a man. Avimelech then had a dream in which God told him the reason for his illness and that Sarah was Abraham’s wife. Avimelech promptly returned Sarah to Abraham and confronted Abraham in righteous indignation. Upon the return of his wife, the bible notes: “… Abraham prayed unto God: and God healed Abimelech, and his wife, and his maidservants; and they conceived children.” (Genesis 20:17). In essence, the Lord provided Viagra for the soul. Later, God promised the people, “If you obey God … keeping all His decrees, I will not strike you with any of the sicknesses 1 In the Beginning
5
that I brought on Egypt. I am God, your Physician” (Ex. 15:26). The prophets also acknowledged God as a Healer and Jeremiah stated: “Heal us, and we will be healed” (from the blessing for healing, Jeremiah 17:14). Throughout the Torah, God is imbued with great healing powers. It is no wonder that it is written, “The Lord giveth, the Lord taketh away” when it comes to health, wealth, and life itself.
In biblical times and many centuries later, even to this very day for some, illness was accepted as God’s punishment for the sins of an individual or of a community of people against the ultimate healer, God. Historically, there have been five recognized sources of illness. Infirmities may be caused by:
1. God for his own purposes;
2. Intermediaries of God;
3. Evil spirits, devils or Satan;
4. The stars and;
5. Sins.
It was also believed that there were four means of healing by the Spirit of God: 1. Faith and prayer;
2. Exorcism;
3. Virtuous living and;
4. Magical means.
Two thousand years ago Ben Sira, a Jewish sage, portrayed the ideal Jewish physician as an instrument of God and wrote, “From God the physician gets wisdom… God brings forth medicines from the earth. With them the physician soothes pain and the pharmacist makes a remedy”. This position clearly states that man may practice medicine for the good of his fellow man, as his skills are a gift from God. A contrarian view from other sages, such as Ibn Ezra, a great Biblical commentator, opined that God’s permission for man to heal was restricted. God had provided man with “a sign that permission has been granted to physicians to heal blows and wounds that are externally visible. But, all internal illnesses are in God’s hand to heal”. Ibn Ezra argued that biblical passages permitting limited healing by man, namely the ability to treat injuries, but that God acts as the (sole) healer of all disease. This viewpoint implies an extremely limited role for physicians (essentially validating only emergency room physicians and trauma surgeons). Seeking care from a physician for a non-traumatic condition would equate with a lack of faith in God’s ability to cure an illness.
Ibn Ezra’s position is supported by the biblical story relating to the healing of Asa (King of Judah in 928 BC) when he became ill. The Bible records that when the king became sick, “he did not seek out God, but only doctors” (Chronicles II 16).
The implication is that the king committed a grave error when he only sought out doctors and did not pray for healing from God. Most current Judeo-Christian believers assert that healing is a partnership between God and a man. While God is the ultimate healer, He delegates part of His role to humankind and asks the physician to practice medicine for the good of man. The Jewish approach to illness and medicine 6
1 In the Beginning
requires the righteous man to recognize the preeminent role of God in healing, while seeking out appropriate medical care. God gives man the power to heal but only if it is His Will that the patient be healed.
The Christian scriptures recurrently depict Jesus Christ as a Healer both meta-phorically and factually. The Gospels and subsequent books record the many heal-ings done by Jesus going “throughout Galilee, teaching in their synagogues, preaching the good news of the kingdom, and healing every disease and sickness among the people.” (Matthew 4:23). The healing done through the “Holy Spirit”
through Jesus was accomplished by either verbal command, thought, gesture, and/
or by laying his hands on the diseased body part of the ill person. His cures included relief from severe pain, fever, bleeding, dysentery, paralysis, leprosy, blindness, deafness, demonic possession, r
estoration of withered limbs, and re-attachment of a severed ear. Jesus also resurrected an older man and a young girl, the ultimate form of healing. At the end of his earthly life, the New Testament tells us that he resurrected himself (exemplifying the adage “physician heal thyself”). In several instances, Christ’s physical healing coincided with spiritual healing of the afflicted, truly “chicken soup for the soul.”
In Islam, God is seen as the ultimate Physician and Healer. The Quran calls itself a book of healing: “We have sent down in the Quran that which is healing and a mercy to those who believe” (Quran 17:82). According to Moslem believers, Allah laid down in the Quran three types of healing:
1. Faith in Allah, not only as Creator but also as the Sustainer and the Protector.
This faith can be demonstrated by the performance of obligatory prayers, fasting, charity and pilgrimage to Mecca;
2. Compliance with health practices including the consumption of honey, olives, fruit, lean meat, and the avoidance of alcohol, pork, excessive eating, sexual promiscuity and sex during menstruation and;
3. Direct healing by Quaranic prayers and recitations.
Many Islamists strongly believe that the very recital of Allah’s name or specific passages from the Quaran are therapeutic. Further, some modern Islamic physicians have claimed that sound waves produced during Quaranic recitations generate electrical stimuli that activate various physiological centers in the brain and body in a most beneficial manner. The Quran’s recitations must be done in loud voice following the instructions of Muhammad who stated “The comparison between a silent reader and a recitor is like a bottle of perfume when it is closed and when it is opened.”
To this very day, many religious people see in God the ultimate and sole healing power. Human healers are, at best, a tool of Providence and, at worst, a superfluous intrusion into the healing process. Many Christian Scientists dispense altogether with physicians and modern medical care and proclaim that healing may and should be achieved only by the power of prayer. Jehovah’s Witnesses adamantly refuse blood transfusions even if they are potentially life-saving because of their interpretation of passages in both the Old and New Testament. The overriding principle seems to be that God will heal believers without transfusions if it is His Will.