Medical Heretics from Rome to COVID
17-minute video and transcript. Plus, Zipline delivers parcels and blood.
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Health Care Administrators Association (HCAA) Address, 2/21/23
Last month, I was on a panel with the eloquent and estimable Jay Kempton (Kempton Group) and Keith Smith (Surgery Center of Oklahoma) at the HCAA’s Executive Forum in Las Vegas. Here’s the 17-minute video of my portion of the presentation. A lightly edited transcript follows. Summarizing my talk:
From Roman times to today, Western medicine has had a self-destructive tendency to stifle dissent and vilify those who question medical orthodoxy.
In the 20th century, this tendency wreaked havoc on medicine’s understanding of genetics, autism, ulcers, and degenerative brain diseases—causing individual suffering and violations of civil liberties.
In recent years, and particularly since the arrival of COVID, this destructive tendency has been on a sharp upswing.
Medical education, the practice of medicine, and public health are becoming drenched in politics and ideology.
These trends threaten the quality of medical care and norms of civil society.
In this very city, Lord knows how many times Frank Sinatra sang “That's Life,” in which he proclaimed that he [had been] a puppet, a pauper, a pirate, a poet, a pawn, and a king. I'm Bob Graboyes, and in my life, I've been a literature student, a professional musician, a newspaper writer, an Africa banker, a Fed economist, a small business lobbyist, and a healthcare professor at five universities.
I'm going to talk about two intertwined themes which have become the mainstay of what I talk about. There are two deep, deep problems that medicine, and more generally healthcare, have. One is a tendency to reject valid, legitimate scientific dissent—orthodoxy. The second is medical doctors and others who are focused on social action projects, rather than on individual patients. And I'm going to say two things: One, this problem, especially during COVID-19, has become markedly worse and is getting worse by the day. And the second part is, it is going to bite everybody in this room if something isn't done to change the course we are on.
Now, as I say in some of my essays, this is not a new problem. In fact, the part about politicization and and rejection of scientific dissent is at least an 1,800-year-old problem in medicine. And the other problem, the focusing on groups rather than on individuals, is at least a 140-year-old problem. 1,800 years ago, the Greek-Roman physician Galen—probably tied with Hippocrates as the greatest figure in Ancient Western medicine. He gave us many or maybe most of the big specialties—pharmacology and urology and all of those were essentially his inventions.
He gave us a lot of bad stuff, too. He was a great guy, but he knew what he knew at the time. Among other things, he pushed the notion that all disease, all health, and all sickness derived mostly from an imbalance of the four bodily humors—which we now know to be nonsense. But nevertheless, for 1,600 years, that belief persisted. Why? Galen was not a Christian, but the early Catholic Church decided they rather liked him, and they sort of declared whatever he said to be sacrosanct and be unquestioned. And for centuries and centuries—more than a millennium—if you dared to question Galen, you were committing heresy.
One of Galen's beliefs was that the heart is composed of two chambers, and that blood flows between the two chambers by means of a set of tiny pores that went from one chamber to the next. Now, we know that all that is wrong, but why did why did it take 1,600 years to find that out? Because you weren't going to do investigations on a cadaver, because that would mean you were questioning Galen and committing heresy. So, no one did it. In the 1200s, a Muslim physician pretty well got the right story on the heart, but his word didn't make it into Christendom.
And about 300 years later, in the 1500s, a Spanish physician by the name of Miguel Serveto (or Michael Servetus, as we know him) for the first time wrote down and marked the correct system, which was that the heart has four chambers, with a set of capillaries running into the lungs and back. He wrote it out. It was the first time in history it had been written. He was thanked by the church at the time by a condemnation to death. He fled from the Catholic realms into Switzerland hoping that the Protestants would give him a better shake. John Calvin ordered him burned at the stake. Not just for his medical beliefs, but it was embedded in theological debate about the basis of the Holy Trinity and that sort of thing. But in part for saying that the heart had four chambers, he was burned to death.
This belief lasted into our own country. Benjamin Rush, the only physician to sign the Declaration of Independence, the greatest doctor in early America, was an absolute fanatical devotee of this. In 1793, during an epidemic in Philadelphia, Rush believed firmly that the way you stopped this thing is by removing 75% of the blood from anybody. And so, his front yard looked like the French Revolution, and his reputation ultimately was ruined by it.
Six years later, George Washington was bled to death. He was one of the final victims of Galenism after 1,600 years. We finally shed Galenism, and for about 100 years, we went into miasmism—which actually came from Hippocrates. This is the idea that disease is caused by bad air—night air. They had an obsession with the ventilation. There’s a long list of things that happened because of miasmism. Ignaz Semmelweis, a Hungarian physician, discovered that if physicians wash their hands between going from one mother in childbirth to another or especially from the cadaver room to the mothers—if they simply wash their hands with a solution—that the death rates for babies and mothers drop precipitously. He was viewed as insulting the cleanliness of doctors and declared a heretic.
Doctors fabricated data to refute him. They ultimately imprisoned him in a mental institution where, almost immediately, he was beaten to death by guards—or beaten severely and died of an infection from the beating about two or three weeks later. About 16 years later, Joseph Lister’s germ theories had become pretty well known among younger doctors. But unfortunately not for the doctors of president James Garfield—a robust man who took two bullets in the gut and would have been fine—except the doctors said, “We're clean. We're doctors. Let's stick our fingers in the president!” Which they proceeded to do for two-and-a-half months—and killed the man. Immediately, there was a change in sentiment.
About two years later, the word “eugenics” was invented, and medicine entered a seriously dark age, where doctors and others were focused on breeding human beings the way you breed soybeans or cattle. They were going to make a better race of human beings. These were doctors who were focusing on society--not patients.
We make a big mistake today by calling eugenics a “pseudoscience.” It was not. It was the hardest of hard sciences. It was taught in medical schools. If you've ever taken a course in statistics, mathematical statistics—that almost entirely grew out of eugenics. Statistics was built so that you could give a scientific veneer to essentially racism and snobbery. The problem with it wasn't that it wasn't science. It's that it was science that you could not challenge. If you had other theories and you brought them up, your career was at an end.
In 1927, the U.S. Supreme Court bought into this. As a result, in the ensuing decades, 70,000 Americans were forcibly sterilized—most of them for ridiculous reasons. And if you think it ended a while ago, the end of that era, so far as we know, came when California finally stopped sterilizing prisoners in 2014.
There were other scandals of this sort all through the 20th century. Bruno Bettelheim said that autism was caused by bad mothers, doing enormous damage both to the autistic children and to their mothers, who were emotionally brutalized by this. And you dared not question Bruno Bettelheim. Ulcers were caused by stress, because no bacteria could live within the stomach juices—until finally we showed it was h. pylori. But that was heresy for a while. Then Stanley Prusiner and others said, well you know maybe Creutzfeld-Jakob and mad cow disease and scrapie are caused by some weird misfolded proteins that don't have any nucleic materials. And that was heresy, and they ridiculed him. He said he stopped talking to the press. I think to this day he will not talk to them because of the opprobrium he got. But ultimately, he won the Nobel Prize for discovering prions—which is what he was talking about. And he said the opprobrium he got from other doctors did not end with his Nobel Prize. So, we have this terrible tradition.
Now, let me say for the next part of this, as I move on, let me just say so you don't get any wrong ideas: I've been fully vaccinated since the first day it was possible. I've gotten every vaccine along the way. I'll continue to get them. I locked down for months with my wife. I have no regrets about doing so. I was fine with some of the early public health measures that were taken. But that doesn't change the fact that we now know with certainty that disinformation and misinformation was sent out by those in positions of power. And anyone who dared to challenge them was ridiculed as a lunatic—a know-nothing.
It didn't matter where you were a medical school professor, or what your accomplishments were. If you opposed the official line, you were a crazy person. They were vilified. Legitimate lines of question which needed to be asked were scuttled. They are only now coming out. We now know, of course, from the Twitter files that social media were absolutely complicit in this blocking what we now know to have been legitimate lines of questioning.
I wrote a piece in 2021 on public health. It started because a left-of-center public health professor, Harold Pollack, (very highly respected, University of Chicago) wrote a piece saying his profession, public health, has a serious problem because it is a political monoculture. He said in particular that one reason he thought that there was conservative opposition to vaccination is because no one in his profession knew how to talk to conservatives. I wrote an article that amplified on it. I said I would carry it further—that I think your profession is one that is also marked by elitism—urban elitism. They didn't know how to talk to African Americans, Hispanic Americans, rural Americans. You were getting low vaccination rates in those communities because the public health people didn't know how to talk to them. And again, if you opposed them, you were a crazy person. He and I had some good conversations on it. I appreciated his willingness to engage. Public health is not quite the same as medicine, but it's gone in some crazy directions.
I wrote down a little list of things that are now considered to be public health issues ready for government intervention. They include climate change, property law, racism, wages, voting laws, transportation, terrorism, crime, policing, juvenile justice, higher education, guns, employment, incarceration, financial lending, identity theft, bullying, gentrification, and--welcome to Las Vegas--online poker. All of these are now fodder for public health to intervene instead of worrying about things that public health is actually good at doing.
A few months later, I wrote an article about the fact that medical schools and the medical profession are going in the same direction. The American Medical Association and the association of American Medical colleges in 2021 issued something called Advancing Health Equity, which is an Orwellian speech code that tells doctors what to say, how to say it, and what to think. I will give you one example from it: A doctor, according to this, should no longer say the following sentence:
Low-income people have the highest level of coronary artery disease in the United States.
because somehow that's offensive. Let me say it again:
Low-income people have the highest level of coronary artery disease in the United States.
A simple factual statement. What the AMA and the AAMC said you're supposed to say now is:
People underpaid and forced into poverty as a result of banking policies real estate developers gentrifying neighborhoods and corporate weakening the power of labor movements among others … … have the highest level of coronary artery disease in the United States.
That's just my favorite example, but there's 54 pages of this stuff, and they are taking it dead seriously. We're now at the point where the AAMC is issuing directives at our medical schools and others. If you're an undergraduate applying for medical school, you had better indicate in your applications, in your essays, that you've already bought hook, line, and sinker into this agenda. Otherwise, very likely, you're not getting into medical school. And you must demonstrate all through school that you support it. They are in some cases reducing the number of courses in science, biology surgery—replacing them with courses in social action. This is making its way into continuing medical education and the practice of medicine, in licensure, and if you look at the title of this this program, you cannot have medical liberty or individual choice in an environment that does this.
The final thing I'll say is it's going to affect all of you in a number of ways. First of all, your patients are going to have worse outcomes because you're going to have doctors who are focused on social action rather than on knowing which end of the scalpel to use. You're going to end up facing litigation. You're going to face administrative nightmares; you probably already are, but they're going to get a lot worse. And if you think that they can vilify banks, realtors, and corporation … wait till they light in on you.
Lagniappe
Mark Rober, NASA engineer of glitter-bomb fame, discusses Zipline’s delivery drones for packages and, in Rwanda, for blood and other medical supplies.
Robert F. Graboyes publishes Bastiat’s Window, a Substack journal of economics, science, and culture—with an emphasis on healthcare. He is a health economist, journalist, and musician in Alexandria, Virginia, and holds five degrees, including a PhD in economics from Columbia University. In 2014, he received the Reason Foundation’s Bastiat Prize for Journalism. His music compositions are at YouTube.com/@RFGraboyes/videos.
https://sensiblemed.substack.com/p/american-medical-lysenkoism relates the dynamic as historical context and current experience, with foreboding. Your astounding post needs to be seen and heard, since the truth of our collective ignorance is silenced now by the loud academic/scientist/physician voices from "experts" who do not demonstrate the hubris/humility required to work within the vast unknowns of 3D. Imho, only by letting go of bedrock/foundational elements of "science", elevating with respectful audience those who dare to work outside the "expert consensus" lines, and connecting disparate voices to paint a bigger picture will we better approximate the truths of our reality.