SICKO: PAUL FARMER, MICHAEL MOORE, SANJAY GUPTA and the difference between the Hippocratic Oath and the Hypocratic Oath

In my experience, one of the things that people need to do is figure out what appeals to them personally. If you are going to devote time to good works when you already have plenty of other things to do, then you have to like what you are doing…
—Dr Paul Farmer

In a moment away from my research for some upcoming interviews, a line came to mind:

If you want to ban boxing, ban poverty.

Yesterday I happened to see on the Larry King show (on line) a few-months-old argument between filmmaker Michael Moore and journalist/doctor/media guest Sanjay Gupta (Senior CNN Medical Consultant).

It was revealing, and for all Michael Moore’s supposed ego and so on (Maufacturing Dissent etc), what he speaks out for is in my opinion about a million times more relevant, revealing and vital than what Dr Sanjay Gupta stands for.

Hearing Gupta being the cool head of reason and ‘balanced’ reporting (on CNN!), I was unable to grasp what it is exactly Gupta does stand for (other than which makes CNN not too uncomfortable).

To be the devil’s advocate in this situation seems to me to be the wrong approach for any doctor who truly believes in the Hippocratic oath, or at least the idea to give care to those in need. Disagree with some of Moore’s methods, sure, but stand in sincere solidarity (as opposed to “I don’t disagree”) with his outrage over a lack of coverage for tens of millions of people (in a country that can afford an endless war).

At a guess, though, Dr Gupta seems to me to be—and maybe even unknowingly—a well-groomed apologist for power-brokers running a medical system that leaves over fifty million people (elderly, women and children—1.5 Canadas) without access to health care in the most powerful country in the world.

By power-brokers I think I mean the HMOs and ‘privatizers’ in general, who base everything including the medical system on the maximization of profit—and thus by definition, not on the maximization of care, let alone universal care.

LOOKING FOR STRAUSS RELIEF

Worse, this American sensibility has a profound influence on the Canadian system. This medical condition is exacerbated by our Prime Minister, heralding from the so-called Calgary School, which is in direct line with President Bush’s near-sighted extremism.

The word neo-con is so profoundly apt.

I have yet to hear one word from Prime Minister Harper offering enlightened, original criticism of his mentor to the south, despite Bush pushing the average citizen in the States to an absolutely inconceivable amount of debt, financially and morally with the rape of Iraq.

FROM BIG PHARMA TO BIG FARMER

And then tonight I was, in a break, reading through the beginning of Tracy Kidder’s wonderful book, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. It is, as the title describes, the story of the remarkable Paul Farmer, an American doctor who has spent a life working with the poorest of the poor (and the unhealthiest of the unhealthiest) in Haiti.

Reading from this book is what triggered the line about boxing and poverty at the beginning of the piece.

And then I wondered: what would a read-through of Kidder’s book on Farmer (let alone a visit with Farmer) do to the belief system of Sanjay Gupta? Would it shift him even a bit towards Farmer’s passion for justice, and away from the amoral emptiness that he, in my opinion, defends—when he should be, as a doctor, defending access to medical care?

Here’s a short video of Paul Farmer talking, echoing the opening quote, and saying why he’s inspired.

Three lines from the book leaped off the page. The first in relation to those in the Western world who cannot get medical coverage (pg 21):

At Zamni Lasante [the Partners in Health clinic in Haiti]…patients were supposed to pay user fees, the equivalent of about eighty American cents for a visit [the average pay in Haiti is a dollar a day or less, according to the book].

Haitian colleagues of Farmer’s had insisted on this. Farmer was the medical director, but he hadn’t argued. Instead—this was often the way, I would learn—he had simply subverted the policy.

Every patient had to pay the eighty cents, except for women and children, the destitute, and anyone who was seriously ill. Everyone had to pay, that is, except for almost everyone.

And no one—Farmer’s rule—could be turned away.

And two aphorisms from German physician Rudolf Virchow (1821-1902), who has a profound influence on Farmer.

One:

Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.

And a second, and this is stunning:

The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.

Wow. Imagine if that was exercised even more fully in spirit and action.

Mountains Beyond Mountains, at least the beginning (being all that I have read), is a deeply inspiring book.

Lots of love and good health to you and yours, and may you always have access to medical care,

Pete xox

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3 Responses to “SICKO: PAUL FARMER, MICHAEL MOORE, SANJAY GUPTA and the difference between the Hippocratic Oath and the Hypocratic Oath”

  1. Karen says:

    Hi Pete,

    How was your trip across the pond? Productive and fun I hope.

    Well you just keep adding to my reading list faster than I can read them, don’t you? “Mountains Beyond Mountains” sounds like a great read. Off to the bookstore!

    Boy what you miss when you don’t watch TV!

    My son is uninsured and has asthma. He had an attack that required a trip to the ER, costing over a thousand (US) dollars (cheap by most standards, yes). Insurance or payment in full is expected at the time of service. He was unemployed at the time, so they put him through as a clinic/hardship patient. He gave them all the information they requested, requiring four trips back to the hospital to give them copies of documents and paperwork. (Apparently they lose faxes very easily.) He called regularly to see if they had set up a payment plan. No response. Last week we found out the hospital’s idea of a “payment plan” was to take no action and then kick his file over to a collection agency that we are now trying to deal with. By the way, the office at the hospital that handles this is open from 10:00 AM to 4:00 PM, Monday through Thursday, clearly limiting access.

    My son’s situation is not unusual; I’ve heard similar stories from friends whose children have “aged out” of their parents’ insurance. My point is that even the “safety net” in place to assist people who are uninsured is a shambles, but also damages the uninsured person’s credit rating in the process. Small wonder medical debt is the leading cause of bankruptcy.

    Even more serious, my son’s fiancée cares for her year-old niece, who has been diagnosed with asthma. Due to the custody situation, the baby is covered by Medicaid. When they bring her into the local ER (different ER from above), they are often treated as if they are an annoyance. They have been given not only poor, but down-right incorrect instructions for her home care as clinic/hardship and Medicaid patients are often seen by first-year residents, with a physician or chief resident simply looking over the chart, often after the patient has been discharged. (Not the way it’s supposed to work and I know of people being called back to the ER days later when an error was discovered.) The instructions they received once constituted very serious medical error. Thank the stars my husband and son have asthma (well you know what I mean) and I have some medical background making us rather well versed in asthma care. Patient protect thyself.

    I fear Dr. Gupta had not a leg to stand on and that certainly makes it difficult to dance around an issue. Mr. King has promised another round on this issue, but I think it’s safe to say round one goes to Mr. Moore on points.

    I would gladly pay more in taxes if my family was guaranteed healthcare and my physicians were free to practice medicine as they have spent so long being trained to do. And there’s the rub; the government guarantees nothing. I think most Americans are against universal healthcare because they fear we’ll end up with something even worse than the broken system we currently have by entrusting our healthcare to the government. Perhaps a very valid point.

    Love and good health to you and yours,
    Karen

  2. Erynn says:

    Karen — I wish I was so optimistic that Americans are against universal healthcare because they believe their own will get worse. One woman of my acquaintance believed that if poor people couldn’t afford health care, that was their own damned problem, because she earned her own money and she wasn’t going to be giving it to anybody — no taxes going to poverty programs or health care of any sort for her, thanks. If people are starving and too sick to work, too bad.

    I just pray she never has to rely on the kindness of the system.

  3. [...] Every time I read Paul Farmer or about Paul Farmer (of Partners In Health), I get both inspired and I learn a lot. I was reading Pathologies of Power this weekend. [...]

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