GESTIÓN EN SALUD PÚBLICA: What do you do when a medical hero is also a villain?

lunes, 30 de abril de 2018

What do you do when a medical hero is also a villain?

What do you do when a medical hero is also a villain?

Bioedge

What do you do when a medical hero is also a villain?

by Xavier Symons | 28 Apr 2018 |

Former US Surgeon General Thomas Parran was best known for his work in championing a revolutionary public health campaign against syphilis in the United States in the 1930s and 40s. Some say that his initiative saved the lives of tens of millions of Americans -- and transformed the public’s view of syphilis from being a sign of moral weakness to a genuine public health problem.

Yet recent research has tarnished the influential doctor’s reputation, and even led a US university to consider stripping his name from a major campus building.

Parran has been implicated in the infamous 1932-1972 Tuskegee Syphilis Experiment, a federally-funded medical trial that involved the deliberate withholding of syphilis treatment from hundreds of African-American males. A 2013 essay by two prominent US medical historians suggested that the idea for a syphilis experiment on African American males came from Parran’s writings. Historians Allen Hornblum and Gregory Dober quote several documents that indicate that Parran was contemplating the idea of a Tuskegee-style experiment. In a January 1932 memo, Parran wrote of Macon County, Alabama: “If one wished to study the natural history of syphilis in the Negro race uninfluenced by treatment, this county would be an ideal location for such a study.”

After his retirement from the office of Surgeon General, Parran worked with academics from the University of Pittsburgh to establish a school of public health -- indeed, he was the first dean of the school, and had the school building named after him. But now both students and staff at the university are demanding that the name be changed, labelling Parran’s legacy a “scandal” to new students.

“This isn’t who we are anymore,” Helen Ann Lawless, a second-year graduate student in the public health school, told STAT. “We are still attached to this legacy … we can’t have his name on our building because it venerates him”.

The University has established a committee to consider whether Parran’s name should be removed

“Die, my dear Doctor! That's the last thing I shall do,” said the 19th Century British foreign secretary Viscount Palmerston, not long before he slipped his cable. For all of us, dying is the last and perhaps most significant moment of life. Which is why recording the exact cause of death is a matter that calls for scrupulous accuracy – not just for epidemiological purposes, but also as part of our personal and social history.

But our disturbing lead story today – that Flemish doctors under-report euthanasia by a mind-boggling 550% -- throws all this to the winds. The most common practice, at least according to the latest research into the topic, is that most Flemish physicians who practice euthanasia lie on the death certificate.

Perhaps their offence is more understandable than jurisdictions which require doctors to lie. In many, like Oregon, they are told to record the patient’s underlying disease as the cause of death – as if JFK died of Addison’s disease rather than an assassin’s bullet.

Perhaps we should keep in mind the wise words of the author of a study on death certificates: “Death certificates are really important. We owe it to our patients to be able to accurately record why they die” — and thus to “help the living.”