I was born in a rural village outside of Hue, Vietnam in 1976, a year after Saigon fell and the war ended. My family of four struggled to survive in the post-war shambles, and in 1981, my mother had no choice but to flee Vietnam by boat with my older sister and myself. Through the support of the refugee resettlement program, we began our lives in the United States in 1982, wearing all of our belongings on our backs and not knowing a word of English.
Though we struggled for years to make ends meet, we sustained ourselves through public benefit programs: food stamps, Medicaid, Section 8 Housing, and cash aid. These programs were lifelines that enabled me to focus on my education, and they allowed me to be the physician and public health expert that I am today. Looking back, I firmly believe that the more we invest in the lives and livelihoods of immigrants, the more we invest in the United States, its ideals, and its future.
So, when I first learned of the current administration’s plan to make it harder for immigrants with lower socioeconomic statuses to gain permanent U.S. residence, the so-called changes to the “Public Charge” rule, I felt outraged and baffled by its short-sightedness.
If this proposal comes into effect, government officials would be forced to consider whether an applicant has used, or is deemed likely to use, public benefit programs like Section 8 Housing, Medicaid, the Supplemental Nutrition Program (SNAP), and Temporary Assistance for Needy Families (TANF). Additionally, applicants with pre-existing health conditions could be rejected purely on these bases.
The implications of this rule are not hard to predict (and have already been observed throughout the country): noncitizen parents who are hoping to get green cards will not enroll their citizen children in government healthcare, which they have a legal right to obtain, out of fear that harnessing public benefits will prevent them from gaining legal permanent residence. According to the Kaiser Family Foundation, President Trump’s proposal could lead to a decrease in Medicaid and CHIP enrollment by a minimum of 15% and as much as 35%. Any proposal that decreases the number of insured American citizens, as this measure surely would, would increasethe financial strain on taxpayers who will be forced to compensate for unpaid coverage. Furthermore, Forbes estimates that Trump’s proposal would decrease legal immigration to the United States by more than 200,000 people a year and therefore “would have a negative impact on the Social Security System”- a deficit that American taxpayers would have to help cover.
If the moral argument that every human being deserves the pursuit of a better life doesn’t work for you, then let the economic one suffice. A 2016 study by the National Academies of Science, Engineering, and Medicine concluded “immigration has an overall positive impact on long-run economic growth in the United States” and “immigration is integral to the nation’s economic growth.”
Whether you are an immigrant or were born in the US, we all have a responsibility to vocalize dissent against the Department of Homeland Security’s morally and fiscally-flawed anti-immigrant proposal. Vote, attend town-hall meetings, write to your representatives, conduct personal research, engage in constructive dialogue, and comment below to get the conversation started. Remember, the Statue of Liberty reads: “give me your poor, your tired, your huddled masses.” If we match xenophobia and ignorance with empathy and facts, we can ensure that America remains a beacon of hope for future immigrants, just as it was for me in 1982.
Happy New Year, GlassHospital readers.
The year’s end provides the opportunity to reflect on the year that was.
These few stories stuck out as some of the most impactful of the year–and what they portend for the future:
1. Gene editing: In November, at the International Summit on Human Genome Editing in Hong Kong, Chinese biologist He Jiankui shocked the world with his announcement that he had manipulated at least two embryos to change a trait (or more??) in twin baby girls. The reaction was mostly critical, including calls for a moratorium on the use of CRISPR gene-editing in humans.
The upshot: stories like this will be with us for the foreseeable future. While the power of CRISPR to remedy harmful genetic conditions seems hopeful and fantastic, there’s a whole history of eugenics movements that should guide us to avoid the hubris of selecting for ‘desirable’ traits in humans.
2. #ThisisOurLane: Also in November, an NRA staffer (to this point unknown) tweeted a response to an article in the Annals of Internal Medicine recommending that doctors ask patients about gun use and safety as a health measure. The tweet infamously suggested, “someone should tell self-important anti-gun doctors to stay in their lane.” This was met with a firestorm of response from doctors across the spectrum, particularly those that care for gunshot victims (ER docs, surgeons, etc.) who tweeted under the hashtag #ThisIsOurLane.
The upshot: It’s hard to quantify the cumulative impact of the conflict, which is sure to go on, but the Justice Department did just ban bump stocks.
3. Bill of the Month: NPR, in conjunction with Kaiser Health News, started a monthly series examining outrageous and inexplicable health care bills. It’s been one of their (repeatedly) biggest stories of the year, as exemplified by the (insured!) Texas teacher who faced a $108,951 hospital bill after treatment for a heart attack (he was taken by ambulance to an out-of-network hospital–hardly the time, it seems, to price compare).
The good news: His bill was lowered to $332 after the glare of national media attention.
The American College of Physicians recently released an updated position paper on “Reducing Firearm Injuries and Deaths from Gun Violence in the United States.”
The College’s recommendations center around the notion that gun violence should be treated as a public health epidemic, and that it’s well within the purview of doctors and other health professionals to ask their patients about firearms—namely, do you own them, and if so, are they safely stored? Are they kept in a place where your children can’t get to them?
This makes sense to me, but I’m a doctor. I don’t hunt, nor have I ever owned a gun.
The College’s position makes some very uncomfortable—it’s not a medical issue, they say. This is about personal behavior. Choice. Individual rights.
The NRA sent a tweet in response to the position paper:
Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves. https://t.co/oCR3uiLtS7
— NRA (@NRA) November 7, 2018
Told to “stay in our lane,” doctors have loudly declared #ThisisOurLane, and now have a Twitter handle and thousands upon thousands of tweets stating that it’s medical professionals who care for gunshot victims. Many sent pictures of themselves spattered with blood from taking care of gunshot victims in emergency rooms and operating suites.
One doctor, a forensic pathologist and medical examiner in Oakland, tweeted back to the NRA:
Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my fucking highway. https://t.co/48S9UIFaV2
— Judy Melinek M.D. (@drjudymelinek) November 9, 2018
Understandably, Dr. Melinek’s tweet went viral, and she was interviewed the world over—from Africa to Australia—even on Amanpour.
Dr. Melinek was kind enough to speak with me—our interview occurred recently for #MedicalMonday on KWGS-Public Radio Tulsa, and drew a tremendous response.
Like Dr. Melinek, I find it frustrating that the NRA’s strong advocacy has had such a chilling effect on research into gun safety and gun violence in the U.S.
Shutting down attempts to gather more detailed information is a bully tactic of someone or something afraid of truth. How can people make informed decisions without really knowing the effects of gun ownership and use?
Advocate for gun rights all you want. But let the research be done.
This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.
Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to ‘prescribe’ medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically indicated.
My answer thus far has been, “Not now. Likely never.”
This has not been a popular response. One patient looked at me as if I’d put a lump of coal in his Halloween bag.
I’m not a fan of medical marijuana for several reasons. The main issue is the lack of proven medical efficacy. I know there are thousands of anecdotes from people whose pain or anorexia has been diminished by marijuana–and I’m genuinely glad for them. But I’d like to see better powered controlled trials of cannabis products head-to-head with accepted therapeutic agents. Having the FDA weigh in on marijuana’s safety and efficacy would also go a long way toward legitimizing pot’s medicinal use.
Another major problem is smoking the stuff. If we had proven, standardized dosing of edibles, I’d be more supportive of medicinal use. But smoking anything–tobacco, marijuana, vapor juice–is not a healthy practice, and one I counsel patients to avoid. I hear the arguments about the purity of pot and how it’s ‘more natural’ than manufactured tobacco products. The bottom line is that inhaling burning plant matter into your lungs is a terrible idea–regardless of the herb.
If voters want to legalize marijuana for recreational use, I have no objection–provided we put in place a legal framework to make sure that people don’t get hurt. Standardized dosing and measures to assure product consistency would be integral. And we’d need adequate enforcement to make sure that people aren’t impaired when at work or in other situations in which their marijuana use could jeopardize others.
Putting doctors in the middle of what amounts to a political, legal, social, and economic debate steers the medical profession in a race to the bottom–and let’s face it–our profession has enough problems already without being the gatekeepers of grass.
Remember that marijuana is still scheduled by the Drug Enforcement Administration as a Class I narcotic, defined as having “no accepted medical use and high potential for abuse.” So even though medical weed is now legal in my state, I have no interest in violating or abetting violations of federal law.
In fact, as it turns out, since I work at a university, our legal counsel is of the opinion that no provider in our system shall recommend marijuana, since our institution has numerous federal grants and funding streams and must therefore comply with all federal rules and regulations.
Some have suggested that given our national opioid epidemic, marijuana can serve as a safer alternative for pain control. Since most cannabis is homegrown, and where legalized a tax revenue source–this does make medical marijuana a more appealing alternative to propping up the seemingly ubiquitous heroin/fentanyl drug cartels.
This argument makes pot part of a harm reduction strategy, which I’d be more supportive of if the evidence were stronger.
Right now I see the pot economy as a Wild West with hundreds of entrepreneurs and medical professionals looking to stake claims in this new quasi-legal economy.
Get back to me when we have more state/federal legal congruence and clarity on the stuff’s true medical benefits.
This essay originally appeared as a Doximity Op-(m)ed.