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Demystifying Medicine One Month at a Time

Tag: obituary

Whistleblowers

My son and I recently saw the Oscar-winning documentary “Citizen Four” about NSA contractor and leaker Edward Snowden. It’s a riveting film, because it not only covers the topic of unwarranted government surveillance, but it was made in ‘real time,’ as Laura Poitras, the filmmaker, was in Hong Kong filming Snowden and reporter Glenn Greenwald as the first stories broke and Snowden’s identity became known.

Tuskegee-syphilis-experiment-test-subjectsIt’s an interesting coincidence, then, to read the obituary of an almost-whistleblower by the name of Dr. Irwin Schatz. Schatz is remembered for writing a letter to the authors of a medical journal article in 1965 about the infamous “Tuskegee Syphilis Study,” in which black men in the South, primarily Alabama, were followed without treatment for decades to learn about the ‘natural history’ of untreated syphilis. The study was administered by the United States Public Health Service, and is widely remembered and taught as an egregious example of bad medical ethics. If the profession’s dictum is “First, do no harm,” the Tuskegee study caused irreparable harm by not treating an illness for which there was a surefire cure: penicillin.

The obituary contains all of Schatz’ three-line letter, which was sent to the study’s senior author:

“I am utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is available. I assume you feel that the information which is extracted from observation of this untreated group is worth their sacrifice. If this is the case, then I suggest the United States Public Health Service and those physicians associated with it in this study need to re-evaluate their moral judgments in this regard.”

Unfortunately, when his letter went unanswered, he did not persist. It took the whistleblowing of a Public Health Service investigator named Peter Buxtun to finally bring the study to a close in 1972. Unsurprisingly, it took Buxtun a number of tries to bring the unethical nature of the study to light. He first tried to go through official channels, as early as 1966, but was met with resistance on several occasions. It wasn’t until he leaked the information to a reporter at the Washington Star that the story received enough attention to stop the study. 

Snowden registered his concerns with his superiors, too, before ultimately deciding to go to the media because no one in the hierarchy seemed poised to question the status quo.

RIP: RH (1941-2010)

Death from a condition that makes even doctors tremble.

A scary way to die.

Veteran U.S. Diplomat Richard Holbrooke died this week of an aortic dissection.

The man considered largely responsible for the Dayton Peace Accords, which ended the war(s) in the former Yugoslavia, had an outsized personality in a world usually replete with protocol and bureaucracy (don’t let those wikileaks cables fool you).

One thing Holbrooke seldom gets credit for is the way he negotiated a settlement on the billions in dues owed by the U.S. to the United Nations when he was U.N ambassador during the Clinton Administration. Imagine having to convince 192 or so foreign governments to cut you some slack, one-by-one.

Sadly, his death was unexpected, and will leave incomplete what he probably hoped would be his biggest legacy: some type of lasting peace and stability in Afghanistan and Pakistan.

The news stories report he was meeting with Secretary of State Hillary Clinton when started to feel ill. The next thing we’re told is he was rushed to George Washington Hospital (very close to the State Department in Washington) and taken to a 20+ hour operation to repair the tear in his aorta.

Over the weekend we were told he was in “critical” condition, and by Monday his obituaries ran.

Think of the aorta as a huge muscular pipe that takes blood pumped from your heart and streams it to the rest of your body. That pipe is constructed in layers, the innermost of which is called the intima. For unknown reasons, that inner lining can sometimes tear away from the rest of the pipe, causing the blood to go haywire, clotting in the pipe, and causing there to be a significant diminution of blood going where it’s supposed to go. Imagine your legs going numb. Or your arms.

Our life-giving pipe.

The strange thing is, even though we think of the aorta as a pipe, it’s well innervated (connected to our nervous systems). So the tear is exceedingly painful–classically described as chest pain that radiates through to the back.

It’s a nightmare to diagnose, and as you can tell by the effort to save Holbrooke, a bloody mess to treat.

To diagnose it you first have to think of it. The test of choice is something called a CT angiogram, a specialized CT scan that looks at the blood vessels in the chest and/or abdomen. (Wait! Didn’t I just read something interesting about CT scans recently? Where was it?)

If you actually make the diagnosis of a big tear like Holbrooke had, it’s off to surgery. As fast as possible.

Though I wrote that we don’t truly understand what causes dissections, we do know some things that increase the risk: High blood pressure. Smoking. For some reason, being male. Atherosclerosis.

John Ritter is said to have died from a dissection. Famously, Dr. Michael DeBakey, the pioneering cardiovascular surgeon, suffered a dissection at age 97. He supposedly knew what was happening to him, and his young second wife, in spite of his protests, called paramedics and got him medical attention.  He managed to survive to age 99.

I can imagine the scene in the GW emergency room as Holbrooke “presented.” Utter chaos. The news accounts make the hospital look clean and efficient, as though there was no trouble diagnosing this horrible condition and rushing this famous diplomat off to a heroic life-saving operation.

Sadly, neither image jibes with reality.

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