Granted, observers of the Garfield collection can view the three pieces of spine removed from the body of the James Garfield. They can evaluate the placement and path of the red plastic probe, which represents the pellet that pierced the body of the President. All while onlookers are asked reflect upon what was not known on July 2, 1881, the day Charles Julius Guiteau shot the late President. It is hoped that they realize that if the same occurred today, the President would have lived. According to a professor of surgery at the University of Medicine and Dentistry of New Jersey and a medical historian, Dr. Ira Rutkow, “Garfield had such a non-lethal wound. In today’s world, he would have gone home in a matter of two or three days.” I inquire, would he?
President Garfield, once hit by buckshot, lay on what was to become his deathbed for 80 long days. Doctors did little to help him; in truth, they harmed him. This does not surprise me. I have longed questioned the sanctity of medical science and surgery. I surmise, practices may not be safer now, than they were then. Still, I know nothing with certainty. I understand only what I observe, as do those strolling through the Garfield exhibit.
Spectators at this current showing, doctors and patients among these, marvel at how medicine and surgery have improved. Still, mishaps, those that occurred more than a century ago, and those that occur now do not amuse me. The numbers of persons that have been misdiagnosed or operated on in error causes me great dismay. The myth of miracles does not bring me solace or a sense of security. I rarely think surgical treatments are truly a cure. For me, the events surrounding Garfield’s death do little to ease my mind; they only affirm my sense of doubt.
As I contemplate my reservations, I ask you to consider these. Please compare and contrast the story of James A. Garfield with those you know of personally.
Assistant Curator of the National Museum of Health and Medicine, Dr. Lenore Barbian, spoke of the President’s passing. She stated, “No one expected Garfield to live through the night.” At least a dozen medical experts probed the president’s wound. They used their bare hands. Metal instruments were not sterilized. These practices were common at the time, at least in the States. Ultimately, sepsis set in, and after eighty long and difficult days, James A. Garfield passed.
It was not that sanitary practices and procedures did not exist. They did. These methods were in use and available in France, Germany, and other parts of Europe. It was only in America that these systems were not widely accepted. For me, this validates what I believe is typical in medicine, particularly in American medicine. Innovations are thought too avant gardé. They are considered untested, or untrue. Thus, they are not utilized. I think what was true than is truer now.
As I appraise the American Medical Association, the Food Drug Administration, and other health care commissions I am concerned. The influence of Pharmaceutical Corporations and the power they wield disturbs me. The deliverance of insurance is disquieting to say the least. Anxiety overtakes me as I assess the way medical decisions are made in this country.
I offer a few tales, sad, and true.
• Closed-Door Deal Makes $22 Billion Difference. GOP Negotiators Criticized for Change In Measure on HMOs, By Jonathan Weisman. Washington Post. Tuesday, January 24, 2006; Page A01
House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation that would save the health insurance industry $22 billion over the next decade, according to the nonpartisan Congressional Budget Office.While I might wish more money were spent on medical science, on prevention of illness, research, and development, I do appreciate the finer details of this story. Lobbyists loom large. Dollars doled out for preserving a flawed system benefit no one but the insurers. We, the citizens of this country, with thanks to the Grand Old Party negotiators will spend twenty-two billion dollars that perhaps, we need not spend. Apparently, the rates paid to Medicare may be out-of-balance; assessments may have been skewed.
The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.
Private insurers attract healthier seniors than the traditional government-run Medicare system, so their payment rates -- based on the elderly population as a whole -- exceed the actual cost of treatment.I think this next article speaks for itself. The echoing effects are quite loud.
• FDA’s Lobbying Questioned, By Brody Mullins. Published on Thursday, July 24, 2003 by Roll Call (Washington, DC)
In a rare lobbying campaign by a federal agency, the Food and Drug Administration has formed an unofficial alliance with the pharmaceutical industry to urge House Members to vote today against a bill that could flood the nation with cheap prescription drugs from Canada and overseas.I also wish to address the issue of a doctor in tow. U.S. Senate Majority Leader Bill Frist, M.D. has quite a record. This man is a doctor, the Senate Majority Leader, and a mogul. Dear reader, you might recall his expert testimony in the case of Terri Schiavo. This profoundly professional physician thought himself able to accurately diagnose a “patient” from afar. This good doctor is know as the Bad says Journalist Doug Ireland.
The FDA’s extraordinary moves to kill the bill — and the informal lobbying partnership between a federal regulator and the industry it oversees — has come under fire from several Members who support the legislation.
“What they did might not be illegal, but it certainly was untoward,” said Rep. Sherrod Brown (D-Ohio), whose office received a call from an FDA lobbyist. “In my 11 years, I’ve never seen anything like this.”
In the last week, Administrator Mark McClellan and other FDA officials have spoken with key Republicans and Democrats to highlight the agency’s opposition to a bill sponsored by Rep. Gil Gutknecht (R-Minn.) that would allow “reimportation” of less expensive drugs sold abroad.
Meanwhile, a pair of officials in the FDA’s Congressional affairs office spent last week calling key lawmakers in both parties to say, among other things, that the bill would cost the industry $2 billion a year because of new packaging to guard against counterfeits.
The FDA’s lobbying effort against the bill is the latest example of the close ties the Bush administration shares with the pharmaceutical industry, one of the biggest financial backers of President Bush and GOP leaders, who oppose the legislation.
• The Bad Doctor. Bill Frist’s long record of corporate vices, By Doug Ireland. LA Weekly. Thursday, January 9, 2003.
While TV gushed last week over the Republicans’ new Senate majority leader, Bill Frist, intervening in a traffic accident, portraying the former heart surgeon as a "Good Samaritan," in truth the GOP has simply replaced a racist with a corporate crook.Yes, there is much to assess as we study medical science, then and now. In science as in life, what is known seems to have greater credibility than what might be. A Food and Drug Administration, though corrupt is a known entity. A Pharmaceutical industry, that has its own best interests at heart, is better than no drug production at all. An endearing doctor that speaks well and looks good, even as he steals from Medicare and Medicaid, is far superior to a fumbling bumbling fool, or are these one in the same? I understand this. Humankind is comfortable with what they know; change is a challenge, one we as humans hardly ever accept.
Frist was born rich, and got richer — thanks to massive criminal fraud by the family business. The basis of the Frist family fortune is HCA Inc. (Hospital Corporation of America), the largest for-profit hospital chain in the country, which was founded by Frist’s father and brother. And, just as Karl Rove was engineering the scuttling of Trent Lott and the elevation of Frist, the Bush Justice Department suddenly ended a near-decade long federal investigation into how HCA for years had defrauded Medicaid, Medicare and Tricare (the federal program that covers the military and their families), giving the greedy health-care behemoth’s executives a sweetheart settlement that kept them out of the can.
However, I wonder if what we think we comprehend is often not valid. We seek expertise; yet, I theorize, no one knows our body better than we. Each individual has an intimate knowledge of what is within, or they can know if they choose to be sensitive and informed. We want the wisdom of those that are trained to diagnose and treat illness and injury. Are they truly wise? “The number of people that doctors kill per day from medical malpractice is roughly equal to the amount of people that would die if every day, three jumbo jets crashed and killed everybody on board,” stated Dr. Welch.
Thus, again I wonder what James Garfield was thinking as he lie, awaiting his own demise. Did he know that he did not need to die, if only doctors would listen to him?
In mid-August, the doctors insisted that Garfield be fed rectally, and he received beef bouillon, egg yolks, milk, whiskey, and drops of opium in this manner. “They basically starved him to death,” said Dr. Rutkow, noting that the president lost over 100 pounds from July to September.
People, physicians included, work to be objective; they wish to cause no harm. Yet, this can truly be a challenge. Still, humans attempt to be impartial, to be helpful; they endeavor to learn from history. Hence, we have this display.
We review the findings and acknowledge Garfield was struck down during a time of transition in medical science. The doctors attending the President could not determine the location of the bullet and this became their primary concern. We understand that perhaps, this need distorted their perception. They were no longer able to look at the life and the man. They thought only of their diagnosis. They feared their own flaws and the possibility their failure. [This attitude is still true today. Consider doctors and their fear of malpractice and how their apprehension distorts their view of their patients.]
We can muse that in the 1860s, more than two-decades before the assault, British surgeon Joseph Lister established the “Sterile Technique.” We can accept that, twenty years later, this scientific method was frowned upon in America.
We know that historians agree; the massive infection that took the life of the President resulted from practices that were not germ-free. Nevertheless, due to negligence, the President, and his family suffered needlessly.
Call me old fashioned and you will not be the first; still, I do not necessarily trust doctors. A friend of mine, a physician, has long said that medical school is as a trade college. Diagnosis is the most difficult procedure. My acquaintance, the doctor, muses that a surgeon is as a mechanic. S/he must use the tools at his or her disposal to determine ailments. A distorted skeletal structure does little more than signal where an injury might be. The details are often obscured or invisible. Musculature gives clues to matters of concern; however, it does not direct a diagnostician to the specific source of pain.
Years ago, ignorance and an unwillingness to change may have hindered the Hippocratic oath. Diagnosis a weighty issue, as it is today. In 2006, lack of knowledge and a reluctance to adopt new practices still affect our medical systems. Passing up the dollar may be a more dire concern for many a doctor. Political affairs also cloud the clear minds of numerous physicians. Again, the patient suffers.
In modern times, “Do no harm,” is not the cry that comes from those in medicine. It is for this reason I wonder; would a patient in modern America be better off than President Garfield was. I think not.
I offer the following articles for your further review. These were not used within the body of this text; though, I think they are equally important. I believe an assessment of these might broaden our view of American medicine in the year 2006.
• Superfluous Medical Studies Called Into Question, By David Brown. Washington Post. Monday, January 2, 2006, Page A06
In medical research, nobody is convinced by a single experiment.
A finding has to be reproducible to be believable. Only if different scientists in different places do the same study and get the same outcomes can physicians have confidence the finding is actually true. Only then is it ready to be put into clinical practice.
Nevertheless, one of medicine's most overlooked problems is the fact that some questions keep being asked over and over. Repeated tests of the same diagnostic study or treatment are a waste -- of time and money, and of volunteers' trust and self-sacrifice. Unnecessary clinical trials may also cost lives.
All this is leading some experts to ask a new question: "What part of 'yes' don't doctors understand?"
• Former FDA Chief Joins Lobby Shop, By Marc Kaufman. Washington Post. Wednesday, February 8, 2006; Page A06
Former Food and Drug Administration commissioner Lester M. Crawford, whose sudden resignation last fall after less than three months in office remains a mystery, has joined a lobbying firm that specializes in food and drug issues.
Crawford is listed as "senior counsel" to the firm Policy Directions Inc. Among the companies and organizations listed as clients are Altria Group Inc. (formerly Philip Morris Companies), Merck & Co. Inc., the Pharmaceutical Research, and Manufacturers of America (PhRMA,) the Grocery Manufacturers of America, and the American Feed Industry Association. A spokesman for the firm said neither Crawford nor anyone else wished to discuss his appointment. When he resigned in September, Crawford said simply that it was time for someone else to lead the agency. Sens. Mike Enzi (R-Wyo.) and Edward M. Kennedy (D-Mass.) have asked the Department of Health and Human Services inspector general to look into whether Crawford resigned because of an undisclosed financial conflict of interest.
• Prescription for Power. Drug makers' lobbying army ensures their legislative dominance, By M. Asif Ismail.
Washington, April 28, 2005 — The deep-pocketed pharmaceutical and health products industry has lobbied on more than 1,400 congressional bills since 1998 and spent a whopping $612 million* during that period, a Center for Public Integrity review of lobbying records revealed. Drug companies and manufacturers of health products have used more professional lobbyists in the last six and a half years—almost 3,000—than any other organized interest, the analysis also found. In comparison, the insurance industry, second-largest in terms of spending, spent $543 million* in the same period and employed just over 2,000 lobbyists.
In recent years, the pharmaceutical industry has scored a series of legislative victories on Capitol Hill, which could potentially translate into tens of billions of dollars of additional revenue to drug companies annually. The federal government will buy drugs worth at least $40 billion from the companies every year once the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 goes into effect next year. In addition, critics have accused the industry of having undue influence over the Food and Drug Administration, the agency that regulates pharmaceutical interests.
Industry-watchers say the drug companies' recent successes in Congress and with the FDA show how effective their lobbying campaign is. "The [lobbying] money is very well-spent," said Dr. Jerry Avorn, author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs. "The fact that we are the only country in the industrialized world that does not have any provision for negotiating drug prices, the fact that we are spending far more per capita on drugs than any other country and the fact that when legislation is written it often seems to be exactly the kind of legislation that benefits the pharmaceutical industry [shows] they are getting their money's worth.”
According to information we have received, a statistical study of hospital deaths in the U.S. conducted at the University of Toronto revealed that pharmaceutical drugs kill more people every year than are killed in traffic accidents. The study is said to show that more than two million American hospitalized patients suffered a serious adverse drug reaction (ADR) within the 12-month period of the study and, of these, over 100,000 died as a result. The researchers found that over 75 per cent of these ADRs were dose-dependent, which suggests they were due to the inherent toxicity of the drugs rather than to allergic reactions.
• FDA Advisers Tied To Industry, By Dennis Cauchon
More than half of the experts hired to advise the government on the safety and effectiveness of medicine have financial relationships with the pharmaceutical companies that will be helped or hurt by their decisions, a USA TODAY study found.
These experts are hired to advise the Food and Drug Administration on which medicines should be approved for sale, what the warning labels should say and how studies of drugs should be designed.
The experts are supposed to be independent, but USA TODAY found that 54% of the time, they have a direct financial interest in the drug or topic they are asked to evaluate. These conflicts include helping a pharmaceutical company develop a medicine, then serving on an FDA advisory committee that judges the drug.
Please Review the Rays. They may not be X-Rays; however, they may reveal much.
• A President Felled by an Assassin and 1880’s Medical Care, By Amada Schaffer. New York Times. July 25, 2006
• James A. Garfield The White House
• Trial of Guiteau
• Charles Guiteau Collection Georgetown University Library Special Collections
• Medical Errors - A Leading Cause of Death By Dr Barbara Starfield, MD, MPH. Johns Hopkins School of Hygiene and Public Health
• A Gruesome Stroll Through Medical History, By Harriet Baskas. NPR (National Public Radio)
• Rest in Pieces, Some of Washingon's Museums Display a Visceral Feel for History, By Peter Carlson. Washington Post. Tuesday, January 24, 2006
• Washington Post Examines Unnecessary Clinical Trials. Medical News. January 4, 2006
• The Bad Doctor, Bill Frist’s long record of corporate vices. LA Weekly Thursday, January 9, 2003
• Superfluous Medical Studies Called Into Question, By David Brown. Washington Post Monday, January 2, 2006
• Washington Post Examines Unnecessary Clinical Trials. January 4, 2006
• Closed-Door Deal Makes $22 Billion Difference, GOP Negotiators Criticized for Change In Measure on HMOs, By Jonathan Weisman. Washington Post Tuesday, January 24, 2006
• A Glossary of Medical Fraud, By L.J. Davis. Mother Jones.March/April 1995 Issue
• Doctors Kill More People Than Guns and Traffic Accidents Combined, By Don Harkins. The Idaho Observer. April 1999
• American Medical Association
• Food Drug Administration
• National Museum of Health and Medicine
• Dr. Lenore Barbian
• Dr. Ira Rutkow
• Drug Lobby Second to None, How the pharmaceutical industry gets its way in Washington. By M. Asif Ismail. The Center for Public Integrity.
• Hippocratic Oath -- Classical Version Public Broadcasting Service (PBS)
• Prescription for Power, Drug makers' lobbying army ensures their legislative dominance, By M. Asif Ismail. Lobby Watch. The Center for Public Integrity.
• Avoiding Medical Mishaps Dr. Don Berwick, president of the Institute for Healthcare Improvement. Trustees of Boston University and WBUR. Story aired: Wednesday, June 14, 2006
• Prescription Drugs - Leading Killer in USA Cancer Cure Foundation
• FDA Advisers Tied To Industry, By Dennis Cauchon. USA Today. Monday, September 25, 2000
• Former FDA Chief Joins Lobby Shop, By Marc Kaufman. Washington Post Wednesday, February 8, 2006
• FDA named "Fraud and Drug Administration" by consumer health advocacy group, By Mike Adams. NewsTarget Network. Thursday, November 18, 2004