Snapshot of the World—9/2007

1. USA 

As we left the USA on September 8, the presidential campaign had been underway for months with candidates from the left and right, Democrat and Republican, presenting their positions on subjects from Iraq to Healthcare. Both parties were deeply divided on dealing with these issues.

Also occurring as we left the USA, a poll on the public's feeling about the president and Congress was released. The president's performance approval rating was near a low of 29%, whereas Congressional approval was even lower, 11%; both the lowest in history [6]. The press ranked below both in another poll. So, everything was not perfect in the USA, a picture we would see in every country we visited. Everyone has their problems and many of the problems are the same.

So as we set out on our trip we would see these issues unfold in countries across the world: government control vs individual freedom to choose; terrorism; rising healthcare costs worldwide; the excesses of Socialism and the excesses of Capitalism; and greed.

2. Japan 

Our plane touched down in Japan for a stop. The Japanese economy has been recovering in the past years. In the last decade Japanese banks had poor lending policies based on personal favor and not on good financial credentials. This lending process led to problems in the economy and to its slow growth. Individual citizens did not want to buy goods because they felt safer saving their money. They did not trust the government policies. During our travels the Prime Minister of Japan, Shinzo Abe, resigned after a year in office because of corruption in his party and because of his desire to support the war against terrorism in Afghanistan, a position that is not popular in Japan [7], [31]. Yet, months earlier when North Korea was threatening Southeast Asia with its development of nuclear weapons, Japan looked to the USA and others for help, a curious double standard of behavior. The New York Times in September 2007 [8] reported that Japanese women, who manage the family finances in their culture, were speculating in the currency markets and in stocks to grow the family money. The “sub prime” crisis caused the stock markets to collapse worldwide. Many of these Japanese women lost their family savings. Yes, this experience in Japan was repeated in households around the world and in the USA. The costs of healthcare in Japan are rising as everywhere with no clear answers. The government has a major influence on healthcare in Japan.

3. China 

We next landed in China. Beijing, a city whose streets were clogged with bicycles 10 years ago, was now full of cars in heavy traffic. No bicycles were seen. The result of the booming Chinese economy built on the cheap labor of its 1 billion citizens made its low-cost goods attractive to consumers around the world. So as the Chinese made money, their affluence could be seen in the auto-filled roads and the new construction visible everywhere. Capitalism had penetrated Communism as each individual reached for his/her own success in life. As a result, workers in Europe, the USA, and other developed countries were losing their jobs as industries transferred their manufacturing to China. This was a scenario seen more than 2000 years ago as India dominated the world trade. Europeans at that time had a high demand for Indian cotton and dyed goods. India's production of cotton clothing commanded 25% of all world trade, putting people out of work in other countries as money flowed into India for its products—an example of Capitalism and Globalization in a world thousands of years ago [9]. So, the dominance of one economy in world trade is nothing new. But its effects on others cause real everyday problems elsewhere. Every country we visited was affected by the growth of the Chinese economy.

Yet, here in China, too, there were problems. A worldwide dissatisfaction with Chinese products such as contaminated dog food and toys painted with lead-based paints led companies and consumers to reject Chinese goods in September 2007 [10], [11], [12]. The Chinese government blamed the greedy companies for making this problem while the companies blamed the Chinese manufacturers' desire to save money by producing substandard products as the cause. The Chinese government demanded an apology from a major US toy company as the issue affected its trade worldwide. The company admitted it had overreacted, but the problem did exist [13]. The Occidental world and its culture was meeting the Oriental world and its culture.

The major rise in industry in China has led to pollution. A Global Warming Conference at the UN in September 2007 stated that China and the USA are the world's biggest polluters [14]. One Chinese company using cotton dyes for clothing reportedly discharged its dyes into the river near the plant polluting the water and exposing the people nearby to contamination. Companies worldwide whose goods were made in China, fearing a consumer backlash, sent teams to China to demand better environmental control [15]. For 2 days Beijing stopped car traffic as a test to reduce air pollution before the Olympics are held there in 2008; the experiment succeeded in reducing pollution. All of these issues confirm that as the country grows rapidly, it is not building the infrastructure to supervise its products or companies well. The Chinese government is working on all of these problems. The end result in the coming years will be higher prices for Chinese goods as higher wages for the Chinese worker and infrastructure costs raise the price of production of everything in China [16]. Inflation in every country in the world will result as prices for goods rise, according to a new book published during our trip by the former Chairman of the US Federal Reserve, Alan Greenspan [17]. In addition, newspapers in China reported a crackdown on corruption in government [18].

A Chinese doctor told the conference I attended that more hospitals had image-guided surgical systems and endoscopes than in the previous years, but that healthcare costs were rising rapidly. Are these investments in technology a good expenditure in a country struggling to provide healthcare to its people? This key question is true in the developed and developing worlds. One of the speakers at the conference was Tuncalp Ozgen, from Turkey, who is also president of his university and a neurosurgeon. He stated that the money we are spending for all this healthcare equipment is the peoples' money and must be spent responsibly. He believes that doctors should evaluate this technology before it gains widespread use to ensure that the technology has a value for its cost. Few seemed to be listening to his ideas but were more interested in getting the new technology to “be ahead of the others,” a problem seen in the USA and elsewhere. Doctors just do not care to understand the real political issues. “What, me go into politics?” one neurosurgeon said. Seventy percent (70%) of the population in China, mostly in the rural areas, do not have insurance to pay for care and thus are without healthcare. These are the same issues faced by countries rich or poor we saw around the world.

One young doctor we talked with invested his money in buying homes. He did not trust the Chinese stock market, which he believed was manipulated by the government. The people knew of reports of the banking system in China, which had loaned money to companies with little proof they were sound businesses. (Sound familiar?) Yet the stock market values were growing as those anxious to make money in and outside of China speculated on its economy. He said that many of his peers agreed with him and were skeptical of investing in the stock market. All he and his friends wanted was a chance to have the things in life they could not have because of government controls in the past, and the freedom to pursue the life they wanted. Individual freedom again is the key focus of a population long subjected to emperors, authoritarian leadership, and Communism. People want individual freedom and opportunity.

In Tianjin, a coastal manufacturing city 2 hours from Beijing with a population of 11 million people, where our conference was held, we could still see people on bicycles, but the enormous growth of the city over 10 years was obvious. Luxury apartments were being built in downtown Tianjin. A newly created economic development area was rising in an area of the city, formerly just vacant fields, and was now a booming area for international corporations. Yet, even with all of this growth, the people were courteous and respectful of each other, typical of the cultures of Asia but becoming uncommon in the developed world where people have become more concerned with themselves than others. Is the greed of Capitalism reaching all levels of society and behavior?

4. Paris, France 

The day we arrived in France from China, the new Prime Minister and others in the government proclaimed that, “France was bankrupt.” It could no longer afford all the social welfare programs of the past. The government had a deficit for each of the last 25 years, and this situation, they stated, was unsustainable. Later times for retirement and longer working hours were being proposed to a population now accustomed to “entitlements” by the government [19], [20], [28]. Although the powerful unions were set to oppose any changes, the people generally agreed that change was necessary according to reports in the newspapers. Socialism in France has failed.

French doctors in the past have protested low pay and governmental controls in a system of socialized medicine [21]. When a hospital runs out of its allocated money, the people cannot get care.

We passed by the home of former Prime Minister Jacques Chirac, who is now being pursued in the courts for corruption charges relating to the time when he was Mayor of Paris before he became immune to prosecution as Prime Minister [22]. As George Orwell wrote in his book, Animal Farm, which is a satire on Socialism, “All pigs are equal but some are more equal than others” [23]. This fundamental flaw in governments' leaders who give themselves special privileges others cannot have is one of the basic flaws of Socialism, Monarchies, and dictatorships, and, yes, democracies, too. We read or saw about this corruption in Japan, China, France, England, and yes also in the USA as politicians get more powerful.

5. Other countries in Europe 

6. Iran and Islam 

On the day before we left England for home, President Ahmadinejad of Iran addressed the UN General Assembly in New York and spoke at Columbia University. There he quoted from the Qur'an as he spoke and interpreted how Muhammad had encouraged teaching, scholarship, and investigation. He praised academic freedom but stated that “only a pure scholar and researcher, free from wrong ideologies, superstitions, selfishness, and material trappings can discover the reality.” (Who determines what person's beliefs are wrong ideologies and what is that reality?) He went on to say, “Science and wisdom can be misused, a misuse caused by selfishness, corruption, material desires and material interests…Corrupted independent human beings resist acceptance of reality, even if they do accept it, they do not obey it…Scientists and scholars are misused for personal, group, or party interests…Ruling powers are misusing many scholars and scientists in different fields, with the purpose of stripping nations of their wealth…” [32]. These statements are more of the same rhetoric. Who makes all these judgments? Certainly not the individual but most certainly a few in power in the government. This is how an authoritarian government operates, dictating what should be done to others. Unfortunately, President Ahmadinejad wants people in all countries to adopt this system of values, behavior, and government based on a very strict interpretation of the Qur'an. Yet, how can one justify the killing of innocent people, the abuse of women, the use of children for sacrifice, the arming of terrorists worldwide that occurs in Iran? That is his interpretation of the Qur'an, and he can justify any action from it as indicated above. Those are not the principles of freedom and governments established by the Magna Carta in England in 1215 and the Declaration of Independence in the USA in 1776 [33].

7. Islamic history 

Islam began with Muhammad in the 600s and grew to one of the great civilizations of the world in the next 1300 years making many excellent contributions in art, science, and scholarship that have benefited civilizations all over the world. In the history of Islam, separate sects have quarreled and fought wars with each other for the right to be the caliphate, or leaders of the Muslim world. In the 1700s a very orthodox sect arose in what is now Saudi Arabia to promote a return to the true values of Muhammad. This is the Wahhabi sect established in the Kingdom of Saudi Arabia, which has supported this literal interpretation of the Qur'an for the last 300 plus years. It is from this sect that Osama Bin Laden arose. This literal interpretation of the Qur'an is the basis of the beliefs of Ahmadinejad and his associates.

But the world of today is not the world of 600 AD [34]. It is now 1400 years later. We have gone through cultural, social, artistic, and scientific revolutions during that time. There are new changes occurring every day. We live in a world of differing viewpoints, as I mentioned at the beginning. We are different; no one person is better than the other. We have different cultures and beliefs. There must be room for all to exist, for no one group of people or their culture is better than the other. That is the problem today when one culture plans to exterminate another. In today's world when we have the power of ultimate destruction of humanity, we need to find solutions to this coexistence.

8. Myanmar (Burma) 

As our plane traveled through the air to land in the USA, 100000 people, mostly monks, peacefully marched in the streets of Myanmar, formerly Burma, to protest the rule of the military junta that has ruled the country since 1962 [36], [37]. This regime has been repressive, denying free speech and the results of free elections. Protestors were shot during this recent march.

9. Conclusion 

What we saw and heard in 18 days is a microcosm of the evolution of human civilization. From the repressive government of Myanmar, to the fundamentalist policies of Iran, to the liberalization of freedoms in China from communism, to the socialist and capitalistic democracies of Europe and the USA, it is obvious that the individual is the best person to decide his/her future. As Will and Ariel Durant have described in their book, The Lessons of History, dictatorships, monarchies, socialistic, and democratic governments have all survived at periods in history and have been successful in providing for the people [35]. I used to say that democracy is unstoppable, but I have seen that any form of government including democracy can be corrupted. We found corruption every place we went from the USA to China, Japan, Europe, and England. The Durants state that corruption has been present throughout the history of humankind and is probably less now than in previous centuries [35]. We saw greed everywhere, which has gone on for centuries. Yet, what is unstoppable is the desire for people to be free and to decide what they want to do with their own lives. We heard this from the young Chinese, and it is obviously the desire of the European and American civilizations in modern times. We have heard this desire for freedom and opportunity in small gatherings of government officials and successful professionals in Egypt and have seen it in the middle and lower classes in South America. We have heard it in Russia and in Romania, both part of the Communist empire in the 20th century.

The Durants said in their book, “Democracy is the most difficult of all governments as it requires the widest spread of intelligence.” They state, “Democracy has done less harm, and more good than any other form of government…If equality of educational opportunity can be established, democracy will be real and justified…If our economy of freedom fails to distribute wealth as ably as it has created it, the road to dictatorship will be open to any man who can persuasively promise security to all…” [35].

10. The message for physicians 

So, what is the meaning of all of this to physicians and neurosurgeons? In the late 19th and early 20th century, physicians in various parts of the world, including Harvey Cushing as a neurosurgeon, actively defined the role of medicine and its practice as a profession and politically by establishing its principles. These were true leaders in our civilizations. But now, in all the countries we visited including the USA, physicians have become passive, only reacting to the changes in medicine thrust upon them by governments. As typified by the Dutch and as is true in all other countries we have visited over the years, many physicians do not realize that they have options in directing healthcare politically so that the people benefit the most. This has been the commitment of physicians from the beginning of time, devotion to the patient. Although this is a high ideal, one must face the reality of limited finances in various societies rich and poor, the lack of responsibility of the public for their individual health, particularly if it is under government control, entitlements, and other factors. As Tuncalp Ozgen stated, doctors have a responsibility to society and cannot live in the vacuum of the operating room. We must be aware of the forces on all of society. Yet, to vacate our responsibility to politicians to determine the healthcare of a nation is in fact a violation of our commitment to our patients—to care for their health.

This commitment can be done individually as some doctors have done in many countries of the world by participating in the political process, or by groups of doctors uniting for this purpose either with or without their medical societies. Yes, just as we plan and approach a patient's medical problem, the political issues can be diagnosed and treated properly by doctors who are skilled at dealing with all kinds of problems every day.

The Durants say that history records “the exceptional because it is interesting.” But there are millions of people who are living good lives and doing good things every day and their deeds go unnoticed among the exceptional events that grab the attention of the media [35]. Doctors need to be among those people who make a more visible contribution to society because that is the only way we can preserve the purity of the profession of medicine for our patients. There may not be one answer for all cultures, but the question is “Can we make it better?” From everything we saw and heard, the answer is “Yes.”