What is the truth?

1. Introduction 

In the 15 years that I have been editor of Surgical Neurology, my wife and I have been privileged to be invited to more than 50 countries on every continent to attend your meetings and to be in your homes. We have discussed our views openly and learned about our respective cultures so that we understand each other's challenges better. Many of you from more than 60 countries have studied with my colleagues and me in Detroit, Chicago, and now in Los Angeles at the University of California. As an independent publication and not part of organizational neurosurgery, we have always been free to express our views on many subjects, regardless of who is involved. What is said in Surgical Neurology's pages reflects the views of neurosurgeons all over the world.

We are human beings first, physicians second, and neurosurgeons last. Surgical Neurology has not just presented science, because to be a good physician, we need to be fine human beings first and then fine physicians before we are neurosurgeons. We serve people all over the world and must have a view and understanding that represents the people we serve.

In the last year, many events have occurred in the socioeconomic and political spectrum, particularly in the United States, which have an overwhelming impact on our lives as human beings, as physicians, and as neurosurgeons. These events affect the patients we see and the positions we take. We all want to practice medicine, but we cannot ignore what is happening politically, socially, or economically, because all of these factors affect the practice of medicine.

This editorial expresses my concerns about what I see happening to us and the public from misinformation that we receive from the press and our governments, about the real facts regarding health care in the United States, and the motives of the media, the politicians, and the political leadership that are having a huge impact on the practice of medicine. From my point of view, having been exposed to medicine for more than 60 years, beginning with my father, I see this period in our history as the most dangerous since World War II for physicians and for citizens everywhere. Based on the comments I have received from other neurosurgeons, these events are happening all over the world. This is an editorial about “What is the truth?” and what you can do about what is happening.

2. The public 

In June of 2008, I was in Morocco for the African Neurosurgical Conference. At an evening speaker's dinner attended by mostly neurosurgeons from the Middle East and some from Europe, the conversation turned to the US presidential election race. Although most of the Middle Eastern representatives voiced their dislike for President Bush, they were very complimentary about candidate Obama. I asked them many questions about where they obtained their information about the US election. They said from CNN. Like many around the world, their views of the United States and other countries are shaped by the news that they read and see. I told them that the average American's views were not reflected by either the media or the movies and television shows they see. Yet, they were adamant in telling me what people in America believed because they were convinced of what they had heard by the media. I told them that the candidate Obama had the most liberal voting record of any in the US Senate and that his beliefs were socialistic, as was his background. They did not accept these facts but were persuaded by his eloquence and the media's support of him. I asked them if they believed what they read in their newspapers. There was silence followed by agreement that they did not believe what was in their newspapers either. Why then do they believe what they read and hear from the media in the United States? These were intelligent physicians. Yet, they accepted what they were told without question. They did not use their own judgment in coming to a conclusion about what they were being told and what they saw. There is evidence I will present below that indicates the press in the United States is biased in its reporting.

When a patient comes to us complaining of pain, do we unquestioningly believe their story, or do we ask why they are complaining of pain? Is there another problem that the patient is really coming to ask us, but is not saying? Where is the scientific judgment that we were trained to use? Do you believe everything that you are told and read? What is the truth? How do you find out what is the truth?

3. Health care in the United States: what are the facts? 

For the past 6 months, I have received letters from readers of Surgical Neurology in response to some editorials I wrote regarding health care. The following words are taken from letters I received from 3 neurosurgeons around the world about their perceptions of health care in the United States:

“… in my opinion, the European system (like the Canadian system) is more just than their United States counterpart. We do not have 50 million uninsured, and who knows how many millions of underinsured. Often, becoming ill in the United States can become a tragedy for poor people.”

or

“I would like to highlight that when a patient enters the neurosurgical department, no money is asked for, no credit card demanded, he is treated in the best possible way and WILL PAY NOTHING!!!…. Seeing assistance refused to one in need because his financial system does not permit him is disgusting … our system could be improved if it abandoned its profound and hidden Communist origins: ‘everyone is the same.’ I am convinced that it is correct to accept the rule that patients are all the same, but that's not necessarily what the medical staff are [sic] ….”

or

“We are definitely very concerned about the US system and its lack of equality for patients!!! Socialism has nothing to do with our system—it is a socially based system! We cannot accept having un-insured citizens. We have seen disasters from Europeans caught in the US health care system once in a while.”

It is obvious to me that these 3 people do not understand the truth about health care in the United States. These are the facts.

4. Freedom of the press 

The First Amendment to the US Constitution states the following:

“Congress shall make no law respecting an establishment of religion, or prohibiting free exercise thereof; or abridging freedom of speech, or of the press, or of the right of the people to peaceably assemble, and to petition the Government for a redress of grievances ….”

The press has freedom, but it also has a responsibility to report the truth. Does it report the truth in the United States or in your country?

In the United States, a Harvard study found what many prior studies revealed: that there is a distinct left-wing bias of the media, with its journalists voting 7:1 democratic, and with news stories having a distinct left bias [7].

From the time of the election of George Bush, there was incessant criticism of him and his policies in the press, but virtually none is heard today of Obama. Why?

Most of the media has not reported the facts about health care in the United States, so the public does not learn the truth from this source; as such, it is not hard to understand why the doctors at the meeting in Morocco or the comments from neurosurgeons quoted above were misinformed. Many newspapers in the United States are experiencing falling circulations, are in debt, or have closed because of a lack of readership and advertising (Project for excellence in journalism, “The State of the News Media 2007; http://www.stateofthemedia.org/2007/narrative_newspapers_intro.asp?media=3). Even the New York Times is on the verge of bankruptcy. Why? Younger people are using the Internet to get their information. Commercial television network news is suffering a decline in viewership, whereas Cable news outlets are rising in their appeal to the people. FOX News, which states that it presents a more “balanced” point of view, has the highest cable news rating and viewership. Still, the other news outlets refuse to recognize the changing interests of the public and are losing viewers. That fact includes CNN. The public's trust of the press and politicians is at 20% to 23%, whereas physicians and nurses rank 67% to 79%, respectively, according to a Gallup Poll in 2004 (amednews.com, 1/3-10/05). What is the truth and why are we not getting it?

Andrew Keen in his book The Cult of the Amateur (Doubleday, 2007) writes about “the destructive impact of the digital revolution on our culture, economy, and values.” At the time he wrote his book, there were 53 million blogs, a number that doubled every 6 months. “These days, kids can't tell the difference between credible news by objective professional journalists and what they read on anyone's blog,” he writes. “The monkeys are taking over,” he says. “Say goodbye to today's experts …. In today's cult of the amateur, the monkeys are running the show.” He predicts that a new Web revolution will take place in which credible information will again be selected.

As more people use the Internet to obtain political and other information, the problem is how they can determine quality from the huge quantity of information they can access. What is the truth?

5. The politicians 

In the recent health care debate in the United States, President Obama has stated that everyone can maintain their own health insurance, whereas the first bill on health care to come from the House of Representatives states the opposite. Ultimately, the proposed legislation will result in total government control of health care. Yet, the press does not report these facts. The president did not tell the truth. Most of the media did not report those facts. Why?

There are other concerns the public has, which relate to the containment of costs resulting in rationing of care.

Senators and members of the House of Representatives have had “town hall” meetings with the people they represent, only to be challenged by questions the politicians cannot answer. So, to defend themselves from the criticisms of the people, the members of congress have described these citizens as “Nazis” or “mobs,” a disrespect and disdain for the people who elected them. In my opinion, there is arrogance in the elected officials who show that they basically do not serve their constituents but only themselves. In my 50 years as a voter in the United States, I have never seen such disregard of the public by its elected officials. The officials are saying that they know and can decide what the public needs. Why? Where did this arrogance, this disrespect for the public come from? What is the truth and why are the politicians afraid of it?

6. The rest of the world 

In the last few months, we have all read about the suppression of freedom of the press in China, Russia, Iran, Venezuela, and other countries. Where are the objections from the rest of the world?

When Salaman Rushdie wrote his The Satanic Verses, exposing his critical views of Islam, he was targeted for death by Ayatollah Khomeini, who became Iran's Supreme Leader in 1979. Khomeini targeted free speech everywhere. Rushdie's book was banned in a number of countries and even in the United States by some booksellers because of concerns for their own security, if the book was sold. The radical Islamists have managed to intimidate other countries and people in different parts of the world. What happened to freedom of speech? Translators of Rushdie's book were killed or injured. Pim Fortuyn was murdered in Holland for his criticism of Islam in 2002, as was Theo van Gogh in 2004 for the same reason [6]. What has happened to freedom of speech? Why isn't everyone standing up to defend freedom of speech? What happened to freedom of the press in China in the recent Tiananmen Square celebrations, in Venezuela in the curtailment of the press, in Russia with suppression of dissent, and in other countries with the same policies? Where is the outrage? What is the truth?

7. Conclusion 

In 1776, the founding leaders of the United States declared their independence from the dominance and repression of Great Britain and stated this:

“We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness—That to secure these Rights, Governments are instituted among Men, deriving their just Powers from the Consent of the Governed, that whenever any Form of Government becomes destructive to these Ends, it is the Right of the People to alter or to abolish it, and to institute a new Government, laying its Foundation on such Principles, and organizing its Powers in such Form, as to them shall seem most likely to effect their Safety and Happiness ….”

What we are seeing in the United States is a corruption and violation of the principles on which the country was founded. We see a president who has espoused government control over the people instead of ensuring that the government protects the rights of the people. The president has nationalized the automobile industry and the banking industry and now wants to assert government control over the health care of each individual by controlling the care that is given, even to the point of making end-of-life decisions for each person. These are socialistic ideas. We witness a congress that has developed contempt for the public, believing that its members have more knowledge to make each person's decisions than the individual. We see a press and media that have abdicated their positions of responsibility to probe for the truth as representatives of the people. We do not know the reasons why this change has occurred. We see a press that believes it is more intelligent than the people, an elitism, in which the elitists believe they are superior to the people. We see the truth being denied to advance the causes of those in power, particularly in the health care debate. We see a fundamental corruption of the principle established by the Declaration of Independence that the people must decide what is best for themselves. The Democrat Party wants a system in which the decisions are made by an elite few on the basis that the issues are too complicated for the people to understand. Not only do we witness these changes happening in the United States for the first time in its 400-year history, but we also see this complacency to the attacks on the basic principles of life affecting the citizens of Europe, some countries in South America, and in Asia. In some countries, dictatorship is ruling the lives of people, whereas others in the free world sit by in denial making excuses not to act for their fellow man. What happened to those in socialistic dominated governments who espouse concern for all? How does that logic even make sense, given their inaction?

This, to me, is the most dangerous time I have seen in the world in my 71 years, besides World War II. The fundamental problem is the corruption of the morals and the lack of devotion to principle by people everywhere. This is not a threat from outside, but a corruption of the values and morality inside each individual. In the end, the people who will suffer the most are the common men and women who have no power or influence. These are the people who suffered the most throughout history, and again will be the victims of this greed of power, and desire for control by the few. Common men and women are the people whose dreams for individual liberty will be crushed in the name of “doing what is best for all,” a promise that does best for some but not for all. “All pigs are equal, but some are more equal than others,” said George Orwell in his book Animal Farm, published in 1945 as a satire on communism.

Over many months, I have reported on the failures of socialized medicine all over the world in an attempt to give Surgical Neurology's readers the facts. My fundamental argument with socialized medicine is that it violates a basic principle of medicine written in these pages many times. The most important principle in medicine is, “the patient comes first.” The patient is the most important goal in medicine. That principle does not say the politicians come first, the hospital comes first, or that the doctor comes first. It says, “the patient comes first.” That is the principle to which we are and must be dedicated. That does not include rationing of care, waiting for care in pain, dying while waiting, government-dictated care, or denying care to the infirm or disabled. Yes, I agree that everyone in the world does not have access to the finest in health care, but we must do the best we can to give the people, wherever they may live, the very best that is available for their health. That is all that can be asked.

In the United States, we have a wonderful system of health care with which most are satisfied. We can make it better, but not by destroying what we have.

For physicians, this societal change toward socialized medicine we now see in the United States represents a fundamental corruption of the profession of medicine. Many of these changes have already happened in countries in Europe and have been accepted by the people there, who believe they are getting the best health care, when the evidence says otherwise. They can have better health care. So can those everywhere. Have we surrendered to the politicians? Where are those who will stand up for principle? Or has the desire for self-satisfaction prevailed over the principle of liberty for all?

How much are we willing to sacrifice for principle? Are we willing to give our lives for principle, as have others? Think about it. Individual freedom is a principle that everyone must fight to preserve constantly, because the sinister forces of evil, greed, and power seek to take it from each person. It is a principle that cannot be taken for granted. Some may not believe that the threat is a concern. I disagree. The time to stop a wrong is when it first appears, or else it will grow like a cancer. That is my personal belief.

I close with a quotation from 1938 that I have used before:

“In Germany … when the Nazis came for the Jews, I didn't speak up because I wasn't a Jew. Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist. Then they came for the Catholics, and I didn't speak up because I was a Protestant. Finally, they came for me, but there was no one left to speak.” Martin Niemoeller, Lutheran pastor who was sent to Dachau Concentration Camp in 1938.

What is the Truth?

May your God bless you and guide you to do what is right, always.