March, 2012

Heal to the Chief

By Michael J. Katin, MD

The 2012 Presidential Campaign in the United States is starting to accelerate, with the big news in January and February having been the success of Ron Paul in the Minnesota, Nevada, Missouri, and Maine primaries and caucuses This represents the most progress any physician has had seeking this office since Howard Dean III in 2004. It may be appropriate to address what happens when a medical professional achieves high political office.

This very column touched on this issue previously . At that time, reference was made to Howard Dean III, Governor of Vermont and then Presidential candidate, to William Frist , Senator from Tennessee and Senate Majority Leader, and Bashar al-Assad, President of Syria. Dr. Frist is out of competitive politics and active in health-related activities, being on the board of the Aegis Sciences Corporation , URS Corporation , and the Clinton-Bush Haiti Fund , and Senior Fellow of the Bipartisan Policy Center (FACS, FBPC?). Dr. Dean is chairman emeritus of the Democratic National Committee, and Dr. al-Assad remains the immensely popular president of the Syrian Arab Republic .

Currently there are twenty physicians in the United States Congress, including three in the Senate, sixteen in the House of Representatives, and one non-voting delegate, Dr. Donna Christensen, from the U. S. Virgin Islands , an emergency medicine specialist. It is interesting to note the breakdown of specialties. All three senators are Republicans, including one orthopedist, one ophthalmologist, and one family practitioner, although the general practitioner, Senator Coburn of Oklahoma, includes obstetrics in his field and reportedly has delivered over 4,000 babies. Of the sixteen House members, fifteen are Republicans, and, of these, there are four obstetrician-gynecologists, two cardiothoracic surgeons, one ophthalmologist, one general surgeon, one anesthesiogist, and one anesthesiologist, in addition to one gastroenterologist, one emergency medicine specialist, and three family medicine specialists. The only Representative from the Democratic Party is Jim McDermott of Washington, who is a psychiatrist; no commentary will be directed regarding this.

It may be appropriate that most of the physicians who have run for Congress come from specialties in which problems are identified, addressed, and resolved. This would certainly apply to the surgical specialties, In addition, the two ophthalmologists, Nan Hayworth and Rand Paul, may have particular insight to focus on the true nature of problems and correcting them (sorry --too obvious). Emergency medicine practitioners have to make urgent life-and-death decisions, and even though gastroenterology is an Internal Medicine subspecialty, it is strongly procedure-oriented. Only with family medicine and, particularly, psychiatry, can problems be dealt with on a gradual basis and results may not be seen for months or even years . Unfortunately, problems such as the National Debt, border security, entitlement reform, and energy dependence are being addressed by our government as if it doesn't matter if anything is corrected within the next decade. .

What king of track record is there for physicians as chief executives? Dr. al-Assad's achievements speak for themselves. "Papa Doc," Francois Duvalier , was, in fact, a physician who made the transition from graduate work at the University of Michigan to become President for Life of Haiti. In contrast, his son, "Baby Doc," Jean-Claude Duvalier, is not a medical professional; instead, he followed the path of many children of physicians by studying law but, not as typically, became President of Haiti at age 19. The list also includes Sun Yat-Sen, first President of the Republic of China, Antonio Neto , first President of Angola, Salvador Allende, late president of Chile, Arnulfo Arias, President of Panama (distinguished by having been President three times and deposed by military coups all three times) Hastings Kamuzu Banda , first President of Malawi, and Michelle Bachelet, president of Chile from 2006 to 2010. This does not include physicians who had high political profiles without actually being heads of state, such as Che Guevara who studied medicine at the University of Buenos Aires, George Habash, founder of the Popular Front for the Liberation of Palestine, and Ayman al-Zawahiri (whose sister is a Professor of Medical Oncology), who is both a surgeon and the current head of al-Qaeda.

Why have radiation oncologists not sought positions in government? We may have the appropriate specialty to address social and economic dilemmas. Every day we have to assess problems, work out complicated plans, and then carry them out in collaboration with other highly-trained personnel and using sophisticated equipment. We may not get rapid feedback on all our results but we usually will know within one to two years if treatment was successful. We have to accommodate patients' economic and social issues, as well as their other medical problems. We work with other approaches, such as surgery and chemotherapy, and try to make all parties satisfied while coming up with a program for the good of the patient. Would not this combination of skills be able to work for the good of the citizen as well? In fact, a radiation oncologist recently served as President of his country. This was Tabare Vazquez, President of Uruguay from 2005 to 2010. In addition to being a practicing radiation oncologist, he was mayor of Montevideo prior to running for President, which he achieved on his third attempt. During his presidency he continued to go to a hospital-based practice once a week while trying to bring together diverse factions in his country, elected as a Socialist but heading a coalition termed the Broad Front. From all reports, he did an excellent job, including measures to reduce the incidence of cancer (including banning smoking in all indoor public spaces).

How would President Vazquez match up against President Obama?
President Vazquez President Obama
Elected as a Socialist, left his party Elected as a Democrat
Against smoking indoors Against smoking medical marijuana in California
$100 million program to help the poor $500 million program to help Solyndra
Brought political factions together Uses unilateral executive actions
Annual economic growth 6.5% Annual economic growth 2.5%
Works with IMRT Can't work with IMF
0 wars 3 wars
Has programs to produce more food Has programs to produce more food stamps
Unemployment 6.1% Unemployment 8.3%
Volunteers in medical clinic weekly Fore!

What prospects do we have in the United States? The only radiation oncologist in Congress has been Parker Griffith , who won election in 2008 in the 5th District in Alabama, defeating a physicist! Elected as a Democrat, he switched to the Republican Party but was defeated in the primary election in 2010. He is again running for that seat. Even if he does not start to move up the political ladder, thanks to the internet and other social media (with the help of our IT specialists) it could still be possible to launch a grassroots campaign to propel one of our own into the White House. We can look forward to the State of the Union Address, retitled National Grand Rounds, when the sergeant-at-arms announces , "Mister Speaker, the President of the United States, FACRO!"