1. Sledge, George W. Jr. MD

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Lately I've been reading stories about traitors. I don't mean traitors in the political sense, those who sell out their country for money or ideology or some other vague motive. I must admit they don't interest me very much; they seem relics of the Cold War or some other half-forgotten conflict. The traitors I see popping up everywhere are traitors to their profession.

GEORGE W. SLEDGE JR.... - Click to enlarge in new windowGEORGE W. SLEDGE JR., MD. GEORGE W. SLEDGE JR., MD, is Professor of Medicine and Chief of the Division of Oncology at Stanford University.His

We all make mistakes. To say "nobody's perfect" is to not say very much. If a civil engineer miscalculates stress loads and a building or a bridge collapses, he may not be a very good engineer, or may be a pretty good engineer who had one horrible day. But it is likely he is horrified by what has occurred.


Physicians make mistakes regularly, simply because of the sheer volume of data they confront and the innumerable decisions they must make on a daily basis, decisions made on inadequate data and our imperfect understanding of human biology. Others often catch these mistakes before they can cause real harm ("others" usually being nurses, without whom the health care system would be a deadly shambles).


These errors may be acts of sloppiness or miscalculation or just having a bad day, but they are not treason to the profession. They need fixing, but rarely affect the moral essence of a profession, its ethical raison d'etre.


Nor am I talking about the evil men and women do that is divorced from their profession. Being a professional-in any profession-does not prevent one from committing drug abuse, or rape, or murder, or cheating on one's spouse, or being an embezzler. As wrong as these are, as horrid as they may make someone, they are still at some remove from one's profession.


Something Darker

What I am talking about is something else, something darker.


Take this story from my local paper: three serving California Highway Patrol officers and three retired officers as well as a defense lawyer were arrested and charged in the murder of a young man they suspected of stealing valuable antiques. The lawyer was the mastermind of the conspiracy, and the police officers either participated in the murder or its cover-up. The attorney wanted to "send a message," according to the story.


Or take the staff and officers of the American Psychological Association. A 542-page report, commissioned by the organization, recently concluded that the APA had worked with the U.S. Government to enable the torture of detainees. The APA has announced the departure of most of its staff leadership, including its CEO and (I kid thee not) its ethics director. The APA task force worked with the Pentagon and the CIA, its goal being to "curry favor" with the U.S. Defense Department, according to the report.


Several years ago I read about Robert Courtney, a Kansas City pharmacist who diluted chemotherapeutic agents, giving patients suboptimal doses of their prescribed agents (Taxol and Gemzar, according to the paper). The purpose was financial; Courtney was said to be worth more than $10 million.


Or, if you want to get much closer to home, consider the tale of Dr. Farid Fata of Detroit. Fata, a medical oncologist, was convicted last month of administering chemotherapy to patients who did not, in fact, have cancer. He agreed with prosecutors that as many as 553 patients might have been victims of his scheme. He was sentenced to 45 years in prison for Medicare fraud.


Speaking to the court, according to the Detroit News, Fata said "I stand before you ashamed of my all went wrong. I cannot bring back the past. My quest for power is self-destructive... They came to me seeking compassion and care...I failed them."


The paper also interviewed several of his victims, who as a group did not think 45 years (in essence, a life sentence) nearly enough punishment. One, a retired auto plant supervisor, walks with a cane related to chemotherapy-induced peripheral neuropathy. "I've got to live with this the rest of my life. He'll probably live longer than me."


Treasonous Behavior

What all these case have in common is the treasonous behavior of those who committed the acts described. What do police do? They maintain law and order. What do lawyers do? They serve society's goal of justice. What do psychologists do? They heal troubled minds. What do pharmacists do? They guarantee the purity of our drug supplies. What do oncologists do? They provide compassionate and appropriate care to cancer patients.


The cops and the lawyer who murdered the young man in California betrayed the foundations of their profession, betrayed the very concept of law and justice. The APA officials who, perhaps out of a misguided sense of patriotism, helped the CIA torture their fellow human beings, betrayed not only their profession but also the very Enlightenment values that serve as the basis for their profession. The oncologist who gave chemotherapy to someone who didn't have cancer so that he could bilk the government was so far away from "first, do no harm" that one cannot even think of him as a physician.


Fata was turned in by a colleague and by his business manager. The colleague saw a patient of Fata's who didn't have cancer but received chemotherapy and was concerned that this might just have been the tip of the iceberg. Instead of ignoring it, he contacted their business manager, who contacted the FBI.


The Detroit News quotes the colleague (Dr. Soe Maunglay) as saying "It is very difficult to process and it is overwhelming at the same time. It was very, very disappointing to see not even an oncologist, a human being doing this type of ...tortuous activity. So I was questioning my faith in humanity, as everybody would have." Dr. Maunglay is a member of ASCO, and I thank him for standing up for his profession, and for humanity.


Khalid al-Assad

Finally, you may have read about Khalid al-Assad. Mr. Assad was the retired chief of antiquities at Palmyra, in Syria. Syria is currently in the throes of horrors we can barely even imagine: a brutal civil war, made worse by the emergence of the Islamic State (ISIS), an organization that thinks nothing of beheading civilized men. One of the people beheaded was my son's high school classmate, who had devoted his life to helping Syrian refugees.


Khalid Al-Kassid had given his life to finding and protecting glories of ancient Palmyra, a civilization on the far eastern edge of the Roman Empire. In addition to murdering the innocent, ISIS believes in destroying "idolatrous" antiquities, or looting and selling them if they are not to be blown up. Al-Kassid had, news reports say, hidden some of the irreplaceable legacies of this past civilization.


The ISIS thugs interrogated the 82-year-old for a month in the belief that he would reveal where Palmyra's treasures were hidden. I hate to think what he went through. When he continued to refuse his captor's demands he was beheaded, and his body tied to a pole on a city street.

Figure. Palmyra... - Click to enlarge in new windowFigure. Palmyra

It is easy to reduce professions to their technical components, as if ICD-10 codes equated to medicine. If cops are defined as people who ride around in patrol cars, and lawyers as people who file legal briefs, and pharmacists as people who fill prescriptions, and doctors as those who write them, and archeologists as people who dig up old things-in short, if one ignores the ethical component that makes a profession a profession-then in no time at all one finds oneself in a world made up of murderers and torturers and poisoners, with nothing to hold on to. A world where ISIS is the tragic norm.


Some men betray their profession, and some hold to their profession's moral compass and do not. Some of the latter pay a terrible price for their courage. Let us celebrate those who do not, and in the process maintain our civilization, or at least that part of it which is worth saving.