The
background for this report has been the Editor's personal life
experience.
In the medical arena this began in 1952 when, as a
undergraduate at Johns Hopkins University in Baltimore, Maryland the
Editor
started working during summers as an operating room
orderly and then a operating room scrub technician. In medical school he worked as a blood bank
and laboratory technician. By the time he became a physician he had
gained a valuable appreciation of hospitals and how they functioned. During his 1960 Fellowship year at
Johns Hopkins Hospital he
worked nights and weekends as a Emergency Room physician at the Union
Memorial Hospital in Baltimore. The many hours on-duty during surgical
internship at Yale Medical
Center and subsequent residency training in
neurosurgery at Johns Hopkins Hospital made being a military neurosurgeon
seem almost easy in comparison.
After
teaching clinical neurosurgery at Johns Hopkins Hospital and Temple University Health Sciences Center in Philadelphia the Editor founded the
Department of Neuroaugmentive Surgery at the Sister Kenny Institute in
Minneapolis with the assistance of Earl Bakken (founder of Medtronic) and Drs. Loren Leslie
(then Director of the Sister Kenny Institute)
and Charles Ray (who had been an assistant professor of neurosurgery
at Johns Hopkins).
The
purpose of this innovative facility was to utilize the new
discipline of implanted
electronic devices designed to "augment" function of the nervous system as part of
the rehabilitation of patients with problems not otherwise amenable to
treatment. Because the most effective neuroaugmentive devices,
at that time, turned out to be the spinal cord neurostimulators for
relief of intractable pain the neuroaugmentive group had many "failed back surgery"
patients referred to the facility.
This experience provided
important insight in regard to why some patients were worse after
surgery than before. The related research in regard to this issue
demonstrated that failure to adequately diagnose, or treat,
lateral spinal stenosis
was the most common reason for surgical failure.
This
experience, and additional related research, led to efforts to develop better diagnostic and therapeutic
measures needed to decreased the incidence of failed back surgery
cases as well as providing insight as to how preventive
care and subsequent health
maintenance programs could could be used, in many situations, to avoid the need
for surgery in the first place.
This focus on spine care led to the creation, of the Low
Back Clinic of the Sister Kenny Institute, the Institute for Low Back
Care (Minneapolis), and the present
Center for Restorative
Spine Surgery located in St. Paul in 2003.
In 1972 the Editor was a member of a United States Biomedical
Instrumentation delegation to the Soviet Union led by Dr. Joseph
Saunders. This experience was quite and eye opener. The
Russians worked hard to keep American delegations busy, comfortable,
and uninquiring. Because the editor's brother-in-law was the
resident United Press International correspondent in Moscow the group
was provided with unusual insight and opportunity to explore the
Soviet Medical system. "Informed Consent", as we
know it simply did not exist. Specialty care was device poor but
theoretically advanced. Basic care, although less sophisticated
than that in the United States, was more readily available.
During the 1970's the Editor was a representative of organized
neurosurgery in the drug and device areas. This involved the
writing of standards and it wasn't unusual for standards groups to
create rules which "were smarter than they were."
Being in Washington at the genesis of medical device legislation the
editor experienced firsthand the real world of politics and how things
really happen. In
providing testimony to the Congress of the United States government
the editor observed a prominent consumer advocate providing false
testimony. When this was later brought to his attention in
private he acknowledged that he had lied but retorted: "but I made the point
didn't I?." These experiences were real eye openers.
Other
"eye openers" have been the government's political agendas.
The editor, as the chairman of Food and Drug Administration medical device panel
observed the process by which experienced and knowledgeable consultants were
removed from serving on FDA panels because of potential or real
conflicts of interest. Rather than protecting the public interest
by the application of "sunshine"
principles, these true experts were often replaced by politically "correct",
but inexperienced
minorities for the apparent purpose of maintaining a "balance."
Unfortunately, such choices reflecting an expediency dictated by the
wrong motives deprived the public of important guidance in
the areas under consideration. Effective means of keeping experts
as consultants while at the same time negating their potential
conflicts of interest were not utilized.
As a member and chairman of local and national ethics
committees the Editor became aware that it was not a popular deed to bring up
discussions as to what was in the patient's best interest rather than
those of the physician or hospital. Minnesota physicians
have been well-known in the past for placing their patients best interests at the
forefront in the physician-patient relationship based on
Charles Mayo’s (1865-1939) dictum that: “The patient’s best interest
should come first”.
Unfortunately this is not always
the case.
Few medical professionals
today evidence an awareness of what ethics
are, or the reasons as to why they are important in today's practice
of health care. Those who have
appeared to understand ethics frequently suffer from memory lapses
when they are confronted by self-interest. Medical ethics is
often an afterthought in the medical community. This clearly
needs to be continually readdressed.
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