As a student of medical systems the Editor has had the firsthand opportunity of surveying the Russian medical system, particularly biomedical instrumentation in the Soviet Union. The Soviet system medical establishment possessed limited technologic advancement. It made up for this by importing and by “reverse engineering” medical devices. The limitations limitations were, however, made up for by other strengths, particularly in the field of theoretics*. The most dramatic departure from American medical practice was the absence of informed consent, as we know it, prior to surgery. Informed consent appeared to be essentially non-existent for the average patient in the Soviet Union.
Fedor Serbinenko– pioneer in the development of intra-vascular catheters designed to occlude brain aneurysms and arterio-venous malformations. He was the “father” of modern neuro-vascular catheter coiling.
Pytor Ufimtsev– whose publication “Method of Edge Waves in the Physical Theory of Diffraction” was ignored in Russia but served as the basis for the development of “stealth” airplane technology in the United States.
The credo of communism has always been that the workers of the world needed to unite to create a society where all were equal. For many who had suffered previous oppression and persecution this appeared to be an attractive alternative. Many altruistic individuals were attracted to the communist movement because of this. A case in point were the many Americans who joined the Lincoln Brigade during the Spanish Civil War.
Were that it could have been possible for all of the well intentioned to have had a firsthand opportunity to see communism at work before they jumped in. The power of propaganda can be great. For those not brainwashed it was evident that one form of subjugation had been only replaced by another brutal regime.
The personal and medical privileges accorded to the upper echelons of the Communist Party were unconscionable compared to what was afforded to other Soviet citizens. In the 1970s all of the cardiac pacemakers implanted in Russia were manufactured in Hungary. The only exception to this were those provided to members of the Supreme Soviet who traveled to Paris to have Medtronic pacemakers (manufactured in Minneapolis, Minnesota) provided to them because of their significantly higher safety and efficacy.
The only obtainable luxuries were sold in stores (berioskas) which catered only to foreigners and communist party officials. Only foreign currency was accepted at berioskas. The average Russian citizen was not even allowed to enter a berioska (and also not allowed to possess foreign currency). How long would something like this have lasted in the United States? Not very long.
Our concept of informed consent was not in evidence. In making hospital rounds patients were simply told they were having surgery with little discussion of the nature of the procedure or the risks involved.To have experienced the Soviet system makes one circumspect regarding any political system professing equality and fair treatment for all. To what degree do they deliver and to what extent do they deviate from their charge? To what extent does the public view these actions with a critical eye and to what extent do they protest transgressions? Vigilance and appropriate action are the responsibility of those who consider their freedom of thought and action to be important and wish to maintain it.
Alexander Lifson, (1940-1999) was one of the leading young neurosurgeons at the N. N. Burdenko Institute in Moscow before coming to the United States in 1978. His understanding and insights into the Soviet health care system have served as an important frame of reference for many of his colleagues who have attempted to better understand the process of health care so that better conclusions could be drawn for a better future.