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Surgical Neurology 71 (2009) 263–265www.surgicalneurology-online.com

Editorial

“If you do not take control of your life, someone else will”B

On a recent trip to Italy to attend a meeting of the ItalianNeurosurgical Society, I talked in detail with 2 neurosur-geons about the practice of medicine and neurosurgeryin Italy.

The first neurosurgeon mentioned to me that allneurosurgeons are paid by the government and paid exactlythe same wage. As a result, he said that there was noincentive for anyone to work harder than the next. Even theresidents do not read because it will not matter to theirincome. He had a personal satisfaction that led him to workhard and treat many patients, yet neurosurgeons nearby didonly 20% of the cases he did with the same pay. This lack ofincentive, he said, is the result of a socialistic governmentand society. “Meritocracy,” or being rewarded for what youachieve, as he believes, exists in the United States, but doesnot exist in Italy, or for that matter, most of Europe and therest of the world. “Egalitarianism” he said (socialism, byanother name, in which everyone is treated and awarded thesame), does not work. That is the system in Italy.

I asked a second neurosurgeon why neurosurgeons anddoctors do not organize or band together to get power. Iwas told an endless series of excuses, such as, “I am tiredwhen I get home from work,” “I do not have the time,” “Itwill not make a difference,” and so on. I asked him if hedid nothing what would happen in the next 5 or 10 years,and he agreed that the situation for medicine and doctorswould get worse—yet, he was totally defeated, as are mostdoctors around the world. They have been defeated bypoliticians and governments against whom and which theythink they have no power.

Doctors have power. There is no one else who can providemedical care, and if doctors find the things common to all—which are important to them as a group—such as: (1) betterpay, (2) less control of their medical decisions, and (3)improvement in the quality of medicine for the public (andthey agree on these things), then they could band togetherand would have power.

B The views and opinions expressed in this editorial are those of theEditor-in-Chief, and the views expressed herein are not necessarily those ofthe Publisher.

0090-3019/$ – see front matter © 2009 Elsevier Inc. All rights reserved.doi:10.1016/j.surneu.2008.11.006

I found the same attitude at the meeting of FLANC, theLatin American Federation of Neurosurgical Societies, heldin Bogotá, Columbia, in October 2008. The neurosurgeonswith whom I talked all agreed that the above issues are theones that are of concern to them, but they are leaderless indealing with them, except for Brazilian neurosurgeons,whom I have described before as being the best organizedand the most effective in dealing with their government.However, few are asking the Brazilians how they havesucceeded.

The recent election of Illinois Senator Barack Obama,who will has now succeeded President George Bush inthe United States, and the recent presidential electionpolitics have striking parallels to the situation of doctorsand medicine worldwide.

From the day Bush became president 8 years ago, therehas been daily and incessant criticism of him and his policiesby the press and the left. Amazingly, he is blamed foreverything that people believe is wrong. He has become thescapegoat for everyone and every nation's problems. If thissame attitude were used against blacks, or any other group,there would be huge criticism that the perpetrators wereprejudice. Yet, that sort of rationale escapes those every-where who criticize the president.

The press and others bombard the public with poorlysubstantiated information, criticizing the Bush administra-tion about issues that the public accepts without proof orexamination. The criticisms include, the worldwideeconomic disaster; the falsification of information aboutthe reasons for invading Iraq and persisting there; theinability of the coalition forces to defeat the terrorists; thestatements by the Bush administration that Medicare andSocial Security will go bankrupt; the high price ofgasoline; the poor status of the United States around theworld; the failure of Middle East negotiations; the responseto Hurricane Katrina; and any other problems that haveoccurred. I have heard these criticisms echoed byneurosurgeons and others in Africa, South America, andEurope; and President Bush, himself, did little to counterthese criticisms.

Actually, none of these accusations are true if one takesthe time to examine the facts behind each. The war in Iraq is

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being won; the terrorists are being defeated and are leavingfor Afghanistan, Africa, and other countries to cause troublein those places; and the Medicare and Social Securitysystems will be bankrupt by 2017 and 2041, respectively,according to government reports.

The failure of both political parties to act for the past 30years has made the United States dependent on others forenergy—offshore drilling and the use of clean coal have beendiscouraged. In addition to the negative influence of theenvironmentalists, all these criticisms have cost the UStaxpayer a 4-fold increase in the price of gasoline anddependency on the monarchies and dictatorships that rungovernments still stuck in the Middle Ages. Yet, most in theworld do not agree with US policies. So what? And no leaderanywhere in the world has had much of an impact on thepersistent state of warfare against Israel in the Middle East.As far as Hurricane Katrina is concerned, yes, there wasgovernment ineptitude, but the graft and corruption inLouisiana that led to the misuse of federal taxpayer dollarsallocated for the building of protective walls to prevent riverflooding was also a principal cause of the disaster. Little isever said about the latter point. Why? Because scapegoatcriticism is easier.

How did all this misinformation occur? People all overthe world are surprised when I tell them the facts. Theyhave never heard that before, they say. Why? Because thepress has given the public biased information that few havebothered to verify. A recent study by the Pew ResearchCenter, Washington, DC, in the United States (Investor'sBusiness Daily; November 12, 2008; “Uncommon knowl-edge”), found that most of the information produced by thepress in the United States is leftist in tone and content. Ihave asked people all over the world if they believe whatthey read in their newspapers, and they uniformly say,“No.” One Italian lady asked me for evidence that the warin Iraq is being won. I cited news that is available in anynewspaper in the world to the discerning reader. The terroracts have dropped sharply; the factions in the governmenthave united to defeat the terrorists, as in Anbar Province;more oil is being produced than during the SaddamHussein regime; the country has its own army that isassuming control of more of the country each day; and thegovernment is making decisions that parallel a democracy—a far distance from life under Hussein. Yet, this Italianwoman was under the belief that nothing was happening.Why? What information is she and others getting from thenews media? Who is telling people the facts?

What does all of this have to do with doctors andmedicine worldwide? The public has been brainwashedeverywhere that the quality of medicine provided byphysicians is bad, the costs are high, and that the onlysolution is for the government to control medicine and thedoctors. Then, everyone can have health care and the costwill be less or free—all of which is totally false. In theUnited States, doctors are accused daily—via the press—ofabandoning the health care of the poor, that 15% (45 million)

of the people in the United States do not have healthinsurance, that the infant mortality in the United States ishigher than many countries in the world (Investor's BusinessDaily;March 30, 2007), and that our health care is not asgood as other countries. The US automobile companiesblame their failure on the high costs they pay for health care.Newspapers and a government organization, the Institute ofMedicine, state that doctors cause almost 100000 deathsfrom medical errors in hospitals each year (JAMA;284:93-95, 2000). Doctors, worldwide, must really be bad is whatthe public is led to believe.

All of the above claims are also false, but not evendoctors critically examine what is told to the public andbelieve what is said. They and the public accept what thepress and politicians say without doubt. Yet, doctors do notdo this with a scientific article, and besides, doctors do notrespond to these criticisms anywhere I have been in theworld. Why not? Maybe the reason is that they are asdefeated as the Italian neurosurgeon or neurosurgeons Ihave talked with all over the world. The misinformation istoo great for them to challenge. For example, it does noteven make any sense that the United States is ranked 39thin infant mortality in the world. Even if all the developednations in the world were better, that number is less than15, and it is impossible to believe that the United States isbehind 24 developing countries. In addition, infantmortality statistics are reported differently in countriesaround the world, and infant mortality is defineddifferently in many countries. Even the World HealthOrganization states that this difference in reporting is thecase. So, we are seeing a comparison of incomparablestatistics that are reported in the newspapers that everyoneimmediately accepts. Why?

Physicians have a Bush problem: they say nothing intheir defense. By doing so, their opponents claim victoryin the eyes of the public. Former President Bush's greatestflaw is that he is not a good communicator, whereasPresident Obama is a superb communicator, but what hesays is not substantiated either. The press did not pursuehis superficial promises and statements either, and in othercases, did not publish what they thought would be criticalof him. All of the evidence from his background, votingrecord, and statements support that he is a socialist. Yet, noone wants to use that word. Only time will tell whatObama's record will be. I even spoke to a group ofneurosurgeons about the health care positions of bothcandidates, but some in the audience were reluctant toaccept the truth about either candidate. Their minds weremade up emotionally; the facts did not matter.

So, this is a public relations problem that doctors haveworldwide. They and their medical societies believe they arepowerless to deal with this problem. They are defeated likethe Italian neurosurgeon, along with neurosurgeons anddoctors worldwide.

Think of this idea: in the United States, as is true inall other countries, the public (our patients) visits doctors

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throughout any given year, and in the United States, by arough calculation, there are 1 billion visits from thepublic to doctors each year, which means that eachpatient is being seen many times by doctors; patients havegreat faith in doctors. Do doctors, worldwide, take a fewminutes to explain to their patients what is going on inhealth care and what their opinion is so that the public(their patients) should know? It is simple to do andeffective. Doctors have the largest lobby or support groupin their countries: their patients, who are the public. There

are other steps that can be taken, but this is an idea tostart you thinking.

What is at stake is no less than our future, our careers, thepractice of medicine, and the quality of health care for thepublic. As I mentioned in my talk in Columbia, “If you donot take control of your life, some one else will.”

James I. Ausman, MD, PhD(Editor)

E-mail address: surgicalneurology@dc.rr.com