Missouri Medicine’s Social Contract With Humanity – What Happened?

Posted on | August 27, 2012 | 5 Comments

Mike Magee MD

Is it the duty of a medical association to speak out on behalf of patients and the public when confronted with bad science and bad medicine? What is Medicine’s social contract with humanity? This was the question addressed by Gary Pettett MD, a neonatologist and then president of the Missouri State Medical Association, in MSMA’s journal “Missouri Medicine” in 2011.(1) His comments are extremely relevant at this moment in time, coming on the heels of the remarks of Rep. Todd Akin (a member of the Congressional Committee on Science, Space and Technology) on “legitimate rape” last week.

I’ll come back to Dr. Pettett’s comments in a moment. First, let’s talk Missouri. Although the state represents only 1.9% of our nation’s population, it is over-wieghted in scientific clout and influence. In 2011, the state received 477 million in 1085 NIH grants. The state has nearly 900 biotechnology companies, institutes and research facilities. Six Missouri universities are categorized by the Carnegie Foundation as having “very high” or “high” research activity.(2).

Missouri has six medical schools that produce 2.7% of the nation’s medical graduates, and two of the largest state medical societies. The Missouri State Medical Association(MSMA) has 6500 doctor members and the Missouri Association of Osteopathic Physicians and Surgeons(MAOPS) has one of the largest osteopathic physician (D.O.) memberships in the country in part because osteopathic medicine was born in Kirksville, MO in 1874. Both state associations are overrepresented in membership to their national medical associations, the American Medical Association and the American Osteopathic Association.(3,4)

Approximately 50% of the medical students at Missouri medical schools are women and 2 of the 6 medical school deans are women – Margaret Wilson DO and Betty M. Drees MD. Bennita Stennis, head of Scientic Affairs at MSMA, is a woman. The immediate past president of the MAOPS, Victoria Damba DO, is a woman as is their current 1st Vice President C. Lee Parks.(3,4,5,6,7,8,9)

The Missouri State Medical Association last month celebrated the election of one of their own, David Barbe MD, as chair-elect of the AMA.(10) Current MSMA president, St. Louis ophthalmologist Steve Slocum MD has two stated goals for his tenure this year. First, he’d like to advocate for “fewer regulations and encumbrances which have negative impacts on the doctor-patient relationship.” Second, he’d like to “further establish the MSMA as the preferred source of medical information for the Missouri Congressional delegation.”(11)

If Dr. Slocum or any of the state’s medical school deans – Margaret Wilson DO (A. T. Still University Kirksville College of Osteopathic Medicine), Marc B. Hahn DO (University of Medicine and Biosciences College of Osteopathic Medicine Kansas City), Philip O. Alderson MD (St. Louis University School of Medicine), Robert J. Churchill MD (University of Missouri-Columbia School of Medicine), Betty M. Drees MD (University of Missouri–Kansas City School of Medicine), Larry J. Shapiro MD (Washington University School of Medicine) – had such discussions last week with state legislators to be certain they understood Rep. Todd Akin’s declarations on “legitimate rape” had no biologic standing, they must have occurred in private. If so, they were non-transparent, and provided no reassurance to either patients or to the public.

And that brings us back to the enlightened remarks of Missouri State Medical Association past-president, Gary Pettett, in his President’s Forum in Missouri Medicine in November, 2011. In reading his remarks, reflect on the fact that he is a neonatologist who has keynoted at the Midwest Center for Practical Bioethics(12). Did he consider speaking up publicly when he heard the words “legitimate rape” emerge from the mouth of a current member of the US Science, Space and Technology Committee and a candidate from Missouri for US Senate? We don’t know, but here are Dr. Pettett’s words in 2011 (1):

On advocacy: “Ernest et al have attempted to provide a more robust operational definition in the specific context of physician advocacy as ‘action by a physician to promote those social, economic, educational and political changes that ameliorate the suffering and threats to human health and well-being…’ ”

On activism: There is “the need for physicians to be aware and contribute to the improvement of the socioeconomic and political factors which adversely impact the health of their patients and those in their communities.”

On professionalism in medical associations: “Most physician organizations that promote ideals of professionalism have similar ethical obligations which they articulate in their Mission Statements. So, at least, at some fundamental level, it would appear that physicians have a basic moral obligation to engage in public activities that advocate for the health of their patients and fellow citizens.”

On leadership: “Taking a clear and very public role as health care advocates may be the best way for the medical profession to sustain it’s leadership role and to regain greater public trust that has arguably diminished over the past few decades.”

On the AMA: “The American Medical Association (AMA) has endorsed a similar policy to ‘advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being’ in its Declaration of Professional Responsibility: Medicine’s Social Contract With Humanity.”

What was the scorecard (based on standard Internet search and review of institutional website newsrooms) for Missouri Science and Medicine last week on its “Social Contract With Humanity” when a Senate candidate and member of the Congressional Committee on Science, Space, and Technology simultaneously debased American women and American Science?

Missouri State Medical Association – no comment
Missouri Association of Osteopathic Physicians and Surgeons – no comment
Dean, Saint Louis University School of Medicine – no comment
Dean, Washington University School of Medicine – no comment
Dean, Missouri University of Missouri–Kansas City School of Medicine – no comment
Dean, A. T. Still UniversityKirksville College of Osteopathic Medicine – no comment
Dean, University of Medicine and Biosciences College of Osteopathic Medicine Kansas City – no comment
Dean, MissouriUniversity of Missouri-Columbia School of Medicine – no comment.

Why? Perhaps part of the answer and responsibility lies with the performance of their parent organizations:

American Medical Association (and the American Medical News)- no comment/coverage
American Osteopathic Association – no comment
Association of American Medical Colleges (and their Council of Deans) – no comment.

I know that in the political thicket called health care there are competing interests, but I keep coming back to Dr. Pettett’s words on leadership: “Taking a clear and very public role as health care advocates may be the best way for the medical profession to sustain it’s leadership role and to regain greater public trust that has arguably diminished over the past few decades.” It’s got to be better than silence.

For Health Commentary, I’m Mike Magee.

References:
1. Pettett G. Obligation or Option? The Physician’s Role In Advocacy. Missouri Medicine. Presidents Forum. November 2011. 386-389. http://www.omagdigital.com/publication/?i=94489
2. National Institutes of Health and Missouri. http://www.faseb.org/Portals/0/PDFs/opa/MO.pdf
3. http://www.msma.org/mx/hm.asp?id=home
4. http://www.maops.org/
5. A. T. Still University Kirksville College of Osteopathic Medicine
http://www.atsu.edu/kcom/about/dean.htm
6. University of Medicine and BiosciencesCollege of Osteopathic Medicine Kansas City DO
http://www.kcumb.edu/NewsDetail.asp?id=121
7.Saint Louis University School of Medicine
https://www.slu.edu/medicine/school-of-medicine-administration
8. Missouri University of Missouri-Columbia School of Medicine
http://medicine.missouri.edu/about/dean-bio.php
9. Missouri University of Missouri–Kansas City School of Medicine
http://www.med.umkc.edu/about/deans_welcome.shtml
10. Washington University School of Medicine
http://medschool.wustl.edu/about/dean_welcome
11. Slocum S. MSMA’s 2012 – 2013 President. http://www.msma.org/mx/hm.asp?id=President
12. Pettett G. Medical Professionalism. What’s Trust (not Truth) Got To Do With It? November 10, 2009. Center For Practical Bioethics. http://practicalbioethics.tv/2009/11/10/Gary-Pettett/professionalism.html

Comments

5 Responses to “Missouri Medicine’s Social Contract With Humanity – What Happened?”

Molly Mettler
August 27th, 2012 @ 6:12 pm

I applaud your efforts to hold so many feet to the fire. Silence in the face of ignorance, whether it’s benign or malignant, is not an acceptable response. Missouri, speak up!
Richard Heimburger, M.D., FACS
August 27th, 2012 @ 7:26 pm

Dear Dr.Magee,
Thank you for your Health Commentary. I am also disappointed in the lack of response from the academic and political intelligencia in Missouri to Todd Akins’ rape remarks. I am a retired surgeon who has practiced in Missouri most of my professional life, though educated outside Missouri and very concerned about professionalism

I write in defense of Todd Akin, and am surprised that he has not explained his response but did offer an apology.
I believe that what is meant by a “legitimate rape” is one which is prosecuted, brought to trial by an appropriate court of justice and was convicted legally for rape.
I do not know how many have been tried and/or convicted in Missouri and have been unable to find out, but but I think in comparison to the number of abortions that there are not so many, in fact, probably are “rare.”

As far as the woman’s body being able to reject an unwanted pregnancy, I believe there are spontaneous abortions, bleeding, “threatened abortions”, and lost pregnancies through out the pregnancy, in fact when I go to the hospital I often see pregnant women being kept at bed rest in the hospital to avoid losing a much wanted fetus or child.

I hope that this is helpful. Please contact me if I can be of further help.

Yours truly,

Richard A. Heimburger, M.D., FACS
5407 Thornbrook Pkwy.
Columbia, Mo. 65203
(573) 445-3208
Mike Magee
August 28th, 2012 @ 7:58 am

Thanks, Molly, for this and all you have accomplished at Healthwise in advancing information therapy and advocating for informed and empowered health consumers. Mike
Jody Picone
August 28th, 2012 @ 1:54 pm

What I continue to struggle with is the entirety of his statements and the notion that women have control biologically of completing an abortion “shutting it down”. Both statements roled in one sentence are extremely concerning but people are not even talking more about the biological part of his statements. Is this the norm that people perceive about women’s health and women’s issues. What is happening in this country.
Mike Magee
August 28th, 2012 @ 3:06 pm

Thanks for your comment, Jody.

This is the latest in a long line of medical science misinformation targeting women. The words are the result of ignorance or worse. But responsibility must be shared by medical and science leaders from organizations, learning institutions and associations who choose to remain silent. In doing so, they remove an essential “check and balance” that our society relies on to protect us all.

Mike