Report: Shortage of 90,000 Doctors by 2025

Originally posted on Hoosier Econ:

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In a report prepared for the Association of American Medical Colleges a grim outlook was given concerning physician supply in the United States. Here is what was found:

Demand for physicians continues to grow faster than supply, leading to a projected shortfall of between 46,100 and 90,400 physicians by 2025.  The report can be read here. Much of the shortage will be from stronger demand of people getting on Obamacare.

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Where have you gone, Morris Fishbein? Our nation turns its lonely eyes to you.

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I count no man a Philosopher who hath not, be it before the court of his Conscience or at the assizes of his Intellect, accused himself of a scurrilous Invention, and stood condemned by his own Judgement a brazen Charlatan.’
      Robert Burton, The Anatomy of Melancholy (1621)

Morris Fishbein M.D. (July 22, 1889 – September 27, 1976) was the editor of the Journal of the American Medical Association (JAMA) from 1924 to 1950 and in 1961 became the founding Editor of Medical World News, a magazine for doctors. In 1970 he endowed the Morris Fishbein Center to encourage the study of the history of science and medicine.

Fishbein  was also notable for exposing quacks such as  John Romulus Brinkley, a physician (in the diploma-mill sense of the word–he paid $500 for diploma he purchased from the Eclectic Medical University of Kansas City, Missouri) who in 1917 pioneered the notion of the goat testicle “transplant” as treatment for erectile dysfunction. The procedure involved removing the testicles of young goats and sewing them to the abdominal walls and scrotal tissues of men without any attempt to connect either the nerves or blood vessels of the “grafted” tissues.

Clinically useless, Brinkley made a fortune over the next decade through his goat gonad rejuvenation procedure.  Although he never finished his degree at Bennett Medical College in Chicago (where he left after his third year) and often operated while inebriated, Brinkley became one of the most famous doctors in the United States.  He claimed that his procedure cured 27 ailments including emphysema, acne and obesity.   It didn’t cure or even impact any of them.    What planting goat parts into people did do was solely self-serving.  It lined  Brinkley’s pockets and fed his ego and in doing so killed a lot of patients.  His operation was often lethal.

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Dr. John, R. Brinkley

Throughout his career this phony surgical grifter found himself incessantly challenged by Quack-buster extraordinaire Dr. Morris Fishbein.  Relentless in his pursuit of exposing the fakery, fraud and pseudoscience of this charlatan and quack, he eventually succeeded.

I am well aware of the criticisms of Dr.Fishbein–many are valid, some are exaggerated and some are utter nonsense.  He was, after all, human.

That being said, however, in the final rendering  Dr. Morris Fishbein left the profession of medicine a better place for having been here.  The same cannot be said of Dr. John R. Brinkley.

Similarly, the same cannot be said of Dr. Henry Andrews Cotton, M.D.,  (1876 – May 1933) a psychiatrist and Medical Director of New Jersey State Hospital at Trenton who used the emerging medical theory of infection-based psychological disorders to pull patient’s teeth under the premise they were suspected of harboring infections.  If this failed he subsequently removed the tonsils, sinuses, testicles, ovaries, gallbladders, stomachs, spleens, and cervixes of his patients. If these maneuvers failed Cotton then went for the colon–with special emphasis on the right side of the hindgut, which, he declared, had particularly ”decadent tendencies.”

From 1907 to 1930 he killed hundreds of patients and maimed many more.  Cotton reported cure rates as high as 85%. His fame in the U.S. spread rapidly and it took decades before his alarmingly high post-operative death rate of over 30% (mostly from peritonitis) raised any red flags.

Illustration of a mouth with teeth removed from Cotton's book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

Illustration of a mouth with teeth removed from Cotton’s book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

The same can also not be said of  Dr, Walter Jackson Freeman II, M.D. (November 14, 1895 – May 31, 1972), a neurologist without surgical training who pioneered the ice-pick lobotomy in the U.S.. and performed nearly 3500 of them in 23 states.  Seeking a faster way to perform the procedure, Freeman adopted Amarro Fiamberti’s transorbital lobotomy and perfected it by using ice picks hammered into the frontal lobes through the back of each eye socket.   Without anesthesia he was able to do these procedures  quickly and outside the operating room.   And in doing so he popularized the lobotomy in the U.S..  I’ve seen the results of Freeman’s work.  During a workup of a patient who I was consulting on for dementia an MRI revealed bilateral atrophic genu of the corpus callosum.   The patient and his family initially denied any history of prior brain surgery or injury but on further questioning recalled having something done to him in college that left him with two black eyes.  He said he was suffering from depression over his final exams and this was done to him at the student medical clinic during the same time frame Freeman was traveling to college campuses in his lobotomobile offering his services.   Neither the patient nor his family realized he had had a lobotomy.  Many of Freeman’s victims were children as young as 12.

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Dr. Freeman and his “lobotomobile”

The Medical Follies

The following quotes are taken from The Medical Follies, by  Dr. Morris Fishbein. He writes:

“Folly in the singular is recorded as weakness of intellect, foolishness, imbecility, etc. But in the plural, whatever it may retain of the singular, it has taken upon itself a new glory. ‘The Follies,’ after two decades of association with the theater, have come to mean entertainment—a spectacle, bright, flashing, exotic, devoid of plot, nude of truth and easy to enjoy except by those to whom still adheres some early piety.

“The incompetent or unprincipled physician, licensed to practice medicine by a too complaisant State is the greatest menace to scientific medicine – as great a menace as all the cultists put together.”

“Now, scientific medicine offers no such system. It aims, by the utilization of all available knowledge, to determine the cause of disease, and then, by the use of all intelligent methods, to benefit and heal the disease. It does not promulgate any theory or principle to the exclusion of established facts. It does not say, for example, that all disease arises in the spine and all disease can be healed by manipulating the spine….”

“The great fallacy of all the ‘systems’ of disease and their healing lies in this ‘all or nothing’ policy. When that policy runs counter to demonstrable facts the result is invariably disaster.”

What do Brinkley, Cotton and Freeman all have in common?  They all gained public recognition and became rich from what they did, Scarcely anyone doubted them publicly in the medical profession,  and they all practiced unmitigated and unmolested murder for decades before any red flags were raised.  In all likelihood all three were also sociopaths.

In the final rendering  Dr. Morris Fishbein left the profession of medicine a better place for having been here.  Brinkley, Cotton and Freeman most assuredly did not.  Sociopaths seldom do.

Bent Science and Bad Medicine: The Medical Profession, Moral Entrepreneurship and Social Control

Disrupted Physician

IMG_9005The Medical Profession, Moral Entrepreneurship, and Social Control

Sociologist Stanley Cohen  used the term “”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.1  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.   Belief in the seriousness of the situation justifies intolerance and unfair treatment of the accused.   The evidentiary standard is lowered.

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil. 2

And according to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social…

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Oliver Wendell Holmes, the Massachusetts Medical Society, Tinsel Erudition and Pretended Science Redux

images-10As the oldest medical society in the United States the Massachusetts Medical Society can count some of the greatest minds in the history of American medicine as members.  My how far we have fallen.  This same author has previously unintelligibly compared the field of medicine to Barbra Streisand’s face and shamelessly and opportunistically blamed the Boston Marathon bombing on “marijuana withdrawal.”   
The sophomoric mnemonics are neither clever nor illuminating.  Unworthy of  Readers Digest circa 1957, this dumbing down of doctors needs to end.  The very soul and practice  of medicine is being castrated and lobotomized by the same dull and very very blunt instrument. 
How does one reconcile the fact that the very same medical society that publishes the New England Journal of Medicine is allowing this type of tripe and rabble to get past editorial review?  In 1969, through an act of the state legislature, the Massachusetts Medical Society updated its mission to read:
“The purposes of the Massachusetts Medical Society shall be to do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of citizens of the commonwealth.”
With a foundation and history built and based on of scholarship and critical thought we need to support the highest levels of science, fact, intelligence and reason.  Stupidity tries but it should not win.  Before the Boston Society for the Diffusion of Useful Knowledge in 1842, Dr. Oliver Wendell Holmes delivered two long lectures entitled “Homeopathy and Its Kindred Delusions.” He characterized one of its popular practitioners, Dr. Robert Wesselhoeft, as one of those:  
“Emperics [quacks], ignorant barbers, and men of that sort…who announce themselves ready to relinquish all the accumulated treasure of our art, to trifle with life upon the strength of these fantastic theories.” That “pretended science” as Holmes called it, was “a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and artful misrepresentation, too often mingled in practice…with heartless and shameless imposition.”
 And Holmes words are as apt and appropriate today as they were in  mid 19th Century Boston!   Probably more so.  It’s no different. No different at all.    Be it homeopathy or 1939 quack spirituality, quackery is quackery is quackery.  Silence is definitely not the answer.
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