Tag Archives: Thomas Jefferson

Christian Healthcare for Christian Nationalists

 

Christian Nationalism (CN):   The belief that the United States is, and always has been, a Christian nation.  An oxymoron in the context of the explicit language of the Bill of Rights and the Constitution.

CN Proponents:  Titans of  American Ignorance in all its anti-historical, anti-rationalist, anti-democratic glory.  Nationalism, as set forth in the Bill of Rights and the Constitution, does not permit the qualifier, “Christian.”  The phrase is quite literally non-sensical.

America’s Founding Fathers:   A group of educated gentlemen, some avowed Christians and others deists influenced by English and French freethinkers. Whatever their personal convictions, the Founders collectively established  a secular republic predicated on religious freedom and the separation of Church and State.  The documents they bequeathed to us and that continue to shape our national sense of self – the Declaration of Independence and the Constitution – do not establish a Christian nation.[i]

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It’s August 21, 1790, and George Washington sets pen to paper and writes a letter to the Hebrew Congregation of Newport, Rhode Island.  Following the state’s ratification of the Constitution, Washington congratulates the Newport congregants for joining a nation where “every one shall sit in safety under his own vine and fig-tree and there shall be none to make him afraid.”   And he continues: “For happily the Government of the United States gives to bigotry no sanction, to persecution no assistance, requires only that they who live under its protection should demean themselves as good citizens, in giving on all occasions their effectual support.”

Now it’s  June 7, 1797, and Washington’s successor, John Adams, adds his ringing endorsement to Congress’s unanimous ratification of the Treaty of Tripoli.  All the nation’s “citizens and inhabitants thereof”  are enjoined “faithfully to observe and fulfill the said Treaty and every clause and article thereof.”   Article 11 of the Treaty begins with this avowal: “the government of the United States of America is not in any sense founded on the Christian Religion.”  The Article in its entirety mitigates in no way at all the plain meaning of this statement.

And now on New Year’s Day, 1802, Thomas Jefferson composes a letter to the Danbury Baptist Association.  Here the  third president asserts, famously, that “the legitimate powers of the government reach actions only, & not opinions.”   It followed that Jefferson contemplate[d] with “sovereign reverence that act of the whole American people which declared that their legislature should ‘make no law respecting an establishment of religion, or prohibiting the free exercise thereof,’ thus building a wall of separation between Church & State.”[ii]

These words tell us how the first three American presidents understood the nation they helped create.  But more important than these words or any other words they wrote or spoke, is the document they and their colleagues signed in 1787 and bequeathed to future generations.  This charter of government, the Constitution of the United States, took effect on March 9, 1789 and has guided the nation these past 233 years.

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Christian Nationalism, code for an un-American Christian Nation-State, seeks to overthrow the Constitution, the founding document on which the American Republic is predicated.  The prospect of a Christian Nation that consigns the values, principles, and precepts of the Constitution to the dustbin of history is the stuff of nightmares.  Many nightmares.  What follows is a gloss on one of them:  What might well follow, indeed, what ought to follow, in the domain of healthcare after the CNs come to power:

  1.  Society’s commitment to public health would be overturned by the Supreme Court.  Jehovah’s Witnesses and Christian Scientists would be entitled, as a matter of law, to deprive their children of life-saving blood transfusions and tissue and organ transplants.  If you’re a Christian Scientist parent, for example, go ahead and let your children die, as they have in the past, from untreated diabetes (leading to diabetic ketoacidosis), bacterial meningitis, and pneumonia.  What American courts define as criminal neglect would be sanctioned – as long as it resulted from one or another variety of Christian belief.  A litmus test for membership in the Christian Nation could be repudiation of compulsory childhood vaccination, with parents who deny their children vaccination on religious grounds applauded for putting their children at risk, and sometimes sacrificing them, out of adherence to their version of a Christian Life.  Similarly, during times of pandemic, Christians who, as beneficiaries of Divine protection, chose to ignore quarantine directives from leftist health organizations like the CDC and WHO would  receive the blessing of the  State.  All such groups would be following in the footsteps of many contemporary Evangelicals.  As Covid-19 gripped the nation and the world, Evangelicals from California to Florida, courageous Christians all, refused to follow social distancing and stay-at-home guidelines; they continued to assemble for communal worship in churches and homes, placing themselves and their communities in peril.[iii]
  2. America’s long and inglorious tradition of discrimination in medical education would be rejuvenated on behalf of the Christian state.  Examples of exclusion by race, religion, and gender abound, and they can be drawn on to guide Christian Nationalists in any number of discriminatory practices for marginalizing the presence of non-Christians in American healthcare.  Consider only that by the mid-1930s, over 2,000 American medical students, 95% of whom were Jews, were driven to Europe to pursue medicine.  Seven years later, Charles Drew wrote a blistering letter to the editor of JAMA, protesting the AMA’s racially based exclusion of qualified black applicants whose state chapters refused them membership, thereby keeping them out of the national organization.  The American Nursing Association (ANA) was little better.  Founded in 1896, it  allowed qualified black nurses from states with racist state chapters direct admittance to the national organization only in 1950.  The Georgia chapter, incidentally, continued to exclude blacks until 1961, and retreated only after the ANA threated to expel it from the national organization.[iv]  And let us not forget quota systems, implemented to keep Jews out of both elite universities and medical schools after World War I.  After all, they were followed by the quota system implemented in the Immigration Acts of 1921 and 1924, a device to keep East European immigrants out of the country – a project no doubt congenial to Christian Nationalists.[v]
  3. Christian Healthcare would enjoin believing Christians to follow the dictates of conscience in deploying life-saving medications, procedures, and technologies on nonbelievers. EMTs and Medics, for example, would no longer be legally or professionally obligated to provide assistance to Jews, Muslims, Hindus, atheists, and other non-Christians. This will require a Constitutional amendment, since the Constitution makes no allowance for conscience as a ground for violating laws and lawfully implemented directives, as in the denial of life-saving medical interventions.  The First Amendment provides only for freedom of religion, understood as the freedom to practice the religion of one’s choice through voluntary affiliation with one or another House of Worship (or no House of Worship at all).
  4. It follows that Christian physicians, nurses, and other providers would be free, as practicing Christians, to provide services only to Christians. They might, at their conscience-driven discretion, avoid nonbelievers entirely or simply privilege the needs (as to medications, nourishment, and allocation of scarce resources) of Christians.  Self-evidently, Christian surgeons would be under no legal, professional, or moral obligation to operate on Jews, Muslims, Hindus, atheists, and other nonbelievers; nor would Christian anesthesiologists be required to administer anesthesia to them.  Professional codes of ethics would have to be revised (i.e., Christianized) accordingly.  In toto, under the auspices of a Christian nation, there would be a vast expansion of the “refusal laws” that individual states have passed to free hospitals, physicians, and nurses from any obligation to provide patients with abortions and other reproductive services, including contraceptives, genetic counseling, infertility treatment, STD and HIV testing, and treatment of victims of sexual assault.  Constitutional amendments would be required on this score as well, since such “laws of conscience,” whatever their religious moorings, have no legal, judicial, or moral status in the Constitution.
  5. Following the example of the National Blood Program of 1941, the blood bank set up to provide Caucasian-only blood to the American armed forces, all nationally sanctioned blood banks should be limited to Christian donors.[vi]  There is ample historical precedent regarding the sacrosanctity of Christian blood and blood products; witness the Italian residents of Bolzano who, newly absorbed into  Bavaria by Napoleon in 1807, launch an armed revolt against mandatory smallpox vaccination lest Protestantism be injected into their Christian veins. Over a century later, a Nazi military directive forbidding the transfusion of Jewish blood into the veins of German military personnel led to the death of countless war wounded.  America was little better in the collection, identification, and storage of  blood.  The Red Cross Blood Donor Program, after refusing the blood of black Americans for a year, began accepting it in January 1942.  But it continued to segregate blood by donor race until 1950; southern states like Arkansas and Louisiana held firm to segregated blood collection until the early 1970s.[vii]  These precedents will be seized on in the time of CN.  In the new America, the blood of nonbelievers could be collected by their respective agencies, and made available to hospitals and clinics amenable to receiving and storing impure blood for non-Christian patients. Institutions that continued to  permit cross-religious transfusions would require signed waivers from Christian patients willing to accept transfusions of non-Christian blood under exigent circumstances.  Such waivers could be incorporated into Living Wills.

Christian Healthcare is only one of the societal transformations that await the ascendancy of Christian Nationalism.  The anti-intellectual disemboweling of American public education, especially in the South, is already well under way; where will it end up when the white CNs assume control?  To those who espouse it, I say:  Congratulations.  You have destroyed the America envisioned by the Founding Fathers and enshrined in the Constitution and Bill of Rights.  You have replaced the wall of separation between Church and State with a wall of separation between Christian and non-Christian.  In so doing, you have laid the seedbed for one more religious theocracy, a Christian sibling to the virulently anti-democratic Muslim theocracies of the Middle East.

The American theocracy will reach its apotheosis over time.  But when the Christian Nationalists assume political control, there will be immediate changes.  The United States will all at once be a two-tier society stratified along religious lines.  It will not only be Jews who, failing to throw their votes to Christian leaders, will have to watch their backs.  Everyone who opposes Christian National hegemony will be at risk.  We will all have to, in the ex-president’s  subtle formulation, “watch it.”

What to call the new state?  Christian Nationalists may profitably analogize from the example of Saudi Arabia.  If we replace “Saudi” (i.e., the Kingdom of Saud) with the New Testament’s “Kingdom of God,” and let “New Jerusalem” stand  for it, we arrive at a suitable replacement for the United States of America.  Here, Christian Nationalists, is the nation of your dreams and our nightmares.  I give you  New Jerusamerica.

January 6, 2021

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[i] I am grateful to my friend and colleague of many decades, Professor Jeffrey Merrick, for his help in formulating my comments on the Founding Fathers, religion, and the founding of the American Republic.  Among recent books elaborating in scholarly detail these comments, see especially Steven K. Green, Inventing a Christian America:  The Myth of the Religious Founding (New York:  OUP, 2015).

[ii] Washington’s and Jefferson’s letters and Adams’ remarks to Congress are in the public domain and widely reproduced on the internet.

[iii] Ed Kilgore, “Many Evangelicals are Going to Church Despite Social-Distancing Guidelines,” New York Magazine, April 17, 2020  (https://nymag.com/intelligencer/2020/04/many-evangelicals-defying-guidelines-on-in-person-gatherings.html); Bianca Lopez, “Religious Resistance to Quarantine Has a Long History,”  (https://blog.smu.edu/opinions/2020/08/07/religious-resistance-to-quarantine-has-a-long-history).  “In numerous parts of the United States,”  Lopez writes, “certain stripes of Christianity and quarantine orders stand in direct opposition, resulting in deadly outcomes due to the COVID-19 pandemic.”

[iv] Edward C. Halperin, “The Jewish Problem in Medical Education, 1920-1955,” J. Hist. Med. & Allied Sci., 56:140-167, 2001, at 157-158; Patricia D’Antonio, American Nursing: A History of Knowledge, Authority, and the Meaning of Work (Baltimore: John Hopkins, 2010), 130.

[v] David Oshinsky, Bellevue:  Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital.  NY: Doubleday, 2016), 196-198; Ian Robert Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in The United States and Canada, 1880-1940 (Ithaca: Cornell University Press,1997), 224-227.

[vi] Charles E. Wynes, Charles Richard Drew: The Man and The Myth (Urbana: Univ. Illinois Press, 1988), 67; “Nazi Order Prohibiting Jewish Blood for Transfusions Causing Death of Many Soldiers,” JTA Daily News Bulletin, March 2, 1942 (https://www.jta.org/archive/nazi-order-prohibiting-jewish-blood-for-transfusions-causing-death-of-many-soldiers).  Note that I am not addressing Christian sects, like Jehovah’s Witnesses, whose members refuse blood transfusions altogether, only those that accept transfusions, but only of Christian blood.

[vii] Thomas A. Guglielmo, “Desegregating Blood:  A Civil Rights Struggle to Remember,” February 4, 2018 (https://www.pbs.org/newshour/science/desegregating-blood-a-civil-rights-struggle-to-remember).  For   lengthier consideration of blood and race in American history, see Spencer Love, One Blood:  The Death and Resurrection of Charles R. Drew (Chapel Hill:  Univ. North Carolina Press, 1996), 139-160.

Copyright © 2022 by Paul E. Stepansky.  All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

Anti-vaccinationism, American Style

Here is an irony:  America’s staggering production of generations of scientific brainpower coexists with the deep skepticism about science of many Americans.  Donald Trump, a prideful scientific illiterate, rode to power on the back of many others who, like him, were skeptical about science and especially the role of scientific experts in modern life.  He maintains their allegiance still.

Why does this surprise us?  Anti-intellectualism was burned into the national character early in American history.  Those skeptical of this claim should read Richard Hofstadter’s brilliant twin studies of the 1960s, Anti-Intellectualism in American Life and The Paranoid Trend in American Politics. From the beginning of the American Experiment, democracy was antithetical to so-called European “elitism,” and this ethos gained expression, inter alia, in antebellum medicine.  

The Founding Fathers, an intellectual elite in defense of democracy, were not part of the movement away from science.  When Benjamin Waterhouse introduced Edward Jenner’s smallpox vaccine to America in 1800, Washington, Adams, and Jefferson hailed it as the greatest discovery of modern medicine.  They appreciated the severity of smallpox, which had ravaged the Continental Army during the War of Independence.  Indeed, Washington was so desperate to rein in its decimation of his troops that, in 1777, he inoculated his entire army with pus from active smallpox lesions, knowing that the resulting infections would be milder and far less likely to cause fatalities than smallpox naturally contracted.  When Jefferson became president in 1801, he pledged to introduce the vaccine to the American public, because “it will be a great service indeed rendered to human nature to strike off the catalogue of its evils so great a one as the smallpox.” Not to be outdone in support of Jenner’s miraculous discovery, Jefferson’s successor, James Madison, signed into law in 1813, “An Act to Encourage Vaccination.” Among its provisions was the requirement that the U.S. postal service “carry mail containing vaccine materials free of charge.”[1]

But this appreciation of the vaccine was short-lived, and Jefferson’s hope that the value of vaccination would seep into public consciousness was never realized.  In Jacksonian America, the Founding Fathers’ belief that medical progress safeguarded democracy gave way to something far less enlightened:  democracy now meant that everyone could be, indeed should be, his own doctor.  Most Americans had no need for those with university educations, much less clinical experience in governmentally managed public hospitals.  Jacksonian America emerges as what the historian Joseph Kett termed the “Dark Age of the profession.”[2]  During this time, the nation lay claim to a medical elite only because a few monied medical intelligentsia – John Collins Warren, Valentine Mott, Philip Syng Physick, William Gibson, and David Hosack, among them – found their way to European medical centers in London, Edinburgh, and somewhat later, Paris. 

Otherwise, it was every man for himself, which usually meant every woman for herself and her family.  Homeopaths, herbalists, Thomsonians, eclectics, hydropaths, phrenologists, Christian Scientists, folk healers, faith healers, uroscopians, chromo-thermalists – each exemplified the democratic mind in action.[3]  Sad to say, homegrown “regular” American medicine of the day, with its reliance on depletive (bleeding, vomiting, purging) and stimulative (alcohol, quinine) treatments, was no better and often worse.  The belief, Galenic in origin, that all diseases were variants of the same global type of bodily dysregulation is startlingly close to Donald Trump’s holistic medieval approach to bodily infection and its treatment.

The birth of scientific medicine in the decades following the Civil War could not still the ardor of America’s scientific illiterati. The development of animal blood-derived serums (antitoxins), forerunners of modern antibiotics, was anathema to many. Among them were religionists, mainly Christian, for whom injecting blood product of a horse or sheep into the human body was not only repugnant but sinful.  Better to let children be stricken with smallpox, diphtheria and tetanus, sometimes to the point of death, than violate what they construe as divine strictures – strictures, be it noted, not intimated, much less codified, in the body of doctrine of any of the five major world religions.[4]

Antivaccinationists of the early 20th century were an unhappy lot.  They were unhappy about the proliferation of medicines (“biologics”) for treating illness.  And they deeply resented the intrusion of the State into domains of parental decision-making in the form of newly empowered social workers, visiting nurses, and educators.  In fact, antivaccinationism was part and parcel of resistance to all things progressive, including scientific medicine.[5]  Holdovers from the free-wheeling anything-goes medicine of antebellum America – especially devotees of homeopathy and, of late, chiropractic – were prominent in its ranks.    

Now, in the face of a global pandemic no less lethal than the Great Influenza of 1918-1919, we hear the same irrational musings about the dangers of vaccines that animated the scientific illiterati at the turn of the 20th century. For the foes of public health, any misstep in the manufacture or storage of smallpox vaccine – a much greater possibility over a century ago than today – was enough to condemn vaccination outright. In1901,smallpox vaccination of school children in Camden, NJ led to an outbreak of 100 cases of tetanus, with nine deaths.  Historians believe that, in all probability, the outbreak resulted not from a contaminated batch of vaccine but rather from poor care of the vaccination site.  But Congress accepted the possibility of contamination, and the incident led to passage of the Biologics Control Act of 1902.[6]  Henceforth every manufacturer of vaccine had to be licensed by the Secretary of the Treasury (relying on the PHS Laboratory of Hygiene), and each package of vaccine had to be properly labeled and dated and was subject to inspection.[7]  

And this leads to a second irony: the more preventive medicine advanced, incorporating additional safeguards into vaccine production, storage, and administration, the greater the resistance of the illiterati.  Throughout the 20th century and right down to the present, the antebellum notion of science-free “medical freedom” continues to hold sway.  Then and now, it means the right to put children at risk for major infectious disease that could result in death – and the right, further, to pass disease, possibly severe and occasionally fatal, on to others.

It follows that, then and now, the science illiterati are skeptical, if not distressed, by the State’s commitment to public health.  It was Oklahoma Senator Robert Owen’s proposed legislation of 1910 to combine five federal departments into a cabinet-level Department of Public Health that pushed the opponents of medical “tyranny” onward. The Anti-Vaccination League of America, formed in 1908, was joined by the National League for Medical Freedom in 1910.  Eight years later, they were joined by the American Medical Liberty League.  For all three groups, anti-Progressivism was in full swing. “Medical freedom” not only exempted children from compulsory vaccination, but from medical examinations at school.  Further, young adults should not be subjected to premarital syphilis tests. Nor did the groups’ expansive view of medical tyranny flinch in the face of public education about communicable disease: municipal campaigns against diphtheria were to be forbidden entirely. 

With the death of the founders of the Anti-Vaccination League (Charles Higgins) and the American Medical Liberty League (Lora Little) in 1929 and 1931, respectively, antivaccinationism underwent a dramatic decline.  The Jacksonian impulse that fueled the movement simply petered out, and by the later ‘30s, Americans finally grasped that mainstream medicine was not simply another medical sect. It was the real deal:  a medicine grounded in laboratory research that effectively immunized against disease, promoted relief and cure of those already infected, and thereby saved lives.

But was the embrace of scientific healing really universal?  A pinnacle of life-depriving anti-science occurred well beyond the 1930s.  Consider the belief of some Christian sects that certain life-saving medical interventions must be withheld from children on religious grounds.  It was only in 1982, 81 years after von Behring’s discovery of diphtheria antitoxin launched the era of serum therapy, that criminal charges were first brought against parents who had withheld necessary treatment from their children.  Of the 58 cases of such parental withholding of care, 55 involved fatalities.[8]  Child deaths among Christian Scientists alone included untreated diabetes (leading to diabetic ketoacidosis), bacterial meningitis, and pneumonia.  Now things are better for the children, since even U.S. Courts that have overturned parents’ criminal convictions have come around to the mainstream belief that religious exemption laws are not a defense of criminal neglect – a fine insight for the judiciary to have arrived at more than a century after serum therapy scored major triumphs in the treatment of rabies, diphtheria, tetanus, pneumococcal pneumonia, and meningococcal meningitis.

Should vaccination for the Covid-19 virus be a requirement for attendance in public and private schools?  How can the question even be asked?  As early as 1827, a Boston school committee ordered teachers to require entering students to give evidence of smallpox vaccination.[9]  Statewide vaccination requirements for smallpox followed in Massachusetts in 1855, New York in 1862, Connecticut in 1872, and Pennsylvania in 1895.  And the inoculations were effective across the board.  They quickly brought outbreaks of smallpox underway at the time of inoculation under control, and they prevented their recurrence in the future. These laws and those that followed were upheld by the Supreme Court in 1922 in Zucht v. King.[10]      

Twentieth-century vaccines were developed for pertussis in 1914, diphtheria in 1926, and tetanus in 1938.  In 1948 the three were combined and given to infants and toddlers at regular intervals as the DTP vaccine.  There was no hue and cry in 1948 or the years to follow. And yet, the same fear of vaccination that led the New York State Health Department to launch a statewide drive to immunize children against diphtheria now renders a new generation of parents resistant to mandatory Covid-19 vaccination for their own children.

Bear in mind that the anti-science rhetoric of today’s illiterati can be mobilized just as easily to resist DPT or any subsequent vaccine administered to their children. Why subject a child to DPT vaccination?  Perhaps combining three different vaccines into one injection entails heightened risks. Perhaps the batch of vaccine in the hands of one’s own doctor has been contaminated.  Perhaps one’s child will be among the miniscule number that have a minor allergic reaction.  And, after all, children who contract diphtheria, pertussis, and/or tetanus will hardly die from their infections, especially with the use of antibiotics. Why inject foreign matter into healthy infants – the very argument adduced by the opponents of diphtheria vaccine a century ago. 

The problem with antivaccinationist rhetoric in the 21st century is that its proponents are all beneficiaries of more than a century of mandatory vaccination policy.  If they lived in a society bereft of vaccines – or, for the unvaccinated, the immunity conferred by the vast herd of immunes – they would have led very different lives.  Indeed, some would not be here to celebrate solipsism masquerading as individualism.  Their specious intuitions about the risks of vaccination are profoundly anti-social, since they compromise the public’s health. Parents who decide not to vaccinate their children put the entire community at risk.  The community includes not only their own children, but all those who desire protection but cannot receive it:  children too young to be vaccinated, those with actual medical contraindications to vaccination, and the miniscule number who have been vaccinated but remain unprotected.[11]    

Nor is it strictly a matter of providing equal protection to individuals who seek, but cannot receive, the protection afforded by compulsory vaccination. In a secular society, religious objections to vaccination pale alongside the health of the community. Whether framed in terms of a “compelling state interest” in mitigating a health threat (Sherbert v. Vernerin [1963]) or the individual’s obligation to comply with “valid and neutral laws of general applicability” whatever their incidental religious implications (Employment Division, Department of Human Resources of Oregon v. Smith [1990]) , the U.S. Supreme Court has consistently held that mandatory vaccination laws need not allow religious exemptions of any kind.  

Antivaccinationists might bear in mind a few particulars as they align themselves with the infectious dark ages.  Between 1900 and 1904, an average of 48,164 cases of smallpox and 1,528 smallpox deaths were reported each year. With the arrival of compulsory vaccination in schools, the rate fell drastically and outbreaks of smallpox ended in 1929. The last case of smallpox in the U.S. was reported in 1949.[12]  

Among American children, diphtheria was a major cause of illness and death through 1921, when 206,000 cases and 15,520 deaths were recorded.  Before Emil von Bering’s diphtheria antitoxin became available in 1894 to treat infected children, the death rate among children struck down, especially during the hot summer months, could reach 50%. Within several years, use of the antitoxin brought it down to 15%.[13]  Then, by the late 1920s, diphtheria immunization was introduced and diphtheria rates fell dramatically, both in the U.S. and other countries that vaccinated widely. Between 2004 and 2008, no cases of diphtheria were recorded in the U.S.[14] 

Between 1951 and 1954, paralytic polio cases in the United States averaged 16,316 a year, of which 1,879 resulted in death. Then science came to the rescue.  Jonas Salk’s dead-poliovirus vaccine became available in1955, and Albert Sabin’s live-poliovirus variant four years later. By 1962, there were fewer than 1,000 cases a year and, in every year thereafter, fewer than 100 cases.[15]

Now, alas, some parents still worry that the measles component of the MMR (measles, mumps, rubella) vaccine available since 1971 may lead to childhood autism.  Why?  Resist the disease-promoting mythologies of the illiterati at all costs.  Autism is a neuro-developmental disorder with a strong genetic component; its genesis is during the first year of life, before the vaccine is even administered.  None of the epidemiologists who have studied the issue has found any evidence whatsoever of an association, not among normal children and not among high-risk children with autistic siblings.[16]  The fact is that children who do not receive a measles vaccine have been found 35 times more likely to contract measles than the vaccinated.[17]  And measles is no laughing matter. When contracted later in life, measles and mumps are serious and can be deadly.  They were among the major systemic infections that felled soldiers during the Civil War, the Spanish-American War, the Anglo-Boer War, and World War I.[18]                  

All of which leads to a conclusion in the form of an admonishment.  Accept the fact that you live in a secular society governed by law and a network of agencies, commissions, and departments lawfully enjoined to safeguard public health.  Do your part to sustain the social contract that came into existence when the Founding Fathers, elitists molded by European thought who had   imbibed the social contractualism of John Locke, wrote the American constitution.

Vaccination is a gift that modern science bestows on all of us – vaccination proponents and opponents alike. When one of the two FDA-approved Covid-19 vaccines comes to a clinic or storefront near you, run, don’t walk, to get your and your children’s shots. Give thanks to the extraordinarily gifted scientists at Pfizer and Moderna who created these vaccines and demonstrated their effectiveness and safety. Make sure that everyone’s children grow up, paraphrasing the U.S. Army’s old recruiting slogan, to be all they can be.   


[1] Dan Liebowitz, Smallpox Vaccination: An Early Start of Modern Medicine in America, J. Community Hosp. Intern. Med. Perspect., 7:61-63, 2017 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463674).

[2] Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780-1860 (New Haven: Yale University Press, 1968), p. vii. 

[3] Robert E. Riegel, Young America, 1830-1840 (Westport, CT: Greenwood Press, 1973 [1949]), pp. 314-315, quoted at  314. 

[4] John D. Graberstein, “What the World’s Religions Teach, As Applied to Vaccines and Immune Globulins,” Vaccine, 31:2011-2023, 2013.

[5] James Colgrove, “’Science in Democracy’: The Contested Status of Vaccination In the Progressive Era and the 1920s,” Isis, 96:167-191, 2005.

[6]  Harry F. Dowling, Fighting Infection: Conquests of the Twentieth Century (Cambridge, MA: Harvard University Press, 1977), 38; Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997), 73-74.

[7] Jonathan Liebenau, Medical Science and Medical Industry: The FormationOf the American Pharmaceutical Industry (Baltimore: Johns Hopkins, 1987), 89-90.

[8]  Janna C. Merrick, “Spiritual Healing, Sick Kids and the Law: Inequities in theAmerican Healthcare System,” Amer. J. Law & Med., 29:269-300, 2003, at 280.

[9] John Duffy, “School Vaccination: The Precursor to School Medical Inspection,” J. Hist. Med. & Allied Sci., 33:344-355, 1978,

[10] Kevin M. Malone & Alan R. Hinman, “Vaccination Mandates: The Public Health Imperative and Individual Rights, Law in Public Health Practice (2009), 262-284, at 272.

[11] Alan R. Hinman, et al., “Childhood Immunization: Laws that Work,” J. Law, Med &I Ethics, 30(suppl):122-127, 2002.

[12] Frank Fenner, et al., Smallpox and its Eradication (Geneva: World Health Organization, 1988).

[13] Karie Youngdahl, “Early Uses of Diphtheria Antitoxin in the United States,” The History of Vaccines, August 2, 2010 (https://www.historyofvaccines.org/content/blog/…).

[14] Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th Edition (The Pink Book). National Immunization Program, Centers for Disease Control and Prevention (http://www.cdc.gov/vaccines/Pubs/pinkbook/downloads/dip.pdf); Diphtheria. WHO, Regional Office for the Western Pacific (http://www.wpro.who.int/health_topics/diphtheria).

[15] CDC. Annual summary 1980: Reported Morbidity and Mortality in the United States. MMWR 1981;29; CDC, Reported Incidence of Notifiable Diseases in the United States, 1960. MMWR 1961;9.

[16] Frank DeStefano & Tom T. Shimabukuro, “The MMR Vaccine and Autism,” Ann. Rev. Virol., 6:585-600, 2019.

[17] Hinman, op. cit. (note 11).

[18] Paul E. Stepansky, Easing Pain on the Western Front:  American Nurses of the Great War and the Birth of Modern Nursing Practice (Jefferson, NC:  McFarland, 2020), 36, 50, 96, 144.

 

Copyright © 2020 by Paul E. Stepansky.  All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

The Politics of Medical Freedom

Winner of an Independent Publisher Books Award Bronze Medal for 2017, Paul Stepansky’s In the Hands of Doctors:  Touch and Trust in Medical Care is now available in paperback and as an eBook.  For the paperback edition, Stepansky has written a new preface, a stirring defense of Obamacare as a path to universal health care in America.  It is given here in its entirety in appreciation of the readers of “Medicine, Health, and History.”

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In the Hands of Doctors:  Touch and Trust in Medical Care

Preface to the Paperback Edition
Copyright © 2017 by Paul E. Stepansky.  All rights reserved.

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 In our time, political speech and writing are largely the defense of the indefensible.
                                         — George Orwell, “Politics and the English Language” (1946)

Now, less than a year after publication of In the Hands of Doctors, the Patient Protection and Affordable Care Act of 2010 (aka Obamacare), which I roundly endorse in this book, is gravely imperiled.  Congressional Republican legislators have joined a Republican President in a commitment to repeal the bill that has provided health insurance to over 20 million previously uninsured Americans.  The legislation thus far presented to replace it by the U.S. Senate  (the “Better Care Reconciliation Act of 2017”) would, according to the Congressional Budget Office, leave 15 million Americans uninsured in 2018 and 22 million by 2026.   Proposed cuts and caps to the Medicaid budget, which are part of the legislation, would, according to the CBO, decrease enrollment in the program by 16% over the next decade.  In brief, these cuts and caps would jeopardize the health and well-being of the one in five Americans and one in three American children dependent on the support provided by Medicaid.  Disabled and other special-needs children as well as elderly nursing home residents would suffer the most.  A Congressional vote simply to repeal Obamacare absent new legislation would have even more catastrophic consequences.
      Congressional opponents of the Affordable Care Act, no less than President Donald Trump, appear to live in a hermetically sealed bubble that makes only grazing contact with the socioeconomic ground below.  They share space in the bubble with colliding political abstractions that they grasp, one after the other, and radio back down to earth.  The political bubble dwellers offer us yet again the palliatives of context-free “medical choice” and “medical freedom” as remedies for the real-world suffering addressed by Obamacare.
     But these terms, as used by politicians, do not speak to the realties of American health care in  2017.  Rather, they hearken back to the era of the Founding Fathers, when issues of health, illness, freedom, and tyranny were much simpler.  Freedom, as the founders understood it, operated only in the intertwined realms of politics and religion.  How could it be otherwise?   Medical intervention did not affect the course of illness; it did not enable people to feel better and live longer and more productive lives.  With the exception of smallpox inoculation, which George Washington wisely made mandatory among colonial troops in the winter of 1777, governmental intrusion into the health of its citizenry was nonexistent, even non-sensical.
     Until roughly the eighth decade of the nineteenth century, you got sick, you recovered (often despite doctoring), you lingered on in sickness, or you died.  They were the options.  Medical freedom, enshrined during the Jacksonian era, meant being free to pick and choose your doctor without any state interference.  So liberty-loving Americans picked and chose among mercury-dosing, bloodletting “regulars,” homeopaths, herbalists, botanical practitioners, eclectics, hydropaths, phrenologists, Christian Scientists, folk healers, and faith healers.   State legislatures stood on the sidelines, rescinding or gutting medical licensing laws and applauding the new pluralism.  It was anarchy, but anarchy in the service of medical freedom of choice.
     Now, mercifully, our notion of medical freedom has been reconfigured by two centuries of medical progress.  We don’t just get sick and die.  We get sick and get medical help, and, mirabile dictu, the help actually helps.  In antebellum America, deaths of young people under 20 accounted for half the national death rate, which was more than three times the death rate today.  Now our children  don’t die of  small pox, cholera, yellow fever, dysentery, typhoid, and pulmonary and respiratory infections before they reach maturity.  When they get sick in early life, their parents take them to the doctor and they almost always get better.  Their parents, on the other hand, especially after reaching middle age, don’t always get better.  So they get ongoing medical attention to help them live longer and more comfortably with chronic conditions such as diabetes, coronary heart disease, inflammatory bowel disease, Parkinson’s, and many forms of cancer.
     When our framers drafted the Constitution, the idea of being free to live a productive and relatively comfortable life with long-term illness did not compute.  You died from diabetes, cancer, bowel obstruction, neurodegenerative disease, and major infections.  Among young women,  such infections included the uterine infection that routinely followed childbirth.  A major heart attack simply killed you.  You didn’t receive dialysis and possibly a kidney transplant when you entered kidney failure.  Major surgery, performed on the kitchen table if you were of means or in a bacteria-infested public hospital if you were not, was rarely attempted because it invariably resulted in massive blood loss, infection, and death.
     So, yes, our framers intended our citizenry to be free of government interference, including the Obamacare “mandate” that impinges on Americans who choose to opt out of the program.  But then, with the arguable exception of Benjamin Franklin, the framers never envisioned a world in which freedom could be extended by access to expert medical care that relieves suffering, often effects cure, and prolongs life.  But then, neither could they envision the enfranchisement of former slaves and women, the progressive income tax, compulsory vaccination, publicly supported health clinics, mass screening for TB, diabetes, and  syphilis, or Medicare and Medicaid.  Throughout the antebellum era, when physicians were reviled by the public and when neither regular medicine nor the rival alternative sects could stem the periodic waves of cholera, yellow fever, and malaria that decimated local populations, it mattered little who provided one’s doctoring.  Many, like the thousands who paid $20.00 for the right to practice Samuel Thomson’s do-it-yourself botanical system, chose to doctor themselves.
     Those who seek repeal of Obamacare without a credible legislative alternative that provides equal, preferably greater, health benefits to all Americans seem challenged by the very idea of medical progress.  Their use of terms like “choice” and “freedom” invokes an eighteenth-century political frame of reference to deprive Americans of a kind of freedom associated with a paradigm-shift that arose only in the final quarter of the nineteenth century.  It was only then that American medicine began its transition to what we think of as modern medicine.  Listerian antisepsis and asepsis; laboratory research in bacteriology, immunology, and pharmacology; laboratory development of specific remedies for specific illnesses; implementation of public health measures informed by bacteriology; modern medical education; and, yes, government regulation to safeguard the public from incompetent practitioners and toxic medications – all were part of the transition.  The Jacksonian impulse persisted into the early twentieth century, flaring up in organized opposition to compulsory childhood vaccination, and  finally petering out in the 1930s, by which time it was universally accepted that scientific medicine was, well, scientific, and, as such, something more than one medical sect among many.
     “We hold these truths to be self-evident,” Thomas Jefferson began the second paragraph of the Declaration of Independence, “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”  What Jefferson did not stipulate, indeed what he could not stipulate in his time and place, were the hierarchical relationships among these rights.  Now, in the twenty-first century, we are able to go beyond an eighteenth-century mindset in which  “Life, Liberty, and the pursuit of Happiness” functioned as a noun phrase whose unitary import derived from the political tyrannies of King George III and the British parliament.  Now we can place life at the base of the pyramid and declare that quality of life is indelibly linked to liberty and the pursuit of happiness.  To the extent that quality of life is diminished through disease, liberty and the pursuit of happiness are necessarily compromised.  In the twenty-first century, health is life; it is life poised to exercise liberty and pursue happiness to the fullest.
     Why, then,  is it wrong to require all citizens to participate in a national health plan, either directly or through a mandate (i.e., a tax on those who opt out), that safeguards the right of people to  efficacious health care regardless of their financial circumstances, their employment status, and their preexisting medical conditions?  What is it about the Obamacare mandate that has proven so troubling to our legislators?  When you buy a house in this country, you pay local property taxes that support the local public schools.  These taxes function like the mandate:  They have a differential financial impact on people depending on whether they directly benefit from the  system sustained by the tax.  To wit, you pay the tax whether or not you choose to send your children to the public schools, indeed, whether or not you have children at all.  You are obligated to subsidize the public education of children other than your own because public education has been declared a public good by the polity of which you are a part.  The same goes for that portion of local taxes that provides police and fire protection.  We accept a mandate to support policemen and firefighters whether or not we will ever need them, in the knowledge that other members of the community assuredly will.  Similarly, those who opt out of Obamacare should pay a price, because they remain part of a society committed to health as a superordinate value without which liberty and the pursuit of happiness are enfeebled.
     It is inconceivable that the Founding Fathers would have found unconstitutional or unfair or governmentally oppressive a law that provided life-promoting health care that enabled more Americans to discharge the duties of citizenship and live more freely and productively in pursuit of happiness.  They declared that citizens – all of whom, be it noted, were white, propertied males – were entitled to life consistent with the demands and entitlements of representative democracy.  Their pledge, their declaration, was not in support of a compromised life that limited the ability to fulfill those demands and enjoy those entitlements.
     When, in our own time, the word “choice,” as used by Republican politicians, means that millions of Americans who rely on Obamacare will end up leading compromised lives, the word becomes semantically contorted and ethically bankrupt.  The absence of Obamacare does not, ipso facto, empower lower-income, assistance-dependent Americans to buy the comprehensive health insurance they need, especially when the tax credits under legislation proposed thus far provide far less support than the subsidization lower-income families now receive.  Freeing insurers from Obamacare regulations so that they can offer inadequate policies that lower-income Americans can afford to buy does nothing but maximize the medical risks of these financially choice-less Americans.  Here is a fact:  Economic circumstances wipe out the prerogative to make prudent choices in one’s own best interest.  For lower-income Americans, a panoply of inadequate choices is not the pathway to right-minded decision making.  With the Senate’s “Better Care Reconciliation Act,” unveiled in June and updated in July, 2017, millions of low-income Americans, especially those dependent on Obamacare subsidies and Medicaid, would have had an absence of credible and affordable choices for obtaining health care adequate to their needs.  The call simply to repeal the Affordable Care Act, which the Senate has rejected as of this writing, would take us back to a status quo ante when millions of Americans were either priced out of, or completely denied, health coverage.
     Of course, adult citizens may repudiate mainstream health care altogether on the basis of philosophical or religious  predilections.  Christian Scientists and Jehovah’s Witnesses, for example, hold theological beliefs that often lead them to refuse medical treatment.  Certainly, they are free to pursue health through spiritual healing or, in the manner of medieval Christians, to disavow corporeal health and earth-bound life altogether.  But by law they cannot deny their children, who deserve to live to maturity and make their own choices, the healing power of modern medicine, whether it comes in the form of insulin, antibiotics, blood transfusions, or surgery.  Nor should they be allowed to undermine social and political arrangements, codified in law, that support everyone else’s right to pursue life and happiness through twenty-first century medicine.  Those who, prior to the Affordable Care Act, had inadequate insurance or no insurance at all are not struggling to free themselves from the clutches of federal regulation; they are not crying out for new free market health plans through which they can exercise freedom of choice.  Rather, they are struggling to put food on the table and keep themselves and their families healthy.  To this end, they need to be free to avail themselves of what modern medicine has to offer, unencumbered by politically debased notions of freedom and choice.
     At this moment in history, in a fractionated society represented by a President and Congressional leaders whose daily missives bear out George Orwell’s acute observation about the corruption of language brought on by political orthodoxies, In the Hands of Doctors may have a wistful ring.  I hope not.  I am addressing the personal side of health care – the reality of a doctor and patient, alone in a consulting room, often surrounded by high-tech diagnostic aids but always containing those vital low-tech instruments with which one person reaches out to the other:  the physician’s eyes and hands and voice.  The human face of doctoring, which now includes the doctoring of nurse practitioners and physician assistants, remains essential to the success of any doctor-patient relationship, whatever the institutional arrangements that bring together this doctor and this patient, the former to help the latter.
     Endeavoring to understand the several aspects – and possibilities – of the doctor-patient relationship, I write about the nature of clinical caring; the relation between caring and patient trust; the need to recruit and train physicians who can bring this caring sensibility to their patients; the role of empathy in medical caring; and the obligation of medical educators to revivify primary care medicine to meet the critical shortage of frontline physicians within underserved American communities.  These issues will not go away, whatever the fate of Obamacare.
     When federal legislation, through the practical assistance it provides, extends the reach of trusting doctor-patient relationships to the most vulnerable  groups in society, it has a  function that is both binding and enabling.  It fortifies the webbing that underlies the increasingly disparate parts of our national mosaic.  Obamacare, the Children’s Health Insurance Program, Medicaid – these programs do not “bring us together” in a feel good way.  They do, however, prevent a free fall in which the subcommunities and interest groups into which society has decomposed land so far apart they are no longer in hailing distance of one another.  As to the enabling function, a comprehensive medical safety net for all Americans – let’s call it what it is: universal health care – revitalizes political democracy by extending to all Americans a greater possibility of life, liberty, and the pursuit of happiness.  In the everyday world, this pursuit boils down to the ability of more people to stay on the job or to work from home rather than not work at all.  Society benefits, since chronically ill people pursuing happiness under the umbrella of universal health care will better resist the complications and collateral illnesses that follow from their primary illness or illnesses.  Society also benefits by enabling healthier happiness-pursuers to avoid hospitalization and, among the elderly, to push back the time when nursing home care is required.  And finally, society benefits by seeing to it that all children, especially those who are disabled, receive every medical advantage as they traverse their own challenging paths to productive, choice-wielding citizenship.
     Obamacare is a far cry from universal health care, but for all its limitations and current financial straits, it has provided these binding and enabling functions for millions of Americans previously without a medical safety net.  Woe to politicians who shred it in the name of choice, a pleasing vacuity that evades the reality of disease and pain among many who are relieved to have a single avenue of subsidized care where none was previously available.
     Health care should be a national trust; everyone deserves what twenty-first century medicine has to offer, regardless of how much or how little choice can be worked into the offering.  Politicians who feel otherwise are enemies of the polity.  Jefferson, who as president helped set up the first smallpox vaccination clinics in the south and then, in retirement, planned a state-supported clinic to provide free medical care to those who could not afford it, would not have brooked the empty insistence that medical freedom and medical choice, unhinged from socioeconomic reality, trump access to medical care per se.  Nor, for that matter, does choice, whatever it may or may not mean, obviate our moral obligation as a society to see to it that best available treatment, whatever the pathway that leads to it, means treatment rendered by caring doctors willing to know their patients as people.

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In the Hands of Doctors:  Touch and Trust in Medical Care, 1st pbk ed

Paul E. Stepansky

978-0983080770        2016/2017pbk        348pp        $26.95pbk

Release date: September 12, 2017

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