Wednesday, March 23, 2005

Bill Frist: Quack

In an ideal world, we would all be knowledgeable enough about the relevant issues of the day such that we could independently evaluate and assess the related arguments. This would elevate the debate and eliminate the sway that charlatans have over us. But, as we all know, we live in an incredibly complex world and it is simply infeasible for us to consistently formulate opinions from a position of personal expertise. As a result, we are, more often than not, being led to conclusions by trusted individuals who claim authority on a given subject. Without this reliance on trusted experts, our most important decisions would be decided by processes no more accurate than the flip of a coin. It is the only way to rationally proceed in such an expansive universe.

But, as Uncle Ben told Peter Parker, with great power comes great responsibility. Thus, those who claim expertise must be willing to employee it honestly. Failing to do so is a deep betrayal. It is no mere act of deception; it has the potential of leading people against their own beliefs and away from the path that they would follow if they knew the truth. With consequences so severe, we must forever guard against the expert who uses that title to mislead the masses. They must be marked so that no man or woman would ever believe a word crossing his lips.

That brings me to Senator Bill Frist.

Senator Frist has never made a secret of his medical pedigree. Before joining the United States Senate, he was indeed an extremely talented heart surgeon. There is no question that his knowledge and expertise places him among the elite in the medical profession. His accomplishments in the field are indeed impressive and, were I in need of a surgical cardiac intervention, I would not hesitate to place myself in his care (although I might opt for someone who had practiced more recently).

Therefore, he clearly deserves the "medical expert" descriptor so frequently assigned to him. I would not begin to challenge this claim.

However, having achieved his current position on the national stage, he has consistently invoked his medical background in service of ideological goals that are at odds with medical science. Let's observe.

On March 11, 2003, Bill Frist took to the floor of the Senate to rail against the practice of "partial-birth abortion."
Mr. President, I rise in support of the Partial Birth Abortion Act of 2003. And I do so with a deep passion not only for the protection of life, but also for the ethical practice of medicine. Before coming to the Senate, I had the opportunity to study and practice medicine for 20 years… I know there are ethical bonds to the application of surgical procedures -- bonds that in a moral sense should never, ever be crossed by a surgeon. Indeed, I took an oath to treat every human life with respect, with dignity, and with compassion. But abortion takes life away. And partial-birth abortion does so in a manner that is brutal and barbaric and morally offensive to the mainstream medical community… The fact is that partial-birth abortion is a repulsive procedure…
In this excerpt, he is clearly attempting to establish his right to argue from a position of authority. Having done so, he describes the procedure in a fashion intended to inflame passions. Thus, observers would reasonably conclude that the procedure is considered both unnecessary and barbaric by the medical community at large.

What he fails to mention is that the term "partial-birth abortion" has no meaning in the field of medicine. The correct term is "intact dilation and extraction." Moreover, this term does not describe a distinct procedure.
The recently crafted political term partial-birth abortion loosely means "partially vaginally delivering a living fetus before killing the fetus and completing the delivery." This definition broadly includes all methods of second-trimester abortion (done after the first 3 months of pregnancy).
From the position of someone who claims to be an expert, these are not subtle distinctions. While it may be to the advantage of an ideologue to misrepresent the opinion of the medical community, one claiming the mantle of medical expert should strive to make these differences clear. Senator Frist knows these distinctions exist, yet chooses the path of political expediency. Those who trusted him to speak as a medical scientist were undeniably misled.

More recently, he appeared on "This Week with George Stephanopoulos" to discuss, among other things, administration policy regarding abstinence-only sex education programs. Apparently, some of these programs were making wild and misleading claims and Stephanopoulos wanted to get his opinion on the subject -- especially since he is a medical professional.

(Off Camera) Okay, let me switch to another subject. There was a bit of an uproar in Washington this week about this issue of these abstinence programs that are funded by the Federal government, the funding has doubled over the last four years but there was a report by the minority staff at the House Government Affairs Committee that showed that 11 of 13 of these programs are giving out false information. I want to show some of the claims they identified in the curricula…A third [claim] suggested that tears and sweat could transmit HIV and AIDS. Now, you're a doctor. Do you believe that tears and sweat can transmit HIV?


I don't know. I can tell you ...


(Off Camera) You don't know?


I can tell you things like, like...


(Off Camera) Well, wait, let me stop you, you don't know that, you believe that tears and sweat might be able to transmit AIDS?


Yeah, no, I can tell you that HIV is not very transmissible as an element like, compared to smallpox, compared to the flu.
For the record, there has never been a recorded instance of HIV transmission via tears and sweat. Never. Moreover, this is not some obscure piece of medical trivia known only to specialists in the field. This is a widely known and well accepted medical fact. Yet, Frist equivocates furiously, admitting only that HIV is less transmissible than the wildly contagious smallpox and flu viruses. While what he says is true, it vastly understates the difficulty of transmission. And it obfuscates the matter at hand: HIV transmission through tears and sweat. He never answers this elementary question and leaves his trusted viewers with the impression that such transmission is possible.

Finally, the recent case of Terri Schiavo has afforded Frist another opportunity to make political hay from a position of authority. According to the Washington Post:

Bill Frist…went to the floor late Thursday night for the second time in 12 hours to argue that Florida doctors had erred in saying Terri Schiavo is in a "persistent vegetative state."

"I question it based on a review of the video footage which I spent an hour or so looking at last night in my office," he said in a lengthy speech in which he quoted medical texts and standards. "She certainly seems to respond to visual stimuli."

As I noted above, Bill Frist is a cardiac surgeon. In the real world, he would never be called upon to diagnose a patient in Schiavo's condition. His expertise on this matter is of no greater value than any other medical school graduate. You might as well call upon a dermatologist or a podiatrist to render an opinion. But diagnosing outside of his specialty is hardly his greatest sin in this situation. That's because Frist has never actually examined the patient in question. He has merely observed heavily edited videotape provided to him by those challenging the prevailing diagnosis. If he engaged in such behavior during the course of his medical career, he would almost certainly have been sued for malpractice and seen his license revoked.

Despite behaving in a manner that, if practiced by a physician, would represent a grave violation of his Hippocratic oath, Senator Frist continues to capitalize on his medical background. He frequently dismisses the arguments of the opposition by asserting, essentially, that "I'm a doctor -- who you gonna trust?" And surely, on the strength of his supposedly medical expertise, many do. But, as these examples demonstrate, that trust is misplaced. His first responsibility to "do no harm" has been amended to read "do no harm to conservative ideology." His adoring public should be made aware of these shifting priorities.

On one level, he is certainly free to practice the political arts in the manner of his choosing. As a politician, he employs his professional and personal assets exceptionally well. Those who support his agenda are well served by this style of play. But, once an individual makes clear that his political goals supersede all others, we should not accept claims of unrelated expertise. A politician like Frist is a politician first and, therefore, a politician only. He serves one master, not two. Claims to the contrary should be seen for what they are: naked attempts to con his trusting public.

Ultimately, we cannot prevent him from presenting himself as a medical professional when he finds it to be politically expedient. But, if he claims to be a doctor, we must judge him as one. That judgment leads one to a singular conclusion: Bill Frist is a quack.

So, Senator Frist, pick your poison. You are either a politician or a quack. Only one of these roles has any honor -- I suggest that you select it.
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