Readers may wonder why I often include somewhat humorous references when the disease is so serious. I do this because I believe at some level if one cannot see some humor in challenging situations, then it may well drive you crazy thinking about it: such as GDD not being recognized by most doctors.
I wanted in this blog to take an overview of corruption, lying, drunkenness, sexual abuse, criminal behavior, cover-up, and just simple thinking exactly in the confines to the box that we are instructed to think in by 'experts'.
In order to remain sane: the reference to Dante's Divine Comedy seems appropriate.
I would like to think that for 20 years of my career I have focused on patient safety in Medicine. Over the last 10 years my focus has shifted to protecting patients from Medicine. Unintentionally on my part, GDD has become for me the great cause of protecting patients.
I will start with a broader overview of abuse of power by physicians. The reader can add in the word alleged for many of the accounts below in accordance with modern parlance.
In many respects the first eye-openers for many us had been the Spot-Light story from the Boston Globe on sex abuse against minors committed by Roman Catholic priests. 6 % of priests were sex abusers, that is 6% were criminals. It turns out that perhaps this 6% figure of criminals applies to all professionals - this includes physicians.
The most recent criminals that have come to public attention, include Dr Robert Levy, the pathologist, and Dr Reginald Archibald, the pediatrician. I have written about Doc Sanders, the sports doctor, and ofcourse most recognized of all is Dr Larry Nassar, the sports medicine doctor.
Huge recent accounts of misconduct by publicly unnamed physicians, are multiple physicians from the central eastern states who traded/ sold opiate drugs for money and/or sex, and a broad network of fraud of physicians with prescribing unneeded orthopedic devices to patients.
There are more equally terrible accounts of misconduct that at present I will not write about.
So the ground level perpetrators of these crimes fit into the general corruption of abuse of power- where the perpetrators crimes involve one of the vices, or combination: money, power or sex. Referencing Dante's Inferno, in the medieval age of Christianity, the minor sins, where the occupants were relegated to the first 6 levels of Hell involved self-indulgence. My favorite being the 4th circle of Hell for the hoarders and squanderers (I think I may be a hoarder), circle 7 for violence, circle 8 and 9 for fraud and treachery, circle 10 involves the devil. In the modern age, maybe circles 1-6 can be compressed into just 2: ignorance as circle 1, and greed as circle 2, treachery, fraud and now introducing cover-up, as circles 3, 4, and 5, respectively. Circle 6 as rape, circle 7 as violence, circle 8 as these issues against children and the innocents. I have now excluded hoarding as sin punishable by Hell, and have left out the devil too.
What is absent in almost these ground level perpetrators is the contribution to the sin by the supervisors. I think it is critical to focus on the role of administrators, supervisors and their various lackeys.Perhaps two of the most powerful articles on this subject, which I direct the readers to: Ending Sexual Harassment in Academic Medicine. Dzau VJ, et al. and Time's Up for Medicine? Only Time Will Tell. Choo EK et al. Both articles N Engl J Med 379:vol 17. Oct 25; 2018. These articles emphasize, and I fully agree with, the only way to get meaningful change is to hold supervisors accountable.
The Sandusky case was noteworthy as the president of Penn State was called out, fired, sued and imprisoned, and based only on ignoring one email from an assistant coach that Sandusky was in the players showers with a young naked boy. This forms the quadriga of my assessment of systemic change: supervisors need to be called out, fired, some sued, and some imprisoned. Without that no lasting change will occur. Administrators from institutions leaning towards corruption, have to see the outcome of what happened to other administrators at other centers, who have been fired for abuse of power.
What also is missing in all cases is: capturing the wider net of lackeys is necessary. One obvious individual is the head of HR. Most often they are well aware of the misconduct and are actively involved in the cover up. In the documentary production of "In the Heart of Gold..." the Nassar story. An interesting component is that a Faculty Hearing committee had assessed one victim's complaint in 2015 about the sexual molestation, and the committee cleared Nassar of wrongdoing. The program described that a female basketball coach who early on defended Nassar against girls complaining about him will be looked at for criminal behavior. What was not mentioned, but is necessary, the Faculty Hearing committee must also be looked at for their misconduct of clearing Nassar. Members of Faculty Hearing Committees, Institutional Grand Juries have to date avoided scrutiny: these also have to be held accountable, when they have performed as institutional toadies: which often or near always they do, that is why they are in that position.
The criminal behavior of the Michigan State faculty hearing committee was echoed by the recent report of an old story, Reginald Archibald. Apparently in 1960 there was a grand jury evaluation at Rockafellar University that cleared Archibald of sexual molestation. He went on for another 30 years of a career of sexually molesting children. Presumably these committee members are all dead now, but their estates could be held responsible.
One aspect of these settlements that I am very much opposed to is the institution bearing the expense of the misconduct settlements. My opinion is the administrators, supervisors and their lackeys responsible for the cover-up/turning a blind eye, should be principally responsible. In the Archibald case, it was reported that with the hundreds of legal cases that will ensue the institution may go bankrupt. Who suffers then? It is the faculty, staff and students of the institution- and they are all innocent and undeserving of punishment. This same misassignment and misalignment of responsibility was what happened with the banking crisis of 2008, bankers were engaged in fraudulent activities, but the banks, shareholders and American public were held responsible> the bankers still received their outsized salaries and bonuses.
The other critical important event occurring with the Archibald case is that despite the fact that his molestation crimes occurred 20-60 years ago - they will still be prosecuted. This has been a dirty trick that many administrators at many universities have played, often successfully, with rape victims: the rape occurred 4 years ago or 6 or 8 years ago - so far too far in the past to do anything about (really?). For criminal cover-up administrators should be responsible for 50 years as the Archibald case showed. If the administrators are deceased, then their estates held responsible.
For most of these incredible misconduct cases, one obvious absence is: why did no one speak up? It is possible that there were whistle blowers who were squelched en route. Quite often administrators circle around the perpetrators, for a number of reasons: because the circling is almost always successful, to avoid institutional embarrassment, and the ground level perpetrators are buddies with administrators, or have some other hold over them. In all of these ground level perpetrator cases, probably atleast 20 people would have known about the misconduct, and for lengthy careers like Levy or Archibald, probably hundreds of people were aware. So why did no one speak up? The reason is cowardice. The cowardice unfortunately is understandable. Individual people speaking up, intuitively know, that if they speak up, the only change that will happen is that they themselves will get fired. This contradicts the rallying words of Allie Rayseman: if only one person spoke up the molestation would not have happened to her. The reality is, if one person spoke up, they would have been fired. The reality is that perpetrators are protected (as described above) until they aren't. What makes the 'aren't' is when it becomes no longer politically feasible for administration to cover up the misconduct- then these same cover-uppers distance themselves. This certainly happened in the Nassar case.
An additional obvious change is to eliminate sovereign immunity for state institutions. Like the electoral college, maybe at one time it made sense, but now it just serves to allow state institutions to function as organized crime syndicates - having no accountability.
The Robert Levy case is the most recent, and in many respects the worst. As bad as the others are, Nassar, Sandusky, and Archibald, which were sexual molestation, and no intention or possibility at the time of the crime for imminent death of the subject, the wrong diagnoses by a drunk pathologist were directly responsible for injuries that have resulting in the likelihood or actuality of early demise. By my re-interpretation of the circles of Hell, the sexual perverts are a circle 6 and Levy circle 7 and 8- especially when one considers the scale of the misconduct. Thousands of victims, evaluated by a drunk pathologist. How many bystanders must have been aware of this? Easily approaching 100 silent side-liners.
There are interesting additional ethical questions beyond this, when considering a perpetrator- alcoholism is considered now a disease, hence somehow forgivable, but in reality is it any different then child molestation - is that not also a disease? Is what Levy did less serious than Nassar, because he was drunk and Nassar a child molestor? His misconducts would have resulted in death directly, not Nassar's. Whether one or other is worse, what is constant is that the cover-up for both situations is of the same severity- so for cover-up of serious misconducts I have assigned them circle 5 of Hell.
Are there other doctors who have been working on patients drunk for decades involving thousands of patients. Yes. Are they currently being covered up. Yes.
Returning to the related subject that has impacted the lives of virtually all GDD patients. What about all the doctors who have told patients with GDD, it can't be from a GBCA injection, because you have normal, kidney function. Many of these same doctors ordered further MRIs with GBCA, making the patients much sicker as a result. What about them, do they deserve a place on a circle in Hell? Why do they deny it? I think in reality it is because the majority of doctors are like the majority of everyone else- they think inside the box. There is so much studying involved in university education in Medicine and much if it is in memorizing information. So there is the tendency to memorize what is generally accepted as gospel and other stuff as heresy, until it ain't. I don't think most of them should be in a circle in Hell, if any in circle 1. Forgive them, they know not what they are doing. There are some physicians who have been actively hostile to patients, they really deserve a seat in Hell. Perhaps even worse, if they know GDD exists and choose to ignore it, for various reasons, and ofcourse none of them good, they deserve a lower circle, maybe in the circles 3-5.
Ultimately, perhaps more than ever before in human history, despite as it may seem on the national level, we are in the era of accountability of senior administrators. I myself am focused on holding individuals accountable for their bad acts. One has to use wisdom sense: cowards probably should not hold much blame, yet one must remember the words of Martin Luther King Jr: "In the end we will remember the silence of our friends and not the words of our enemies". If anyone reading has to think: "Is Dr Semelka thinking of me?", the answer is "Yes, I am thinking of you".
Richard Semelka MD Consulting
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