Currently Happening Presently Now: MEDICAL ABUSE

CASCADE EFFECTS OF MEDICAL TECHNOLOGY
Annual Review of Public Health Vol. 23: 23-44 May 2002.

_{Cascade effect refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. With regard to medical technology, the term refers to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. Examples include discovery of endocrine incidentalomas on head and body scans; irrelevant abnormalities on spinal imaging; tampering with random fluctuations in clinical measures; and unwanted aggressive care at the end of life. Common triggers include failing to understand the likelihood of false-positive results; errors in data interpretation; overestimating benefits or underestimating risks; and low tolerance of ambiguity. Excess capacity and perverse financial incentives may contribute to cascade effects as well. Preventing cascade effects may require better education of physicians and patients; research on the natural history of mild diagnostic abnormalities; achieving optimal capacity in health care systems; and awareness that more is not the same as better.}

Selling sickness: the pharmaceutical industry and disease mongering
BMJ. Apr 13, 2002; 324(7342): 886–891.

_{Some forms of “medicalisation” may now be better described as “disease mongering”—extending the boundaries of treatable illness to expand markets for new products
Alliances of pharmaceutical manufacturers, doctors, and patients groups use the media to frame conditions as being widespread and severe
Disease mongering can include turning ordinary ailments into medical problems, seeing mild symptoms as serious, treating personal problems as medical, seeing risks as diseases, and framing prevalence estimates to maximise potential markets
Corporate funded information about disease should be replaced by independent information}

THE POLITICAL ABUSE OF MEDICINE AND THE CHALLENGE OF OPPOSING IT
Sm. Sci. Med. Vol. 25, No. 6, pp. 649-657, 1987.

_{A fundamental aim of medicine is to protect and promote health. The practice of medicine has, however, been used to promote political aims which may be detrimental to health. The article attempts to isolate the ways in which political abuses may interfere with good medical practice: by allowing health policies to be influenced by undemocratic political considerations; by using health services to reward or punish political supporters or opponents; by direct medical involvement in political acts which contradict accepted medical ethics; and by the support which conventional medical practises give to perpetuating inequalities in health and social services. Each of these is examined with the use of a number of examples. The ways in which medical personnel have opposed the political abuse of medicine is explored by a brief review of the opposition of Chilean doctors to torture, the involvement of South African doctors in opposing the abuse of health services in perpetuating apartheid, and the growing medical movement in opposition to nuclear war. Some comments concerning the monitoring of a multitude of medical disciplines which are open to political abuse are made. The purpose of the paper is primarily to stimulate debate around this important issue and it does not attempt to provide a comprehensive review of the political abuse of medicine.}

Whither Nuremberg?: medicine's continuing Nazi heritage.
Med Glob Surviv. 1995 Sep;2(3):148-57.

_{The medical crimes of the Hitler regime are commonly perceived to have been committed by a few demonic physicians working in isolation from the mainstream of the German medicine. The success of this myth has imperiled the value system of medicine today. The World Medical Association (WMA), established to address the ethical challenges arising from the German tragedy, has itself been compromised by this legacy. The leadership of the WMA has included doctors once associated with the Nazi SS terror organization and linked to crimes prosecuted at Nuremberg. Despite these recent revelations the WMA has yet to address the ethical issues raised by its own Nazi heritage or to pay homage to the victims of the Nazi regime.}

Psychiatry and political-institutional abuse from the historical perspective: the ethical lessons of the Nuremberg Trial on their 60th anniversary.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 May 9;31(4):791-806.

_{Sixty years ago at the Nuremberg Trials, 23 Nazi leaders were tried as war criminals, in what was known as "The Doctors' Trial". This trial exposed a perverse system of the criminal use of medicine in the fields of public health and human research. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims. The aim of the present work is to review, from the historical perspective, the antecedents of the shameful euthanasia programmes for the mentally ill, the procedures involved in their implementation and the use of mentally ill people as research material. The Nuremberg Code, a direct consequence of the Doctors' Trial, is considered to be the first international code of ethics for research with human beings, and represented an attempt to prevent any repeat of the tragedy that occurred under Nazism. Nevertheless, the last 60 years have seen continued government-endorsed psychiatric abuse and illegitimate use of psychoactive drugs in countries such as the Soviet Union or China, and even in some with a long democratic tradition, such as the United States. Even today, the improper use of psychiatry on behalf of governments is seen to be occurring in numerous parts of the globe: religious repression in China, enforced hospitalization in Russia, administration of psychoactive drugs in immigrant detention centres in Australia, and the application of the death penalty by lethal injection and psychiatric participation in coercive interrogation at military prisons, in relation to the USA. The Declaration of Madrid in 1996 constituted the most recent attempt to eradicate, from the ethical point of view, these horrendous practices. Various strategies can be used to combat such abuses, though it is uncertain how effective they are in preventing them.}

The pharmaceutical industry and the German National Socialist Regime: I.G. Farben and pharmacological research
Journal of Clinical Pharmacy and Therapeutics
Volume 34, Issue 1, pages 67–77, February 2009.

_{Before the National Socialist party came to power, the German pharmaceutical industry constituted an international reference as far as the development of new medicines was concerned, having been responsible for synthetic analgesics (phenacetin, phenazones, acetylsalicylic acid), arsphenamine, barbiturates and sulfonamides. The year 1925 saw the founding of I.G. Farben (Interessen-Gemeinschaft Farbenindustrie AG), a conglomerate of companies that would monopolize the country’s chemical production and come to own all its major pharmaceutical industries. During the World War II, I.G. Farben participated in numerous operations associated with the criminal activities of the Nazi executive, including the use of slave labour in plants built close to concentration camps, such as that at Auschwitz. With regard to medical and pharmacological research projects, I.G. Farben became involved in experimental programmes using patients from the Nazi regime’s euthanasia programmes and healthy subjects recruited without their consent from concentration camps, on whom various pharmacological substances were tested, including sulfamide and arsenical derivatives and other preparations whose composition is not precisely known (B-1012, B-1034, 3382 or Rutenol, 3582 or Acridine), generally in relation to the treatment of infectious diseases, such as typhus, erysipelas, scarlet fever or paratyphoid diarrhoea. Furthermore, I.G. Farben played a decisive role in the German army’s chemical warfare programme, contributing to the development of the first two neurotoxic substances, later known as ‘nerve agents’, tabun and sarin. Some of these activities came to light as a result of the one the famous Nuremberg Trials in 1947, which saw 24 executives and scientists from I.G. Farben brought to justice for, among other offences, the use of slave labour in the concentration camps and forced experimentation with drugs on prisoners.}

Political Abuse of Psychiatry—An Historical Overview
Schizophr Bull. Jan 2010; 36(1): 33–35.

<sub>The use of psychiatry for political purposes has been a major subject of debate within the world psychiatric community during the second half of the 20th century. The issue became prominent in the 1970s and 1980s due to the systematic political abuse of psychiatry in the Soviet Union, where approximately one-third of the political prisoners were locked up in psychiatric hospitals. The issue caused a major rift within the World Psychiatric Association, from which the Soviets were forced to withdraw in 1983. They returned conditionally in 1989. Political abuse of psychiatry also took place in other socialist countries and on a systematic scale in Romania, and during the first decade of the 21st century, it became clear that systematic political abuse of psychiatry is also happening in the People's Republic of China. The article discusses the historical background to these abuses and concludes that the issue had a major impact on the development of concepts regarding medical ethics and the professional responsibility of physicians.

Time and again, human rights and mental health organizations receive reports on cases of abuse of psychiatry for political purposes. The fact that these reports come from a wide range of countries shows that there is an ongoing tension between politics and psychiatry and that the opportunity to use psychiatry as a means to stifle opponents or solve conflicts is an appealing one, not only to dictatorial regimes but also to well-established democratic societies.

In these regimes abuses of the human rights of those politically opposed to the state are often hidden under the guise of psychiatric treatment. In democratic societies ‘whistle blowers’ on covertly illegal practices by major corporations have been subjected to the political misuse of psychiatry....

The political abuse of psychiatry in the Soviet Union originated from the concept that persons who opposed the Soviet regime were mentally ill because there was no other logical explanation why one would oppose the best sociopolitical system in the world....

Their symptoms could resemble those of a neurosis or could take on a paranoid quality. The patient with paranoid symptoms retained some insight in his condition but overvalued his own importance and might exhibit grandiose ideas of reforming society. Thus, symptoms of sluggish schizophrenia could be “reform delusions,” “struggle for the truth,” and “perseverance.”...

While most experts agree that the core group of psychiatrists who developed this concept did so on the orders of the party and the Soviet secret service KGB (Komitet Gosudarstvennoi Bezopasnosti) and knew very well what they were doing, for many Soviet psychiatrists this seemed a very logical explanation because they could not explain to themselves otherwise why somebody would be willing to give up his career, family, and happiness for an idea or conviction that was so different from what most people believed or forced themselves to believe. In a way, the concept was also very welcome because it excluded the need to put difficult questions to oneself and one’s own behavior. And difficult questions could lead to difficult conclusions, which in turn could have caused problems with the authorities for the psychiatrist himself.....</sub>

War crimes and medical science.
BMJ. Dec 7, 1996; 313(7070): 1413–1415.

_{Several factors may need to converge; a certain ecology is required. But if biomedical insights grant physicians sudden new explanatory and technological powers, if economic trends intensify pressures to rationalise healthcare costs and develop utilitarian strategies, if state political forces directly enlist the medical profession in an agenda of social and economic transformation, and if an ideology of hate and stigmatisation permits the dehumanisation of one sector of the populace then we may see a turning towards something we had relegated to bitter mid-20th century memory...}