Editorial from Medscape General Medicine [TM]
William H. Foege, MD, MPH
It has been more than 200 years and yet the miracle has not been dulled. A population of a few million people provided an unbelievable wealth of talent, integrity, intelligence, and honesty. How could we have been so fortunate to have the likes of Washington, Madison, Jefferson, and Franklin providing leadership for an idea about how people could best live in the aggregate? There are explanations that have some plausibility. Genius clusters may not be random, as genius may attract genius. There certainly were not the possibilities that exist today in medicine, physics, computer sciences, and business to pull the best minds of a society away from politics. Nonetheless, the United States was blessed with leadership that was several standard deviations above the mean.
I grew up worried about representative government. I simply did not want the average person treating my cancer, caring for my parents, or leading my country. But we have learned that this original group provided a framework that gave us a margin of safety even when we had average intellect in leadership positions. Indeed, the safeguards were so good that we have even successfully negotiated countless encounters with greed, dishonesty, and bad decisions. What a concept. We may have a political system so good that it can be operated by less than the best, just as it takes less ingenuity to drive a car than build that car. And the opportunities that now abound outside of politics may mean we will never again see another combination like the one that sent us on our way.
It wasn't until exposure to statistics that I first worried about something worse than representative government. If we could have leadership two standard deviations above the mean, what would prevent us at some time from having leadership two standard deviations below the mean? Is our system sufficiently resilient to withstand that possibility? What if those in charge were unable to see the future in their minds? What would the population do if they found themselves in that position? Would they demonstrate, as they did against the Vietnam War? If they did, would the leadership understand or even care? What if the leadership lacked ability but possessed ravenous ambition? Would we just hold our breath and wait? For how long would we wait? Would we wait to find the point that finally breaks the system? There are apparently incubation periods required for society to understand the destructive impact of slavery, disenfranchised women, or McCarthyism, but in retrospect, we see the dangers with absolute clarity. What does it take to see those dangers prospectively?
We shouldn't dismiss what is happening to the economy, retirement plans, and hopes for children and grandchildren. We can't overlook the deliberate attempts to provide those of us who have been blessed with even more financial rewards, subsidized by the poor. We should be heard regarding myopic attempts to squeeze just a little more oil from irreplaceable wilderness areas. We should take personally the rejection of scientific explanations of global warming and our role in making the situation worse. We should complain when our country refuses to be part of global efforts to improve the environment. As health workers, we should not ignore the failure of the United States to back the World Health Organization attempt to provide the strongest global antitobacco measures. We should be concerned by the view of the world that we are an arrogant and selfish society. We should worry about civilians in Iraq and the horrors that will now be added to what many already thought was unbearable.
Yes, we should do all of that. But we should be absolutely incensed when the administration suggests they will not take the nuclear arrow from their Iraqi quiver. This administration has inherited the awesome responsibility of a nuclear arsenal that must be dismantled in agreement with all other countries. It is not simply a nice thing to do. It could be the most important act of our time. We lose our moral authority if we suggest there are situations in which we might find nuclear weapons useful. Why won't everyone then find situations in which it would be useful to them? When asked whether people won't be frightened by this possibility, one administration official thought not, because, he said, our record is clear! It doesn't require much checking to see how clear that record is. Only one country has ever used nuclear weapons in war. Did he mean to say we shouldn't worry because we would never use them again?
When the power of nuclear weapons caused politicians in this country and the Soviet Union to lose their direction, health workers provided leadership, through Physicians for Social Responsibility and the International Physicians for the Prevention of Nuclear War. JAMA provided an annual focus to review the dangers. These groups said there are things we regard as untenable for health. War is on that list, but nuclear weapons head the list. It is time to declare that again. To be heard with urgency and absolute conviction. Social norms now rule against yelling "fire" in a theatre or talking about bombs in an airport. For administration officials to talk about the use of nuclear weapons falls below the level of socially acceptable behavior. Our lack of surprise, the muted outcry, the business-as-usual approach is simply a sad commentary that we are becoming inured to substandard and imprudent behavior. Health workers must collectively provide the moral compass that helps this administration become, in the words of Jonas Salk, good ancestors.
William H. Foege, MD, MPH, Professor Emeritus, Emory University School of Public Health; email@example.com