91 Comments
Jul 8Liked by Martin Greenwald, M.D.

I agree. I am a physician. My job as a physician is to do my best to diagnose and treat the patient who seeks my advice. It is not my job, as a physician, to advocate for social justice or political positions. As a citizen I have that right outside of my role as a physician, but not in my professional role.

For years, the main stream medical associations and educational institutions have taken political positions— IT IS NOT THEIR BUSINESS! It is not appropriate! It is just not ethical or moral. Our power as physicians is to help the sick and comfort the dying with our skills with medicine, surgery and counseling.

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Would it be appropriate, ethical, or moral, for a medical association to take a stance on the killing of medical professionals or the bombing of medical facilities in foreign countries?

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Jul 8Liked by Martin Greenwald, M.D.

No. Because apart from the general condemnation of specifically and deliberately attacking medical services during a time of conflict, taking a stance on a particular situation will always involve interpretation of facts and details specific to to the act that is being condemned in a location that is either outside the scope of most organizations (like what does the AMA have to do with conflicts outside the US?) or has nothing to do with its mission (UCLA trains for physicians in the US not faraway land). The fog of war is thick and it is unnecessary to issue opinion statements about events in war.

This is not really that hard. If you want an organization that wants to advocate for something call it that: like Docs for Palestine or Docs for Israel or Docs for La-la-land. But most people won’t care since docs don’t have any particular insight into such things.

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Here we go with specifics and here is why it is no good to discuss as a doctor in the office— let us just say I take care of many gays in my practice — being gay in Gaza is a death sentence. Is the war in Gaza by Israel a liberation of gays? Where is the only country where an Arab woman in the Middle East be a doctor? The country starts with I, ends with L. Is it morally correct for Hamas to locate assets in a hospital? Or steal aid from UN to feed its soldiers and build its tunnels?

I happen STRONGLY to believe that the pro-Palestinian movement in the US is either anti-Semitic (antiZionism today is antisemitism), anti-Western (favors theocracy over nation states with liberal democracies) or ignorant (it fails to understand that Palestinians have REPEATEDLY and CONSISTENTLY favored a decades long war to destroy Israel that create a state. AND the Palestinians). A person wearing a Palestinian flag in the US is either AntiSemitic, antiWestern, or ignorant AND it has NOTHING to do with being a doctor! I am not Jewish nor Israeli nor married to either and I don’t have religious beliefs about the second coming or apocalypse.

I know know evil when I see it, and Hamas is it.

I also know naivety and hubris when I see them, and insistence of advocating for political positions in medical care is both.

I, as a doctor, don’t need nor want my professional organization to take any stances on politics, even if I agree with them 100%. I need them to keep me educated about the things I need to know to help me be a better physician.

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I cut off a sentence: Palestinians don’t want a state— they want to destroy Israel. OVER and OVER and OVER. And OVER. And they celebrate self annihilation. AGAIN and AGAIN!

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I believe you are misinformed on this point, and if you would try and put yourself in the shoes of a Palestinian who has lived under a brutal occupation for decades now, or to honestly listen to those who are advocating for the Palestinian cause, you would be more understanding.

When Israel was created in 1948, where do you think they got the land from?

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Sorry. Nice try. Palestinian leaders have failed their people. Again and again. It is war they want. The right of return is a poison pill. But again, this is WHY THIS CONVERSATION IS UNNECESSARY IN MY PRACTICE!! You are proving my point!!!! Israel was created in a vacuum of political power after withdrawal of the mandate. All states are born in the same way that Israel was born— a consolidation of power.

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A vacuum of political power is one way to put it. Another way to put it would be, "We told everyone living there to get out because this land is ours now, and if they resisted we killed them." And you are certainly correct that this is how many states are born, people with power steal the land from people with less power. Does it make it right? Is it a practice we should still be supporting in the 21st century?

I will leave you with a thought experiment. Imagine you are living in your house and someone comes to your house with a gun and says, "Get out, your house is mine now. Leave or die." Now also imagine your local police and military cannot defend you from the people with guns, because the people with guns are backed by the largest nations in the world, so you have no legal recourse to reclaim your home.

To save your life you take what you can carry to a place where the people with guns say you are allowed to live. In this place the people with guns control everything that goes in and out, and regularly patrol, beat people, and incarcerate people without due process. The correct term for this is a concentration camp, this is where you now live with your fellow refugees who also had their homes stolen. Any attempt at resistance, peaceful or otherwise, is met with absolutely brutal repression.

Welcome to the life of a Palestinian.

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I think a good counterpoint to this would be the divestment movement against apartheid South Africa in the 1980's. Student groups successfully pressured many colleges to sever all financial ties with South Africa, and this led to states and larger organizations following suit, which eventually brought down the apartheid regime. We have seen similar attempts to do just that against Israel here in the US just recently.

Does the medical institution/association have any financial connections to Israel? Purchase of medical equipment or services? Conferences? Connections to medical facilities in Israel? If so then it has some power to change what is happening on the ground in Gaza and to be an example for other institutions to follow suit.

You talk about the fog of war and futility of determining the truth of a contentious situation, but there are objective facts that are hard to refute. The rate of civilian killings by Israel is shocking to the conscience and has very few equals in modern warfare. The very state which freed itself from apartheid, South Africa, is leading the case against Israel for genocide and crimes against humanity, which has been deemed by the ICC to be a credible case.

Would you really force doctors to stay silent about this at work? Particularly if their institution had tangible ties to a state which was committing crimes against humanity?

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Oh for Gods sake. Let college kids do their thing. We all know they are idiots because we once were idiots too. But, when I’m going in for treatment for my cancer the last thing I want to hear or think about is fracking Palestine!!! If my oncologist starting spouting off about that 💩 I’d say it’s time to find a new doctor who is focused on my health.

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What if your patient is connected to Israel? Do you boycott them too? Is your institution ok with that? What constitutes being connected with Israel and being deserving of boycott when Jewish schools and homes outside of Israel are being shot at, firebombed and vandalized? Does this mean that just being Jewish is too Zionist for some pro-Palestinian protestors? What does the Jewish patient then think when their oncologist comes in wearing a watermelon pin? Should they worry their care will be compromised in the interest of their Dr maintaining BDS principles?

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No you treat all people with integrity and compassion, no matter their upbringing or beliefs. You then explain it isn't Jews that you are boycotting, its the state of Israel and their war crimes against the Palestinian people, and if you find this position intolerable you would be happy to refer this patient to another doctor.

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How can you possibly treat everyone with integrity and compassion while still holding the views you hold? It's a wonder you aren't dead of cognitive dissonance. Jews ARE the state of Israel.

Would I "force" you to stay silent about it at work? No. But if you displayed your political views (whatever they are) while caring for me, I'd find another doc. And if the terms of your employment prevent you from espousing political views at work, then I'd vehemently support your right to find another job.

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South Africa is a fucking joke of a country.

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When medical facilities are Hamas terror infrastructure they get bombed.

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I think it’s very important to recognize that ‘bombing hospitals’ or whatever you call it is not the reality of what goes on in Gaza. That’s a convenient myth. Tne reality is that all civilian infrastructure in Gaza exists to support Hamas and that is hospitals, clinics, UNWRA schools, ambulances and mosques. So if I were you I’d ask myself who did that. Go whine about it to the polygamist of Doha, Ismail Haniyeh.

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Yes this is the ideology of every terrorist. All targets are legitimate, and there is no distinction between civilian and military targets. If you have ever read Osama Bin Laden's Letter to America, I think you and he would find you have a lot in common about how warfare is conducted.

"The American people are the ones who pay the taxes which fund the planes that bomb us in Afghanistan, the tanks that strike and destroy our homes in Palestine, the armies which occupy our lands in the Arabian Gulf, and the fleets which ensure the blockade of Iraq,"[...] "This is why the American people cannot be innocent of all the crimes committed by the Americans and Jews against us."

He even mentions Israeli occupation of Palestine as a rationale for attacking the US.

"(i) Palestine, which has sunk under military occupation for more than 80 years. The British handed over Palestine, with your help and your support, to the Jews, who have occupied it for more than 50 years; years overflowing with oppression, tyranny, crimes, killing, expulsion, destruction and devastation. The creation and continuation of Israel is one of the greatest crimes, and you are the leaders of its criminals. And of course there is no need to explain and prove the degree of American support for Israel. The creation of Israel is a crime which must be

erased. Each and every person whose hands have become polluted in the contribution towards this crime must pay its*price, and pay for it heavily." -Osama Bin Laden

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Nice job. You have exposed yourself as a Hamas apologist. Truth doesn’t matter to go. Everything is inverted. Hope you remember what side of the body the major organs are.

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He/she/it not a Hamas “apologist.” He/she/it is a Hamas supporter.

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If they are only medical facilities and not Hamas infrastructure.

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I cannot tell you how many times I have told patients that the exam room is a politics free zone. I do not want politics to contaminate my patient visits, but even further than that, I strongly encourage my patients to not concern themselves about things that are out of their control. Vote in the national elections, sure, but after that, concentrate on local politics, where you can have an effect, or no politics. Coming in w a systolic blood pressure of 195 because you are so upset about the the recent election benefits no one. I've lost at least one patient over this stance, but I do feel it is good health advice.

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Hard agree here

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I worked at a hospital in California (an academic one) and the attending physician brought in donkey cupcakes on the evening Biden was elected president. I was shocked that such an “intelligent” person thought that all the people working that evening believed the same as her… bc even if we didn’t think Trump was the right candidate- that didn’t mean we all wanted donkeys on our cupcakes. It was seriously a barf in my mouth moment… Especially bc when trump won 4 years earlier- the next day at work (same institution) was all gloom and doom and crying and “democracy is over”. So pathetic and annoying

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I study medical cultures for fun and I have witnessed a shift in the focus on issues like burnout, sexism and racism within training and practice and their impact on patient care to systemic issues as the cause of all problems for patients and medical trainees and professionals. A shift from an internal locus of control to an external one. Once it became more fashionable to be a first generation medical student from a marginalised background (around 2019) then it also became ok to blame external factors for their oppression (despite being among a handful of the population privileged to be in medicine) and the oppression of the 'communities they serve'. The intensity of dealing with an emotional charged setting of hospital care is already high. Add a fashionable Omnicause, the lingering impact of COVID response, the traumatising training/practice setting and the loosening of hierarchical authority and professionalism that medicine is known for that has enabled 'the personal is political' to creep in and you get a toxic mix of people who are unclear about their role and responsibility to their patients first. Political activism at work is seen as abiding by the tenet of do no harm and doing justice work and no one is telling them otherwise. Or if they are, some aren't listening.

It is important for patients to feel safe, and for some that means knowing their doctor is gay, Black or any other intersectional marker that helps them. But there is still a line, and crossing it makes it about the doctor's communal narcissism and need for validation than what is best for the patient in front of them.

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Whither adult professionalism?

It's *so* recent that people "forgot" that this has never been how civilized pros have behaved. As in, within the past 10 years.

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To contextualize the clear increase in activism, there have been a number of issues that have emerged since 2008 that have made people genuinely afraid for the future. Since people spend their most alert hours at work and have the majority of their adult conversations there, the temptation arises to attempt to solve the problems of the world by working in concert with their coworkers.

This wasn't such a problem at the time of the Vietnam War, because opinions were basically generationally split— the young folks who opposed the war had no workplace power.

It is interesting that here in Houston, TX we just elected a new state senator who is emergency room nurse and whose political organization is largely composed of coworkers. She won by 45 votes in a runoff.

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>there have been a number of issues that have emerged since 2008 that have made people genuinely afraid for the future

Too bad. It's not the job of their co-workers to be their psychoanalyst.

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It wouldn’t be bad if people were just politely discussing things when they had time at work to talk, or impolitely in a mutually agreeable fashion. But we cant have normal things I guess nowadays. It used to be just one side would go batshit insane if you disagreed with them (or, for a long time at least—plenty of times in history where people were even more divided—but now I see it creeping into the other side too.

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> A hypothetical hospital in which doctors wore pins and protested for conservative causes would likewise be problematic for precisely the same reasons

Sure, but hospitals where doctors engage in noisy pro-capitalism protests are hypothetical exactly because they don't exist. This is exclusively left wing people problem and it's not unique to medicine. Every institution and industry is afflicted with this disease.

It's time we start thinking of leftism as a sort of socially transmitted illness, a bit like drug addiction. Those afflicted lose interest in their work, their friends, their families and can't focus on anything except activism. Just like with drugs the more they engage in this the more they spiral downwards, needing ever more extreme acts to satisfy their cravings. They wreck not only their own mental health but the lives of the people around them too, by draining the institutions where they work until they're no longer capable of carrying out their mission.

The right wing should _not_ be understood as a mere mirror image of the left in this context. The right is actually the absence of leftism. "We just want to grill, man, why do you keep hassling us?" You don't see this kind of toxic behavior from them, ever, because they aren't obsessed with ideology to begin with.

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I will share a story. I practice medicine in a private multi specialty clinic in rural PA with about 14 providers. About 4-6 years ago with the BLM and anti police movement, the local police asked our practice to display posters that said we support our local police. Despite the fact that doing so would not be particularly brave (we are in Trump country with gun ownership is high and with many hunters) we did not display it.

The most conservative partner (woman, hunter, Christian, anti-DEI, anti-BLM) argued we should NOT display this poster because it signals political ideas that have no place in a medical office, despite the fact that she agrees with the sentiment. Patients are not in our office to subject themselves to political ideas that raise their blood pressures; instead she will lecture them on the importance of blood pressure control. She could take the sign home, but she would not allow it displayed in the office. I agreed with her.

Left wing elites and right wing elites are not mirror images.

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The amount of comments that support activism in the workplace here is dispiriting. This literally wasn't a thing until 10 years ago...for a reason. You're there to do a job, not to tell everyone where you stand. To go thru the mental gymnastics so you can make a connection to Israel-Gaza conflict from a medical system in a CA after, say, heart surgery seems to stretch the limits of logic. But it's happened in corporate America so why not medical systems.

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Because they aren’t serious doctors. Something else occupies their minds as being far more important, to them, than the provision of medical services to humanity: their own moral superiority with which to submit the unrighteous and punish them mercilessly is the ultimate virtue to these people.

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"The surest way to work up a crusade in favor of some good cause is to promise people they will have a chance of maltreating someone. To be able to destroy with good conscience, to be able to behave badly and call your bad behavior 'righteous indignation' — this is the height of psychological luxury, the most delicious of moral treats." -- Aldous Huxley

Covid is another glaring and particularly ugly example of this phenomenon.

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Oh please, most people become medical professionals because they sincerely want to help people, not lord over them. If empathetic people like these were not deeply disturbed by the slaughter of tens of thousands of women and children and the bombing/attacking of medical facilities, I would be concerned.

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First, I wonder if "most people become medical professionals because they sincerely want to help people", if those people can put their classes, rounds, bedside consulting, labs on the back burner to concentrate on a political situation.

And yes, I hope people, my doctor, etc would be outraged by mass human fatalities, but those conversations are not appropriate in the hall, in exam room, outside patient/personnel areas. Keep it at home by yourself or invite like-minded people over and discuss.

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Is wearing a Palestinian flag pin going to significantly hinder someones ability to do their job though?

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If I am his patient, I am offended. I don't want to know where you stand on US politics, religion, or world events. I'm a lot of things also. I have strong opinions about many things, but I don't place them on my shirt, wear them on my sleeve or parade them anywhere else. My ideas, thoughts, allegiances, and so on are my business only.

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It would make me feel like I don’t want to be treated by this person.

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As a patient, it would leave me with serious questions. Is a doctor who is activist enough that he or she just has to announce their left-wing views to me in some obvious visual way going to make their best effort with me if they suspect I disagree with their politics? This is the same type of doctor who was saying that the unvaccinated should be refused treatment at hospitals during the pandemic, even long after it was obvious that the vaccines didn’t prevent transmission.

Unless you think it’s also okay for doctors to wear red MAGA hats during their rounds — and you’ll forgive me if I don’t believe that your commitment to the principle of “free speech at work” extends that far — left-wing activist doctors can keep their Palestine flag pins in their pockets until they’re off the clock and off the premises.

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I would be more concerned about lack to compassion for the patient in front of the doctor than lack of empathy for thousands of bombings far away. Also— how come no compassion for the Uighurs in China? That is closer to genocide there than elsewhere.

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Quoting the Hamas ministry of savagery.

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Thankfully I am not a political person, but I was giving birth when Biden was elected, and I remember being surprised at how openly everyone in the hospital was happy about it. I hadn't even voted for obvious reasons, and frankly could care less at the time, but what if I WAS the kind of person who cared?

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As always, you could fire like three people and the rest would quiet down instantly. But also as always, the people in charge are too cowardly to do so. Wouldn't want some rando to yell at you on social media, after all!

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I totally agree that politics unrelated to medical care should be kept out of the hospital. But what about issues clearly related to medical care? Unequal access to medical care? Cuts to Medicare and Medicaid funding? The required reregistration of Medicaid recipients?

In terms of optimizing the day-to-day hospital function, these should probably be left to the efforts of professional organizations, the chapters of which may perhaps meet at hospitals. And dues to one of these organization may be part of employee compensation.

You rightly state: "And if you want to speak out, you can do so outside of work, just like the rest of us."

When medical professionals speak out outside of work, “just like the rest of us,” should they be discouraged from foregrounding their medical credentials? I have a PhD in a historical discipline and describe myself to audiences as a professional historian. This attracts both support and interest in what I say and instant resistance as a pointy-headed intellectual.

My belief is that everyone should announce their credentials before and as they speak, so that our society can continue learning how to deal with academic preparation as a useful but not infallible indication of quality.

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I'm sorry, Dr. Weber, but credentialism, appeals to authority, deference to The Experts™, etc. has proved a meaningless and frankly, wholly undeserved exercise. If you've even a modicum of honesty, I probably don't need to waste thumb strength typing its myriad and numerous examples in the last 4 years alone.

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Who handles your medical care? Does having passed med school count? If you don't get your medical care from medical school graduates, how do you determine who is more qualified than they are?

I tried to indicate in my comment that credentials are a start toward determining whether someone has something worth allow to say and has the knowledge to back it up.

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And to answer who handles my medical care...I do. I'd seek a pro to repair a broken bone or stitch up a gaping wound, but I'll be damned if I'm letting one "diagnose" me with diseases I may not even have or write prescriptions for 10 different drugs to mask the symptomatic consequences of my shitty lifestyle choices.

Case in point:

https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d

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Completely agree. I’m a pediatric resident and during orientation there was a bowl of rainbow and BLM stickers we were “free to put on our badges, no pressure though!”

I had the stickers on my badge for a year but took them off this month. I support gay rights, and trans rights but I am more in line with Cass than WPATH when it comes to pediatric gender care.

It just feels gross to express “hey look I’m on the Left team!” at work. My expertise is pneumonia, gastroenteritis, cellulitis, meningitis. That’s what I’m trained in. Thats what I’m here for. Team ideology makes people lose sight of the nuance that’s present in all issues, especially medical ones. I want to fight against that urge, not dive head first into it when it comes to medicine and medicine related political issues

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I appreciate this- and I agree. The question it raises for me (and perhaps sheds a small light on the mindset of the medical protestors) is what is the difference- or where is the line between- “do no harm” and “allow no harm to happen”? I understand that the protests are in themselves harmful to those (including myself) who hold a different opinion- but the protesters probably feel that they are doing what they can to try to stop harm from happening. Full disclosure- I am not a medical professional and tend to hold the idea that medical practitioners are “better” people than the rest of us.

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"... credentials are a start..." No, they're not even that anymore. Whether by fear mongering, lying, plagiarizing, outright fraud or mere fecklessness, silence and inaction, credibility is shot. Allopathic "medicine" and its fellows in mental "health" are the equivalent of the bureaucratic establishment Blob we far too charitably refer to as the "government." Few implicitly trust in these systems or their water carriers now and though painful, I'm grateful the band aid's finally been ripped off.

Sunlight truly is the best disinfectant.

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It’s a slippery slope in medicine because health outcomes are so heavily socially determined. For a healer, I can empathize the desire to combat issues like poverty as this has very real impacts on health. And when healthcare outcomes are so clearly radicalized, I absolutely think it makes sense to consider what this means and what to do about it. Social determinants of health are very real and very relevant to medicine.

But the Israel-Gaza is totally and completely irrelevant, what are these people thinking? I cannot emphasize.

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Generally agree that politics should stay out of work, but if medical workers and physicians wanted to protest the killing of medical staff/ bombing of medical facilities in foreign countries, that seems like an appropriate issue for that type of workplace. Though where one might draw the line on what is and isn't appropriate would be difficult. Only issues directly related to the medical field?

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Why would that be appropriate? What, specifically, are you expecting UCSF do about such things?

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They could issue a statement saying they would no longer purchase equipment or services from Israeli owned businesses until such time as Palestinians are given full statehood and a permanent cease-fire is in effect. Divestment and sanctions is what brought down the South African apartheid regime, and it could bring down the Israeli regime as well.

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Jul 9·edited Jul 9Liked by Martin Greenwald, M.D.

It is grossly unethical for a doctor to reduce the quality of their services to make a political stand. If I found out the hospital treating my wife's cancer refused to buy the best equipment because it was from Israel, or China, or Texas, or whatever place idealogues don't like this year, I would be absolutely livid.

There is a trust in doctors that general public has, an agreement, that doctors are on the patients' side above all else. Breaking that agreement for a cause will kill people. Burning the trust, as it already has done in public health, will kill even more people. The western world moves further toward low trust and dishonesty as the norm.

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Here is a thought experiment for you then. Imagine the Nazis won the war and are now the dominant power in Europe. They use Jews as unwilling test subjects for their medical experiments, and many Jews die as a result. However, this experimentation leads to great advances in Nazi medical science because they do not have to worry about their test subjects dying. Nazis now sell the best medical equipment in the world.

So now you have to choose, the best Nazi medical equipment, or less effective equipment for your wife's cancer. Which do you choose?

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Of course I’d choose to get my wife the best treatment, and if my doctor decided for me not to let my wife have it, that would be grossly unethical.

Now if you say would I support a national policy of sanctions that would prevent access to the equipment, that is debatable and i personally would support it. Governments have to make tradeoffs like that: it is their job. Doctors’ job is to help their patient.

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I would argue that to utilize Nazi medical equipment, or to prevent doctors from protesting the use of such equipment, would be grossly unethical. But I guess on that point we simply have different value systems.

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Jul 8·edited Jul 8

That's silly. Why would anyone take such a huge step to help out a violently Islamist Iranian puppet state that's holding several Americans hostage? You'd have to be completely ignorant of the situation at best, or at worst some kind of spittle-flecked anti-Semite who doesn't care what devils he embraces as long as it inconveniences some Jew somewhere.

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Because they care about human rights and human flourishing. Ask yourself, what would Jesus do in Gaza?

I think if you allowed yourself to see what is being done in Gaza unfiltered by your media bias, and you had a shred of humanity in you, you would be horrified.

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This just gets stranger and stranger. Why would someone who cares about human rights and human flourishing go to the mattresses to protect a vicious and brutal Islamist regime? What "human flourishing" has been done by Hamas or its Iranian puppetmasters?

I guess they've gotten pretty good at digging tunnels, so that's something.

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Do you recognize that civilians live in Gaza? Ordinary people like you and me who just want to live out their lives in peace? Or is everyone in Gaza to you a terrorist or terrorist sympathizer?

You call the Islamists vicious and brutal. In your mind, is the correct response to violence, more violence? A wise person once said, "An eye for an eye will make the whole world blind."

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Why don’t you whine to Sinwar about the war?

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So sad that Hamas has infiltrated the entire civilian infrastructure of Gaza. Especially the hospitals. Which is a war crime.

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