Response to 2009 Question of the Year
We should frame peace-building in academic medicine in terms of where we do and do not have influence. Much discussion about peace-building poses the question in terms of whether “we” should intervene militarily in conflicts (e.g., in the Sudan) over which we otherwise have little influence. This begs the question of the role that our own nation has in fomenting war. It is also symptomatic of the thinking that the military is always the solution. In the political and economic realms, the United States competes with Europe and Asia. In the military realm, however, it reigns supreme. The United States thus tends to lead with its strength, choosing to resolve conflicts by military threat or attack.
As American academics, our primary responsibility should be to influence the actions of our own government—by monitoring its actions, applying the scientific methods at our disposal and the moral and ethical principles to which we subscribe, formulating and suggesting policy, and disseminating our findings to the people. In a democracy, the citizenry would then determine the course of action. As academics in medicine, our expertise is in the realm of morbidity and mortality, encompassing the direct effects of violence as well as the indirect effects arising from the collapse of health services, poor access to water and food, and damage to infrastructure, economies, and societies. As American academics in medicine, then, we should first concern ourselves with the morbidity and mortality caused by our own government's actions.
During this decade, our nation has been responsible for invading and occupying two countries halfway around the globe—Afghanistan since 2001 and Iraq since 2003. In the case of Iraq, the invasion of 2003 was preceded by comprehensive economic sanctions, which hampered the rebuilding of its infrastructure after the Gulf War of 1991. The consequences included childhood deaths, mental illness, juvenile delinquency, begging and prostitution, as well as cultural and scientific impoverishment.1
In 2002 and 2003, the American people were not convinced by the Bush administration that war on Iraq was justified. However, despite massive demonstrations against the war prior to its launching, the intellectual classes, the corporate media, and our elected representatives went along with the administration. Democracy failed us in this respect. Before the war, academic medicine should have been recounting the health toll of the First Gulf War and the sanctions regime. With its onset, we should have been disseminating the images and recounting the narratives of casualties of the war.2 As it progressed, we should have been acutely interested in the number of casualties caused by the war. The best estimates for deaths among Iraqis are those of a July 2006 survey that reported 655,000 deaths as a consequence of war.3 Insofar as we have failed to pay attention to such findings, academic medicine has failed its constituents.
At the mention of history or political economy, our learners groan. We are not interested in politics, they say. But unreflective learners repeat the blather that they are fed by the corporate media. Their interest in politics extends only as far as protecting physician reimbursements. But academic medicine has the responsibility to produce physicians who advocate for the cause of health—in particular for the health of those whose voices are otherwise unheard, whose deaths are otherwise uncounted, unmourned, unopposed, and unorganized against. To do so, our analysis must be geographically broad and historically deep.
As the United States pulls its troops out of Iraq and sends them to Afghanistan, as our military wields drones called Predator and Reaper, academic medicine should concern itself with whether the cause of peace is thereby served by these acts of aggression. The British and the Soviets failed in their attempts to militarily control Afghanistan, while inflicting untold casualties on the populace. Let us in academic medicine get to work to prevent the United States from doing the same.
2 Yamada S, Fawzi MC, Maskarinec GG, Farmer PE. Casualties: Narrative and images of the war on Iraq. Int J Health Serv. 2006;36:401–415.
3 Burnham G, Lafta R, Docey S, Roberts L. Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey. Lancet. 2006;368:1421–1428.