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Eric Reinhart, MD Profile picture
@_Eric_Reinhart
May 24 • 32 tweets • 8 min read • Read on X
Why is ethical dissent so rare among medical doctors, who have historically––and still now––simply gone along with so many profoundly violent, unethical practices and professional norms? 1/
Despite its image of itself as a distinctly virtuous profession dedicated to protecting human life and dignity, organized medicine’s participation in state violence is far from a new phenomenon. Nazi medicine, for example, emerged from within mainstream German medicine, which 2/
had long been considered to represent the world’s most sophisticated and advanced medical establishment and played a central role in shaping the American profession. US medicine’s participation in eugenics, repression of the Civil Rights Movement, long-standing practices of 3/
racial segregation and abuse in medical care, support for apartheid in South Africa, and core contributions to US government torture programs, for example, are all well-documented. And the profession has also played a central role in shaping and then opposing change to the 4/
profoundly violent capitalist U.S. health system that, by placing profits over people, is responsible for at least tens of thousands of preventable deaths each year.

What lies behind these shameful realities that contravene the medical field’s most basic ethical ideals? 5/
#1 The American medical profession’s self-serving denial of the intrinsically political nature of medicine and public health. By selectively appealing to political neutrality and utilizing ideologies like “humanitarianism” as a way of sidestepping the political determinants of 6/
health, both leaders and rank-and-file doctors can retreat from ethical responsibility beyond the bedside whenever accepting it might incur risks. Meanwhile, their lobbying groups carry on with explicitly political projects focused on maximizing the field’s profitability. 7/
#2 The vulnerability of doctors and non-profit institutions in America’s privatized health industry, in which very few workers are unionized and most are thus subject to constant risk of reprisals, discrimination, and dismissal, often under the guise of discipline for lack of 8/
so-called professionalism. This, in turn, supports an intensely hierarchical professional culture characterized by very little tolerance for ethical dissent. Many doctors fear their careers will be harmed if they speak against injustices in which their colleagues and 9/
institutions are complicit. And institutional leaders are wary of upsetting the philanthropists upon whom their personal careers and fundraising goals depend. These fears are particularly potent now, when criticizing the Israeli state is falsely equated to antisemitism and 10/
billionaire donors have been publicly attacking individuals and institutions that do not repress pro-Palestinian speech to the degree they demand. 11/
#3 The US medical profession’s long-standing racism and opposition to anti-apartheid protest. At home, the AMA supported segregated hospital care and exclusion of Black doctors, only apologizing in 2008. Internationally, it supported South African apartheid into the 1980s. 12/
We need to cultivate a much stronger critical ethical-political awareness and sense of responsibility in medicine to generate the changes we need. It's to this end that I've been publishing, often with colleagues, a variety of essays that approach this from different angles. 13/
Some of those essays are linked here below.

Most recently, with Mary Bassett. 14/
thenation.com/article/societ…
The week prior, with Joelle Abi-Rached. 15/
thelancet.com/journals/lance…
With Bram Wispelwey. 16/
aljazeera.com/opinions/2023/…
On the need for an expressly political education among health workers. 17/ jamanetwork.com/journals/jaman…
On the political-economic determinants of health and the importance of decompartmentalizing health policy. (You can bypass paywall obstacles here: ) 18/
drive.google.com/file/d/1MyAPs6…
nejm.org/doi/full/10.10…
On a framework of "structural medicine" with Aletha Maybank and Daniel Daws. 19/
thelancet.com/journals/lance…
On accompaniment and a critique of the shallow, depoliticized framework of 'medical ethics' as it is taught in the US. 20/
bostonreview.net/articles/eric-…
On apartheid logic in global health. 21/
thelancet.com/journals/lance…
On how medical billing colonized care within US healthcare. 22/
thenation.com/article/econom…
On how US clinical medicine has cannibalized public health. 23/
thenation.com/article/societ…
And a follow-up to that piece that emphasizes the necessity of bottom-up public health system design and implementation. 24/
statnews.com/2023/02/24/fix…
An example of the kind of public health movement and programs we need. 25/
nejm.org/doi/full/10.10…
A further elaboration of that paradigm. 26/
time.com/6278659/how-co…
On the obstacles to deprofessionalizing and democratizing care. 27/
nytimes.com/2023/05/22/opi…
On the corruption of the current US health system and the toll it takes on both those who work within it and those who depend upon it for care. 28/
nytimes.com/2023/02/05/opi…
On one possible route for organizing ethical dissent among doctors through collective protest billing practices. 29/
slate.com/news-and-polit…
On the fundamental and ongoing racism of psychiatry as paradigm and practice. (Specific chapter here: ) 30/
drive.google.com/file/d/1qgOGz8…
cup.columbia.edu/book/ordering-…
And an essay on how we might begin to reorganize US mental health systems and care delivery on the basis of public health and community wellness rather than top-down, pathologizing, and racializing psychiatric frameworks. 31/
jacobin.com/2023/11/chicag…
And an interview about the NYTimes essay above on the demoralization of US health workers. 32/

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More from @_Eric_Reinhart

Eric Reinhart, MD Profile picture
May 21
A @PIH staffer sent me a recent internal email purporting to explain why the org has not made any public comment on the unfolding genocide in Gaza. It makes no mention at all of the fact that this isn't just a random atrocity among many; it's one sponsored and enabled by the 1/
US government with which PIH collaborates, from which they receive funds, and within which they have extensive ties with officials in positions of power. Also no mention of the fact of widespread US suppression of protest and pro-Palestinian speech that would make PIH's 2/
public comments especially important––both locally in the profoundly reactionary Harvard/HMS climate and also within national and global public health discourse. This post-hoc rationalization is not honest, and worse, it's being used to justify ongoing complicitous silence. 3/
Read 9 tweets
Eric Reinhart, MD Profile picture
May 20
Why does it matter that many of the world's most influential peer-reviewed academic journals systematically censor submissions related to Israeli violence against Palestinians? The ICC relies in part on scientific evidence to bring charges for criminal acts. By refusing to 1/
publish research related to Palestine or, in other cases, imposing non-standard review processes and long delays in brining such research to press, journal editors are impeding the availability of evidence to stop and deter war crimes and genocide. 2/
Criticizing @NEJM and others who are enforcing "the Palestine exception" is therefore not simply an intrnal academic issue; it has major ramifications for efforts to stop ongoing massacres. Editorial complicity with US imperialism and Israeli colonialism is a major problem. 3/
Read 11 tweets
Eric Reinhart, MD Profile picture
May 16
Fanon's observations about the political tendencies of doctors are as relevant today as ever. They are rooted in what he saw as he worked as a psychiatrist in French-colonized Algeria during its struggle for liberation, in which as many as 1.5 million Algerians were killed. 1/13
Doctors, when economically and professionally incentivized, are an “integral part of colonization, of domination, of exploitation," he wrote," and “we must not be surprised to find that doctors and professors of medicine are leaders of colonialist movements.” 2/
But while Fanon testified first-hand to doctors’ tendency to align with colonial violence, he also believed and showed that doctors can choose to do otherwise and instead become vital contributors to collective movements for freedom, care, and justice. 3/
bostonreview.net/articles/eric-…
Read 13 tweets
Eric Reinhart, MD Profile picture
May 15
🧵"The Palestinian challenge to US medical ethics"

For the past 7 months, the world has been witnessing the murder of health workers, as well as their abduction, torture, execution, and the dumping of their bodies in mass graves; killing of patients in their hospital beds; 1/14
deliberate bombing of hospitals and clinics; targeted destruction of health and sanitation infrastructure; blockades to humanitarian aid and essential medications during a historic famine manufactured to serve as a weapon of war; and the infliction of conditions designed to be 2/
incompatible with life on Palestinians in Gaza.

These facts have been documented in orders issued by the International Court of Justice on Jan 26, 2024, and March 28, 2024, and in a detailed report entitled Anatomy of a Genocide, published on March 25, 2024, by the UN 3/
Read 14 tweets
Eric Reinhart, MD Profile picture
May 14
Today in @TheLancet: The US health industry is the largest sector in the world's largest economy, and the medical profession leverages massive political power through it. Given this, our silence on US-enabled genocide in Gaza is utterly indefensible. 1/
thelancet.com/journals/lance…
I'm grateful to @jabirached_ for working with me on this. She's been pushing for months––including via this essay that was rejected by medical journals––for the medical community to confront the fact of genocide and our responsibility to stop it. 2/
bostonreview.net/articles/the-w…
I'm also thankful for Bram Wispelwey, Yara Asi, Mary Bassett, Tanya Zakrison, Lara Jirmanus, Ṣẹ̀yẹ Abímbọ́lá, Adam Gaffney, Qaali Hussein, and many others who have refused to be complicit and have chosen to speak out despite the professional risks. 3/
aljazeera.com/opinions/2023/…
Read 4 tweets
Eric Reinhart, MD Profile picture
Apr 23
I was invited to give a lecture at a US medical school in January 2024 for International Holocaust Remembrance Day with a focus on the German medical students who were part of the resistance group, The White Rose. I accepted and said I would of course draw parallels to 1/
our responsibilities in the face of an ongoing US-Israeli genocide against Palestinians. I was asked not to, as "it would just distract from the point," which was ostensibly that doctors should see political organizing and dissent as part of their ethical responsibilities. 2/
I did not end up giving any lecture, but this experience, organized by people who imagine themselves moral authorities and leaders in medicine, was profoundly disheartening. If the point of history is just to use it to evade meaningful engagement with the present, count me out.3/
Read 5 tweets

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