MEDICAL WARRIOR - Fighting Corporate Socialized Medicine by Miguel A Faria, Jr, MD, Hacienda Publishing, Macon, Georgia, 207 pages, $24. ISBN: 0-9641077-2-4

Miguel A Faria, Jr, MD, escaping Cuba at age 13, seized the opportunities available in the U.S. To obtain a medical education, become a neurosurgeon, and rise to Clinical Professor of Surgery (Neurosurgery). In addition, he became Adjunct Professor of Medical History at Mercer University School of Medicine, as well as editor of the Journal of the Medical Association of Georgia. In 1996 he became Editor-in-Chief of Medical Sentinel. His first volume, Vandals at the Gates of Medicine--Historic Perspectives on the Battle Over Health Care Reform was reviewed in Sacramento Medicine in April 1998. Medical Warrior is a collection of Faria's essays in which he discusses the "vandals within the gates" of medicine.

After a quick overview of Vandals at the Gates, Faria moves quickly to the modern "Trojan Horse" in which physicians succumb to the allurement of government medicine -placing vandals within our ranks. This almost imperceptibly shifted physicians’ loyalties from the patients to insurance carriers including the government in the case of Medicare and Medicaid. At this time, Faria sees an even greater rescue effort required to free medicine from the clutches of third party medicine. The author finds it ironic that as other countries move away from government (socialistic) medicine, our politicians and medical organizations are leading us, with little opposition, toward government control.

Dr Faria observes organized medicine's interface with government. He notes that Dr. James Todd of the AMA introduced Representative Fortney "Pete" Stark (CA) at the Washington, DC 1993 AMA summit, Stark delivered a vitriolic speeches against organized medicine. Nevertheless, organized medicine political action committees (PACs) have paid $203,200 into Stark's coffers, making him the second highest recipient of funds from organized medicine. Why do we support someone with such contempt and derision for our leadership?

And Dr. Faria is not above vitriol himself. In 1990 the National Practitioners Data Bank (known as the "Data Bank" or NPDB) was implemented "to encourage peer review; impede unscrupulous, unethical, or incompetent physicians from moving from states (where they had been disciplined) to others where their disciplining actions are not known and where they may establish new medical practices unhindered; or to enhance the overall quality of health care delivery." As editor of the Journal of the Medical Association of Georgia, Faria wrote a scathing editorial that outlined his objections, predictions, and suggestions. The Association then passed a resolution: "RESOLVED, that MAG take immediate action through legislative avenues to seek the repeal of The Data Bank, as a violation of the civil liberties of American physicians." He states that while the AMA House of Delegates was pressing for abolition, the Board of Trustees of the AMA opted "to pursue vigorous remedial action to correct all operational problems with the NPDB." However, their actions turned out to be softball when the government bureaucrats were playing hardball.

Faria feels that the Data Bank has not fulfilled or contributed significantly to its originally stated mission. He believes that his predictions have come true. The first year garnered 18,561 adverse actions and malpractice pay outs that were permanently filed in the Bank. The Bank makes no distinction between authentic malpractice actions and suits that were settled when there was no evidence of malpractice merely to avoid the exorbitant costs of litigation. No other profession has been subjected to or singled out to such mandated blacklisting. Meanwhile physicians in the V.A. system and Department of Defense, chose not to participate and are exempted from the Data Bank.

Dr. Faria draws on other authors to bolster his arguments. In The Holocaust Memorial, Ayn Rand, and Politics in Pre-Revolutionary New York: Lessons for Today, author Joseph Scherzer, MD states: "Was Ayn Rand correct when she wrote that the difference between a welfare state and a totalitarian state is only a matter of time? There are frighteningly accurate predictions of the present government and corporate rape of Medicine in Ayn Rand's Atlas Shrugged."

As a historian, Faria advises us to go back to Hippocratic medicine and back to putting patients first. The individually-based, competitive marketplace, that does not compromise a physician's ethics, the patient-doctor relationship, or the patient's right to choose and spend their own health care dollar as they see fit, will bring down spiraling health care costs voluntarily.

As we devote our final Journal issue of the year to the challenges of medicine, if we are challenged to accept criticism of those within our ranks constructively, and criticism of those outside our ranks without paranoia, there are lessons to be learned.

Del Meyer, MD