The Need for Political Reform

“Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”----Rudolf Virchow

"Madness is rare in individuals - but in groups, parties, nations, and ages it is the rule."---- Friedrich Nietzsche

Dr. Ralph M. Waters (1883-1979)

The story of CO2 illustrates how wartime subsidies accelerate medical knowledge, but peacetime politics perverts such knowledge to promote private profits at the price of public health.

The myth of CO2 toxicity persists even though modern research proved that carbon dioxide is benign, beneficial, and essential for life at the turn of the previous century. Nurse anesthetists embraced CO2 supplementation to optimize cardiorespiratory function, maximize morphine dosage, prevent ether explosions, and minimize morbidity and mortality. Clinicians utilized Carbogen, a pressurized mixture of carbon dioxide and oxygen, to treat asthma, pneumonia, influenza, heart attacks, strokes, smoke inhalation, alcohol intoxication, carbon monoxide poisoning, drowning, and respiratory problems in newborn babies. Carbogen was commonplace in fire trucks, hospitals, and physicians’ offices, and it saved numerous lives.(1-8)

Dr. Ralph Waters, the first university anesthesiology chairman, characterized carbon dioxide as “toxic waste, like urine,” and promoted mechanical hyperventilation to “rid CO2 from the body.” Regardless of motive, seldom has a civilian caused so much harm to so many. Hyperventilation has killed countless patients(9-16); CO2 treatment has disappeared from medical practice; blood pressure has become the counterproductive standard of medical management; toxic anesthetic “overpressure” has supplanted beneficial opioids; physicians have embraced harmful alkalosis; and the proven principles of Crile, Henderson and Lundy are abandoned and forgotten. CO2 confusion has derailed stress research, machine design, monitoring practices, humane animal research, and theoretical advance.(17) Airway security and mask management is largely forgotten in anesthesia practice. The failure of professional anesthesiology organizations to produce sorely needed CO2 guidelines and standards is most simply explained by commercial interests that seek profits at the expense of public health. The problem is political in nature, and only political reform can restore medical progress.

“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.”

---Rudolf Virchow

"The medical profession in the United States ceased, very largely, to be a profession of the fatherly confessors and unprofessing humanitarians and became one of the largest groups of hardheaded petty-bourgeois hustlers in the United States, and their professional association became the most ruthlessly materialistic lobbying association of any professional group."

----Carrol Quigley

1. L. W. Crile GW, Anoci-association. (Saunders, Philadelphia, 1914), pp. 223-225.

2. Y. Henderson, A Lecture ON RESPIRATION IN ANAESTHESIA: CONTROL BY CARBON DIOXIDE. Br Med J 2, 1170-1175 (1925).

3. Y. Henderson, Observations on RESUSCITATION FROM ASPHYXIA AND PREVENTION AND TREATMENT OF SECONDARY PNEUMONIA BY INHALATION OF CO(2). Br Med J 2, 687-689 (1931).

4. Y. Henderson, Public Service as an Element in the Life of the American Scientist. Science 77, 584-585 (1933).

5. Y. Henderson, The Wesley M. Carpenter Lecture: Atelectasis, Massive Collapse and Related Post-Operative Conditions. Bull N Y Acad Med 11, 639-656 (1935).

6. Y. Henderson, Resuscitation with Carbon Dioxide. Science 83, 399-402 (1936).

7. Y. Henderson, How Breathing Begins at Birth. Science 85, 89-91 (1937).

8. Y. Henderson, in Cyclopedia of Medicine. (1940).

9. K. Fecho, F. Jackson, F. Smith, F. J. Overdyk, In-hospital resuscitation: opioids and other factors influencing survival. Ther Clin Risk Manag 5, 961-968 (2009).

10. F. J. Overdyk, Postoperative opioids remain a serious patient safety threat. Anesthesiology 113, 259-260; author reply 260-251 (2010).

11. F. J. Overdyk, postoperative Opioids Need System-Wide Overhaul. Anesthesia Patient Safety Foundation Newsletter, (2010).

12. F. J. Overdyk, Q. Ahmed, Postoperative monitoring of obese patients with obstructive sleep apnea. Anesth Analg 108, 1044-1045; author reply 1045 (2009).

13. L. S. Coleman, Should soda lime be abolished? Anesth Analg 102, 1290-1291 (2006).

14. L. S. Coleman, in apsf Newsletter. (Anesthesia Patient Safety Foundation, Administrator, Deanna Walker Anesthesia Patient Safety Foundation Building One, Suite Two 8007 South Meridian Street Indianapolis, IN 46217-2922 e-mail address: walker@apsf.org FAX: (317) 888-1482, 2010), vol. Winter 2009-2020.

15. L. S. Coleman, A call for standards on perioperative CO(2) regulation. Can J Anaesth, (2011).

16. L. S. Coleman, Soda lime is a dangerous relic of a forgotten past. Anaesthesia 70, (2016).

17. L. S. Coleman, Four Forgotten Giants of Anesthesia History. Journal of Anesthesia and Surgery 3, 1-17 (2015).

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