Do No Harm; J. Orient, M.D.

Furthermore, I must "follow that method of treatment which according to my ability andjudgment I consider for the benefit of my patients." I may not subordinate my judg ment to that of a secret council. I may not sacrifice my patient's welfare to a social agenda. I may not deny my patient a cancer treatment or heart surgery so that his re sources can be used to benefit someone with a higher social priority, such as a person who is entitled to a free checkup. I want the best medical care for my patients and for all Americans. We cannot provide the best until we get the cost down. We will not lower costs by abolishing the Oath of Hippocrates and destroying the This article is adapted from a statement by Dr. Orient on behalf of the Association ofAmerican Physicians and Surgeons before the White House taskforce on health care reform, George Wash ington University, Washington, D.C., March 29, 1993.

patient-physician relationship. The Oath of Hippocrates dates to the fifth century B.C. ; the acceleration of American medical costs dates to 1965. Costs skyrocketed because the govern ment got into medicine. Costs will not de crease until we get the government out of medicine: out of private physicians' offices, where regulations are driving physicians out of business, especially in rural areas and inner cities; out of hospitals, where compliance costs add a huge administrative overhead; out of the pharmaceutical industry, where government adds $250 millionto the cost of marketing a single new drug; out of the medical marketplace, where government intervention has destroyed the normal economic mechanisms that keep costs reasonable in a free market. We need to bring patients back into the financial equation. We must allow patients to benefit from their prudent spending and saving decisions. All Americans should be permitted to use pre-tax dollars to establish their own medical savings accounts.

To preserve excellence in American med icine, we must preserve patients' freedom of choice-not tum it into the sham of picking Monolith A or Monolith B, both offeringthe same government-dictated benefits pack age. If government forces us all into a bureau cratically managed system, we willstillhave something called "health care," delivered by persons called "health care providers." But such a system will have no place for ethical physicians, whose Oath forbids them to accept a situation of conflict of interest with their patients. Government bureaucracy has never con trolled costs. The promise of universal ac cess to comprehensive service under a global budget and government rules is, in a word, bankrupt. Government officialsdo not take an oath to do no harm. What a government system can accomplish is to destroy the art and science of medicinein these United States of America. 238 BOOKS Drug Policy and the Decline of American Cities by Sam Staley Transaction, 1992 • 257 pages. $29.95 Reviewed by Doug Bandow T he drug war is raging on the streets of cities across America, but off the front pages. While Uncle Sam's expansive and expensive efforts to staunch the nation's taste for drugs have failed to end substance abuse, they have turned scores of urban areas into combat zones. Indeed, the war on drugs has become a war on cities. Observes Sam Staley, president of the Urban Policy Research Institute: "the policies that form the core of the Drug War strategy are hastening the destruction of central city economies by abrogating the institutions that are most likely to lead to economic rejuvenation: private property, respect for civil liberties, and smoothly operating mar kets."