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Defending Ahmed and Mohamed

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Ahmed and Mohamed Ibrahim This weekend, doctors at Children’s Medical Center of Dallas spent 34 hours separating Ahmed and Mohamed Ibrahim, conjoined twins. As the pictures demonstrate, they were joined at the tops of their heads, so they would have to spend their entire lives lying on their backs but for this surgery. So far, the twins are both in critical but stable condition, in a drug-induced coma. The surgeries, as of today, were successful.

They were also expensive and time-consuming, which has led to some questions. Dr. Joe Stirt, an anesthesiologist, rhetorically asks:

Oh, and did I mention that the current procedure, in Dallas at Children’s Medical Center, involves five neurosurgeons, as many anesthesiologists, countless plastic surgeons, head and neck surgeons, orthopedic surgeons, vascular surgeons, nurses, intensive care unit nurses and respiratory therapists, all of whom are NOT taking care of hundreds, if not thousands, of poor kids in Dallas who could really benefit from this confluence of money and expertise?

Ken Womack lays out the issue starkly:

I’d hazard to guess there are plenty of children in Texas whose lives could be made significantly better if these medical resources were made available to them rather than devoted to making life better for two people from Egypt.

How about spending that “year of intense preparation” providing pre-natal care for poor women in the state? I bet there are plenty of poor pregnant women who could use “extensive diagnostic tests”.

Why not use the 10 surgeons and support staff occupied by the twins to perform neurosurgery, craniofacial surgery, plastic surgery, general surgery and oral surgery for procedures for children who need those surgeries in Texas or elsewhere in the U.S.?

I live in Dallas, and yesterday at church we prayed together for the twins. I was glad to do so. I hope that they recover safely, and that they live long and healthy lives, unmarred by health problems related to their conjoinment. I hope that Dr. Stirt and Ken feel the same way, and they’ve given no indication that they do not. But they do raise an important question: Couldn’t the $2 million spent on this procedure have gone to better use helping more than two kids?

The problem with the suggestion that the time and money could have been better spent on taking care of many children rather than just these two children is that it suggests an action. The action that is suggested by the question is to deliberately turn away these children because others could be better-helped with the time and money. The question suggests that each decision to treat or not treat any patient should be based in part on a financial equation, which is exactly the sort of thing I thought most of us hope would never be true. Aren’t doctors supposed to provide the best possible care to all patients regardless of their ability to pay? Or does that only apply to certain kinds of insurance, or certain kinds of procedures?

Besides, since these kids showed up with $125,000 in hand, this seems like it would be an odd expression of the free market!

I’ll address time and money separately. I don’t know that any kids were turned away for any condition during the time that this procedure was planned and carried out. I don’t know that any kids will be turned away as the doctors rest at home, recovering from the time spent this weekend. As far as I know — and I believe as far as Dr. Stirt or Ken Womack know — no kids or pregnant moms were turned away for any reason at all that would not have been turned away but for this operation.

In certain careers, time spent on one task is always time not spent on another. The time I spend stocking cans of peas is time lost from stacking cans of corn. But in other careers, things aren’t so clear. The time I spend surfing the web at work isn’t time lost from helping customers, it’s time lost from goofing off in some other way. When a big project comes up, the customers don’t necessarily suffer. Instead, regular customer care is handled by coworkers, and smaller projects give way or are picked up by other people so that I can focus on the big project. There is considerably more give and take than in a factory or on an assembly line. Given my limited observations of doctors, I suspect that they have even more latitude than I do, and I doubt any of the regular patients of these doctors suffered.

The team of doctors working during the 34-hour procedure included ” five neurosurgeons, two plastic surgeons, a pediatric general surgeon and an oral surgeon.” Frankly, I’m not sure what neurosurgeons do all day when they’re not busy operating on people’s brains, but I feel pretty confident that they’re not working with scalpel in hand 40 hours per week. The plastic surgeons likewise probably took more time away from waiting for patients and performing boob jobs than from helping accident victims regain their appearance. We’re talking about nine surgeons here, and I would hope that surgeons do not spend 40 hours a week in surgery. I sure wouldn’t want to be the one on the table at 4pm on a Friday if that was the case!

Perhaps it seems odd that I’m suggesting that time expanded to accommodate a remarkably lengthy exercise. What I’m actually suggesting is that the increased load was shared by many people, and so each person’s contribution was small enough to be absorbed by “free time.” If it turns out that someone was denied medical care because the doctors he or she needed to see were busy, of course I’ll change my tune on this point.

In summary, it’s not a zero-sum game. Children’s Medical Center of Dallas can take care of Ahmed and Mohamed and every other child in Dallas, and we can rejoice for all of the children who improve, and mourn for those who do not.

Money is more difficult. I believe that most of us are so accustomed to seeing insanely large numbers thrown around that it’s easy to forget that they’re insanely large. A million here, a million there — it adds up, and pretty soon you’re talking about real money. In this case, the direct costs of the surgery were $125,000, an amount presented to the hospital thanks to the efforts of the World Craniofacial Foundation. While the surgery might be expected to cost around $2 million normally, all of the people involved are donating their time, and Children’s Medical Center of Dallas is not charging anything for use of their facilities.

So the total actual cost of the entire procedure is $125,000, and that was paid. The rest is all pro bono. The problem with this is what, exactly?

In fact, the WCF does more than just handle high-profile conjoined twins cases. They are headquartered here in Dallas, and are dedicated to helping all children with craniofacial deformities, with a special focus on kids in Romania. They say, “We do not want one child to go through life with a face that was not transformed because funds were not available to the family.”

If you agree, you can donate money to help them help children at their website.

In summary, the costs are largely illusory, and even the opportunity costs are not real. What few costs were real were paid by a private foundation through private donations.

Ahmed and Mohamed
It should be noted that these children were not born to a Sultan who dropped in with his entourage and swept all others aside by waving large stacks of cash. They were born to poor parents who live in a small town 500 miles south of Cairo, Egypt. So far the WCF has paid for all costs related to the surgery, including the costs of flying the twins and their father here to Dallas and putting them up in the area for the last year. They are expected to be here at least two more years, so your donation can still help. You can even donate via Paypal at the bottom of this web page.

Given that this is a privately-funded and charitable project, I’m not sure that the nationality of the children makes a difference, but it does seem to be an issue for some that there are uninsured children here in America whose needs are not being met, while these children are being helped with a large-scale highly-publicized project. If you feel passionately about this, I suggest contact the WCF and suggesting that you would like your donation earmarked for use by American children. A good friend of mine recently had a baby boy born with a cleft palate, and I know that the procedures that they have had to take him in for haven’t been cheap. They live in the Dallas area already, so Children’s Medical Center of Dallas is just a short drive down the road, and medical insurance has covered most of the costs so far. Others are probably not as fortunate, so please, visit the WCF website and learn more.

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  • Good job, Phillip. Thank you.

  • A good defense, Phillip, but I still have to disagree with your reasoning.

    No, I don’t think the time, money and other resources devoted to the twins took much if anything away from kids in Dallas who needed care. But the effort to separate the twins was a year-long project. And the key word there is “project.”

    This is not, as you say, a rich family who sought out the world’s best medical care when the conjoined twins were born. So how, then, do poor Egyptian kids from a small town end up in Dallas?

    Simple. They are a project.

    They’re a project for the Dallas hospital. They are a project for the individual doctors, nurses, support staff and everyone else who donated their time. They are a project for the individuals who donated the $125,000. And they are a project for the World Craniofacial Foundation.

    A noble project? Absolutely.

    But the hospital, the staff, the donors and the WCF all chose the twins as a project to undertake.

    The hospital and staff could have chosen to undertake – for example – free pre-natal examinations for illegal immigrants as a project. And I’m sure Children’s has many worthy projects they are involved in.

    But there is a limited capacity for any organization, individual or donor to devote time, money and resources to these kinds of projects.

    And I have to think there is some healthcare project in the state of Texas that would be more worthwile and benefit more people than a year-long project to separate these twins.

    The Dallas twins project is compassionate, it’s noble, it’s a damn nice thing to do for the twins.

    In my opinion, however, it is not anywhere near the best project a hospital such a Children’s, a staff such as the one involved, the donors who showed their generosity or even the WCF – which also advocates the Romanian project you referenced – could have chosen.

  • Eric Olsen

    Very nice job Phillip, I agree with your conclusion although, again, I can understand Ken’s consternation: “why this particular project?” Is “this project” the best use of time and money? I don’t know, but it’s pretty great for the twins. Every child who needs it deserves to be a “project” – let us always strive to reach more not resent those who do receive.

  • ClubhouseCancer

    Eric’s right, as usual, and so is Phil. And may I add that a team of professionals from the fields of medicine and philanthropy determined that this project was worthwhile. One might assume they know better than us, esepcially since by Cap’n’s own admission above, we don’t know what other projects the good folks may have undertaken in the place of the twins.

  • Eric Olsen

    Thanks CC, and thanks to Ken for bringing the matter up

  • The relevant issue is not the amount of Time invested, neither is it the financial cost, or The Selection Criteria.

    The real issue is moral.

    Life is sacred.
    A child, even one born to a poor family in a poor country, deserves a basic normal life.

    The choice is not between one child or another but between one cause or another.

    Is war a better cause?

    Could some of the monies and energy invested in wars be more wisely used toward life saving goals and projects?

    Instead of letting goverments and fanatics rule by division why not get together and demand the best for all humanity?

  • ClubhouseCancer

    Wow, Corinna. You’ve nailed it, and given us a lesson in perspective.

    Your last sentence is especially juicy and correct.

  • Brava! Amen to that.

  • Well done, Phillip.

    Ken, a better operation to criticize would be the one on the adult Iranian twins. They did not meet the criteria for separation to most neurosurgeons. The operation failed because the pre-op research concentrated on the top and mid-head and a large blood vessel at the base of the skull was missed. That vessel bled them out — much too fast for new blood to be pumped in. Even so, as I said on the other thread, the operation was a publicity and money bonanza for Raffles Hospital. It is the kind of case that should be taught at the Wharton, not U.Penn Med.

    As I’ve mentioned on my blog, I have always been interested in twins. (I have sisters who are identical twins and just a year younger than I am, so my study of the topic started early.) I’ve read about everything there is about conjoined twins. The most interesting pair I am currently aware of have one body from the waist down and an arm each. That is a huge challenge. Though they move pretty well, they are never going to have any privacy.

  • Corinna: Nothing personal, but your comment is ridiculous.

    Life not war? What a brilliant thought!

    Every child deserves a basic, normal life? What a concept!

    It’s very easy to say these things – to talk about moral responsibilities, how life is sacred and whatnot. But how about spending some time in the real world?

    A lot of kids and grownups get sick and otherwise have bad things happen to them. No matter how good the intentions of society are, there will always be people who suffer. Kids die. We can keep some kids from dying if we try hard enough. And maybe we could keep some more kids from dying if we didn’t focus so hard on these twins.

    And the world is full of bad people. War is, as they say, hell, but (sometimes) it’s an ugly necessity of this world.

    The two things are unrelated.

  • Well, there is a question of where do you focus your resources. Costa Rica which doens’t have a military spends more on health care than other countries in Central America.

    Everyone should get healthcare. That isn’t the case now, but it should be goal.

    But the bottom line is if they were your kids, you would think all of this time and money would be too much to invest in trying to make their lives better.

  • No solutions, just desire…

    Here’s the thing: I grew up in a Republican family. They all consider me liberal, if you can believe that. I consider myself a libertarian or an independent, but tend to vote more conservatively than not.

    So when I read statement like “Everyone should get healthcare,” I agree completely with the stated words. But implicit in that statement is usually the understand that it really means, “The government should provide everyone with free healthcare,” and that statement has a whole host of problems ranging from the moral to the practical.

    As a practical man, the idea that so-and-so lives with a debilitating illness or that so-and-so can’t afford a $1400 monthly prescription drug bill is just wrong. In the richest country on earth, we have the ability to solve this problem without bankrupting ourselves.

    Of course, as a practical man, I’m also very aware of the probable abuses of any proposal I’ve ever seen thus far to involve the government in health care even more than it already is. In fact, government is in a certain sense the biggest part of the problem already, as drug costs are based largely on the $2 billion it takes to get a drug past the FDA to market, and doctors in small towns in Eastern Kentucky have to pay $80,000 each year in malpractice insurance.

    It’s a conflict. I cannot put my brain on hold to follow my heart any more than I can close off my heart to follow my brain. And I realize that the issue is not as simple as all that, either.

    I believe that America has survived for as long as it has for more reasons than just a well-written set of founding documents or some decent choices in leaders over the years. I believe that you could put the same documents into place somewhere else and not have nearly as happy a result. It is the American people that have made America what it is today, and I fear that the increased polarization in this country is causing what external forces could not – America’s destruction.

    Instead of thinking of ourselves as Americans working together to build a better future, we are starting to believe that it is us against them, left against right, Democrat against Republican, rich against poor, dark skin against light skin, and on and on. These issues have always existed – we’ve had leaders killed in duels and an atrocious history of race-based slavery and robber barons and so on. And perhaps I’m guilty of longing for the “good old days” that never really existed.

    But it is sad to me that all of the ways I can think of to try to meet the “everyone should get healthcare” goal runs smack up against a large segment of the population that will try to get for them and theirs and screw the rest of us.

    Still, I believe that we can meet the needs of conjoined twins from wherever in the world they happen to be born and still meet the needs of kids in Dallas.

  • Cap’n Ken: Some people will never support war. Their beliefs, morals, and principles won’t permit such a thing. Deal with it: We are part of the real world too.

    Phillip: “perhaps I’m guilty of longing for the “good old days” that never really existed.”

    I suspect so. And sadly, I fear good days — old or new — will never come to pass. Frankly, I don’t give a hang about abuse: If people need help, help them. That people are forced to do without medical care is nothing less than a sin.

  • Eric Olsen

    All of this makes the health care debate very germane. Please reply to San per the email if you would like to participate. Thanks, EO

  • Natalie, I’m about to bring up what seems to be the primary source of disagreement between us. I see shades of gray on this issue, as with most others, and you don’t seem to, as with most others. Just as I believe that war and terrorism can both be bad but one is worse, so too I believe that the situation we have in American where people are without medical insurance is bad, but there are worse possibilities.

    So again, I’m not denying that it would be better if everybody had access to perfect medical care, and that anything short of that is bad. Yet.

    Yet. What is the solution? To eliminate FDA oversight of the drug approval process would be to reduce the development costs of medicines by anywhere between $400 million and $2 billion per drug. Reducing the length of patent protections granted to drug manufacturers would allow for increased competition on even newer drugs, bringing the prices down still more, but that can’t happen unless the costs the manufacturer pays to get the drug approved goes down (see previous point), since the extended patent terms are largely there to provide a way for companies to make back the money they spent dicovering and developing the drug in the first place.

    There is the minor downside that unsafe drugs might make it onto the market, but smarter people than I have suggested that rubber-stamp approval of drugs that have made it through the testing process in Canada or Europe or other countries with sufficiently stringent testing would be a good first start.

    To not do those things is nothing less than a sin, right?

    I really think that deep down we all agree on the problem. It’s the solution on which we all differ, and it isn’t cold-hearted or evil to suggest that some uses of money are more efficient or even “better” than others. Private citizens can donate to whatever cause they wish, as I said above, but government policy should be set on more practical grounds.

    If two million dollars had actually been spent by the US government on separating conjoined twins when so many other children need important care around the country and the world, I think I would object — though I’d still be happy for these two.

  • The waste and added costs from insurance companies makes single-payer systems like in Canada where everyone is covered and costs aren’t as high seem much better.

    Yes, it should not be as costly to get FDA approval of drugs (and there have been reforms that have allowed drugs to reach marker faster which were pushed by ACT UP).

    But it is hard for the drug companies to complain about the cost when they spend so much on marketing to doctors (my dad is a doctor, so I witnessed many visits by drug reps always with interesting gifts) and to the public (endless prilosec and viagra ads).

  • Except that I met my wife because her family moved to the United States before they would allow a Canadian doctor to operate on their daughter (my wife’s sister). My Canadian in-law that’s a doctor practiced in Canada for a short time, got fed up with the bureaucracy, and moved to the States.

    It’s a complicated system, economics, and health insurance is a complex economic issue.

    As an example, take your complaint about pharm advertising. I happen to think that the system is corrupt, so I won’t argue at all on the visits to Doctors, except to say thanks once again for Wal-greens, who substitute generics whenever possible, resisting any and all pharmco pressure and kickbacks.

    But on the advertising, consider this: ImClone spent $2 billion to try to get their drug approved, and then failed. Let’s assume it had instead gone through. They’ve got a patent good for another 14 years, and they’ve got to try to make back the $2 billion spent. They’ve got to make $143 million each year for the next 14 years in profit to recoup their initial costs. That’s over and above the ongoing manufacturing and distribution costs, legal costs, overhead, etc.

    I don’t know how much it costs to manufacture or distribute the average pill. Let’s pretend it’s twenty cents, which I think is probably very low. How many pills would the company need to sell at a dollar per pill to make back $143 million? Nearly 180 million.

    You don’t do that just hoping people read the business section last weekend and heard you were approved. You market to the doctors so that they’re aware of your new drug. You market to the people so that they’ll put pressure on the doctors to keep up on all the new drugs. And every batch of commercials you run adds a penny to the cost of each pill, but each extra pill you sell makes up for nearly 80 of those pennies, so you keep going.

    And then, just to be sick, when your patent gets close to expiring, you make some incredibly minor change to the drug and market it anew as “Nexxium,” so the generics don’t kill your market.

    Anyway, the system is awful, and there is plenty of blame to go around, but advertising isn’t as foolish as it first seems. Not when you’re talking about starting a billion dollars in the hole.

    BTW, I am not a doctor, nor do I play one on TV, so for all I know Nexxium is just scads better than the original purple pill. Still, I have a past life in manipulative marketing, and I recognize attempted mental coercion when I see it.

  • Sorry, I’ve been trying to back up statements with numbers in them, and I forgot to include this link about drug patents, and this link (among others), listing the amount ImClone spent on their failed attempt to get the drug onto the market.

  • and last i checked, the torts system consumed $1.62 on top of every dollar it paid out in benefits. i mean the cost to society was $2.62 to confer $1.00 of benefits on Victim X.

    that was a ways back, but i cant imagine its much better now.

    you have to watch out for that victim x.

  • Chris, I suggest that the problem there isn’t usually Victim X, but the predatory lawyers who line their own pockets and manage to somehow convince their clients that getting only 38% is the bad guy’s fault.

    Of course, I’ve opened myself up for someone to list a few reasons why lawyers pocket what they do, as I’ve done for the pharmcos.

  • Uh . . . yea. Having worked for a firm that handled big personal injury and wrongful death cases, I know ‘greedy lawyers’ aren’t the full story. In fact, in the area where I worked, PA/NJ/Delaware, there were caps on damages for many of the governmental defendants we sued. We were lucky to get a year’s worth of actual costs for someone seriously injured, a quadriplegic, for example. Thirty percent of the total for cases settled or won at trial has to be weighed against the ones that wither away or are lost. Expenses are also high. Then there is the time factor — years can pass before a case is settled or goes to trial. I think most claims made by people wanting tort reform are at the urging of big businesses. Their interest is in protecting their assets, not the fairness of the system.

  • Drug companies seemed to do fine without spending billions on advertising for many years.

    And doctors say patients often come in asking for a certain drug or even complain when suggest a more appropriate drug that isn’t as heavily advertised.

    Plus I don’t enjoy listening to the lists of side effects in the ads, but that is a minor matter. And they usually say the details are in some magazine I didn’t even know still existed like the Saturday Evening Post.

  • Steve, if you read this link, which I’ll include for the third time on this page so far (<grin>), you might get a partial answer to the acceleration of advertising. The costs of “drug dicovery” have more than doubled in the last ten years. On average, the cost is estimated to be somewhere between 400 and 800 million (depending on how you count it), with obviously rare exceptions like ImClone’s $2 billion lost gamble.

    Of course, there is also this view, which is basically that pharmcos are greedy. That view doesn’t necessarily take into account the high risk involved in the industry, but then, not many pharmcos actually go under, so high of a risk can it really be?

  • Joe

    Phillip, add to your point the fact that most governments place price controls on drugs, except for the US. So that means that the US ends up subsidizing the drug discovery costs while other countries are rewarded with the benefits (newer, better drugs).

  • Phillip: “I believe that the situation we have in American where people are without medical insurance is bad, but there are worse possibilities.”

    For the person without insurance who is not sick, the only worse possibility is death. For the seriously sick person without insurance, death is the only better possibility.

  • Natalie, this is nonsense, really. For years I didn’t have any medical insurance, and I got by just fine. My only worse possibility was death? Rubbish!

    As I mentioned earlier, if you present yourself at an emergency room, they pretty much have to take care of you. While the law is written to cover true emergencies, I found during those years that bronchitis, for one, was considered enough of an emergency by doctors to be treated. Fortunately, the prescribed antibiotics were available in generic form for less than ten dollars. At the time I could have collected cans to cover that cost.

    I would pay $23 out of my pocket today for what cost me about $9 then, and that’s after I pay $552 per month for health insurance.

    So my only worse possibility was death? It’s a good thing I didn’t know that. In fact, I didn’t get health insurance at all until I got married, and I thought I was doing just fine the whole time. Most years, I’m still paying far more in insurance costs than I actually use up in benefits, so that actually seems like a worse possibility. Of course, I still pay it because that’s what insurance is for.

    For someone seriously ill, yes, life sucks without insurance. But you paint such a stark black-and-white picture — as has been your pattern of late — that it is a complete conversation-stopper. If you want to express your opinion as fact and have no counter-responses, that’s fine, but maybe a post would be better than the comments section for that. Here in the comments, I would hope for a little give-and-take.

    A sick person should wish for death rather than go on living without insurance? Where I come from, people take care of other people, and hospitals show some charity to those in need. Children’s Medical Center of Dallas does quite a lot of charitable work, but they’re not nearly the only one. Yes, the bills can pile up. It can be miserable. But worse than death? Natalie, be serious. Very few people find death a relief from sickness, and generally they do so with or without insurance.

    Maybe I’m naive. Maybe I’m lucky to have always lived in places where hospitals took in people who couldn’t afford to pay. But I can’t see how such stark and demonstrably false statements help anybody in any way.

  • To keep this on topic, I’ll point out that Ahmed and Mohamed don’t have medical insurance, and they’re seriously sick. Would they be better off dead? I suspect you didn’t mean what you wrote.

  • They would not be. My own experience includes wishing for death. I speak for myself, not for anyone else.

  • I tried a couple of times to rephrase your statement to reflect your latest comment, but I’m not sure I can do it justice. Can you re-phrase “For the person without insurance who is not sick, the only worse possibility is death. For the seriously sick person without insurance, death is the only better possibility.” in a way that more accurately represents your true views on the subject?

  • For the person without insurance who is not sick, the only worse possibility is death. For this seriously sick person without insurance, death is the only better possibility.”

  • Actually, the word “poor” should be inserted before “person without insurance who is not sick.”

  • Sorry, Natalie, I still can’t agree. I was a poor non-sick person without insurance, and there were lots and lots of worse possibilities between where I was and death. At one point I had the chance to procure insurance very cheaply, but turned it down because I was poor and every dollar helped.

    I was stupid, since I was believing strongly in my own youthful invincibility, but I was lucky. I never got seriously sick or injured until later, after I did get insurance through my job.

    How about, “For some poor people without medical insurance, there are few possibilties that seem as appealing as death. For this seriously sick person without insurance, death sometimes seems like a better possibility.” ?

    Frankly, I still dispute the whole notion. Life can suck sometimes, and I’ve definitely been where death seemed like the best way to deal with things. But as long as I’m not completely incapacitated, there is always a better possibility. If you’re laying in a bed dying, and every breath hurts, and moving hurts and not moving hurts and there is nothing else to do, then yes, maybe death is a better possibility. But if you can type, and show compassion, than there are better options.

    After all, if someone can set up simple webpages to earn money for a boob job, someone else can certainly raise money for medical care.

  • Hi,
    My internet connection was sick, yet although it’s owner is terminally poor, Life was a better choice.
    It cost three days of my writing life (almost), but look, I’m back.

    The real success was in creating a peaceful environment for the technicians who were roaming my apartment.
    So Peace after all might be a good and most healthy solution, Cap’n Ken.

    “Life not war? What a brilliant thought!”

    Well, it is not only a brilliant thought but also not an original one. Dating maybe even pre-Amos (the prophet) as scribbled in the Bible (Old Testament).

    “Every child deserves a basic, normal life? What a concept!”

    Up to this sentence I was thinking you are ironic and appreciated the sophistication.

    But farther on I began to suspect you’ve been taken in by what historians of Nazism and dictatorships have termed as “a inversion of values” – when Good is considered Bad and Bad becomes Good.

    Now suppose you had a sister, let’s say a twin sister, to which you were attached in spirit no less than Siamese are attached in body, and suppose she was very sick and had died only because the parents did not have the means to buy her medicine and proper medical treatment – would you still think that not all children deserve a basic, normal life?

    Couldn’t it be that the notion of Injustice as the irrevocable Reality is just another Brain Washer?

    Now suppose your sister and you as well, have been usurped of childhood by War – will you still hold on to the notion of War as “an ugly necessity of this world.”

    Who enables war if not the obedient masses, who agree to be manipulated by Divide and Rule, before the Romans, in the Nazi Germany, all over the world, generation after generation?

  • salut moi je suis smail pouvrie ok

  • hello are you

  • It seems a given that surgeons NEED to perform surgery. When given a challenge such as this, it provides an opportunity to not only better the lives of the patients, but to hone skills and make them better surgeons for everyone else.

    Besides this practicality, there is the humanity of it. A surgery like this improves human life, individually and collectively.

    Nice post!