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- Anthony N. DeMaria, MD, Editor-in-Chief, Journal of the American College of Cardiology* ()
- ↵*Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 630, San Diego, California 92112
The first evidence of a radicalized physician took me by surprise, and seemed to be an aberration. Ayman al-Zwarahiri had become the second in command of Al Qaeda, and had played a major role in the civilian attacks of September 11. The second instance was equally surprising, but seemed to be the result of mental illness. Nidal Malik Hasan, a psychiatrist, had opened fire on a group of unarmed individuals at Fort Hood, killing 13 and wounding 28. Most recently, a Jordanian doctor, Khalil Abu-Mulal al Balawi, acted as a double agent and killed 7 employees of the Central Intelligence Agency (CIA) with a suicide bomb. By the time the third episode occurred one could no longer avoid the obvious conclusion: an increasing number of physicians are becoming radicalized and are serving as prominent participants in terrorism and assaults.
Ayman al-Zwarahiri was born into a well-to-do Egyptian family populated by physicians and teachers, and was educated in the most prestigious schools in Cairo. Even while going to medical school his religious fervor was increasing, and he sought to establish an Islamic state. In fact, it was while serving in Afghanistan as a surgeon treating soldiers injured in the war against the Soviets that al-Zwarahiri joined Al Qaeda and rose to his leadership position. It has been thought that he played an important role in ministering to the illnesses of Osama Bin Laden. How al-Zwarahiri reconciled his activities as a healer with the planning of the attack upon civilians in the World Trade Center is incomprehensible to me.
Nidal Malik Hasan, the son of Palestinian immigrants, was born and raised in the U.S. After medical school he specialized in psychiatry, with a focus on preventive and disaster psychiatry. He became progressively radicalized while practicing medicine at Walter Reed Hospital, which involved taking care of soldiers injured in Afghanistan or Iraq. Apparently, he had little empathy for these colleagues, since he fired several weapons at soldiers returning from or about to leave for overseas duty at a medical processing center on base at Fort Hood. Although the exact precipitating factor for this attack has yet to be identified, circumstances suggest that Hasan has significant psychiatric issues of his own. That his role in healing military personnel somehow became transformed into killing them is completely incongruous.
Khalil Abu-Mulal al Balawi spent his formative years in Kuwait, attended medical school in Istanbul, and lived and practiced in Jordan. He harbored jihadist feelings from childhood, which apparently were not altered by his medical training. He was trained in active espionage by intelligence officers in Jordan, and ultimately acted as a double agent, killing CIA agents to whom he was to release important information. His action is understandable in the context of a military operation against a perceived enemy. Whether his early jihadist views coincided with the concepts of the Hippocratic Oath is highly doubtful.
The reaction to any wrongdoing is amplified when the perpetrator has a trusted position within society. Thus, sexual abuse by the clergy or the sale of illicit drugs by police engenders particular outrage. The same is true of transgressions by physicians, who are generally accorded a position of considerable esteem and respect in society. So, the horror is magnified when physicians, who have dedicated themselves to preserving life and eliminating suffering, actually kill or maim other human beings. In fact, the taking of life by doctors is particularly paradoxical.
I have considered whether there are common traits that would lead one to both the healing arts and radical militarism. However, I am at a loss to see the connection. The only possibility that comes to mind is a profound sense of idealism and altruism that could draw someone to medicine and then convert them from treating individual patients to addressing widespread social and economic ills. Even here, however, one would think that the appropriate course would be politics rather than war. On the other hand, it is easy to see how the same characteristics that convey success in medicine would also be of value in insurrection. Physicians are generally intelligent, disciplined, relentless, and articulate; they are accustomed to sacrificing immediate gratification for long-term benefit. These traits would also be of value to becoming a good warrior and, in fact, the leader of other warriors. Looked at in this light, it is perhaps a bit surprising that there are not more physicians in politics or leading revolutions.
The participation of physicians in military conflict is not new; Che Guevara among others played such a role in the past. Thankfully, however, the number of physicians who have followed such a path is very small. Nevertheless, the role of physicians in insurrection seems to have become more prominent in recent years. Even assuming an overwhelming desire to correct social ills, there should be a better way than armed conflict, especially against civilians. The saving of life and taking of life are so antithetical that one wonders how such physicians resolve this conflict in their own minds. For our part, it would seem that the most we could do is to watch our colleagues and intervene if they show signs of becoming radicalized. Society will always view physicians as reasonable and empathetic individuals; we should do everything in our power to preserve and maintain this trust.
- American College of Cardiology Foundation