Part I in Panetics 2 (4), pp. 1-11. 1993.

Suggests ways in which panetic analyses could be used to help select medical treatment options and contain health care costs through proper analysis of all dimensions of human suffering involved in connection with any specific medical decision. Presents illustrative tables to gauge the Dukkhas associated with some common health afflictions.

Part II of "Formulating and Selecting Humanely Cost-Effective Medical Treatment Options and Health Care Plans" which appeared in Panetics 3 (2), pp. 12-16. 1994, this paper suggests ways in which data about duration and intensity of suffering can be coupled with data about the incidence, cost, and extent of specific illnesses to evaluate the efficacy of various health care proposals.

An excerpt from Panetics and Dukkha, pp. 185-188, 1994, this is a review of human suffering that results from either current practice or ineptitude in medicine. Summarizes efforts by the professional associations to come to terms with some of these issues. Outlines the critical issues of human suffering surrounding the current debates around euthanasia.

Before there were obstetricians and gynecologists there were midwives. These women went from house to house in the village treating ill and pregnant women with herbs and other available treatments. They were also skilled in delivering babies. In the sixteenth century the women who administered the herbal treatments for female ailments were quickly labeled as witches by the men in the clergy and in "medicine." Any simple organic treatment that the men did not understand was assumed to be the work of the devil. In the eighteenth century, men decided to enter the field of midwifery and turned what was once a natural and instinctual event into a "medical problem requiring surgical expertise." Women midwives were suddenly viewed as unclean and untrained.

The men edged out the women by passing laws against the practice of medicine without a license. Those who received licenses were white males educated in allopathy. These men brought surgical experimentation into the realm of labor and birth.

Women's mortality rate increased 300 per cent when medical students performed birthing as opposed to trained midwives who worked in the same hospital.

"The introduction of men into the lying in chamber in place of female attendants, has increased the suffering and dangers of childbearing women, and brought multiplied injuries and fatalities upon mothers and children; it violates the sensitive feelings of husbands and wives and causes an untold amount of domestic misery. The unlimited intimacy between a male profession and the female population silently and effectually wears away female delicacy and professional morality..."

Discusses the problems of value-judgments involved in current decision making about whether to approve drugs, additives, and other substances for public use. A substance judged safe by a Federal official of "practical" persuasion would be judged unsafe by one of "ultraconservative"conviction. Suggests that the data are too diffused and fragmentary as yet to prepare a definitive table of suffering by intensity to help decision-making, but that the initiative must be undertaken.

Siu served on a number of food and drug panels for the US government.

The unforeseen consequences which arose from curing hypothyroidism in an isolated population in Central Africa are examined. Survival and reproduction increased, but the food supply was insufficient to support the population and malnutrition and starvation became more common.

A rebuttal to criticisms of Geelhoed's arguments that single-factor medical and health care interventions can sometimes create unforeseen consequences equal to or worse than the conditions the intervention had been intended to alleviate.

In 1994, long before the tobacco settlements of 1999, Davis conducted this prototypical panetic analysis in order to test the practicality of Ralph Siu's proposals for panetic analysis.

Is the issue of food and possibly drug safety amenable to panetic analysis? Certainly, development of panetic tables which include both direct and indirect consequences of decisions in the arena of food safety decision-making would be a good place to start. Perhaps this effort could be a way to raise the awareness of the body politic.

Could we do this on an international basis? Probably, its a bit early to try, as the climate, even in this country, has not yet reached the point where the public realizes that the food supplies of the world are very complex and interdependent--on weather, political, economic, and cultural aspects of most of the world’s food producing regions. Education of the US public is a worthy goal.

In tbe past 50 years, life expectancy has improved more than during the entire previous span of history. Infant deaths in children under age 5 have fallen drastically within the past 50 years. Smallpox, which killed more than 5 million annually in the early 1950s has been eradicated entirely. Vaccines have drastically reduced the occurrence of measles and polio.

Despite such improvements, the absolute level of mortality in developing countries remains unacceptably high. Child mortality rates in developing countries are about ten times higher than those in the established market economies. Almost half of tbe preventable deaths among children are due to diarrheal and respiratory illness, exacerbated by malnutrition. Seven million adults a year die of conditions that could be inexpensively prevented or cured.

The author proposes a series of strategies to deal with these challenges.

Pain can be measured, but suffering is a mental state, a product of the ego of both the sufferer and others, including the inflicter. Thus the observer, through empathy or separeteness, influences the measurement as much as does the state of mind of the sufferer.

According to data from Physicians for Human Rights (PHR) and the International Committee of the Red Cross (ICRC), close to 70 countries are contaminated with mines with close to 500 injuries a week or 2400 a year. We have world wide problem of injuries that will need the skills of surgery in developing countries. The author reviews the tools available to surgeons and others attempting to cope with this human catastrophe.

The author assesses the consequences of "vertical" health interventions for the people affected and asks whether we know what we are doing. Humility in health care requires us to loiter long enough past our headliner triumphs to be still observant and honest when the later consequences of our many publicized victories are evaluated in the context of the humanitarian enhancement of lives in individuals and the societies composed of them.

In September 2000, George Magazine named Dr. Glenn W. Geelhoed, Secretary of the International Society for Panetics, as a "Citizen of the Year" for 2000 along with Lisa Belzberg, Unita Blackwell, actor Michael J. Fox, Kelly Stone and Frank Mailer. Here is what the magazine has to say about Geelhoed's unique contributions:

THE MEDICAL MISSIONARY

"Starting in medical school, Glenn W. Geelkhoed's passion has been to provide help wherever there are too few doctors and there is too much illness. So,though he has a day job–as a professor of surgery and international medical education at George Washington Medical Center–Geelhoed finds more fulfillment moonlighting as a medical missionary. For 34 years, he's been spending three to six months each year in needy nations like the Congo, treating patients and training local caregivers. Often operating solo, without organizational support, Geelhoed recruits students and other doctors to join him; most return again and again. ‘I'm an American; I've been on the receiving end of a whole lot of advantages and have not even paid back the interest,’ Geelhoed said recently enroute to India...’We need to take on problems affecting people with far fewer resources. Power and plumbing are not essential parts of the practice of medicine. What is essential, he added,is ‘the willingness to take on some responsibility and see what can be done with fingers, eyes, ears--and a heart big enough to direct them.’"

Anyone interested in learning more about Glenn's ventures and adventures can order his book, "Out of Assa: Heart of the Congo", available from the bookstore on the Society’s website, or by mail from the Society’s office address. What follows are some of Glenn’s remarks to a group of students.

Glenn W. Geelhoed, MD, MA, DTMH, MPH, FACS

"Whenever mass disease occurs, it is a result of 'disturbance of human culture'."

-Rudolph Virchow

Ralph Siu argued, in his founding works on panetics, that we are now living in an era in which more suffering is inflicted by humans on humans than is inflicted through natural causes. Some may assume that, if true, this is partly because, in the more fortunate regions of the world, the ravages of disease inflicted through "natural" causes have been reduced.

But , in the past and in the present, the hand of man has been a co-equal partner with nature in the inception and spread of many epidemic diseases. In most cases, they can be considered as much humanly as naturally inflicted.

A summary of news articles about the debate over pain management.