Peering into the Past and Future: Riding Down the Rhine and Danube

It was time to travel despite a war in Eastern Europe, runaway inflation, political turmoil and exploding Omicron SARS-CoV2 variants. With a KN-95 mask, COVID antigen tests and $50 worth of digital guidebooks in hand, we boarded a river boat to glide upstream down the Rhine, Mein and Danube, from Amsterdam to Budapest  to find history, fine spirits and the origins of ancestor’s past. 

We were going to the edge of civilization, as the Romans had defined it circa 2000 years ago. The Rhine and Danube were the North and Eastern boundaries of the empire, warding off the barbarians, the Goths, Vandals, Visigoths and Franks. The Franks had plundered Eastern and Western Europe, united under Charlemagne and eventually (?with the help of intermarriage and French wine) settled down in France so their ancestors could appreciate fine architecture, food and Jerry Lewis.

 The tragedies of history were retold by guides, museums and historical plaques as the craft dodged buoys and passed feudal castles. In Amsterdam, Cologne, Regensburg, Vienna, Rothenburg, Bratislava and Budapest were military monuments, holocaust memorials, mass graves, ramparts and moats, museum artifacts, artillery and ballistic impacts on stone walls that testified to perpetual war and oppression from the Middle Ages onward. The grievances are engraved in our schoolbooks: Romans v. Barbarians, Christians v. Arabs (Crusades 1-4), Protestants v. Catholics (30 Years War and others), Ottoman Empire v. “Civilized” Europe, Habsburgs v. National Uprisings in the mid nineteenth Century, Prussian Wars of the late 19th century.  The 20th century brought us World Wars I and II ending the Holy Roman and Ottoman Empires and Hitler and the Third Reich at the expense of over 60 million lives.

As we headed South and East along the Rivers, I encountered glimpses of my Jewish heritage. The Jewish Diaspora from antiquity forced migration from Western to Eastern Europe along the Rhine and Danube. Jews were  multilingual merchants, bridging the Arab and European divide and helping to create the trade routes from Asia, Africa and Europe. They were artisans in the pre-industrial world and creators of the financial world that allowed the development of city-states. Judaism financed the release of Richard the Lion Hearted of England’s release from captivity and paid for the defense of Vienna against Ottoman Invasion in the 17th century. Yet, each town’s history was marked by the same recurring theme: Jewish expulsion and persecution.

Tragedy often begets opportunity. Science, medicine and art blossomed along these European river tributaries. Booerhaave, the Dutch physician, organized hospital divisions, defined pathology and described his eponymous esophageal rupture syndrome. Dicke, an Amsterdam physician, recognized  abdominal pain and diarrhea in Dutch children reintroduced to bread following privations of World War II and described celiac disease. Down the Rhine at Erlangen, Germany, Demling and Classen devised a modified electrified wire passed through an endoscope and allowed non surgical removal of bile duct stones in a jaundiced nurse in 1973, introducing therapeutic biliary endoscopy to the world. Wilhelm Conrad Rontgen, discoverer of X rays, taught on the Mein River at Wurzburg in the late 19th century. Sigmund Freud’s psychoanalysis treatise and practice was a part of 1890’s Vienna. Laszlo Biro from Budapest, invented the ballpoint pen and freed the world from fountain pen leakage.

Music flourished along the river, providing the world with the classics from Mahler, Mozart, Beethoven and Liszt.

 History was infused in everything we saw and consumed. I ate herring in Amsterdam as the Dutch West India Company sailors did before traveling to Nieuw Amsterdam and quaffed Riesling from The Rhine Valley from Middle Age monastery vineyards. A McDonalds and statues of Ronald Reagan and George Bush in Budapest were symbols of who won the Cold War. 

The realities of the past portend the fragility of peace for the future. The murmurs from these ancient rivers give us pause to respect and cherish our freedoms. 

Hidden Agendas in Medicine, Politics and Journalism

“You’re out,” shouted Matt.  Matt was the second baseman and bonafide schoolyard bully whose underlying goal was to win every game. “Fielder’s choice and I get to decide,” he declared as if he was a major league umpire.  With sweat dripping from my brow, I dutifully left 2nd base in the sweltering summer of the mid ’60’s in Queens. After the game, I consulted a higher authority (my dad) who informed me that fielder’s choice did not give infielders the right to choose who is or is not out.  It would be a conflict of interest, he told me.  I brought this enlightened info back to my stickball overlord and was greeted by scorn and a subtle threat of possible physical harm in the future. 

While learning about truth, honesty, civility and camaraderie in school, the real world of hidden agendas creeped in. New and improved Fruit Loops tasted  exactly the same as the old Fruit Loops. Two box tops and $2.00 did not get you “life sized action figures” but ant sized plastic toy soldiers. Reality only accelerated with age. “This VCR  is state of the art and will remain a standard for years,” the Circuit City salesman told me with a straight face in 1982 as I drained my bank account of $1,200.  Obviously, the advertising on cereal boxes and a stereo salesman suffered from hidden agendas or conflicts of interest.

The world of medicine brought its own litany of hidden agendas. Pharmaceutical representatives extolling the virtue of their brand name products when a generic and a lower cost substitute achieved the same goals. I entered the profession during the era of drug sponsored free Caribbean vacations, five star restaurant outings,  and “free” basketball playoff tickets. Was there a potential for bias in prescribing habits when you’re cutting into a filet mignon paid for by an acid reducer you haven’t used before? One would have to think so.

Transparency in medicine became clearer when government edicts regulated Pharma’s gifts to the medical profession. The trips, five star restaurants, and  sporting event tickets disappeared.  Finally, even complementary pens and trackpads were forbidden. Quite rightly, transparency in prescribing was demanded by consumers. Today, the consumer can check on their provider’s lunch reimbursements, Medicare payments, and Big Pharma consultant fees. A simple internet search will quickly reveal the truth regarding your doctors financial ties—if any— to pharmaceutical companies and the like.

Regretfully, most of the world operates with hidden agendas and conflicts of interest unbeknownst to the consumer or general public. However, to the world of medicine’s credit, regulatory agents have collectively required physicians to publicly reveal conflicts of interest.  For example, if you are a physician presenting a paper at a meeting regarding your research on a drug, you must disclose any conflict you have with the company making or marketing said drug.  Furthermore, your research paper must cite any conflict you have as well.

Certain areas of the field of medicine have escaped transparency and issues of reporting conflicts of interest.  Lobbying has produced the DSHEA Act of 1994 which stripped regulation and FDA oversight from over-the-counter pharmaceuticals. Many over-the-counter medicines have not been subjected to vigorous oversight or proof of efficacy.  Billions of dollars of products are bought that may have little or no assurance that they help or improve what it professes to do on the package information. Fortunes have been made from this lack of transparency to the patient slash consumer.  It would seem, in the public’s interest, that a warning indicating that a product that has not been rigorously tested and proven in its stated efficacy, should be placed on the product packaging.

It seems that physicians and some areas of medicine are leaders in self-reporting conflicts of interest and public available transparency of these conflicts should be the standard applied to all businesses that interface with the public at large.  For example, politics operates in the world of dark money facilitated by Citizen’s United and the death of campaign reform.  So when a politician publicly espouses a certain political opinion, why do they not have to disclose any influence or conflicts of interest they might have that would benefit from their political stance on an issue?  Doesn’t the American citizen need this transparency to be an educated voter?

Furthering this argument, Journalists in a variety of communication forums report information in the public’s best interest.  Under their by-line in a newspaper or in a chyron on the bottom your television screen there should be a clear statement of any conflict of interest the journalist might have.  If you own stock in a company that spilled oil into the ocean, I’d like to know that when you present information on the oil-spill.  

A rational world should apply the rules that govern conflicts of interest or hidden agendas in a schoolyard playground the same as they should in the world of medicine, politics and journalism to name a few.  Self-reporting, fairness, and truthfulness should be a minimal requirement for all who interface with the public who are purportedly looking out for your best interest.  

Let’s level the playing field.