Dermatology Online Journal

Parable: The origin of Adam
Mauricio Goihman-Yahr MD PhD
Dermatology Online Journal 14 (6): 17

Professor(E) of Dermatology and Immunology,Vargas School of Medicine, Central University of Venezuela Caracas, Venezuela

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There is a Midrash that tells that when God fashioned man from the soil, He used dust gathered from all the corners of Earth. Thus, there is no place on this planet where man cannot live, nor is there a place to which a given man is truly a stranger.

Medical knowledge has originated all over the planet, having been flown, literally, from one corner to the other. This was true even in antiquity. Egyptian discoveries were used in Babylon and vice-versa. Chinese methods to prevent smallpox were introduced in Britain by Lady Montagu. Cinchona from the Americas treated malaria all over the world. Today, journals, meetings, and the Internet provide so much information that the problem is not the ability to receive it, but rather to incorporate and use it properly.

Individual physicians, trained in one region, often travel to and practice in many other nations. It would seem that there is nothing as universal as the nature of man, his ailments, and the knowledge about them. Thus physicians, as well as priests, should be allowed to travel, learn, teach, and practice throughout the planet, from whence the substance (even if allegorically) of man was made.

Throughout history, centers of learning and well-being have emerged. These centers are usually, but not uniformly, also associated with individual freedom, wealth, and power. Physicians have been attracted to these centers where they have contributed to and then disseminated new knowledge. For example, the School of Medicine of Salerno, the first in Medieval Europe, was reputedly founded by a Jew, an Arab, a Greek, and a Latin teacher; it gathered students from all over the western world.

However, currently the international flow of physicians who participate in teaching, practice, and even research, is not only regulated (which to some extent is appropriate), but also severely curtailed. The obstruction is not only through laws and regulations, but also by manipulation of public opinion. It is obviously appropriate that the knowledge and credentials of foreign physicians should be ascertained before allowing them to practice and teach. But is there justice in the methods of the current restrictions? Some of the restrictions appear particularly unreasonable when, for instance, in the US, non-physicians are allowed to do certain medical procedures because all there is a dearth of physicians to perform them. Newspapers and street signs are clogged with ads extolling the virtues of faith healers, ethnic healers, psychics, or pseudo practitioners and beauty specialists. This situation is quite similar to other types of bureaucratic systems. In my country (Venezuela), it is exceedingly difficult to obtain proper building permits because requirements are very strict. Yet, it is very common for people to enter an area of land and build a set of hovels, with no sanitary or architectural standards whatsoever. These hovels will persist, in all likelihood, until washed out by some flood. The inhabitants of these areas are allowed to live in misery and disease without intervention. Are not these 2 sets of circumstances very similar?

On the other hand, some well-intentioned individuals argue that poorer countries should not be deprived of physicians, including dermatologists, who have been trained locally. The loss of these physicians would contribute to the dwindling lifeblood of these unfortunate nations. In truth, many "poor nations" are not poor, but instead, countries where resources are badly distributed. Rulers usually do not live badly, nor do foreign investors fare badly. Medical students and physicians during training perform useful service for their communities. This is more than can be said of students of many other disciplines or even standard citizens. Physicians would not leave their countries permanently unless conditions of work in the latter were so bad or so limited that they would prefer to cut their roots and even leave many family members behind. They do this to fulfill the potential that their abilities allow them elsewhere.

Was it illegitimate that American Dermatology allowed Rothman, Lever, Pinkus, and Canizares to flourish on US soil? They may have perished figuratively or literally in their countries of origin. Was it wrong for Elie Metchnikoff to create cellular immunology at the Institut Pasteur of Paris, rather than languish in Odessa? Furthermore, was it wrong for Dr. Hatta to be the right hand of Dr. Ehrlich during the creation of the basis of humoral immunology and chemotherapy? Was it wrong for Kitasato to work in the US? Was it wrong for the US to provide a haven that allowed Renato Dulbecco to develop in the US or should he have stayed as a peddler in the streets of post-war Italy?

My point is simple. Physicians, including dermatologists of all countries should wholeheartedly understand and approve of the universal nature of science, knowledge, and medicine. Dermatology and other branches of medical knowledge should be able to flow unimpeded on the sea of human welfare and not be damned by damming.

© 2008 Dermatology Online Journal