When I was a first-year medical student, I happened across The Citadel, a novel published in 1937 by A.J. Cronin, himself a physician. The following is from the review on Amazon:
The Citadel follows the life of Andrew Manson, a young and idealistic Scottish doctor, as he navigates the challenges of practicing medicine across interwar Wales and England. Based on Cronin’s own experiences as a physician, The Citadel boldly confronts traditional medical ethics and has been noted as one of the inspirations for the formation of the National Health Service. The Citadel has been adapted into several successful film, radio, and television productions around the world, including the Oscar-nominated 1938 film starring Ralph Donat, Rosalind Russell, Ralph Richardson, and Rex Harrison.
From the Wikipedia entry:
Cronin once stated in an interview, ‘I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug …The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.’
Reading this novel had a profound impact on me, and that impact has lasted up until today, more than 50 years later.
Medical school always had its own set of peculiar struggles, as does everything. Certainly, Basic Training in the military is an eye-opener. What makes medical school unique is the profound contrast of the reality with the ideal. Like many students, perhaps most, I entered medicine with a deep sense of the magnitude of what I was doing. It had a “spiritual” element, almost as though I was entering a religious order and now would be taking on the mantle of responsibility that was more than just a job. I had read the Oath of Hippocrates and could sense the heavy responsibility that had been felt by the ancients and the duty that this road would take.
It would serve no purpose to recount those years in detail. Suffice it to say that, like those of Andrew Manson, the protagonist in The Citadel, my experiences were intense. They ranged from the utter heights to the deepest depths. The mettle of my character was refined and amalgamated in ways difficult to fully understand, even now. I graduated having many of the same feelings described by Cronin in the interview referenced above. I was conscious of my own mortality. I understood what it was like to make mistakes, but over all of it I had a firm desire to really make a difference in a system that was filled with obstacles.
The worst aspects of medical education have improved significantly since the time I spent there. The 40-bed wards are gone. Attending physicians take a more active role in the care of patients. Medical students and resident physicians no longer spend an exhausting 80 hours or more a week in patient care. There are multiple safety measures in place for patients and those caring for them. Up until Covid, I thought that we had made real progress in things.
But those are the externals. Has the internal moral compass really changed? Yes, it has in many individuals, but what about collectively in our profession? Consider those who told their patients, “I would sooner watch you die than give you hydroxychloroquine.” Has their moral compass changed? What about the medical leaders who allowed patients to die without allowing them to try ivermectin, despite the pleas of their family? Did their moral compass change? Or those who treated the unvaccinated as lepers? What about the medical ethicists who advocated denying care to those unvacinated?
How about the late-night comic on this YouTube clip who advocated a similar policy? Or those in the audience of that comic who thought this was outrageously hysterical? True, he was not a healthcare professional, but the problems we see run very deep in our society as evidenced by the audience response.
Now it is known that the premise upon which those people based their discrimination against those not vaccinated was false. The mRNA agent did not halt transmission and may have even enhanced it by blunting the symptoms in some. Have any of them recanted and apologized? Perhaps that is the most egregious of their actions.
Or how about the governmental officials who promulgated the CARES Act and PREP Act that shielded those who denied this care? Although, in theory, willful fraud was excluded, this has never been tested. The Pharmacy Audit Assistance Service gleefully celebrated the extension of this act until 2029!
How about those leaders of academic medicine, presidents of medical organizations, medical school Deans, and Chief Medical Officers who went along with this? Did the governmental monetary compensation for following protocols play a role in these decisions? These were known at the time by some to be faulty, but their voices were ignored or chastised. Now it is clear to all, but has accountability been forthcoming? What about those who received no monetary compensation, but still went along with things they knew, or should have known, to be wrong? Why did they do it? Fear for their job? Probably for some, but not all.
What would A.J. Cronin say about our response to Covid? We don’t have to look hard at all, as the books and articles have already been written! Search on these authors to see: John Leake, Peter McCullough, Scott Atlas, Paul Alexander, Peter and Ginger Bregin, Harvey Risch, Pierre Kory, Robert Kennedy, Jr., Naomi Wolf, Alex Berenson, Robert Malone, Zev Zelenko, Mark McDonald, Sabine Hazan, Jay Bhattacharya, Martin Kulldorff, George Fareed, and Brian Tyson and many, many others. I apologize to anybody not listed, but in truth the list could go on for pages.
The point is we DID have individuals ringing the same bell that Cronin rang back in 1937. We had many courageous people who did what needed to be done and pointed out what Cronin highlighted in his interview quoted above:
Cronin once stated in an interview, ‘I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug…The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.‘
The Covid hysteria has ended, but the tangible effects linger and have not been adequately addressed. Three groups of people were involved:
- The victims
- The architects
- The enablers
The victims need restoration and compensation. Jobs need to be restored. Members of the military, hospital workers, and first responders need full reinstatement. Unfortunately, as documented in the upcoming Children’s Health Defense movie, Duty to Disobey, lasting damage continues. Perhaps more ominously, we still may not have seen the true repercussions of the mass administration of the mRNA agents on society. The loss of the integrity of the medical and scientific professions and the resulting effect on trust will take years, if not decades, to resolve.
Of course, for those who died needlessly, restoration and compensation are beyond possibility. So is restoration of the lost loves, years of education, lifetimes of work for a goal and so, so much that was wiped out for, what it turns out, no good reason.
The architects need investigation, prosecution, and if found guilty, punishment. But what about the enablers? Certainly, there is a continuum of enablers, and they need rehabilitation if possible. At one end of the spectrum are those who saw what was happening, knew it was wrong, but did not intervene out of fear of the personal costs. At the other end were those who were truly confused and could not imagine a medical and public health system would steer them wrong. How do we deal with these people?
We need to value critical thinking, courage, ethical behavior, and moral reasoning in those we accept into training in the health professions, and even more, in those who advance to leadership positions. The actual study of leadership needs to be a part of education in the health professions.
This should be by no means only a preparation for leadership IN medicine. We need to understand that a physician should not be a “treater of disease” but a “leader of patients!”
Are these the things we really value in selecting those for entry into and advancement within the medical profession? You be the judge:
The American Association of Medical Colleges (AAMC) controls every aspect of entrance into medical school. They control the development and administration of the Medical College Admission Test (MCAT) as well as the American Medical College Application Service (AMCAS), both of which are required for admission to medical school. They have a monopoly on medical education!
What do they value in applicants? They are very specific and outline this in The Premedical Competencies for Entering Medical Students. Those qualities sound good. They sound like the qualifications we would all want in practicing physicians. However, one must dig a bit deeper to match the words with the meaning:
In 2026, as part of a continuing review of our programs, the AAMC updated the titles and definitions of “cultural humility” (now called “self-awareness”) and “cultural awareness” (now called “understanding others”) to better reflect the meaning of the competencies and the behaviors medical schools are looking for in future medical students. The competencies were last updated in 2022 to reflect current expectations for medical students.
The AAMC has had a strong commitment to DEI in medicine. This is from 2023:
Throughout the country, we continue to be challenged with misinformation, disinformation, and misguided anti-diversity, equity, and inclusion (DEI) actions that are confronting higher education and our academic medical institutions and that will harm the health of our communities. We want to underscore that the AAMC is here to support your efforts to lead in the name of diversity, equity, inclusion, and racial justice. Your commitment and dedication to this work is important, recognized, and lauded.
Has anything but the words really changed? Is the monopoly on medical education really committed to the value of critical thinking, courage, ethical behavior, and moral reasoning in those we accept into training in the health professions, and even more, in those who advance to leadership positions?
We must make a conscious effort to form healthcare “Communities of Practice” that are composed of groups of vertically and horizontally integrated professionals. Those just entering, those in active practice, and those in retirement can utilize such a Community of Practice for the effective transgenerational transfer of both tacit and explicit knowledge. We may be able to attempt to restore the soul to medicine, but unless and until there is a change in the structure of academic medicine, it will be left to the public and grassroots medicine.
A.J. Cronin has so much to teach us.
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