Matthew DeCamp, Leonard Rubenstein and I published a piece in the British Medical Journal about how normal clinical care was perverted in the torture milieu by the CIA and its physicians. Very topical given the latest State of the Union, and Trump’s love for Guantanamo.

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Dear Dr. Berger,

How can doctors and patients understand what is meant by “quality of life”?

Amy Allara, Maryland

Dear Ms. Allara,

It depends on the context, of course. The term “quality of life” is naturally unclear, so one has to ask some serious questions even to find out what is being referred to.

Read more in Medium.

Given that many attempts to improve the US health care system have failed, what should be done next, and how can real change be achieved?

Read my piece on Medium.

We have lost so much in the past year. Some losses are obvious and concrete (voting without foreign interference; the freedom to pursue rigorous journalism; access to reproductive health; leaders who eschew corruption). Others, no less important, are more abstract, beliefs and hopes whose promise our country has never achieved: that any human deserves respect no matter what group she belongs to; that pluralism makes us stronger. But there’s much that is less tangible whose loss we haven’t realized. What if there are so many missing pieces to our imagined America that we are left with a vague sense of unrightness rather than a clear mark of absence?1_D1m2utm_oCFAhDmTLXLupA

New on Medium, my thoughts about the concept of yeush (despair) in Jewish law, and how it can help us figure out what to do with the losses of the Trump era.


I have a huge pack of them but they’re all stubborn.
Like a Jack London story.
The wolf? Seasonal affect.
The danger’s a cold menorah.
Prometheus! I call thee!
I have latkes!


For the Third Night

I believe in the truth
Of before, during, after.
Such a god; ourselves.
No map or mirror
Enfolding everything.

Take a moment.
Watch it slither
Then shrivel
On the shiny table.

Be present at the
Loss of everything
Thought an old bridge
Crumbling like cake.


Seventh Night

All the lights that guide our days
Small, mundane and functional
Collaborate to frame the ways
We navigate the practical.

Do they make an ideal flame?
Not obviously, no.
But defeated, old, and lame
We might laud their glow.

Dear Dr. Berger,

What are the ethical arguments for and against providing an alcoholic with a liver transplant?

Robin Katcoff, Baltimore, MD

Find out the answer at the Talking To Your Doctor blog

I’m an internal medicine doctor, which means I see adult patients in Baltimore. Today I saw one of my favorite patients. She has chronic pain and a particular gastrointestinal syndrome which leads to frequent hospitalizations. Both make it very difficult, and really — in practicality — impossible for her to work. Her disability is taking a while to come through, because “chronic pain” and “back pain” are too often not considered as “real disease” by the powers that be. She can’t afford many of her prescriptions because she lacks an income. She might get evicted any day.

I realized today what medical intervention would help her the most.

You know what prescription she needs?

Money. She needs money.

This originally appeared in the Forward newspaper.

I stood, legs apart and face to the wall, in the Capitol Police Vehicle Maintenance Division. In other words, a garage. And I thought: I want to shake the hand of the person who invented plastic zip ties. They’re probably doing extremely well for themselves.

But let’s start from the beginning. How did I get here, hands cuffed behind my back, and why did I still feel, all in all, pretty good?

I’m a doctor who’s been in practice almost 10 years. During my training I wasn’t that involved in politics, and after 2009 even less involved. I was complacent after Obamacare passed.

In the following years it became evident that more and more patients were able to seek me out and start seeing me as their new doctor because of the insurance available through the Affordable Care Act. Sure the legislation wasn’t perfect.

Everything can always be improved. I even rolled my eyes and acted supercilious at those who wouldn’t shut up about single payer. Why rock the boat? Then Trump happened. During the run-up to the election I understood the abstract possibility that he could win. Though I’m certainly no prophet and I didn’t come near to predicting what eventually happened, I was really worried that a President Trump would wipe out the progress of the past few years: the millions more Americans with insurance; the decrease in the rise of healthcare costs, the improvements in population health.

I was shocked in November, and after the inauguration it was as if I had woken up from a long nap. With mounting fear and panic I understood that the priorities of Trump and his Congress collaborators are different from mine, and those of my doctor and nurse colleagues — and certainly different than what my patients think is important. Many Republicans believe that government should not help the sick, because being ill is a moral failing. The sick need freedom to cure themselves.

As a response, I founded a social media group called Doctors Against Trump which later, with the help of expert friends, I converted to a political action committee to support candidates who believe in progressive health policies. I started calling my Congressmen and Senators regularly,  and I made use of various on-line tools that connect blue-state voters with red-state constituents, urging them in their turn to call their elected officials.

This was something, but it didn’t feel like enough to me. I wanted to physically and concretely demonstrate support for my patients (sick, weak, old, marginalized), that I wasn’t sitting doing nothing while people were trying to take away their insurance. Once or twice I went and had a polite discussion with a senator’s health aide. That didn’t hit the spot either.

I saw that two separate groups were collaborating in a Senate protest action: those from various faith traditions (priests and ministers, rabbis, ordinary Jews and Christians; probably others too), on the one hand, joined also by health professionals: doctors, nurses, dentists; together with patients ready to tell moving stories for an audience and media. I joined them on a sunny morning in Washington, DC, at a Lutheran church not far from the Capitol and Union Station.

First we joined in prayer (as a Jew, I was happy that specific Christian expressions were deliberately avoided, and no one invoked Jesus’ name). I put on tefillin as a sign of serious piety in the public sphere defending the principle in the Biblical verse “you shall surely heal.” I was also thrilled to meet doctors and others who I had met before only on social media.

After a press conference at which we forcefully articulated our belief, as religious people and doctors, that health is a human right, we started off in a long, stately procession, slow and steady, to the Capitol building, two by two.
Good things come to those who wait, and protesting is no exception. They let the tourists up to the Senate galleries quite quickly, but apparently it was obvious to everyone that we were planning something different.

We finally got to the gallery, looking down at the Senate. It was like a Kabuki theater, Democratic and Republican statues frozen in their feigned gravity while true realities of life and death play out on the other side of the Capitol walls. When the number of the bill was called, we stood up and shouted, “Kill the Bill! Shame!”

Though we don’t yet know, while I write these words, if the terrible bill is truly dead, I am very happy with our work. We used our privilege as doctors and bearers of faith to march against the greed and cruelty of an unfeeling administration. As part of a group of activists I felt the collective frisson that many Jews have experienced in a minyan that davens with intention: the surety that all is not lost even when the hour is very dark. We are powerful precisely because we maintain, even under attack, our beliefs in healthcare and the needs of patients.

So maybe that’s why, when I stood feet apart in the police garage, the zip ties didn’t bite as much as I thought they would.

Read more:

With great respect, Mr. President, this is a banana. You have to remove the outer —

I don’t understand what the hell this yellow part on the outside of this is. Is it an umbrella? A condom? Where is it from?

Mr. President, you are correct that it is yellow. But it is actually part of the banana.

You’re worse than I am! You are removing it because you know that the fruit will explode if you do not. Is this a fruit? Are we real?

It’s a banana.

But where is it from? Could it be a terrorist?
The call with Putin was much pleasanter. I felt relaxed and in control. I am so. done.

Enjoy your lunch, Mr. President.