"Terror doctors": anatomy of a void concept

Michel Thieren
12 July 2007

On 2 July 2007, British police authorities announced that all eight people tied to the failed terrorist attacks in London and Glasgow on 29-30 June were medical professionals. Doctors? How could that be? The shock was palpable on everyone's lips, in all media outlets, news reports, and blogs. "A surgeon's trajectory takes an unlikely swerve", a New York Times story was titled. Edwin Borman, chairman of the British Medical Association's international committee, told the BBC that the link with NHS doctors "would be a ‘betrayal' of society because of the oath they sign up to promising to do no harm". Abdula Shehu, chairman of the Muslim Council of Britain's health committee, worried about an eventual backlash: "To generalise about an event like this and think that Muslim doctors generally should have a different kind of treatment or perception in a negative way should not be the issue here", he said.

The reaction in the blogosphere has been sharp: "Al Qaeda's doctors have turned (the doctors' oath) on its head to 'First do as much harm as possible and kill anyone you don't know. Not even Mengele himself distorted the medical profession like that". With more realism, Pauline Neville-Jones, former (1991-94) head of Britain's Joint Intelligence Committee, wonders "how people's values can be so perverted" and how meaningless it is to assume anything about the kind of people who might become terrorists.

Michel Thieren is a Belgian physician specialising in humanitarian affairs and human rights. He has spent more than a decade managing emergency operations in non-governmental organisations and the United Nations, and was head of office in northern Bosnia for the World Health Organisation in 1995-6. He works as a medical scientist at the statistical department of the World Health Organisation in Geneva

Also by Michel Thieren in openDemocracy:

"There was genocide in Srebrenica..."
(11 July 2005)

"Katrina's triple failure"
(7 September 2005)

Kashmir: brothers in aid"
(17 October 2005)

"Dayton plus ten: Europe interrogated" (24 November 2006) - with Louise Lambrichs

"Deaths in Iraq: how many, and why it matters"
(18 October 2006)

"Libyan justice: medicine on death row"
(19 December 2006)

"Medicine and public health in dark times" (25 April) The accumulated response suggests that being a medical professional supersedes or at least is on the same level as all other identities - ethnic, religious, national and gendered; as if "educated suicide-terrorist" is indeed the troubling oxymoron of our time and that, should these educated people be medical doctors, the oxymoron would become even more disturbing.

The deluge of comment raises difficult questions: can a professional, lifelong commitment to Hippocratic values be associated with a murdering ideology, albeit of religious or political inspiration; why do we expect a terrorist ready to die in martyrdom to be uneducated; and is there a special emotional charge connected to the evidence that there could be Muslim doctors who commit terrorist acts, and if so, why?

The path of medical perversion

The fact is that physicians are human beings first, and thus are not immune from any Faustian bargain. The prevention of simplistic generalisation is more important than digging deep into the mystery of "evil doctors". There are two dangers: to fail to distinguish between ideological crimes committed by doctors and medical crimes committed in the name of science (whether by doctors or not); and to avoid creating issues around the pseudo-emergence of a "medical Islamism" or an "al-Qaida-isation" of medicine. The use of medical knowledge in terror's agenda does not necessarily spring from Islamism. The darkest times of medicine can be found far from today's United Kingdom.

The 20th century in Europe is the era of genocide - Turkey during the first world war, the holocaust in the second world war, and the Balkans in the early 1990s - and this entailed concomitant darkness for medicine and public health.

In 1915, Dr Nazim, one of the masterminds of the Armenian genocide, embraced "Turkism", the comprehensive, integrative idea seeking to bind people of the supposed same race, ancestors, soil and blood. Nazim was an influential doctor ready to put his knowledge into practice to orchestrate mass deportation and killings in the name of "Turkism" more diligently. Almost eighty years later, Radovan Karadzic, the executioner of the "greater Serbia" dream in Bosnia, did not hesitate to trump his own commitment to the oath to carry out ethnic cleansing (even if he did not himself participate directly in medical offences).

The most pathognomonic case of medical perversion by far is that of the Nazi doctors. Leo Alexander, principal medical expert investigator in the Nuremberg medical trial (USA v Karl Brandt et al), recalls: "Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance (...) that there is such a thing as life not worthy to be lived. [...]. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude towards the nonrehabilitable sick" (see Leo Alexander, "Medical Science under Dictatorship", New England Journal of Medicine, 40/46, (1949).

Robert Jay Lifton, in line with Alexander's reasoning, explained Nazi doctors by reference to a "doubling self" (see The Nazi Doctors, Basic Books, 1986), while for bioethics experts Paul Weindling and Volker Roelcke Nazi medicine "followed the intrinsic logic of their scientific disciplines" and constituted as a whole an act of predation in the name of science and by science itself of a rogue system to facilitate its own advancement (see Volker Roelcke & Giovanni Maio, eds., Twentieth Century Ethics of Human Subjects Research. Historical Perspectives on Values, Practices, and Regulations (Franz Steiner Verlag 2004; quoted by Alex Dracobly here).

Medical crimes, evil doctors, bad medicine

Beyond historical interpretations, physicians from Turkey to Germany and Bosnia have commuted a principle of healing into a principle of harming. In the public eye, what counts is that Hippocratic values have been violated by those entrusted with upholding them. The outcry about evil doctor is thus unavoidable. Mengele, Karadzic, Karl Brandt, Nazim, all fired with nationalism and ideologies are juxtaposed without any nuances with other criminal emblems like Harold Shipman, the serial killer of hundreds of his patients; even (and this is a very troubling amalgam) with Jack Kevorkian, nicknamed "Dr Death" - the promoter of unregulated, medically-assisted suicide. Society's eye on medicine is holistic and unconditional, leaving very little room for fine interpretations and detailed analysis on why it sometimes goes wrong.

With the recent development in Britain, the assault on evil medicine has now reached Bilal Abdulla and his "al-Qaida" doctor peers from the National Health Service. They include the detained (but not yet charged) Mohammed Asha; as a devoted father and husband, and an ambitious neurologist - one of the most competitive and prestigious specialties in medicine - the headlines have centred on him as if his case was more serious than those of his seven fellow-detainees; as if Lifton's doubling ghosts had overtaken Asha's soul.

But it is critical here not to get sidetracked and create false issues. "Islamic medicine" is not a suspicious entity and what it really is may in fact be unexpected: a system of medical writings and doctrine elaborated between the 8th and the 12th century from Baghdad and Isfahan to Marrakech and the Andalusian city of Cordoba. In the history of medicine that period corresponds to the golden age of pre-experimental medicine led by historical icons Avicenna and Averroes. A reminder of these times of enlightenment may be necessary to disarm or at least neutralise the resurging of an ethnocentric, xenophobic and colonial discourse around Islam.

Medical rationalism in medieval Islam

"Praise be to Allah, (...) In His goodness, He created man and gave him judgment and speech as privileges. He allowed him access to knowledge through the perceptions of his senses and, through reasoning, opened to him the invisible world. The mind of man is bound to a living soul of which the existence is proved beyond all doubt. Allah distributed judgment and senses among all men at the same time as life" (Avicenna's Poem on Medicine, translated by HC Krueger).

When he starts with these verses the writing of his Poem on Medicine, Avicenna (Abu Ali Ibn-Siná), was for long the undisputedly greatest physician of the Muslim empire from Iran to Spain (see Paul Mazliak, Avicenne et Averroes, médecine et biologies dans la civilisation de l'Islam, Vuibert, 2004). The poem, dedicated to his protector Chams ad-Dawla, prince of Hamadan, represents the essentials of Avicenna's monumental work The Canon of Medicine, amounting to more than a million words - annotated with his own observations and discoveries - that contain all medical knowledge available at that time including Indian Ayurveda, the old Iranian Ahuramazda tradition, Bedouin practices, and Byzantine and Hellenistic medicine (Hippocrates and Galen). The Canon of Medicine, translated from Arabic to Latin in the 12th century remained the most prominent textbook in medical schools all across the orient and the western world for almost 400 years.

Avicenna, the "prince of scholars" - together with many others like al-Razi (Rhazès), remembered for his groundbreaking Treaty on Smallpox and Measles; al-Zahrawi (Abulcasis), "the father of surgery"; and Ibn Rushd (Averroes), the renowned philosopher of Muslim enlightenment in 12th-century Andalusia and the founder of a theory of intelligence - left the legacy on which Vesale and Harvey - with the advent of science and experimental medicine - established the principles of today's allopathic medicine.

What strikes most from medieval Islamic medicine is its entanglement with philosophy and religion. However, frequently at odds with their religious authorities, the physicians of the Muslim empire never compromised medical excellence to accommodate the theological doxa of their time, even if their texts make constant references to the words and precepts of Islam. Consequently, medieval Islamic medicine, despite notable scientific aberrations, came free from all sort of irrational concepts to western, Renaissance physicians. History does not necessarily determine the present but it can surely (with examples like this) illuminate it with the power of Ernst Bloch's The Principle of Hope. Avicennism and Averroeism are powerful barriers against contemporary forms of Islamophobia.

A void concept

In this light, an appropriate attitude towards the events of 29-30 June 2007 in Britain would be to impose interpretative restraint - by acknowledging that an all-pervasive religious ideology has the power to "call to arms" its most educated supporters in the service of humanity as well as to its opposite. As Malise Ruthven noted in 2001 on openDemocracy, the relationship between engineering students and the 9/11 attackers may root itself in an instrumentalisation of the Qur'an; a "cultural schizophrenia", echoing here again Lifton's concept of personality doubling towards Nazi doctors.

A more relevant question is whether doctors like other highly skilled educated people (scientists, physicists, and engineers) are more susceptible to the embrace of ideological rhetoric. In most medical schools, philosophy and social sciences occupy no more than a few dozen teaching hours out of a seven-year-long medical curriculum. From age 18 to 25, medical students are immersed in hardcore sciences with limited exposure to societal realities at a time when others are developing and maturing intellectually and ethically. Physicians may not possess all the social endurance needed to recognise and appraise ideological rhetoric when it comes. For a profession whose power over human's life and death is publicly evident, this can be quite worrying. Yet this is very speculative and no evidence - even the comprehensive studies by Theodor Adorno of the "authoritarian personality" conducted in the United States immediately after the second world war - has ever verified such a hypothesis.

"Evil doctors" are, then, none other than the few who - for whatever ideological or behavioural reasons - have lost their soul as humans. "Evil medicine" is nothing but the ideological reappropriation of medical science (or vice versa, the recapture by medicine of a rogue political or ideological system in the name of science). The paradox is that Bilal Abdulla or Mohammed Asha may have endured a distorted rhetoric and its consequences on a daily basis and for a long time - from Baghdad or Amman at the bedside of wounded children, to England among the tranquility of a regimented suburban life poorly receptive to socio-cultural difference.

Bilal Abdulla is shamefully versed in terrorism but his medical degree is likely to be incidental here. Abdulla may be a doctor (even if he has now been struck off the medical register), perhaps a focal person looking for allies in his core sphere of contacts in the medical community - just as a student would seek support within the company of his immediate student-peers. No more, no less.

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