Fake doctor saved thousands of infants and changed medical history (2018) | Hacker News Reader

Fake doctor saved thousands of infants and changed medical history (2018)

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“You had a raging climate of eugenics which did not directly target preemies, but did directly target children who had severe disabilities. It was an environment where we only wanted to produce the fittest babies. That was a very strong cultural undercurrent. People just felt like these children were not worth saving.”

Yes, the US used to have quality control on people. Ellis Island was a quality control checkpoint for immigrants. The sick were rejected and sent back where they came from.

> The sick were rejected and sent back where they came from.

Only if they were also poor. First class passengers on the boats didn’t go through medical screening.

That's probably because of injustice, it goes without saying that people who lived 'back then' didn't have functional brains and they were all racist automatons.

Most steerage passengers spent about 3 hours being screened at Ellis Island, and most of that was waiting in line. This is not dramatically worse than a typical wait at customs at any international airport at a peak hour. To this day they still let First Class passengers off the airplane first so they get to be the first in line at customs.

> To this day they still let First Class passengers off the airplane first so they get to be the first in line at customs.

Doesn't really help at large airports as that just means you're first in the queue behind the previous 5 planes.

Some airports do have a faster immigration line for first/business passengers though. I don't recall any in the U.S, but Heathrow does for example.

Isn't it the same nowadays? And for many countries in general.

It's the same but even more stringent due to modern medicine. Good luck immigrating into a country with universal health care if you have any number of chronic conditions..

Usually once residency is granted in a place that has socialized medicine, there's a waiting period during which you're responsible for your own care.

Canada and New Zealand have entry visa requirements that there not be an undue burden on the health care system, with cost thresholds around $20,000 CAD and $41,000 NZD.

IIRC, for Canada, it depends on why you are there. There are exceptions for spouses, for example. It seems a lot of countries view family immigration a bit differently.

No guarantees, but in Germany as long as you are registered (resident from an other EU country, refugee, asylum seeker) as opposed to a tourist you are covered. Access to health care is, unfortunately, a different story for people in refugee centers. But you are covered. No strings attached.

There is no way to be a legal resident without public heath insurance here. Which route you choose, public insurance, public as part of your spouse, private is up to you. If you cannot afford it because you are, say, unemployed the state covers the costs for the public model.

Also worth noting, the public model doesn't exclude pre-existing conditions which can make private solutions prohibitively expensive.

Actually, you can become uninsured quite easily. Switch to private insurance, and then lose the means to pay for it. The private insurance has no obligation towards you, and the public insurance companies don't have to take you back, so at this point you're well and truly fucked.

Well, I kind of tried. All you have to do is one of the following:

- drop under the minimum wage required for private insurance and the public has to take you back

- become unemployed and the state covers as mentioned above

Exceptions I know so far: Freelancers, mainly their problem is social security and retirement so. But yes, it can be tricky to return from private to public insurance. But as my insurance company stated, "there is an obligation to be insured, let's talk about your options". One very notable exception applies to people living permanently outside the EU. There it really gets difficult, and you might even loose coverage for conditions you didn't have before left the EU. But don't ask for details here, all I know about that is third hand knowledge.

The UK charges £400 per year per person when applying for an immigrant visa. Gives you access to the NHS, for what it’s worth.

Personally given a choice I would rather not have paid that because the NHS hasn’t been very helpful to me.

The point of socialized healthcare is that you pay even if you don't need it, so that other people can use it.

This, and say one day you need some serious surgery that costs 3 times what you paid in taxes. Socialized healthcare could cover this up to a certain point and nobody would come to you with a bill afterwards. To me it's the best approximation of "sharing health" a civilized country could come with, though some degree of empathy is required to fully understand its value.

Yes. However, only immigrants have to pay the £400 "NHS surcharge"; they are also paying for it through tax and national insurance. The government figured out that it could impose all manner of arbitrary charges on immigrants because they can't vote.

To be fair no one asked them to go to the UK. I can't vote in the country I live in because i am a foreigner, but it is my choice to be there, and I prefer it to my home country.

It's quite possible, even likely in fact, that someone asked them to go to the UK.

If you are talking about skilled individuals, then they probably are in decent paid jobs so £400 isn't a great deal to them.

I can't speak for every country but in most of Europe the opposite is the case. You'll be asked for preexisting conditions - but only once you register for medical care, and only to ensure good information and proper care. For immigration the main concern will be whether you have the means to support yourself (i.e. a job in the country or independent wealth) and whether you are assimilated (language, culture) before you get permanent residency or nationality.

In most EU countries even tourists can receive free/cheap care at public hospitals - but check for the specific country before you travel.

You have left the meat of your position unstated. Are you arguing that states should admit all applicants, regardless of the threat to public health(ebola, smallpox etc)?

Currently the test is primarily for Tuberculosis (I-693). Once you arrive you are still responsible for your own healthcare costs because America doesn't have socialized medicine. Further, no medical exams are required for tourist visas, and many folks such as myself have lived in America for almost a decade, and still have to submit to asinine medical examinations. If I had Ebola everyone around me would have died many times over in the literally ten years I've lived here without an immigration-type medical exam.

Ebola is not transmitted as easily as you seem to believe. It is much less contagious than many other disease, but it is a lot more deadly once contracted.

ebola is much less dangerous than 5 years ago now that medical protocols and vaccines/post-exposure prophylaxis have been established

The USA has a socialized healthcare system, it's called Medicaid and expanding it was a big part of the Affordable Care Act. In some states, such as California, Medi-Cal (the state's name for Medicaid) is fully available to legal immigrants and practically fully available to illegal aliens as well, the latter just have to use the emergency department rather than schedule a physician's appointment.

Our system does however assume that highly capable persons such as yourself are able to not only able to afford medical care, but also to pay for the socialized programs for those who can't.

It's of course no longer possible to immigrate if you're currently or reasonably anticipated to be a Medicaid recipient. [1]

[1] https://www.ilrc.org/public-charge

Injucted by several circuit courts: https://www.npr.org/2019/10/11/769376154/n-y-judge-blocks-tr... Heading to the Supremes.

I'm always impressed by the way a simple turn of phrase can hide disproportionate impact on human lives.

Specifically interesting in this context is that the turn of the 20th century, and the 1920s in particular, is really the birth place of modern immigration policy.

Of note is the fact that the requirement of visas for entry and quotas on point of origin appeared around this time- if you read newspaper op-eds for the immigration act of 1924 (or the earlier chinese exclusion act), these measures are specifically pointed out as a way to maintain the racial makeup of the country.

Prior to that point, visitors could just turn up at Ellis island for entry. Afterwards, the island itself served more as an offshore detention center for what were then classified as radicals, anarchists, and those "likely to become a public charge"— awaiting deportation.

Citizenship, too, could once be had for as little as the price of a dozen eggs-- check out this booklet published 1921: https://archive.org/details/howtotakeoutyour00metrrich/page/...

"All it costs is $1, not a penny more. No witnesses, no examination, no pull required." -- 2 years of residence later, another set of papers (also on Archive.org) and a short literacy test (added in 1917) and you could be a citizen-- but this rapidly changed as additional quotas and restrictions were added.

The history of immigration law is a fascinating topic, and there's a lot of interesting primary sources available.

That booklet is fascinating reading. It's a little bit wild to see these on opposite sides of the same sheet of paper:

> The true American believes in Liberty, Equality, Justice, Humanity. [...] The true American believes that "All men are created free and equal." [...] The true American believes in his own ability, but holds that the other fellow is as good as he and should have the same chance to life and happiness. He believes in equality of opportunity.

> Persons not belonging to the White or Black Race, Anarchists, Polygamists, Criminals, Insane, cannot become Citizens; they will not get First Papers.

And also that Africans were considered more desirable immigrants than Asians!

Some early immigration cases involved people trying to prove they were black to avoid removal.

A literacy test in early 20th century would already exclude a lot of poor people by definition. not sure why you make it sound like it was a formality.

The literacy test was to gain citizenship after you had already been granted permanent residency, so while they wouldn't be eligible to vote in federal elections, illiterate people would still enjoy almost the benefits and rights of any other US person. Almost anyone can learn to read, it's not that hard, almost every 5 year old learns to do it. If an adult in the early 1900's wanted to be a citizen, but were blocked by a basic literacy test and still didn't learn to read it's because they weren't interested in putting the effort into it (there are people with severe disabilities, that is a totally different situation and i'm not addressing that). Of course it's way easier to be born rich, but if you think someone who is poor but motivated can't learn to read you are insulting their intelligence.

The literacy test was a barrier to entering the country, not to citizenship. https://history.state.gov/milestones/1921-1936/immigration-a...

And while that one didn't have a very large effect, the one that did block people from voting managed to filter out black people very well:

https://metro.co.uk/2017/09/20/could-you-pass-this-test-give...

To say that "anyone can learn to read, it's not that hard" because a 5-year-old can do it is disingenuous. It's been well established that children learn language and reading skills exponentially easier than adults due to the "flexibility" of children's minds that is lost with age. It can be nearly impossible for some adults, especially ones with no reading experience when they were young, to ever learn to read.

> A literacy test in early 20th century would already exclude a lot of poor people by definition.

That's actually an empirical statement, it wouldn't be by definition. (Unless by poor you mean "can't read", then it would be by definition.)

I observed that "by definition" is on its way to becoming one of these emphasis phrases, like "literally", no longer literally meaning what they used to.

Yes. Though even in its literal meaning 'by definition' is a weaker statement than 'by evidence'. At least in any argument outside of mathematics.

Most of the time the 'by definition' argument just gives you a True Scotsmen.

Take the classic: all men are mortal (by definition in Ancient Greek), Socrates is a men, thus Socrates is mortal.

As an empiric argument, this would make sense. But the Greeks tried to reach 100% certainty. Mortality was included in their definition of a human (otherwise you'd be at least a semi-God or so.) Of course, that just shifts the uncertainty to the second part: we can not be sure that Socrates is indeed human by that definition, until he actually keels over.

Imagine that "booklet" is the same as the ADs you see when you browse the internet. And they are the equivalent of " You are the XXX visitor and Won this."

Family story:

My Gran Grandfather was from Trento Region in Italy (North), very poor. At these times, there were some organizations working with migrants. (take note)

So he went to migrate from famine and poor.

Once on this organization, they asked him his scholar level, and he was like 3rd grade. Not good enough for the US was sent to Brazil. (note 2) He paid his fees, jump on a shit boat, and three months later, he was in Brazil.

Then arriving, the support he paid for previously was non-existent; all good land was already taken by the Germans, so they only one left were in the rocky mountains were because of the rocks that were very hard to work on the fields (note 3).

What I mean is: what looks easy today was so hard as yesterday.

And please people long ago were not better from today. I do think they were worse.

Note 1: These organizations at that time earned a lot of money with "fees."

Note 2: The people from the south with a more relaxed moral usually lied about this and were sent to the US.

Note 3: It was later known for good wine and tourist places. (grapes love rocky soil and can grow there).

This still exists.

To get a green card for example you need to undergo an exhaustive medical exam and can be rejected due to the results.

Yeah but it's mostly about immunizations. You can still immigrate if you're disabled but have a caretaker.

What’s that, about the top 1% of disabled people?

Indeed, what should we do about the other 99%?

No - if you are considered likely to become dependant on state or federal aid you can be denied. https://www.uscis.gov/greencard/public-charge

To play devils advocate - what's wrong with this?

I was always under the assumption that immigrants were suppose to benefit the native population. Which in this case they likely wouldn't?

Cost, governments are not benevolent entities.

Someone can be both "likely to become a public charge" under the law (which is not yet in effect because three federal courts have ruled it unconstitutional) and also of great benefit to the country.

He's not an American, but Stephen Hawking, for example, was a "public charge" whose substantial medical bills were largely covered by the NHS[1] and the cost of his 24-hour nursing care was made possible through grants.

And while Hawking is an extreme example in both the cost of his care and his ability, a determination that someone is "likely to become a public charge" can apply to just about anyone who might find themselves in need of Medicare. An otherwise healthy 20-year-old with a family history of Parkinson's or Alzheimers. Or, to get even more dystopian, an otherwise healthy 20-year-old with a genetic marker for Parkinson's or Alzheimers. The cost of long term care for these diseases is astronomical but I'm certain there are many Parkinson's and Alzheimers patients that have made substantial contributions to society.

[1] https://www.theguardian.com/commentisfree/2017/aug/18/nhs-sc... (Written by Hawking himself)

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123440/

Hawking and other successful people would also handily qualify for visas based on achievements.

The law saying “likely to be a public charge” is already in effect and is decades old. The recent change that is currently blocked is only about the factors being considered when making that evaluation (specifically, usage of various types of government assistance).

Your sponsor can sign off that you won't become a public charge and they'll become your caretaker.

That’s not quite true. You are probably thinking of the fact that when you sponsor someone for a green card you are required to promise that they will not use government assistance for x years, and if they do you will have to repay it.

Yup, that's what I meant.

Canadian permanent residency class immigration visas still require a full chest x-ray for tuberculosis.

As opposed to a partial chest X-ray?

"The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm."

In health care as a care giver we do it this way to see if we have it. I am not sure why they would not do it this way as opposed to a chest X-ray but I am going to go out on a limb and guess you could probably limit or maybe slow down the reaction with antihistamines or some other means I am not sure of where a chest x-ray would be impossible to hide evidence of TB.

Same for green card and a bunch of other stuff.

In fact applicants must show the X-Ray upon arrival at the port of entry.

This is not accurate.

To get my US Green card, all that was required was an HIV test and a standard US doctor's affidavit that I wasn't disabled.

That's a far cry from a "rigorous physical exam".

And the museum on Ellis Island says that only a small fraction of immigrants were sent back. So thinks hardly changed.

They were primarily concerned about infectious diseases, and most people were kept in holding until it passed or they died.

Can confirm. My brother-in-law’s wife just became a permanent resident. Immunization was the main concern.

I'm having a hard time understanding why someone with HIV or a disability would still be excluded. The US has pretty strong protections for people with disabilities, which makes me feel like we're supposed to honor and include those people. I wonder what the logic is that prevented us from extending that philosophy to immigrants.

HIV is also more of a chronic condition as apposed to a public health hazard these days. It's cost of perpetual treatment isn't significantly different from dozens of other conditions or diseases, and the risk to the public is similar to other diseases like Hepatitis.

Anyone have insight that I'm not understanding?

Edit: elliekelly gave a well-thought out reply below that makes logical sense, even if I disagree with the policy

US laws are for US citizens. Note the many and onerous restrictions that prevent US law enforcement agencies from blowing up US citizens from drone aircraft, which self evidently do not apply to noncitizens.

I don't know your specific situation but I followed an LPR's process to get the green card and it involved a rigorous health exam, including vision, thorax, immunology, vaccines and who knows what else.

The price was in the hundreds of dollars in a somewhat poor country.

The doctor was very clear that he could have been refused because of the results he never saw.

It's speculated that STDs are also tested, but as I wrote, he never saw the test results.

For a bit of perspective, it seems about 2% of immigrants were rejected [1]. I believe most sick people were quarantined, then admitted on the territory.

[1] https://www.history.com/news/9-things-you-may-not-know-about...

It still does health exam for Green Card still works like that +/-

We still do that. People looking to get a green card need a medical exam. Certain conditions will disqualify you from immigrating although those have been scaled back.

Other countries do it too, but also for financial reasons. Canada will disqualify people from immigrating if they will put an undue burden on the healthcare system.

For context, 1920 is five years after Chicago doctor Harry Haiselden murdered disabled baby John Bollinger to widespread public support from all the best people (Clarence Darrow ofc, Hellen Keller ...), and three years after he released a film about it. https://global.oup.com/academic/product/the-black-stork-9780...

there has always been a connection between the policies of Nazi Germany and American's treatment of those who were not valued either because of race or disabilities. I have provided a link to two articles but there are many more

https://www.newyorker.com/magazine/2018/04/30/how-american-r...

https://www.theatlantic.com/magazine/archive/2017/11/what-am...

Whatever your ethical stance may be, refusing to perform a surgery is not murder.

When have a duty of care to them, refuse surgery with the specific intention of causing their death, and prevent others from assisting them, then yes it is.

I cannot even express how much love and gratitude I feel to him and people like him. He is like the father to all those people whose lives he saved. Something inside me is longing to be able to do similar deeds, and have such a meaningful, impactful life!

Perhaps championing Adoption is one such strategy?

Today, young women who find themselves pregnant face a similar stark choice, as mothers of preemies did back then: they're given the choice of either Abortion, or Abandonment in state institutions, both of which dehumanize the lost children.

Adoption of children faces the same cultural ambivalence that preemies and slaves faced historically, even though there are millions of adoptive parents who wait years for a child!

In my province of Canada, the number of adopted infants is in the single digits, while thousands of families wait for years without a child, and thousands of babies are aborted -- and the mother is never given the choice to allow the child to grow up in a loving family...

Perhaps we can make the loss and abandonment of children as unthinkable as slavery and discarding preemies to die was!

I imagine that one of the difficulties is that a woman who gets pregnant and doesn't want to have the child finds that the process of pregnancy and birth is very difficult financially. It increases expenses, and decreases available time for employment which affects their finances from the supply side too.

Many people find that practical concerns, like finances, override any moral qualms they might have on the concept.

If the US ever gets a socialized medical system, it'll be interesting to see if abortions decrease and babies available for adoption increase. Pregnant people will still face a decrease in finances on the supply side because they'll have to take time off work, but removing the expenses could reduce the problems with the practicality of basically being an incubator for needy parents who want to adopt.

The title 'Fake doctor' makes this piece sound very negative from the get-go. I assumed I was going to be reading about people abusing the medical field. Instead it was about a man trying to help save babies.

> Woolsey recalled a sideshow exhibit featuring prematurely born babies whose lives were saved right there on the Boardwalk. Resting in new machines called incubators, the babies made medical history while serving as a prime attraction for gawking tourists.

I read that and thought "what in the world. A spectacle? Can you imagine such a thing today?" Then I finished reading and saw this line:

> Visitors were charged a quarter to view the babies, and the money went to their care.

TL;DR: "Martin Couney, a self-appointed “doctor” — his credentials turned out to be nonexistent — who nonetheless saved thousands of infants, and introduced incubators to the modern world."

> to the modern world

To the USA, the technology was apparently already in use in Europe.

Yeah, that was a weird turn of phrase in the article.

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