Cluelessness and sexism embarrass the American College of Surgeons

i-c0f030748b91eb5edbfeaf625a521227-Greenfield.jpgI’d like to thank Buckeye Surgeon for reminding me of something I had seen and wanted to blog about but totally forgot about. Maybe it was so forgettable that I should just skip it, but as a surgeon I actually don’t think so. Basically, it’s a story of a surgeon making a fool of himself. I know, I know, that’s such an impossibility that it’s well nigh inconceivable, but it actually did happen. Perhaps what brought my attention to this sordid tale is that there is a connection to the University of Michigan, where I went to both undergraduate and medical school.

The surgeon in question is Dr. Lazar Greenfield. Dr. Greenfield can rightly be called one of the giants of surgery. Ever hear of the Greenfield filter? Yes, it’s that Dr. Greenfield, who in 1968 invented a metal filter that could be placed in the inferior vena cava and stop clots from traveling to the lower extremities and into the lungs in the form of often fatal pulmonary emboli. Who knows how many lives were saved by Greenfield’s invention, deceptively simple in concept but difficult in engineering? Greenfield’s contributions to vascular surgery didn’t stop with the invention of the inferior vena cava filter, either. An utterly brilliant man, Dr. Greenfield has authored nearly 200 peer-reviewed scientific papers, 55 book chapters, and 8 books. His textbook of surgery is one of the major surgical texts used by many medical schools and residencies.

The Michigan connection is that Dr. Greenfield became Chairman of the Department of Surgery in 1988, the year I graduated from medical school. Indeed, I remember distinctly a party he held in his condo as incoming chair of surgery for the medical students applying for surgery residencies. Truly, it was a giddy experience for a young medical student like myself at the time to be in the presence of someone who was at the time a veritable god of surgery. After a long and successful tenure as chair, in 2004 Dr. Greenfield stepped down to become Emeritus Professor of Surgery, a role in which he continues to teach and do research to this day. This year, he reached one of the ultimate professional pinnacles in surgery, being elected to be the incoming president of the American College of Surgeons, the largest and most influential surgical organization. Given that Dr. Greenfield is 78, it appeared that he was finishing his career on a high note.

Then, as editor, he decided to write a truly bizarre Valentine’s Day-themed editorial for Surgery News. So offensive was the editorial considered among women that the entire issue of GSN was pulled from the web and Dr. Greenfield was forced to resign as editor. What caused such a ruckus? Dr. Greenfield apparently thinks that semen is a mood-enhancing antidepressant, as this text from the retracted article posted at Retraction Watch, demonstrates. Under the heading, “Gut Feelings,” Dr. Greenfield wrote:

As far as humans are concerned, you may think you know all about sexual signals, but you’d be surprised by new findings. It’s been known since the 1990s that heterosexual women living together synchronize their menstrual cycles because of pheromones, but when a study of lesbians showed that they do not synchronize, the researchers suspected that semen played a role. In fact, they found ingredients in semen that include mood enhancers like estrone, cortisol, prolactin, oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, sperm, which makes up only 1%-5%. Delivering these compounds into the richly vascularized vagina also turns out to have major salutary effects for the recipient. Female college students having unprotected sex were significantly less depressed than were those whose partners used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods were not just a feature of promiscuity, because women using condoms were just as depressed as those practicing total abstinence. The benefits of semen contact also were seen in fewer suicide attempts and better performance on cognition tests.

So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.

That’s right. Forget chocolate on Valentine’s Day. Give your woman a heapin’ helpin’ of man juice, and your “little lady” will perk right up. And, according to ol’ Lazar, it’s all biology, maaan; as in evolutionary biology. For example, as a result of his apparently exhaustive research that man sauce is the cure for female depression, Dr. Greenfield invokes the example of Drosophila:

It has long been known that Drosophila raised on starch media are more likely to mate with other starch-raised flies, whereas those fed maltose have similar preferences. In a study published online in the November issue of the Proceedings of the National Academy of Sciences, investigators explored the mechanism for this preference by treating flies with antibiotics to sterilize the gut and saw the preferences disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).

In cultures of untreated flies, the bacterium L. plantarum was more common in those on starch, and sure enough, when L. plantarum was returned to the sterile groups, the mating preference returned. The best explanation for this is revealed in the significant differences in their sex pheromones. These experiments also support the hologenome theory of evolution wherein the unit of natural selection is the “holobiont,” or combination of organism and its microorganisms, that determines mating preferences.

All of which is rather cool science, but I fail to see how it supports Dr. Greenfield’s joke. But it does all sound really science-y, doesn’t it? Either that, or Dr. Greenfield is a real cut-up. (I know, I know, it’s an old and bad joke about surgeons who think they are a lot funnier than they really are.) Unfortunately, the examples he chose from biology to bolster his case are, even under the most charitable interpretation imaginable, only tenuously related to humans. Worse, the “semen” study is about as lame a study as can be imagined. Not only is it a study in which causation is implied by correlation, but to me the evidence of correlation is not even that compelling. The scatter in the data is simply enormous, with most of the standard deviations in Beck Depression Inventory scores being on the order of 75% of the actual score itself. Indeed, this is the sort of study where the scatter is so huge that, even if statistically significance is found it’s hard to know what the significance is. In fact, given that there were four groups based on frequency of condom use plus the no intercourse group, I strongly suspect that the investigators neglected to control for multiple comparisons.

In other words, in order to make a joke (apparently), Dr. Greenfield picked what is at best a dubious study upon which to base it. Worse, he didn’t simply say that sex makes women happier (which probably wouldn’t have caused much of a stir; after all there’s little doubt it makes men happier, too) or taken a Barry White-like position that it’s time to get it on. Rather, he said that it is the semen makes women happy, that getting it on isn’t enough by itself. In other words, the implication of Dr. Greenfield’s wildly inappropriate little joke, published in the official news magazine of the ACS, is that a woman needs a man to inject his seed into her in order to be truly happy. Therein, I suspect, lies the subtext that elevated the outrage over Dr. Greenfield’s remarks to the level they’ve reached. If he had simply tried to argue, even based on biology, that a little nookie on Valentine’s Day can make a man and woman grow closer based on biology, no one would have complained–or likely even argued. Of course, he would have had to leave out out that final study as his justification and in particular left out the bit of its having nothing to do with “promiscuity”–what is this, the 1950s?–but if he had done those things he might have crafted a mildly amusing paean to physical love on Valentine’s Day. I’m sure that was probably his intent, but instead he ended up implying that unmarried college age women should have unprotected sex on Valentine’s Day because it would make them happier.

In response, Dr. Pauline Chen, who is a surgeon blogging under the headline Sexism Charges Divide Surgeons’ Group, was sharply critical of Dr. Greenfield and the culture at the ACS. In her post, she points out that only roughly 10% of the membership of the ACS is comprised of women, and of that only five of twenty-two members of the ACS governing board are women. Chen’s article also does a good job of pointing out how this incident puts the differences in culture between younger surgeons and the “old guard” (the “gods of surgery,” as I put it). Society has changed. Surgery has changed, but not enough. Many surgeons were afraid of criticizing Dr. Greenfield for fear of professional repercussions; some were simply puzzled; some were quite critical. Ultimately, the firestorm of controversy that engulfed Dr. Greenfield would not be denied.

He was forced to resign as President-Elect of the ACS.

If you look at the comments after Buckeye Surgeon’s post, Dr. Chen’s post, and the Retraction Watch post, you’ll see that the discussion is fairly heated. Basically, the commenters divide into two camps (well, three, actually). First, there is the camp that finds Dr. Greenfield’s article offensive enough to justify retracting the article and Dr. Greenfield’s forced resignation as President-Elect of the ACS. Then, there’s the camp that finds Dr. Greenfield’s article inappropriate and/or offensive but thinks the penalty is too harsh. Then there’s the camp that is truly sycophantic. For example, there is this nauseating letter to Dr. Greenfield from Dr. Randall Cook:

Dr. Greenfield,

This morning I read with tremendous regret about the action by the College Board of Regents which occurred over the weekend. Evidently I had not been paying attention and had no idea such a tempest was brewing. I had missed the now infamous editorial in the News and requested a copy through Dr. Pellegrini but was refused. In order to learn what the fuss was about, I had to resort to the internet and was eventually successful in my search for the document. Actually, it didn’t take long but I had hoped for more help from those whom I thought to be my colleagues.

Let me first say what many others are afraid to admit. The essay was quite humorous and I had no problem getting the joke. That said, I also understand that the climate of political correctness that currently surrounds us simply will not tolerate any humor that even approaches the fringe of offensiveness. Because of that reality, I understand that you had no choice but to resign in order to put the better interest of the College above your own. You are to be admired for not allowing (or helping) the insanity to grow any larger than it has already.

The thought that I’d like to offer you today is simply that the College will be a lesser institution in your absence. And those who attacked you and even those who failed to defend you missed a great opportunity to elevate their own stature. Though I have never met you, I have read many of your publications, heard you speak on numerous occasions and been acquainted with a number surgeons who were proud to have learned under your mentorship. In the end, these, among others will be the accomplishments by which you are ultimately judged.

I can’t help but think that a society paralyzed by correctness is a society in deep trouble. Who will the censors silence next? John Steinbeck, Ernest Hemmingway, J.D. Salinger, D.H. Lawrence, Jack London…and now Lazar Greenfield…you, sir, are in good company.

Randall G. Cook, MD, FACS

All of which goes to show that sexism and sycophancy are alive and well in the ACS. Truly, Dr. Cook has his nose inserted firmly up Dr. Greenfield’s posterior.

Although I did not know Dr. Greenfield, from what I’ve been able to gather, he actually has a a very good, perhaps even exemplary, record recruiting and mentoring women as surgeons. There is also not doubt that he really is a brilliant man and that his contributions to the field of surgery are far more than I could ever hope to match, even if I keep working until I’m his age and beyond. That makes it a shame that Dr. Greenfield decided to write such a breathtakingly inappropriate and embarrassing article for Surgery News. It’s also depressing to see a pall cast over his career because he’s so out of touch that he didn’t see how massively inappropriate his article was or how offensive they would be to so many women. However, I’m not in the camp that says Dr. Greenfield’s apology should be enough and that he didn’t have to resign from his position as President-Elect of the ACS. Words have consequences, and the consequences of Dr. Greenfield’s words were to remind female surgeons, who make up an increasing percentage of younger surgeons as more and more women enter the field, of the bad old days, when good old boys excluded and devalued them. Once that had happened, Dr. Greenfield’s ability to be effective as President of the ACS was destroyed, and he finally realized he had to resign. To do otherwise would have guaranteed that this issue would have dogged the organization until his one year stint as President ended–and likely beyond. It would have sucked the oxygen out of his presidency.

Although one mistake shouldn’t negate a 40+-year career full of amazing accomplishments, one can only wonder what possessed such a brilliant man to write something so utterly clueless and tone deaf. Maybe there really is a generation gap between the “old guard” and the new generations of surgeons coming up through the ranks.