I admit it: I believe in
profiling. In fact, I have personally
profiled people every single day of my professional life.
It turns out, profiling is a
critical component of the practice of medicine.
Without it, a physician would be hard-pressed to make a quick and
accurate diagnosis.
Profiling is what allows a
physician to categorize a patient based on age, gender, race, and body habitus,
as well as dozens of other characteristics.
It is what allows us to scan multiple gigabytes of memory within
milliseconds, and to begin both considering and eliminating potential
diagnoses. We immediately assign
various “labels” (yes, labels! Just
think of it!): old/young, male/female,
white/black, thin/fat, relaxed/distressed, and so on. These characteristics, taken together, and
considered along with the patient’s complaints and presentation, make a
specific set of potential diagnoses most likely. This is known as the “differential
diagnosis”, and sets the course for further examination, testing and treatment.
Profiling is what keeps
doctors from ordering pregnancy tests on elderly women and suspecting sickle
cell disease in Caucasians. It removes
the concern about Tay-Sachs disease in people who aren’t of eastern European
decent, and places gall bladder disease low of the list of concerns in thin,
young white males.
This practice is not unique
to medicine. We profile every day, in
every walk of life, every time we rely on past experiences to make an informed
decision.
“Profiling”” is what results
from understanding the statistical likelihood of an occurrence, incorporating salient
history, and synthesizing the information to guide our further actions. Frankly,
it’s what separates intelligent mammals from lower forms of life.
Why then, when it comes to
the most serious threat to our national security – domestic terrorism – would
we not want to profile? Why in the world would we want to avoid calling statistical likelihood and
past experience to bear?
Let
us not confuse “profiling” with “prejudice”. Profiling is the use of personal
characteristics or behavior patterns to make generalizations about an
individual that are based on facts.
Prejudice, on the other hand, is a pre-conceived unfavorable opinion or
hostile feeling formed beforehand, or without knowledge or reason.
But it’s not as if we don’t
know who the likely perpetrators of terrorist acts are. Repeat after me: “9-11, the Boston bombings,
Ft. Hood shootings, and Benghazi massacre were heinous acts of terrorism,
perpetrated by radical Muslim extremists.”
Yet in the days immediately
following the identification of the two Chechen brothers responsible for the
Boston Marathon bombings, President Obama warned us to “avoid jumping to
conclusions”.
Eric Holder admonished us to
refrain from the assessment that this was, in fact, an act of Islamic
terrorism, reaffirming America’s firm commitment to tolerance of all religions
The administration displayed
the same reticence to identify acts of terrorism employed by Islamic extremists
in the case of the Ft. Hood shootings and the Times Square bomber. Although not
on domestic soil, the murderous attack on our consulate in Benghazi is a further
case in point.
The
militant Islamist movement is alive and well in the United States. Without the fortitude to call it by its proper name
and to employ profiling to identify those who would act on its behalf, we
contribute significantly to our peril.
At
the highest level of our government, there is a pervasive unwillingness to call
jihadist efforts what they are. This is
exacerbated by a refusal to actively profile those individuals most likely to
engage in terrorism fueled by radical Islamic ideology. As a result, we do not have security in this country;
we have “Security Theater”.
To
make matters worse, we are subjected to daily infringements on our personal liberties
for benefit of this illusion of
security.
Hundreds
of thousands of times a day in airports across the nation, random American are
compelled to discard unopened bottles of water and tubes of toothpaste that
exceed the arbitrary 3 oz. size limit.
The
system is ridiculously inefficient, results in thousands of lost hours for
business travelers, and provides a level of stress and annoyance for pleasure
travelers that have undoubtedly translated into a decrease in elective air
travel.
While
the TSA is busy patting down middle-aged blond women and freckled, redheaded
toddlers, they are simultaneously ignoring clear and present security threats. This isn’t just a stupid game; it’s a
dangerous one.
Full
body scanners and enhanced pat-downs aren’t making us safer. These are reactive measures
devoid of common sense and mired in political correctness.
The
Department of Homeland Security is applying “equal opportunity” constructs to
the task of identifying potential terrorists.
This would be tantamount to a doctor doing a biopsy on all skin lesions and moles so as not to
appear “prejudiced” or discriminatory against the ones that are actually
cancerous!
Despite
all of the intrusions into the lives of average Americans, Homeland Security
has failed to secure the homeland. We have spent Billions of dollars and have ended up with front
row seats at “Security Theater”.
Physicians do a patient no
good by refusing to identify and call a disease by its proper name. Diabetes, obesity and cancer become harder to
treat if they are given some colloquial moniker in an attempt to make them
sound somehow less ominous.
That
said, not all breast tumors are malignant.
Physicians rely on a physical exam and diagnostic tests such as
mammograms and ultra-sounds to determine which lesions require additional
evaluation. There are well-known characteristics based on appearance, size,
shape and location that increase the index
of suspicion. That’s why not all breast lumps are subjected to
surgical excision.
Similarly,
there are tumors that are not malignant now, but have telltale
characteristics that reflect a high risk
of becoming cancerous over time.
Those lesions require careful scrutiny and ongoing surveillance.
Tamerlan
Tsarnaev, the now dead mastermind of the recent Boston bombings was on the FBI
watch-list for years. He was deemed to
be such a security concern that he was actually denied US citizenship.
The
government of Saudi Arabia warned U.S. high-level officials at the Department
of Homeland Security specifically about Tsarnaev’s Islamist militancy.
Likewise,
the Ft Hood shooter, Nadal Hassan, demonstrated clear evidence of risk to
become a radical Muslim zealot capable of enacting violence in the name of
jihad.
When
physicians fail to profile, identify and act on lesions that are well known to
be risks for cancer, it’s called “malpractice”.
What shall we call it when our government does the same?
