From Evita to Rudy: The ethics and politics of caring for the famous

May 31, 2000

New York, NY -- June 1, 2000 -- When noted U.S. surgeon George T. Pack performed a hysterectomy on Eva Peron in 1951, his patient was unaware of her diagnosis of cervical cancer, the nature of her surgery, or even the identity of her surgeon. Dr. Pack arrived in the operating room after Argentina's first lady -- known as "Evita" -- was sedated and left before she woke up.

Evita died of cervical cancer in 1952, still unaware that she had cancer. Millions of poor and working-class Argentinians mourned her, but only her husband, Juan Peron, other family members, and a handful of his political advisers knew why she died. Dr. Pack himself maintained Evita's confidentiality until his death in 1969, never disclosing his role in her surgery or any details of her case.

An article in this week's issue of Lancet explores the story of Evita and her doctor in the context of the mid-20th century, when doctors and families often kept patients in the dark about a diagnosis of cancer, and our present time of apparent openness and patient empowerment. The story "illuminates the conflicts that arise when medical care has social and political ramifications," writes Dr. Barron H. Lerner, Angelica Berrie Gold Foundation Associate Professor of Medicine at Columbia University's College of Physicians & Surgeons. According to Dr. Lerner, physicians caring for public figures today continue to face ethical conflicts similar to those Dr. Pack encountered.

"You can try to treat a politician just like any other patient, but the ramifications of your decisions can be very significant," Dr. Lerner says. He cites the cases of Paul Tsongas and the Shah of Iran as situations where a patient's diagnosis was revealed, yet physicians were pressured to provide "incomplete or misleading information." Politics plays a role not only in how much public figures reveal about their health or illness, Dr. Lerner adds, but also--and possibly more importantly--in the treatment decisions they make with their physicians. He points to the example of President Dwight Eisenhower, who went to the hospital by car rather than ambulance while having a heart attack to avoid alarming the public.

While openness seems to be the rule today, Dr. Lerner observes, much is still kept secret. For example, anyone who regularly stays abreast of the news knows that New York City Mayor Rudolph Giuliani has prostate cancer, but the extent of his disease remains confidential.

Dr. Lerner began investigating the case of Evita while researching a historical book, "The Breast Cancer Wars," to be published by Oxford University Press in 2001. His history of tuberculosis, "Contagion and Confinement," was published by Johns Hopkins University Press in 1998.

According to Dr. Lerner, physicians caring for ill public figures should follow Dr. Pack's example and view them "first and foremost as patients."

Columbia University Medical Center

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