Amanda Gorman, a 22-year-old, African American woman wrote a poem called “The Hill We Climb” and read it at President Biden’s 2021 inauguration.  Her poise and positive message were widely acknowledged, but one parent in Miami-Dade County, Florida, found the poem objectionable.  She insisted that this and other literature produced by African-American authors, such as Toni Morrison, would “cause confusion” in young children.  This “objectionable” material was duly removed from libraries serving preteen students.  Many other parents in several other states have suddenly decided that books, poems, and essays written by African-American authors are subversive.  Even informing our children of the history of human trafficking in America is viewed as pernicious.  It may make our children feel ‘uncomfortable.’

Stories dealing with discrimination in America targeting Irish, Chinese, Jewish, Japanese, and innumerable other immigrants, as well as the history of our nation’s treatment of Native Americans and its own citizens of Japanese or German descent, might also make our children feel uncomfortable. Those children might ask their parents what all that fear and fury was about and that could make their parents feel uncomfortable.  The governments of Florida and several other states have consequently decided that there are many books to which our children should not have access. This flourishing of censorship is disturbingly reminiscent of actions routinely adopted by authoritarian regimes.  

While our local and state governments are busy banning books and protecting our children from seeing men who wear extravagant wigs and revealing silk stockings [like most of the kings of England before Victoria became Queen], many industrialized nations are busy promoting inquiry and innovation.  One of the most promising consequences of this yearning to learn has been the development of systems and devices that help blind people see and help deaf people hear.  Most recently added to that arsenal of medical miracles is a computerized system enabling people with spinal cord injuries to walk.

The brain has an identifiable surface area devoted to moving muscles in the legs.  This “motor cortex” sends electrical and chemical messages down the spinal cord and out of the spinal column to nerves that make muscles contract.  We can walk if the signals reaching the muscles are strong enough and appropriately sequenced.  People with spinal cord damage may lose the connections between the brain and the nerves that activate muscles in the legs.  Trauma to the back, such as occurs in some motor vehicle or bicycle accidents, may sever the spinal cord. The result of this disconnection of the brain from the part of the lower spinal cord that activates muscle contraction is called paraplegia. The brain in the paraplegic individual can still send messages to the spinal cord which are intended to move the legs, but with damage to the spinal cord, those messages cannot reach the nerves that control the leg muscles.

Walking is no simple task. Just ask any one-year-old. Developing a system that can identify thoughts that initiate taking a step and delivering that stimulus after it has been greatly amplified to the correct nerves in the correct sequence and with the correct intensity below the breach in the spinal cord is a mind-boggling achievement. This system was developed in Switzerland and has been successfully tested in only one person, a Dutch man named Gert-Jan Oskam. If this work can be replicated in other people with paraplegia and miniaturized to work as an autonomous unit without any connections to or input from external computers, it will change the lives of hundreds of thousands of injured people.

More than 12,000 people in the United States suffer traumatic spinal cord injuries each year. Once damaged, the spinal cord does not repair itself. The injured person is routinely left with paralyzed legs and loss of bladder and bowel control, as well as loss of feeling below the level of the spinal injury. If the cord injury is in the neck (e.g., Christopher Reeves after falling off a horse), the affected person is left without the ability to move his or her arms and legs. A system that can bypass the damage to the spinal cord will not merely restore limb movements but will also reduce the often lethal complications of the paralysis.  Without voluntary movements, affected individuals develop pressure sores, blood clots, bladder infections and other problems. We are designed to move our limbs and our trunks even when we are asleep. Lacking that ability, our life expectancies are reduced.

Healthcare in the United States has provided its own headlines but of a very different sort. In the continuing battle over abortion, Dr. Caitlin Bernard, an obstetrician-gynecologist licensed to practice medicine in Indiana, was censured and fined for discussing her performance of an abortion on a 10 year-old girl from Ohio who was raped.  The child left Ohio because its ban on abortion made it impossible for the raped child to terminate the pregnancy in her home state.  This physician revealed nothing that would identify the child and many antiabortion advocates claimed that the story was a fabrication until the perpetrator was arrested in Ohio and charged with rape of the child.  Dr. Bernard was nonetheless charged with violating patient privacy rules, which she did not, and failing to alert appropriate individuals to an apparent case of child abuse, which she did. Her license to practice medicine in Indiana was under review. 

The child was 6 weeks pregnant when the abortion was performed. The Indiana Medical Board action against the physician treating this child was a warning to all doctors that they risked their licenses, livelihood, and personal freedom if they performed abortions in Indiana, regardless of the circumstances of the patient.  The actions taken against the physician caring for this child were swift and harsh and unjustified.  The actions against the rapist of this 10 year old child are proceeding slowly and deliberately and are likely to result in a plea to a lesser charge.

And so it is that we may be able to help the paralyzed to walk and the blind to see and the deaf to hear through awesome medical advances around the world, but we are still handicapped in America by governing bodies that insist on telling us what our children should be allowed to read and what we are allowed to do to relieve the suffering of our children.  The irony is that those who insist that they are protecting our liberties are the individuals insisting on limiting our choices.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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