Marc Siegel

Marc Siegel is an Associate Professor of Medicine and a Fellow in the Master Scholars Society at New York University School of Medicine.

Recent Articles

Reality Check

During the past two weeks, as the terrorism-alert logo on America's television screens switched to orange, I began receiving the same worried phone calls from my patients that I had received during the fall of 2001. They told me they were not sleeping, thinking constantly about bombs or rushing to buy emergency supplies. In the months after September 11, they had desperately sought gas masks and Cipro; now, they told me, they were buying duct tape and plastic sheeting. In response, I've given my patients the same advice I dispensed back in 2001: Focus on things besides terrorism and continue your normal daily activities. "If you don't want your children to panic, don't panic yourselves," I tell them. "We've been through this before. In the era of the Cold War we had to get used to emergency-response systems, air-raid drills and hiding under desks. And we did." One might also keep in mind the example of Israel, where people are able to live normal lives despite frequent suicide...

Doctor No

It now appears that President Bush plans to privatize Medicare, meaning that HMOs could soon assume a prominent place in America's health-care system for the elderly. Past experience has already taught us that such a scheme won't work for seniors, who are likely to have multiple health-care needs that must be addressed in a timely manner. Bureaucratic restrictions, referrals and refusals governed by outside insurance are anathema to very sick people who must get tested and treated quickly before they are overcome by illness. The way out of our current Medicare conundrum doesn't lie in privatization but in extending coverage and forcing changes in how drug companies behave. But Bush's plan won't help accomplish these goals -- and it will probably make things worse. Currently, patients who have opted for Medicare+Choice -- a managed-care alternative to traditional Medicare that was created as part of the 1997 Balanced Budget Act -- are miserable: Only 13 percent of seniors are enrolled...

The ABCs of Smallpox

M edicine depends on probability: the probability of a disease occurring, the likelihood that it will spread or can be prevented, the odds of a side effect resulting from a tool of treatment or prevention. A risk-benefit analysis evaluates the risk of a disease versus what doctors can do to prevent or treat it. With smallpox, the greatest problem recently has been an exaggerated perception of its risk. The public is divided into two camps: those who are afraid of smallpox and those who are afraid of the vaccine. Smallpox is a debilitating disease that leaves behind disfiguring scars. But it is containable by public health measures that have been in place for more than 100 years. When untreated, it has a 30 percent mortality rate. It spreads by airborne saliva when a person already has a fever as well as obvious skin lesions, so it's easily quarantined. Furthermore, giving the live virus vaccine to victims after infection can reduce the mortality rate to less than 10 percent. And a new...

Cloudy Judgment

Vladmir Putin's decision to storm and gas a theater in Moscow -- where Chechen terrorists had taken about 700 hostages -- was an obvious call; circumstances had left him with little choice. But if the decision to storm the theater was fundamentally just, the execution of the operation by security personnel raises a number of troubling questions. And most disturbing is the question of whether more than 100 lives were sacrificed carelessly because of a lack of adherence to basic principles of emergency medicine and rescue. It is difficult to control the concentration of a gas pumped into a building the size of the theater. In a hospital operating room, doctors use precise instrumentation to keep the concentration of anesthetic gases somewhere between a therapeutic and a toxic range. In the Moscow theater, no such regulation was possible, and there must have been pockets of greater concentration of the gas where anyone present was immediately overcome. These poor conditions were...