Fascism in the Healthcare and Social Life: the Review from Russia

Russian officials and media use the term “fascism” relating to Ukraine these days, actually as a senseless derogative term. There is no reason why the same term cannot be used for phenomena that are in a disagreement with medical and common ethics, often having political motivations. The main topics of this review are invasive procedures used currently or in the recent past in the Russian healthcare without sufficient indications. Among others, the following is discussed: the overuse of thoracic surgery in some respiratory diseases, cauterization of cervical ectopy without epithelial dysplasia, excessive preparations in dentistry. Considering the breast cancer incidence, millions of women underwent Halsted and lately of Patey mastectomy with removal of pectoral muscles without indications, often sans informed consent. Justifications of surgical hyper-radicalism, described in this review, could be heard in private conversations among medics, for example: “The hopelessly ill are dangerous” i.e. may commit reckless acts undesirable by the state. For example, glioblastoma has been routinely operated on, while it was believed by some staff that the treatment was often useless, just forcing many patients to spend the rest of their lives in bed. Many other topics are discussed together with documents and figures in a recently published book that is partly summarized here. This topic is interconnected with certain features of Russian healthcare, namely paternalism, authoritative management style, occasional disregard for the principles of informed consent, professional autonomy and scientific polemics. In conditions of paternalism, misinformation of patients, persuasion and compulsory treatments are deemed permissible. Considering shortcomings of medical practice, research and education, a simple increase in funding is unlikely to be a solution. Measures for improvement of the healthcare in Russia must include participation of authorized foreign advisors.