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Dr. Greenfield’s filter

April 2011

One of my favorite stories in the history of medicine is the well-told events that led to the invention of Viagra. Originally, researchers were looking for a medicine to control hypertension. No luck there, but they had one heck of a time wrestling the pills back from study enrollees, once the trial was closed. Turned out that those pills had one very favorable side effect—and the rest, as they say, was history.

There are countless other examples of scientific breakthroughs that resulted from the serendipity of thought or unintended outcomes. Which leads me to speculate about Lazar Greenfield, MD, and his aptly named Greenfield Filter.

Any hospitalist can attest to the filter’s usefulness in those unfortunate patients who are throwing clots but who have a contraindication to anticoagulation. The solution? Dr. Greenfield’s magic filter, which will, in theory at least, catch all those clots hell-bent on wreaking havoc on oxygen delivery in the lungs. So simple, I can’t believe the device wasn’t invented before the discovery of penicillin.

What sparked Dr. Greenfield’s ingenuity? While I am sure I will never be his official biographer, his recent editorial in Surgery News—which bills itself as the official newspaper of the American College of Surgeons—gives me some potential insight into his thought process and creative mind.

The editorial from Dr. Greenfield, who at the time was the incoming president of the American College of Surgeons, is required reading. Using the title “Gut Feelings,” Dr.Greenfield touted this evidence: that women exposed to unprotected sex are less likely to be depressed because of the antidepressant effects of semen.

He closes with this, “So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.” Yes, you cannot make this stuff up. But let me finish with my fun before I address this subject with some semblance of seriousness.

After reading his editorial, it became apparent to me that Dr. Greenfield had derived his seminal idea for his filter from his complex understanding of, you guessed it, semen. A stretch? You be the judge.

Semen originates in the groin; DVTs are known to originate in the pelvic veins almost as frequently as they do in the distal legs. When either of those substances hits its target, a cataclysmic event occurs.

OK, OK, that pretty much is where the similarities end. But remember, if this guy actually believes that semen can cure depression, I don’t think it’s particularly far-fetched to assume that in studying the passage of ejaculate, he may have spent some time examining the various forms of contraception.

Then, distracted, his mind wandered to blood clots. What if there was a device that could capture clots like those aimed at preventing STDs and unwanted pregnancies? Once again proving that curiosity is the mother of all invention.

In all seriousness (and, yes, it definitely is time for some seriousness), what in the world was this guy thinking? And how about the people who let him publish this tripe? (Turns out, Dr. Greenfield was also editor-in-chief of Surgery News. There’s one mystery solved.)

I guess my take-home point is simply this: Here’s just one more reason to be glad I am a hospitalist. I don’t want to imply that ours is a field without bias, and maybe the gender pay differential is proof of that. But could you imagine our professional society ever considering for half a second allowing such an article to be published?

Generally speaking, the task of balancing a professional career with a family falls harder on women, who now make up more than half of all graduating doctors. Perhaps more than any other specialty, hospital medicine has worked to meet the needs of doctors who want to balance a career with a family by offering set hours and many opportunities to work part-time. Plus, our ability to take on inpatient responsibilities makes it possible for primary care to be much more family-friendly as well.

Dr. Greenfield’s article, which may have been a seriously tone-deaf attempt at some St. Valentine’s Day humor, was also a shocking reminder that sexism does not go softly into the night. I have no doubt that the balance of Dr. Greenfield’s career is outstanding, and it is unfortunate that this lack of judgment will blemish it. If only the publishers had had some sort of device in place to edit out these unfortunate words—a Dr. Greenfield filter, if you will—then all of this would have been avoided.

But at least the bright side of this editorial lunacy is the reminder that hospital medicine has done a great deal to promote gender equality, at least on the wards if not in the operating rooms. And when an incoming president (now an ex-incoming president, and an ex-editor in chief) of the American College of Surgeons publishes a treatise on the antidepressant effects of sperm, it is clear that the evolution of values within medicine remains more important than ever.

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