NEJM Interview: Justin Barr on physician leadership in American society and politics over the past 250 years.

The signing of the Declaration of Independence represented a high watermark in the history of medical representation in American political leadership. Despite the proliferation of nationally important issues on which policy decisions could benefit from medical expertise today, physicians have largely stepped back from the prominent roles they played during the American Revolution. I'm Stephen Morrissey, Managing Editor of The New England Journal of Medicine, and I'm talking with Justin Barr, a transplant surgeon at the Ochsner Clinic and a historian. Dr. Barr has co-authored a perspective article about the history of physician engagement in US politics as part of a series of articles exploring the roles of physicians, medicine, and disease in the American Revolution at its 250th anniversary. Dr. Barr, as you write in your perspective article, five of the 56 signatories of the Declaration of Independence were doctors, including Benjamin Rush, the only one with a formal medical degree. So what influence did Rush have on the independence movement and on medical culture?

It's difficult to overstate the impact that Rush had on the early independence movement. He was a renowned genius with almost total recall, graduated from Princeton at the age of 14 before apprenticing to John Redman, arguably the most famous American physician in Philadelphia, and getting his medical degree at Edinburgh, and then walking the wards with the likes of William Hunter in London and John Pringle, the founder of military medicine, and then came back to be professor at what is now Penn Medical School, the only medical school at the time in the colonies. And he rose in both medical and political circles in colonial Philadelphia. In the early 1770s, he was actually quite young and junior compared to men like Thomas Jefferson and John Adams, who were about a decade older than Rush. But Rush had this keen sense of personality and was able really to see into the individuals, into their lives, into their motivations and perspectives, and helped guide particularly the Boston delegation, who was very much in favor of independence at a time when the rest of the country had not yet come around to that idea, into how to negotiate the delicate political maneuvers to slowly move this country towards independence. He later encouraged, in 1775, Thomas Paine to write Common Sense, actually suggesting the title, which was arguably the most influential tract that swayed many colonists to support independence. He served in the military during the American Revolutionary War. In 1777, William Shippen, another professor at what was Penn Medical School, became surgeon general and instituted a reform bill that established these geographic commands of sub-surgeon generals, and Benjamin Rush was appointed to be the surgeon general of the middle department. He actually served in combat at the Battle of Trenton, the Battle of Princeton, was captured briefly by the British at the Battle of Brandywine, although ultimately resigned his commission after criticizing George Washington. And of course, in 1776, as a member of the Continental Congress, he was one of the 56 signatories to the Declaration of