Paulo Maiora Canamus!

A Baroque angel I ran across.

Science, Fiction, and the Medical Gulag

John le Carré is one of the best-selling authors in the English language, and also one of the most poignant. Le Carré studied at the Universities of Berne and Oxford, taught at Eton, and then served on Her Majesty's Secret Service, before he went on to become the unofficial novelist laureate of the world of Western espionage, a world in which he only describes shades of grey, and in which the good and the decent often die young.

His 2001 novel, The Constant Gardener begins with the troubled marriage of a British diplomat posted in Africa, progresses to his wife's murder in the African bush; as the plot further unfolds, Le Carré initiates us into an almost Ludlumlesque world of faked clinical trials and of pharmaceutical companies that will stop at nothing, and certainly not dead diplomats, in their quest for lucre. Unlike other novels by Le Carré, such as The Spy Who Came in From the Cold, which is good for unforeseen plot twists right up to the last page, towards its end, The Constant Gardener's plot is close to formulaic. This may not be a artistic flaw, but rather a reason to ponder why Le Carré forces his readers to plod through a good hundred pages devoted primarily to the ends and means of a hypothetical pharmaceutical company.

Le Carré has always had an ear to the ground, and not only described human nature but also addressed the problems of the day in his books. Yet in none of his other books that I have read, does the focus of the book drift from its ostensible agonists to their antagonists to such a degree. In Le Carré's other books, bad things happen, people are cruel, but such is life. The explanation for this departure from precedent is, I believe, revealed at the end of the book, when he writes:

"In these dog days when lawyers rule the universe, I have to persist with these disclaimers, which happen to be perfectly true. With one exception, nobody in this story, and no outfit or corporation, thank God, is based on a real person or real outfit in the real world...so with luck, I shall not be spending the rest of my life in the law courts or worse, though nowadays you can never be sure. But I can tell you this. As my journey through the pharmaceutical jungle progressed, I came to realize that, by comparison with reality, my story was as tame as a holiday postcard."

The Science is Getting to be Rather Diluted

One of Ronald Reagan's more amusing stories about life in the old Soviet Union concerned an oblast (district) in which the party official responsible for milk production sent out a telegram to the 49 Kolkhozes (collective farms) ordering them to increase milk output by 10%. A week later, 49 telegrams came back reporting that milk production at all 49 Kolkhozes had indeed increased by 10%. Consequently, out went the next telegram; a week later 31 had been able to raise their milk production by another 10%. A week and another telegram later, 17 had upped their milk production by a cumulative 30%. The next week, 5 Kolkhozes reported that they had been able to increase their milk output by yet another 10%, but when yet another telegram demanding yet another 10% increase went out, only one Kolkhoz replied, plaintively: "Don't you think our milk is getting to be rather diluted?"

Since 2001, scandal after scandal has broken, which serve to confirm the validity of Le Carré's cri de coeur against the pharmaceutical industry. Among them are:

• reports that children died when Pfizer tested a new antibiotic against meningitis in Nigeria without obtaining the informed consent of the patients or the approval of the ethics board at the hospital at which the tests were conducted. A letter from an ethics board that appears to approve these tests is somewhat dubious; according to a doctor at the hospital, at the time the letter was written, the hospital in question allegedly didn't even have an ethics board.
  

• Nor is this all. Because the drug used as a comparison to Pfizer's new drug is generally given as an IV, but this was not feasible under the conditions of the clinical trials, the comparison drug was given at a dose "much smaller than originally planned," to minimize the pain suffered by the patients during the injections. Of course if the dose of the comparison drug was inadequate, which Pfizer denies, then its investigative drug stood to appear to be so much better than the benchmark to which it was compared. Whatever the facts may be, the manufacturer of the comparison drug maintains that "A high dose is essential." Not that some didn't allegedly voice their concerns at the time of the trials. According to the British Medical Journal, "The suit notes that Dr Juan Walterspeil, an specialist in infectious diseases who was assigned to the test, repeatedly warned Pfizer that it was violating international laws, federal regulations, and medical ethics. Dr Walterspeil was subsequently fired.

• the Vioxx debacle, where Merck was forced to withdraw a drug after it was found to be four times likelier to induce a heart attack than a comparison drug. The most chilling aspect of the scandal is that Merck appears to have known of this problem, to have fought efforts to get to the bottom of the problem tooth and nail, and even to have designed clinical trials so as to minimize and misrepresent the number of heart attacks that Vioxx was going to cause.

• the Texas Medication Algorithm Project scandal. Though is not yet been tried, there's a whistle-blower lawsuit in which the Attorney General of Texas alleges that:

  "Johnson and Johnson overstated Risperdal's effectiveness in treating patients with schizophrenia and downplayed the drug's side effects. The suit states that the company also manipulated data collected during development of TMAP, so that Risperdal would appear to be more effective and safer than it actually was. mental health and Medicaid programs were said to have paid "dollars per pill" for Risperdal when it could have paid "pennies per pill" for generic first-generation antipsychotics that were equally effective."

• What happened specifically? A recent large scale comparison of newer medications, which can cost $5 or more per dose, with older medications, that generally cost less than a quarter found, according to the Washington Post (New Antipsychotic Drugs Criticized, Federal Study Finds No Benefit Over Older, Cheaper Drug, September 20, 2005 page A1):
  

"Expensive new antipsychotic drugs that are among the most widely prescribed pills in medicine are no more effective and no safer than an older, cheaper drug that has been largely discontinued, according to the most comprehensive comparative study ever conducted." In fact, in terms of side-effects, the serious side-effects associated with the older drugs were "less troubling than potentially fatal metabolic problems" associated with some of the newer drugs."

• Evidence and common sense suggest that the manufacturers of the newish drugs would have had some idea that these sorts of results might be reported. This could explain why when they funded trials to determine which drugs worked best, their new drugs were not directly compared to the then prevalent treatments; instead the scientists reportedly compared a regimen of the older drugs to a regimen of the new drugs and group education, consumer to consumer discussion groups, individual patient education from the physician, referrals to therapy groups and more. Even at the time, there were rumors that science was not the only consideration in these studies. I cannot predict the verdict, but, in my opinion, it stinks to high heaven.

• the credible, in my opinion convincing, allegations that America's bumper crop of autistic children has been caused by the vaccines that parents have been expected to pay for and let doctors inject into their children.
  

When you have 4 such scandals break, and the allegations involve forged documents, the firing of a doctor who wanted to play by the rules, the rigging of clinical trials, and more, you have a serious problem. And when such scandals surface with a worrying frequency, it stands to reason that they are but the tip of the iceberg; a truer number might be 40, or 400, or more. We can only guess at which of our own health care decisions are made on the basis of "highly diluted" data.

The Road to Serfdom

If you take the time to think about all this, the surprising thing is not that these scandals have occurred; what would be truly surprising is if they didn't occur. What you have here, is that many of the weaknesses of our capitalist system overlap, with catastrophic results.

1) For starters you have pharmaceutical companies, whose primary legal responsibility is to maximize profits, and who make significant financial contributions into the political process, obviously to politicians agreeable to their interests. To suggest that big pharma gets nothing in return for its donations is to imply that its executives are utter morons.

2) Pharmaceutical companies also plow a lot of money into advertising, which may account for why large parts of the media are generally reticent about running articles that are scathingly critical of the products for which, and companies to which, they sell advertising space.

3) Another huge problem is serfdom in academia. In the United States, the Thirteenth Amendment to the United States Constitution bans outright slavery. Unfortunately, it has nothing to say about people who have spent the best years of their life working to obtain an MD or PhD, and believe that if they wish to reap the returns of those years spent studying, they had better be a team player. At least one scientist indisposed to be a "team player" seems to find life easer outside of the United States.


If you at this point still have any illusions about just how deeply deficient medicine in America is, allow me to recommend that you read "On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health," by Jerome Kassirer, MD, a former editor-in-chief of the New England Journal of Medicine. Kassirer tells of his having received a "no strings attached" contract to give talks to his fellow physicians. But when he disdained to don rose-colored glasses, and definitely didn't go out of his way to contort his talks to the benefit of his sponsor's products, he found that his contract was not renewed. More pliant doctors were retained. This, he writes, is the rule, not the exception. Kassirer cuts through the euphemisms to describe how and why medicine in his experience, has become a parody of what it ought be, something more suited to the recesses of Franz Kafka's fertile imagination. As Kassirer summarizes his experiences: "Some physicians become known as whores."

4) What further complicates the situation is the complexity of the science involved. The average lay person has next to no chance of figuring out what is true and what is scientific fiction. And so the best he or she can do is to hope that whatever their doctors decide is wise, and hope, and maybe pray, for the best.

In other words, politicians, torn between easy contributions and complicated science, often fail their constituents. The media, which has to choose between easy advertising revenue and painstaking investigative reporting, does its duty to its stockholders. Physicians and scientists, torn between their conscience and the demands of the job, make their compromises. With the deck stacked so badly, the average lay person has little, if any chance, of getting to the bottom of anything.

Once upon a time, I couldn't fathom how disasters such as Chairman Mao's Cultural Revolution, the Ukrainian Famine of 1932-1933, or the Holocaust could happen. Today the answer seems all too clear to me: spineless (and worse) politicians, a supine (if not craven) press, and professionals and officials keen to be team players are all it really takes to make a huge mess of things. I am convinced that in a hundred or so years, people looking back on the 1990s and today will remark that some of what happened in our day, such as advances in semi-conductors, the internet, genetic research, and more were really impressive. But when it comes to today's medicine, I am convinced that they will only laugh.

When I was a little younger, and a little more foolish, I occasionally felt a little smug when I saw pictures of life in Cuba, where the vast majority of the cars on the road date back to the 1950s, to the time before the embargo of Fidel Castro's Cuba. Little did I know that some of the medical treatments that I, and millions of others, had received, or would receive, were based on technologies that dated back to the 1950s, and even the 1850s, and that scientists who had tried to update our understanding of these treatments had seen their efforts be discredited by research that stinks to high heaven, and, in one memorable case, was even threatened with deportation if he didn't abandon his academic pursuits. I would much rather have to drive a car that dates back to the 1950s than have to see a doctor who, without realizing it, is still caught in the 1950s in some of his opinions. The sad fact is that the joke is on all of us.

Why I am Cautiously Hopeful

The good news is the bad news: if things don't get better, they are going to get a lot worse. Like being pregnant, for a country, being corrupt is a binary option: no country can be "just a little corrupt." Either it has sensible laws and meaningful institutions to stamp out corruption and enforce its laws, or it doesn't. If the latter is true, it is only a matter of time until corruption metastasizes throughout the entire body politic. Look no further than Robert Mugabe's Zimbabwe, once a prosperous exporter of agricultural commodities. Now that a clique of barbarians has seized power, the country has reached the point where it can no longer feed its people. It is the very starkness of the possible alternatives facing us that makes me optimistic.

Encouragingly there already are signs that these much needed reforms are beginning. Whistle-blowers have found the support they need to go public; the TMAP scandal was uncovered by one of them. The litigation over thimerosal has begun. And there are some excellent blogs that provide the critical coverage that the lame-stream media so badly lacks. Among the best of them are the Alliance for Human Research Protection, and Scientific Misconduct by a scientist who put science first. I highly recommend them.

Ten years ago, to publicly talk about such widespread problems in medicine was often to court concerns about your good judgment. Today, to post about the these widespread problems, and link to evidence for your conclusions, is not necessarily terribly common, but within the mainstream. I am convinced that in ten years' time, to not believe that medicine, as we knew it in 2007, was a complete mess, will have become a way of raising worries about your good judgment. We shall see.

Links:
The Alliance for Human Research Protection blog.
The Scientific Misconduct Blog

Books:
John Le Carré: The Constant Gardener
Jerome Kassirer, MD: On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

The Movie:
The Constant Gardener with Ralph Fiennes and Rachel Weisz (Widescreen Edition)

On Coping with One's Limitations

John Milton was once generally deemed the greatest poet to have ever written in the English language; indeed to some he still is. Milton needs little introduction, other than to mention that he was a supporter of and propagandist for Oliver Cromwell, that he was an exception linguist, reading English, Hebrew, Syriac, Greek, Latin, Italian, French, and Spanish, that he became a strong advocate of divorce after his marriage collapsed, and that he went blind.

Here is his poem "On His Blindness," which I hope may offer some solace to anyone laboring to cope with the limitations that fate has imposed:

On His Blindness

When I consider how my light is spent,
E're half my days, in this dark world and wide,
And that one Talent which is death to hide,
Lodg'd with me useless, though my Soul more bent
To serve therewith my Maker, and present
My true account, least he returning chide,
Doth God exact day-labour, light deny'd,
I fondly ask; But patience to prevent
That murmur, soon replies, God doth not need
Either man's work or his own gifts, who best
Bear his milde yoak, they serve him best, his State
Is Kingly. Thousands at his bidding speed
And post o're Land and Ocean without rest:
They also serve who only stand and waite.

Reflections on the Tragic Life of Dr. Mohammed Mossadeq

Not long ago, while the drums of war with Iran were beaten more loudly than they are today, I took the time to read Musaddiq and the Struggle For Power in Iran by Homa Katouzian, a fellow at Saint Anthony College, Oxford. This is a book that requires thoughtful reading to really be enjoyed. At heart, it is an elegy for the Iran that could have, and ought have, been a normal country. If you choose to read it, you'll have to bear with Katouzian when he occasionally delves into the intricacies of Iranian politics, and when his diction is, as it can be, not that of a native English-speaker.

Mohammed Mossadeq was born in 1882, as the son of an official in the Iranian Finance Ministry, and a princess of the Qajar Dynasty, the dynasty that was supplanted by the Pahlavis. He began undergraduate work at the Sci-Po in Paris, studied in Lausanne, and then became the first Iranian to obtain a Doctorate in Jurisprudence, which he did at the University of Neuchâtel. His dissertation was on comparisons of Iranian (read Islamic) and Western European law. He considered obtaining Swiss citizenship, and finding work as an attorney in Switzerland, but eventually his family and country drew him back to Iran.

Upon returning to Iran, Mossadeq, whose family had substantial land-holdings, was soon drawn into politics and elected to the Iranian parliament, and was pretty soon made the governor of far away Azerbaijan Province after he tried to change some practices that he felt were corrupt. To abbreviate the years of political turmoil that followed in Iran:

• Iran had granted the an oil company partly owned by the British government a sixty year concession to extract oil at a time when nobody in the Iranian government understood what petroleum really was, a deal reminiscent of the Dutch buying Manhattan from unwitting Indians for 60 guilders. The more the Iranians understood how disadvantageous the terms of the concession were, the more they pined to renegotiate its terms.

• The Shah of Iran understood that the British were not going to voluntarily relinquish or renegotiate the concession, under which the British government incidentally earned greater tax revenues from the extraction and sale of Iranian oil than the government of Iran. He could not expect much support from the superpowers of his day; the French had undertaken not to meddle in British colonies, as the British had to not meddle in French colonies, the United States was strongly isolationist, and the Soviet Union suffered under a regime of psychopaths. This pretty much only left Nazi Germany as a potential ally, which, after the Diktat of Versailles, hardly felt that it owed the French or British anything, and thus the ouvertures began. As Katouzian writes, Tehran's Central Railway Station was decked out in swastikas, and the Shah even renamed his country, which had been known as Persia for a good two thousand years, "Iran," in order to imply that Iranians were kindred "Aryans."
  

• (In the Middle Eastern political tradition your enemy’s enemy is your friend. When the Reagan administration secretly sold direly needed weapons to Khomeini‘s Iran, none of its political opponents suggested that Reagan was enthralled by Khomeini's dress codes. Similarly, anyone who knows what most Iranians look like would deem the notion that the Shah had fallen for the notion that blue-eyed blonds constitute a "master race" completely absurd. Iran is and has for millennia been a multi-racial and multi-religious society. The Book of Esther in the Bible relates one such story.)

• When the Second World War broke out, the Shah understood all too well that the more the Germans took his British and Russians rivals down a few notches, the better his position stood to become. The British weren't pleased by this epiphany, and forcibly removed the Shah from his own country into exile in a remote part of South Africa. As a replacement, they installed his 21 year old son fresh from a Swiss boarding school n the Peacock Throne. Russian and British armies occupied Iran for the duration of the war. Churchill's laconic justification for this invasion without any legal justification in international law was inter arma silent leges, that is when weapons speak, the laws remain silent.

• At the end of the Second World War, Britain was badly strapped for cash, so badly that food was rationed for several years after the war ended. British politicians were hardly keen on slaying a goose that, for them, was laying golden eggs, regardless of the justice of the Iranians' demand that the oil concessions be renegotiated.

Something had to give; the Iranian parliament elected Mossadeq, who was intent on turning Iran into a modern democracy and ridding itself of its dependency on foreigners, to be Iran's Prime Minister. Katouzian writes that Mossadeq's reputation for unblemished personal integrity accounted for his election as did, I suspect, his Western education, his love for his country, and reputation as a devout Muslim. In 1951 Mossadeq unilaterally nationalized Iran's petroleum assets, which is when things, as they say, "became interesting." The British organized a boycott of the Iranian oil that Iran had "stolen" from the British by all the major oil companies, which began to badly hurt Iran's finances; Mossadeq in turn expelled the British embassy lest its diplomats organize a coup. The most he would offer the British was to have a neutral tribunal at the Hague determine what compensation was due the Anglo-Iranian Oil Company (AIOC), now known to us as BP.

Mossadeq remained adamant that Iran would only control its destiny once it completely controlled its oil. Some went so far as to suggest - wrongly, I believe - that Mossadeq had concluded that for him, no deal was better than any deal, because as long as he could rally his country around nationalizing its oil, and avenging slights at the hands of foreign powers both real and imagined, his popularity was guaranteed, something that stood to change if and when his government had to make hard decisions further down the road.

The Truman administration sympathized with Mossadeq's position, and felt that Britain's unwillingness to renegotiate the concession wasn't helpful as the Cold War began to heat up. Although Katouzian doesn't mention this, many in the Truman administration's State Department were generally not unsympathetic to the New Deal, and quite happy to see a huge British conglomerate be taken down a notch or two, but came to believe that Mossadeq didn't really understand the ramifications of his demands; that he was pursuing pie in the sky.

In those days, there was a curious debate in the Majlis, as Iran's parliament is known. The British may be ruthless, unpleasant, and exploitative, some members of the Majlis argued, while the Americans distinguished themselves by their basic decency and their intent to help all sides reach a fair deal. Nevertheless, they continued, the Americans were so naïv, even clueless to the point of incompetence, about the Middle East, that they argued it would be in Iran's best interests to continue to deal with the capable if predatory British rather than the kindly but naïv Americans.

The impasse, and Mossadeq's intransigence, came to an end under the Eisenhower administration, when Mossadeq was ejected from power in a coup approved by the Dulles brothers, former Wall Street attorneys who left their offices of Secretary of State and Director of the CIA with a history of deeming third world politicians at odds with their former corporate clients to be part of a "global Communist conspiracy," even if the evidence was scant or non-existent, and of then having the government of the United States rid them of such troublesome politicians. Jacobo Arbenz is another who suffered a similar fate.

The coup restored the reluctant Shah to his throne; Mossadeq first spent some years in solitary confinement, and then even more years under house arrest. Nor were these the only tragedies he endured; a child of his developed severe life-long psychiatric problems, which Mossadeq described as "the cruelest fate that can befall a parent." American oil companies got part of what had previously been an exclusively British pie; the hapless AIOC was left with less than the Iranians had at one point offered it. But the real losers were the Iranians; instead of living in a fledgling democracy that aspired to imitate the West, without forsaking its traditions, they found themselves living in an increasingly corrupt regime maintained in power by the Western democracies, with a secret police schooled in the fine art of torture by Israeli advisors.

Katouzian writes, but doesn't consider the ramifications of the fact, that the American government was so disgusted by what it had wrought that within a few years it sought to overthrow the Shah, only to have the British betray the plot to the Shah. This is inconsistent with the notion that it was "all about oil," just as Eisenhower's giving the French, British and Israelis an ultimatum to end their invasion of Suez or face his awesome wrath belies the notion that he was indiscriminately opposed to third world leaders redressing grievances with their former colonial masters.

I somewhat disagree with Katouzian is in my judgement of the Mossadeq. Katouzian concludes that Mossadeq had his flaws and imperfections, but that things could have worked out if only outside powers had not intervened. He correctly writes that Mossadeq could be quite rigid, even intransigent, in this thinking, perhaps a bit of a puritan. This is where I think he underestimates the mistakes that Mossadeq made: politics, after all, is the art of the possible; when Mossadeq made high, perhaps almost unattainable, demands of the British and American negotiators but neglected to thoroughly ensure that he was coup-proof, he did his fellow Iranians no service.

I also think that Katouzian doesn't quite do the consequences that Mossadeq's politics stood to have on Iran's neighbors justice; just south of Iran there were a number of sheikdoms that sat on huge oil deposits, and at the time had largely nomadic populations. By framing the debate over the extraction of the region's oil in highly emotional "us versus them" proposition, he risked inflaming the passions in these countries, and pushing them into the Soviet camp. Half of Yemen eventually went Communist, and Oman would have as well, had it not been for the Shah's and Queen's men. The specter of the neighborhood going to hell at least partly explains, I think, why Iran's elite acquiesced to Mossadeq's overthrow.

I think a leader who would have been willing to make unpleasant, and perhaps even humiliating compromises, dictated by the political realities of the day, in order to negotiate a better deal on a better day, would have left Iran in a much better position that a leader who demanded everything, and got nothing. Iran suffered the tragedies of first having a leader who cared too much about justice, and then a leader who cared too little about justice. Fiat justitia et pereat mundus (may justice prevail and must the world perish) is a neither a dictum of Shari'a law nor the Code Napoléon, but rather a sarcastic gibe by a medieval king.

Like every other country, Iran is not perfect; this book describes how it went from being a normal country in its day to a (reluctant) dictatorship, and then convulsed into the Islamic Republic of Iran. There is a parallel for this in English history; without Charles I, who asserted his divine rights as a king, and buttressed his claims in his infamous Star Chamber, Oliver Cromwell would never have come to be the Lord Protector of England, Commander of the New Model Army, praised by John Milton, and, to this day, an epithet among the Irish. Were it not for the Shah and his fearsome secret police, the Ayatollah Khomeini and the Iranian Revolutionary Guards would never have attained the prominence they did. Regimes that truck heavily in religious zealotry are neither new nor exclusive to the Middle East, and not infrequently result as a reaction to iniquitous governments. Generally if left to their own devices, such regimes, like teenagers caught in the tempests of puberty, become less strident with time. Under Oliver Cromwell, all theaters were closed as immoral and decadent; yet England and English literature recovered.

If you’re interested by the history of modern Iran, and are skeptical of the Manichean understanding of Iran (ironic isn't it that Manichaeism is a philosophy of Iranian origin?) which some right-wing nuts are promoting, or have lingering doubts whether a book that raves about reading a book describing the doings of a sexual predator (Reading Lolita in Tehran) is the most informative and unbiased introduction to contemporary Iran, you'll enjoy Katouzian's biography. I suspect it was written for Iranians and academics; as such, it's a good introduction to the history of Iran by an Iranian historian. Another advantage of the book is that rather than being focused on a single episode or a single aspect of Iran's history in the 20^th century, it is a sort of Bildungsroman of a man and country with, alas, a tragic ending.

Links: Some Iranian exiles run a website dedicated to memory of Mossadeq.

And Katouzian's book.

The Lion in Winter

Blogger would not oblige my repeated efforts to upload a second image into my previous post on the Lion Monument of Lucerne, so here it is. Note that the picture was taken in winter, when tourists from all four corners of the earth are conspicuous by their absence.

Links: For the ne plus ultra of pictures of the Lion Monument, this page is the place to go.

The Lion Monument of Lucerne

My favorite place on this planet is probably the Lion Monument in Lucerne, and I am not the only person to be greatly moved by that tragic monument. Mark Twain visited it on his second trip through Europe, and a German professor of philology by the name of Nietzsche chose the monument as the site to propose to his Beloved. (She demurred; he died a syphilitic.) Nothing of any import has changed since Twain wrote in A Tramp Abroad:

"The commerce of Lucerne consists mainly in gimcrackery of the souvenir sort; the shops are packed with Alpine crystals, photographs of scenery, and wooden and ivory carvings. I will not conceal the fact that miniature figures of the Lion of Lucerne are to be had in them. Millions of them. But they are libels upon him, every one of them. There is a subtle something about the majestic pathos of the original which the copyist cannot get. Even the sun fails to get it; both the photographer and the carver give you a dying lion, and that is all. The shape is right, the attitude is right, the proportions are right, but that indescribable something which makes the Lion of Lucerne the most mournful and moving piece of stone in the world, is wanting.

The Lion lies in his lair in the perpendicular face of a low cliff--for he is carved from the living rock of the cliff. His size is colossal, his attitude is noble. How head is bowed, the broken spear is sticking in his shoulder, his protecting paw rests upon the lilies of France. Vines hang down the cliff and wave in the wind, and a clear stream trickles from above and empties into a pond at the base, and in the smooth surface of the pond the lion is mirrored, among the water-lilies.

Around about are green trees and grass. The place is a sheltered, reposeful woodland nook, remote from noise and stir and confusion--and all this is fitting, for lions do die in such places, and not on granite pedestals in public squares fenced with fancy iron railings. The Lion of Lucerne would be impressive anywhere, but nowhere so impressive as where he is.

Martyrdom is the luckiest fate that can befall some people. Louis XVI did not die in his bed, consequently history is very gentle with him; she is charitable toward his failings, and she finds in him high virtues which are not usually considered to be virtues when they are lodged in kings. She makes him out to be a person with a meek and modest spirit, the heart of a female saint, and a wrong head. None of these qualities are kingly but the last. Taken together they make a character which would have fared harshly at the hands of history if its owner had had the ill luck to miss martyrdom. With the best intentions to do the right thing, he always managed to do the wrong one. Moreover, nothing could get the female saint out of him. He knew, well enough, that in national emergencies he must not consider how he ought to act, as a man, but how he ought to act as a king; so he honestly tried to sink the man and be the king--but it was a failure, he only succeeded in being the female saint. He was not instant in season, but out of season. He could not be persuaded to do a thing while it could do any good--he was iron, he was adamant in his stubbornness then--but as soon as the thing had reached a point where it would be positively harmful to do it, do it he would, and nothing could stop him. He did not do it because it would be harmful, but because he hoped it was not yet too late to achieve by it the good which it would have done if applied earlier. His comprehension was always a train or two behindhand. If a national toe required amputating, he could not see that it needed anything more than poulticing; when others saw that the mortification had reached the knee, he first perceived that the toe needed cutting off--so he cut it off; and he severed the leg at the knee when others saw that the disease had reached the thigh. He was good, and honest, and well meaning, in the matter of chasing national diseases, but he never could overtake one. As a private man, he would have been lovable; but viewed as a king, he was strictly contemptible.

His was a most unroyal career, but the most pitiable spectacle in it was his sentimental treachery to his Swiss guard on that memorable 10th of August, when he allowed those heroes to be massacred in his cause, and forbade them to shed the "sacred French blood" purporting to be flowing in the veins of the red-capped mob of miscreants that was raging around the palace. He meant to be kingly, but he was only the female saint once more. Some of his biographers think that upon this occasion the spirit of Saint Louis had descended upon him. It must have found pretty cramped quarters. If Napoleon the First had stood in the shoes of Louis XVI that day, instead of being merely a casual and unknown looker-on, there would be no Lion of Lucerne, now, but there would be a well-stocked Communist graveyard in Paris which would answer just as well to remember the 10th of August by."

Little needs to be added to Twain's synopsis of the Lion Monument other than its history. When the survivors of the massacres returned to Switzerland, the eve of the French revolution was nigh; it was not until after the madness and bloodshed of the French Revolution and Napoleon ended at Waterloo that erecting a monument to their fallen comrades in arms became feasible. Led by Karl Pfyffer von Altishofen, (1771-1840), one of their lieutenants, they began collecting money for the monument in 1818; the monument, whose construction was supported by, among others, the Czar of Russia, and the Kings of Prussia and France, was unveiled on August 10, 1821, the 29^th anniversary of the massacre.

A small hint for thoughtful visitors to the monument: Don't forget to also get a look at the memorial chapel that is also part of the Lion Monument, and which is not shown to the flocks of tourists, with its inscriptions of "Invictis Pax," that is "Peace to the Undefeated" and "Per vitam fortes, sub iniqua morte fideles," "In life brave, faithful in an unjust death." If you can muster expected in a church, it is worth seeing.

Links: The Homepage of the Lion Monument and nearby museums.
Mark Twain's A Tramp Abroad as a free download.
Penguin Classic's 448 page rendition of A Tramp Abroad
Oxford University Press's 720 page rendition of A Tramp Abroad.