Science, Medicine and Syrian Apple® pickers: How Mr. Trump’s immigration ignorance will hurt America

| 2 February 2017

Decorative Image

http://www.cbc.ca/news/technology/trump-travel-ban-technology-sector-reacts-1.3958864 Mr. Trump, can I offer you some friendly advice, as a former US resident alien and taxpayer. I suggest you consider three unintended consequences that will almost certainly result from your ban on immigration. I could also offer you advice on health care policy, civil discourse and the traditional role of US presidents in appealing to the peoples’ better angels. However, that would not fit in a Science and Innovation blog. I know you have professed admiration for President Lincoln and so I encourage you to read the entire blog, which ends with a quote from him. I am hoping that by focusing on your self-interest my message will be received. What is my message? America cannot be great in Science, Medicine or Innovation, without immigrants. Let me break it down:

Immigrants are overwhelmingly beneficial for the host country.
Most immigrants do not displace citizens in the workplace, they fill vacuums and/or create new markets.
Blanket prohibition of immigration encourages hate and discrimination creating social instability. Such bans alienate your friends and achieve much less than a legitimate, coherent immigration policy.

In addition to my opinions, this blog offers some facts and figures, to counteract the fake news tsunami that those around you use to demonize immigrants. My apologies, this all sounds so serious! Let me lighten the mood and begin with a song! In his 1967 Canadian Railroad Trilogy, Gordon Lightfoot, an iconic Canadian songwriter, sang of the virtue of immigrants (click the link and listen).

There was a time in this fair land when the railroad did not run When the wild majestic mountains stood alone against the sun Long before the white man and long before the wheel When the green dark forest was too silent to be real
But time has no beginnings and hist'ry has no bounds As to this verdant country they came from all around They sailed upon her waterways and they walked the forests tall And they built the mines the mills and the factories for the good of us all

Some (including you) might concede that the dirty and dangerous work of building mines, mills and factories (or the Canadian Railroad, for that matter) is a “wise” use of “expendable” immigrants. However, you likely wonder why immigration merits space in a blog dedicated to medical and scientific innovation? You might also wonder about my qualifications to write on this sensitive subject in a country that is not my home. In fact, I have extensive personal experience with immigration as it pertains to Science and Medicine. I have been an immigrant myself (twice in the USA and once in France). I have held Green Cards in the USA on two occasions (both voluntarily turned in when I returned to Canada). I have also hired many immigrants to work as physicians, scientists and administrators in the USA and Canada. Science and Medicine are global pursuits and always have been. The best and brightest have always moved to the places where the “air” is perfumed with the best ideas and where the greatest opportunities are found. Over the ages, the epicenter for biomedical research and medical practice has migrated around the globe, now Athens, then Cairo, Rome, London, Paris, and Berlin. In the latter half of the 20^th century until now, the ideas and opportunities have arguably been “best” in America. The National Institutes of Health (NIH) and America’s outstanding universities have done more to bring talent to America and spawn innovation than all the countries major corporations. Because of this bright intellectual beacon and the related opportunities in Science and Medicine, there has been massive immigration of talent into America. Many of the world’s best minds have passed through the USA. Some only visited the USA, doing a medical residency program or a postdoctoral fellowship, but many stayed permanently and became citizens. These scientists and physicians (and their smart families) contribute intellectually and financially. They constitute a cadre of talented goodwill ambassadors, creating within America a respect for the achievements of “foreigners” and inspiring tolerance and trust. Now this American advantage is put in jeopardy by the ignorance of a few and by a fundamental misunderstanding of the undeniably favorable risk/benefit proposition of immigration managed by a well-run immigration system. As Head of Medicine I am continuously engaged in the search for global talent to staff hospitals and to run my personal research program. Your misguided immigration policy, as repugnant as it is, will likely drive talent to Canada. However, it seems wrong to celebrate a Canadian competitive advantage borne on America’s new mean-spirited zeitgeist. America is suddenly xenophobic. Even the word zeitgeist might prompt concern in some circles (it sounds vaguely revolutionary!). Your German paternal grandparents would have known that zeitgeist is not some anti-establishment call to arms, it simply means spirit of the times. The spirit of the times is reactionary, frightened and isolationist. It is all walls and borders. MIA is the American spirit of exceptionalism and the cocksure, yankeedoodilistic belief that American liberty, democracy and justice create a melting pot that would refine and improve immigrants of all stripes. Mr Trump, you should have little fear of immigrants. In addition to your German Großvater and your Scottish sheanmhair (grandfather and grandmother) you have connubial connections to Czech and Slovenian cultures by marriage(s). Hopefully, familiarity does not breed contempt! I spent 22 years of my career as a clinician-scientist (cardiologist) in the USA. The first time I lived in America (1982-1998) was in Minnesota. My wife Kathie obtained her PhD in epidemiology. I did my residency in internal medicine and fellowship in Cardiology at the University of Minnesota, a world-class university. We both owe America for excellent training. We both gave back. Kathie worked as an epidemiologist in the Minnesota Heart Survey exploring the role of heart surgery in the observed declines in cardiovascular mortality. I spent over a decade as a staff cardiologist providing cardiac care for American veterans at the Minneapolis VA Medical Centre (VAMC). Interestingly my work situation was somewhat analogous to that of economic migrant workers who perform agricultural services (though physically easier and much better paid). Like people who come to America to pick fruit (a job Americans won’t do) I took on a job that American physicians largely did not want (for economic reasons). In those days (the 1980s) cardiologists were making north of $250,000 in Minneapolis. The VA paid $70-95K/year but offered a route into the US immigration system and to a Green card. I took the VA position because of my friend and mentor Dr. E. Kenneth Weir and our friendship and passion for research. Interestingly the other immigrants at the Minneapolis VAMC included Ken (an Oxford educated, world class researcher and clinician from Ireland), Inder Anand (a globally recognized heart failure doctor from India) and Elliott Chesler (a respected South African cardiologist). Half the Cardiology division was of immigrant origin and, by any standard, our little subgroup punched above its weight (while being paid far below market value). So, Mr. Trump, think of this when you ban immigrants. Is America going to pay its citizens $20/hour to pick apples or $400,000/year to care for their veterans? If not, better welcome immigrants. Even forgetting the value proposition, the intellectual capital that Ken, Elliot and Inder brought to the VA and to America was huge. They were the best and brightest from their home countries and arrived fully trained. They gave their all to their new home. Not a bad value proposition.

Decorative Image

My mentor, Dr. E. Kenneth Weir: An Irish gift to American Medicine and Science

Mr. Trump it pains me to tell you that your policies are nasty and xenophobic, and empower the racist actions of society’s dregs. Under your administration, an amazing Iranian scientist or an immigrant Muslim cardiologist is debased and is viewed as a potential threat. A Syrian refugee is almost certainly here to do no good! Ironically, your policy works against the self-interest of Americans. The policy presupposes there are a mass of Americans who are qualified and willing to do science, serve as academic physicians or write computer code for companies like Apple® but who are unemployed because an immigrant took their position. In the neocon narrative, these mythical American subpopulations are victims of immigration; in reality such workers may not exist. When I lived in LaGrange Illinois, while running the Division of Cardiology at the University of Chicago, every lawn was maintained by current or recent immigrants from Mexico and Central America. I saw little evidence of Americans competing in the lawn care business sector. Yes there are unemployed Americans, but few are trained scientists or physicians. Like lawn care, American science could not function without immigrants. In my lab at the University of Chicago my colleagues included a German Muslim cardiologist and PhD scientists from Holland, Ireland, India, China (X4), Hungary and me, the lead investigator (from Canada). In a lab of 8-10 scientists we never had more than 1-2 American citizens. Why was this? Reverse discrimination? No, in fact there are inadequate numbers of American’s going into science. They are hard to find, even at an elite University. Ambitious people from around the globe are filling the void. My fellow immigrants came to Minneapolis and Chicago for the opportunity to do Science and practice Medicine. They stayed and make the country smarter, healthier and wealthier. America is increasingly dependent on foreign-born workers in science and engineering. In an article in the journal Demography, Mariano Sana reported that the ratio of foreign-born to U.S.-born scientists and engineers doubled in little more than a decade (see figure, Mariano Sana, "Immigrants and Natives in U.S. Science and Engineering Occupations, 1994-2006," Demography 47, no. 3 (2010): 801-20). This trend should not be seen as threatening-like the government, immigrants are “here to help”!

Decorative Image

If you don’t believe me, believe when I say immigration is vital to innovation, listen to Tim Cook, the CEO of Apple®. Asked to comment on how your policies might affect the influx of skilled workers, he said, “I share your concerns” about Trump's immigration order. In a memo to employees that was obtained by The Associated Press he wrote. "It is not a policy we support. "We have reached out to the White House to explain the negative effect on our coworkers and our company”. "Apple would not exist without immigration, let alone thrive and innovate the way we do," Of course you know Mr. Trump that Apple’s co-founder Steve Jobs was the son of a Syrian immigrant. Under your policies there would be no Apple!

Decorative Image

Steve Jobs

Steve Jobs father-Syrian refugee and now American citizen, Abdulfatah John Jandali

Mr. Jandali, a Syrian immigrant to the U.S. works as vice president of a casino in Reno, Nevada. At age 80 he was still working flat out…so Syrian immigration… perhaps not such a bad thing? If you’re interest you might want to read an earlier posting on the subject. Google's CEO, Sundar Pichai, also wrote to his employees that “…more than 100 Google employees are affected by the order, and that "it's painful to see the personal cost of this executive order on our colleagues." So Mr. Trump, Immigration is good business. Until recently America has been very generous, welcoming millions of immigrants. According to the Migration Information Source, the U.S. immigrant population in 2014 stood at 42.4 million (13.3% of the total U.S. population). In 1850 this number was 10%, so there has been an increase…but not radical considering the changes in ease of travel in the past 150 years. However, in the 1970s, perhaps the era you recall as the one when America was great, immigration had accounted for only 4.7% of the population. Then and now immigrants come to America to work (see Table). Many immigrants are well educated with 29 % (10.5 million) of the 36.7 million immigrants age 25 and older holding a bachelor's degree or higher (virtually the same as native-born Americans-30%). In FY 2015, America issued 10,891,745 nonimmigrant visas (78 percent were temporary business and tourist visas. Admittedly, there are also 11.4 million unauthorized immigrants in the USA. However, the argument for immigration reform is quite different in tone and effect than a ban on travel that targets specific religions and countries. Banning immigrants based solely on their country of origin and their religion (by implication) creates an environment where hate and violence are encouraged. You will be held responsible for appalling events both inside your walled borders and without (like the recent massacre of Muslims at worship in Quebec). That murderer was a Quebec university student. The Huffington Post notes he was a fan of both you and the far-right National Front candidate Marine Le Pen. That person’s murderous actions are undoubtedly not something you would support; yet your stated values and your harsh anti-immigrant rhetoric, gave support to his views and inspired his radicalization and violence. President Abraham Lincoln, whom you admire, took a much different approach to people he disagreed with, based on his philosophy of tolerance. Perhaps reading this will remind you of what all people, American and foreign, expect of an American president. “We are not enemies, but friends. We must not be enemies. Though passion may have strained, it must not break our bonds of affection. The mystic chords of memory will swell when again touched, as surely they will be, by the better angels of our nature.” Abraham Lincoln So, I would remind you Mr. Trump that immigrants will be needed if you want to grow Science and Medicine (and make it huge). If you want to lead the world in innovation and make America great again immigrants will be needed. Immigrants will come in all sizes, shapes and colors with a diversity of religions and views. Some will integrate easily, others not so easily. Many immigrants (like me) will come and voluntarily leave America, enriched by the time spent. No country that claims to be interested in Science and Innovation can withdraw from the great talent draft that is Immigration.