As political campaigns have increasingly targeted medical practice issues, there has been a spate of articles and op-eds about the apparent corruption of medicine by politics. The American Medical Association believes it is a significant problem, because it has proposed a solution to keep politics out of medicine.
Nevertheless, it seems as though doctors and other healthcare workers have been steamrolled by the political system into surrendering their autonomy and medical decision-making, writes Dr Arthur Lazarus in MedPage Today, and that scientific results cannot be understood through a framework of rigid political doctrine.
He writes:
I was reminded of this grim reality when Dr Mehmet Oz said that a woman’s right to an abortion was between herself, her doctor, and her local politicians. It’s bad enough that physicians’ political views and party affiliations affect their treatment decisions, but do we really need politicians meddling in the doctor-patient relationship?
It’s no surprise that medical professionals have been guided by their own political ideology to either combat elected officials or join them – depending on the issue. And therein lies the real problem. We have abandoned science and scientific reasoning to further our personal agendas on “the issues”, leading the medical profession into an internecine war and causing further divisiveness among physicians and the practice guidelines and standards promulgated by them.
For example, Florida has effectively banned physicians from aiding in the “transition” of transgender youth in Florida, creating considerable animus and essentially taking the matter out of the hands of practising physicians. The Florida Board of Medicine plans to codify into law its own uniquely derived standards for the treatment of gender dysphoria.
It doesn’t matter that Florida’s standards deviate widely from those of a half-dozen medical societies and organisations. The point is, other than providing comments to the Florida Board of Medicine, practising physicians will have no real input into the final version of the treatment standards. Instead, those who serve on the Florida Board of Medicine will call the shots – and we can’t ignore the fact that all physicians who are board members are appointed by the governor.
Make no mistake, it is not uncommon to become ideologically blind to science when working for powerful people and even weaker sources of influence. Physicians believed pharmaceutical salespeople did not affect their choice of therapy, but studies proved them wrong.
Do No Harm, a non-profit organisation, is a key proponent of Florida’s ban on gender-assisted therapy. In a letter to the Florida Board of Medicine, Dr Stanley Goldfarb, founder and chairman of Do No Harm, accuses the medical establishment of refusing “to side with science”. But whose version of science are we talking about: those in the medical profession who cite favourable outcomes after gender transition therapy, or those who point to its possible harmful and irreversible effects?
The debate reminds me of how two (or more) scientific societies can review the extant medical literature and relevant scientific studies, yet propose vastly different practice guidelines, as was the case with Lyme Disease a decade ago. The Attorney-General of Connecticut had to intervene to help align the discordant guidelines so that patients could be properly treated.
Once again, because of our internal struggles to understand science, its limitations, and applications to medical practice, autonomy and self-determination were stripped from us.
The founder of Do No Harm was troubled by the impact of racial reckoning on medical practice: specifically, he was concerned about claims that systemic racism is responsible for disparities in health outcomes. The issues identified by Do No Harm on their website and in the news are perhaps the most vexing in medical education and practice today: affirmative action admission policies; mandatory anti-racism training; and divisive and possibly race-based discriminatory practices at universities and medical schools that violate academic freedom.
My hope is that we can discuss these (and other) topics without politicians in the exam room. I want to engage in passionate (not over-heated) discussions about social determinants of health, the injection of identity politics into medical research and education, and the validity of implicit bias and whether it contributes to micro-aggressions.
I want to hear more from workers on both sides of the aisle who voiced reasoned opposition to what they perceived as contradictory and unjust COVID-19 policies and later faced recrimination.
I strive to be tolerant of individuals who hold opposing views rather than participate in walk-outs, threaten violence, or snub colleagues by calling them “woke” and other derogatory terms.
“It just tells us how terrible our culture is becoming, that we can’t have an honest scientific debate about the things on which we disagree,” remarked Dr Georges Benjamin, executive director of the American Public Health Association (APHA).
Benjamin recently made that statement after public health expert Dr Leana Wen was forced to cancel her panel discussion at the APHA annual meeting due to credible threats against her life – and she's not alone.
Doctors, not politicians, need to pave the way for crucial civil discourse and the resolution of controversial issues that impact healthcare and our patients’ ability to receive it – issues ranging from reproductive health to mental health to environmental health.
We should reject predetermined political frameworks for interpreting evidence to explain differences in outcomes. It’s time we learned to differentiate politics from science and quash political initiatives attempting to pass as evidenced-based medical principles.
Dr Arthur Lazarus is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, US.
MedPage Today article – Stop Passing Off Politics as Evidenced-Based Medicine (Open access)
See more from MedicalBrief archives:
Ban on affirmative action had ‘devastating impact’ on diversity at US med schools
Political, not legal, threat from US abortion row
Florida bans youth gender-affirming meds and surgery
US paediatricians’ association to bin outdated race-based guidelines
US moves to limit transgender treatments for young Americans