here is one sure way to undermine the public's confidence in medicine, and
that is to politicize it.
Concern about how medicine is practiced has been growing for a long time, but it exploded during the Covid pandemic, the Covid moral panic, and the Covid vax.
Much of the blame once again goes to the news media, which bungled the scientific stories, cast aspersions on those questioning the provenance of the virus, ridiculed some treatments for political reasons and over-praised others, and bombarded us with morality tales about people who refused the vax and got what they supposedly deserved. The media acted as if only establishment figures like Anthony Fauci had credibility and anyone who disagreed was a conspiracy theorist. Even medical students are starting to notice, with one calling this “eminence-based medicine.”
The reputation of science took a beating as well, but for most people science is something remote and mysterious. People are afraid to ask about science for fear they'll get a pile of equations, acronyms, and jargon in response.
Full disclosure: some of my best friends are doctors. Yet somehow I feel guilty about saying so. It sounds more like a conceit, a kind of whistling in the dark.
I never had the flu in my life, nor did I ever get Covid. I had to take that vaccine to stay employed, and two years later I'm still suffering from it. My sister, not a right-winger for sure, told me she experienced “pain down to her bones.” It's pointless to mention this to a doctor, as the doctor will simply dismiss it as “anxiety.” I have no problem with normal vaccines, but if I had to do it again, I'd take the unemployment.
First, ignore whatever the patient says
The current ideology is that everything that's a real disease can be treated by a drug; if it can't be treated, it's not real; and all medical procedures are beneficial if you're sick and harmless if you're not.
Yet almost every patient has a story of a friend who was harmed or even killed by a medical procedure. They know that cancer treatment often causes hearing loss and leads to new cancers. They also know that anesthesia causes cognitive dysfunction that can last a year or more. They might not know that when a nurse tells them not to eat before surgery, it is a serious warning: while a patient starts to awaken after surgery, any food in their stomach has a good chance of going into the lungs. That causes aspiration pneumonia, which has a fatality rate over 40%.
Patients don't even want to think about MRSA, the occurrence of which is virtually synonymous with a visit to the hospital, or iatrogenic perforation of the colon that can occur during colonoscopy, or barotrauma from ventilators that killed so many Covid patients.
Doctors know about these things too, of course, but they must pretend to believe they are extremely rare. They know their ideology is inherently unpopular and they must maintain dominance over the patient to ensure patient compliance. So they assume that a patient who complains of something that's not in the textbooks is either hysterical or influenced by “misinformation.”
First, show the patient who's boss
There are many competing ideologies that patients, given a chance, would gravitate to: naturopathy, chiropractic, Chinese traditional medicine, and osteopathy, all of which reject modern drugs as poisons and promise an easier path to health.
So the ideology has to be rigid, authoritarian and ruthlessly enforced. Back when lobotomies were popular, any doctor who rejected them would do so in defiance of established medical authorities who wrote papers raving about how the evidence for them was overwhelming. Those papers are horrifying to read today, just as the tales about gender reassignment surgery will surely be in twenty years (if they're not censored), but in those days the dogma was that they were a miracle treatment.
That's why they ignore anything you say. It takes time away from their real task, which is typing information about you on their computer; and often they assume the patient is looking for a specific pill they think will cure them. As R. W. Baloh wrote in Medically Unexplained Symptoms: A Brain-Centered approach, patients adopt the same ideology as their doctors and describe their symptoms in terms of the prevailing medical dogma. The ideology isn't just that medicine equals drugs and surgery. It's also that information must only flow in one direction: from doctor to patient. That's a shame: there are patients out there with anecdotal knowledge that could save lives, but it's ignored.
First, ignore the scientific evidence
Most scientists knew the epidemiological predictions that led to the Covid panic were garbage. We all knew that the clinical drug trials, some of which were conducted with no placebo groups or with no attempt to randomize the population, were a disgrace to the profession. It was not science, but propaganda: those doctors wanted a specific result, and they found it.
We all knew that Covid was transmitted by aerosols, that the PCR tests were being done incorrectly (almost every biologist has used PCR), and that masks would be effective only in limited circumstances. It was an opportunity for doctors to add nuance and show their independence as thoughtful, unbiased, educated men and women. Yet those who did risked losing their license.
I've often been amazed how little interest doctors have in science. I know of one doctor who thought it was impossible to distinguish between vascular dementia and Alzheimer's disease (it's not so; guidelines from NINDS, ADA/AHA, and even the DSM (Diabolical Statistical Manual) are all in agreement about this). And try teaching a medical student some science sometime. It's impossible. When I start telling them exciting stuff about NOTCH3 and phospho-tau, they just fall asleep.
First, calculate the probability
Especially among young doctors, diseases are primarily diagnosed on the basis of patient demographics. If you're old, the only things they'll consider are cancer, COPD, and heart disease. Given half a chance, they'll diagnose you with all three. They're guaranteed to guess right eventually.
Migraines hit females three times as often as males. I found from experience that the only way a male can get treated for migraine is to lie and say the previous doctor diagnosed them as such. Elderly patients are given huge doses of vaccines—as much as twice the normal dose—to compensate for their probabilistically lower immune response, on the false assumption that everyone over 62 has a weakened immune system.
Despite the talk of “personalized medicine,” the practice is more regimented and impersonal than ever. Sure, doctors are corporate employees now, and under orders to maximize patient throughput. But that's just an excuse.
First, do harm
That said, doctors aren't as naive about Big Pharma as many people think. I talked to a pharma rep one time I was in a neurology clinic advising the neurologist on some procedure. The rep's job was to give the doctor free samples of some very expensive monoclonal antibody and get him to try it. The doctor's job was to figure out whether it was better, and whether Medicare was likely to pay for it. The rep had actually been a research technician and was knowledgeable and had amazing social skills. I must have looked like a member of the staff to her; I got an armful of colorful brochures with pictures of smiling patients who had amazingly white teeth and looked very healthy indeed.
Aggressive treatment can turn people into permanent patients. Drugs that kill all dividing cells also wipe out the immune system, preventing it from helping to fight the disease. It also makes the patient more susceptible to infectious diseases like Covid. That's undoubtedly why we saw pictures of Vladimir Putin meeting a diplomat at the opposite end of a conference table that was so long they would have needed cell phones to talk to each other.
First, take away the doctor's license
As Canadian pundit David Solway points out, doctors are no longer free to say what they really think. They are mostly corporate employees, either in HMOs or hospitals, and will lose their hospital privileges or even their license if they contradict the dogma. Solway pulls no punches:
My doctor was constrained on pain of losing his licence to justify and implement the corrupt and despotic scheme of the College of Physicians and Surgeons to suppress all dissent from the official position on lockdowns, masks, vaccines, and boosters. As Aaron Kheriaty points out, “Any scientist, physician, or policymaker who broke ranks [was] ‘someone to be ignored as backward or dismissed as a threat to public health. ’”
Solway also reminds us that more than half of German doctors joined the Nazi party in its early days, not because they were fascists, but because they were motivated by a craving for social status and fear of exclusion. (This was undoubtedly also why the philosopher Martin Heidegger joined).
In case you think Solway is overstating his case, consider that even two years after the Covid panic is over, places like Duke University Hospital are reportedly still denying treatment to patients who haven't gotten the vax. Whether you agree a person should get vaxxed or not, heavy-handed actions like this clearly undermine trust in medical institutions.
First, euthanize all the lawyers
Lawyers have forced doctors into a corner. The doctor must treat a disease as aggressively as possible, regardless of the consequences to the patient, or risk being sued if the disease comes back. Patients often don't know what to look for, and hospitals rarely check on them after they leave.
When patients lose confidence in their doctor, it's a catastrophe. A risk-benefit analysis is already a close call. Patients ask what the chances are that the doctor will diagnose them correctly, what the chances are they'll just ignore the complaint and start poking around looking for new problems to treat, and what the chances are the treatment will just make them worse. Politicized medicine changes that calculation. If patients think their doctor is like Anthony Fauci, who famously changed his recommendations about Covid because of politics and expediency, lots of them won't come in at all.
dec 08 2022, 5:31 am. updated dec 09 2022, 4:10 am
