There is a clear and present danger that threatens the many benefits scientific medicine brings to the American people. The link goes to an article in the New England Journal of Medicine this week that says American politicians are substituting their opinion and politics for the judgement of state medical boards that set the standards for scientific medical practice. I have quoted extensively from the article because it is so well written and this journal is one of the most reliable. “In response to the Covid-19 pandemic, however, state lawmakers have embraced measures that could seriously undermine boards’ ability to carry out these functions. For example, North Dakota has enacted a law prohibiting its board of medicine from disciplining physicians who dispense ivermectin for the treatment of Covid-19, despite extensive evidence that use of the drug for this purpose has no beneficial effect. Legislation in Tennessee prohibits medical boards from disciplining physicians for providing any COVID-related treatment unless they are following rule that has been approved by the state legislature. Similar legislative proposals have been
introduced in at least half of states.”
There are other examples. “These efforts to limit the powers of licensing boards are the latest example of a larger movement to undermine the concept of expertise and the institutions that validate it. For example, the 2018 federal Right to Try Act gave patients with serious or immediately life-threatening conditions the right to request access to unapproved medications with virtually no oversight by the Food and
Drug Administration (FDA).” Medications that are proven to work are approved by the FDA. If there is a good scientific argument that a medication should work in this condition based on performance in other settings, the FDA approves it and insurance pays for it. The real purpose of the law is to chip away at the regulatory authority of the FDA. This rule opens the door to treatment with drugs that don’t work. That is terrible for the patient, and you have to pay for it in your taxes and insurance premiums.
Those are just symptoms. There is a much larger problem here. “In the context of this broader cultural attack, expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies….“medical freedom”arguments have long been used to oppose institutions intended to protect consumers, such as medical licensure and the FDA. The difference today is that the anti-expertise perspective has moved into the mainstream…. Perhaps the most substantial threat to expertise is that members of the public are coming to believe that facts don’t exist — that all facts are political and therefore a matter of opinion.” That world view goes back to the days before the scientific revolution. Scientific medicine depends utterly on a shared commitment to proving that treatments work. It depends on fact, evidence, integrity, and the truth.
This is not just an external threat. It is also a threat from within the medical profession. It is a failure of leadership. It is a failure of the medical profession to attend to that primary duty of advocacy for our patients. It is a failure to achieve patient-centered care. Two decades ago, the National Academy of Medicine put it like this:
“The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.
Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. Yet there is strong evidence that this frequently is not the case. Crucial reports from disciplined review bodies document the scale and gravity of the problems Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.” They also pointed to the fact that it takes 17 years for new scientific evidence to be translated into practice. That is a harsh indictment. To make it worse, none of their recommendations have been followed.
Little wonder that many in the US don’t trust institutional medicine in America. I am convinced that Americans have a sense that our medical system does not serve them. They understand that it is arranged around the needs of providers, payers, and institutions. There are good reasons they don’t trust us.
These facts are all the more tragic because scientific medicine is so much more powerful today than it was even a decade ago. We have scientific proof that patients on optimal medical therapy live longer healthier lives at lower cost. Their risk of heart attack and stroke is dramatically reduced. We need a Flexner-type restructuring that restores the place of science in medicine. Only then will Americans trust our scientific healthcare system. Everything written on these pages is designed to help you understand scientific facts and evidence.
The real problem is the abuse of trust by the people who are in the position of power to do their job base on scientific evidence and merit. They are not, and have NOT been. These people, like Anthony Fauci, have abused their authority to profit from their obedient constituents, make harmful sometime deadly decisions which hurt the ordinary citizens. This has been ongoing for more than five decades. People have had enough. A fundamental reform, and transformation of a new system that is just, truly evidence and merit based, honest, and fair is urgently needed.
The legacy system is badly broken, bill.
Why does Truth need a Gatekeeper? Or do we believe that laypersons are not responsible for themselves?
Personally I trust myself more than any FDA or State level pol to make my health decisions. When I want medical advice, I hire my trusted medical provider and purchase their medical expertise. Isn't this really how most want the medical system to work...without all the middlemen?