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Progressive Conformity

I have mentioned before that in my forty-four year career in Medicine and Surgery in both the military and in private practice in Boise I have been blessed to have been surrounded by doctors, nurses, technicians, Catholic Sisters and even a few administrators whose dedication every single day to sick patients remained an inspiration to me throughout my career. I drew energy daily from patients and co-workers, but not from the powers that be in organized medicine. I was actively involved in the IMA/AMA and The American College of Surgeons.

I spent four years on the Executive Committee of The Board of Governors of the College but when I was the only Governor to vote against supporting the ACA (Obama Care) I was asked by my dear friend LD Britt to not come back to the committee—so much for respecting individual conscience. ORGANIZED MEDICINE has long presented themselves as speaking for all of medicine, but the large percentage of health care providers are so busy with their own practices or taking care of sick patients in the ICU or on the wards that they have little time for ‘medical politics” The truth is they want to care but their priorities are patient centric. For many years—maybe it is still true today, the Idaho Medical Association (IMA) had to pay a handsome stipend to delegates attending their annual House of Delegates just to get enough people to show up. They really have not for a long time represented people working in the trenches.

Who ends up speaking for the vast majority of “caregivers” who are busy every day and night giving care. Not organized medicine. If the Covid-19 pandemic taught us anything it was that the motives of organized medicine were more aligned with the Public Health Community than they were with clinical medicine. It was because of the ingenuity and even genius that clinicians identified new treatment strategies for taking care of Covid patients. Organized Medicine and the media have tried to marginalize the contributions made by clinicians. Think about the “noise’ surrounding hydroxychloroquine, Remdesivir, Ivermectin, low pressure ventilation or delayed intubation criteria, or passive immunologic techniques, or polyclonal or monoclonal therapy.

The traditional way that clinicians communicated changed almost immediately. Medical schools, professional journals, even coalescing companies like Medscape, couldn’t meet the clinical need. Instead, physicians from across the world used real time platforms like E-MAIL, FACEBOOK, and Twitter. Meanwhile, on the nightly news we were hearing about positive tests, tracking results and pandemic modeling. Has any group of scientists been more wrong than those who told us that we were in a real pandemic? Prior to 2017 that would mean 2.5% of the population would have to die—8 million people in the USA. Children should go to school—they shouldn’t. Face masks work—they don’t work. Social distancing works—It doesn’t work. Type 2 mitigation works—it has never worked in the history of airborne respiratory viruses and it never will. The real truth is that the pandemic identified the fragile nature of so many American people, and how unhealthy we are as a population. Over 50% of those who died were over the age of 80. Only 5% died without a co-morbid condition—diabetes, obesity heart disease, or immune compromised states.

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From the very beginning physicians who disagreed with the party line about Covid-19 mitigation strategy have been marginalized. Physicians in in Idaho and specifically in Boise have been “counseled” about their radical comments concerning Covid-19 mitigation. ICU nurses and hospital employees have been told not to disclose the actual number of cases and fatalities in their facilities—they were much lower than even the most optimistic physicians could have anticipated. But professional estrangement and “group think” are not new to organized medicine and last week the progressives continue to strike. For individuals to be involved in politics and social justice is perfectly appropriate, but when professional organizations and employers exert political pressure on members and employees history tells us that things won’t go well. Starbucks should sell coffee. Accounting firms like Delhoite should do audits and taxes, The joint Chiefs should prepare to win wars. Hospitals and their organized networks should take care of sick people.

Last week a spokesman for the AMA Dr. Willarda Edwards called systemic racism “the most serious barrier to the advancement of health equity and appropriate medical care that our country faces”. It is not. Poverty is the biggest challenge to access and treatment. Compare the care that a Black colleague of mine in Seattle received when he came down with Covid and was treated in the ICU in a Seattle hospital for 14 days to the care that a white person living on a Seattle or Portland Street would receive. What about the care one of my college football teammates received at the Cleveland Clinic—Sheldon is Black and has had an incredible career in business. He has spent four months in the hospital including dialysis for complications from Covid-19, compared to the average white person living in a West Virginia holler 4 hours away from a hospital. Poverty is the problem and by taking our eye off the ball we decrease our chance of fixing it.

Yesterday speaking for St. Luke’s Leadership Natalie Johnson sent out a memorandum to all St Luke’s employees—doctors, nurses techs, and people working in the business office stating her recognition of the suffering and pain endured by slaves and their descendants. These declarations of the obvious only make the person making the declaration feel good. Racism, any “ism” resides in the heart of the bigot, not in a system. A letter encouraging every employee at St. Luke’s to confront racism, sexism, any other “ism” on the spot in real time would have been worthy of the “Leaderships” call for social justice. And what about asking everyone to not only think about the poor, but to take an active role in ministering to the poor. Publicly supporting Juneteenth in Boise Idaho takes our eye off the ball. The problem is poverty and access—not race or sexism. The definition of VIRTUE SIGNALING is the expression of a moral opinion on a subject meant to make one look like a good person to a particular group. When Jesus spoke he spoke to all of us individually—not to a group. “Do unto others” or “what you do to the least of my brothers you do unto me” speaks to everybody about everybody. Speaking to groups divides us. When the tax collector and the Pharisee approached the Temple the Pharisee spoke of his goodness. The tax collector said “forgive me Lord” Who was the virtue signaler? Who was “confident in their own righteousness”? Luke 18:9-14

Finally a word about “Organized Medicine”. During the 10 years before our entry into WWII during the Weimer Republic more than half of all German physicians and surgeons became the earliest members of the Nazi Party surpassing the enrollments of all the other professional classes including teachers and lawyers. Early on the German Medical Society was instrumental in designing programs that resulted in the marginalization of Jewish and later Catholic physicians. As history played out forced sterilization, turned into Medical experimentation without informed consent and finally signing onto the authorization of the ‘FINAL SOLUTION”—8 million Jews exterminated.

Several books have been written exploring how one of the most educated classes of people were unable to stand up to Nazi authoritarianism even when close friends and colleagues were first being marginalized and then removed from site. Moral theories evolving around obedience, obedience to conformity, and deference to authority have been explored / Economic reasons have been proffered—physician economic insecurity and incentives to economic advancement have been explored. Are today’s physicians and surgeons using the same excuses when they refuse to stand up to the government or organized medicine?

Alan Wells an AMA spokesman in the 1970’s stated: “During the 1930’s German Medicine was admired as being a world leader and innovator in Public Health”. Sound familiar? In a speech prior to the invasion of Poland Hitler spoke of Germany as the body and the 3rd Reich as being the doctor. Sound familiar? Obey and I will take care of you. Sound familiar?

Here is a suggestion for the July IMA House of Delegates. How about a resolution expressing concern for the marginalization of physicians who have expressed opinions different from the mainstream “experts”. These so-called experts have been so wrong for so often that maybe different points of view should have been given an opportunity to have been presented. Nationally people like Dr’s Scott Atlas and Jay Batchahra from Stanford have been particularly prescient as have Marty Makaray from Johns Hopkins and the signers to the Greater Barrington Declaration. In our State many physicians have tried to speak up, many with impeccable credentials from The Mayo Clinic, Johns Hopkins, and The Ohio State University, and Stanford. Several have been counseled by medical directors or hospital administrators and others have been threatened with losing consultants. None of this is appropriate or right. Maybe a letter of apology to these physicians would be in order if The IMA can’t pass a resolution.

My own opinion is that courage is not exclusive to any class of people—professional or otherwise. When physicians or academics, or farmers or pipefitters, or teachers or small businessmen or mothers and fathers, fail to have the courage to stand up to experts who have little in common with them, and who tell them they know “what’s best” for you, then the game is already over.

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