The Corporate Practice of Medicine

I correspond regularly with about 30 doctors and nurses, most of them still in practice. Most live in Boise, but a few of them I spent time with on active duty in the Navy. The perspective that they have given me as they have looked into their own practices, their own concerns about the direction that medicine is going, and most of all—from both military and civilian colleagues regarding the corporatization of medicine that has recently been brought into the headlines in both the mainstream press—NYTs and WSJ, but also in the alternative media in Substack and on “X”, has been universal and alarming.

In an article on Substack by Aaron Kheriaty from Johns’ Hopkins entitled The Managerialist Revolution in Medicine he posits that the health care industry and profession’s problems are not grounded in economics or science but are rather technical. Those that sit on the highest rungs of the health care industry ladder don’t even understand the nature of the problem. The don’t “see the logs in their own eyes.”

As I have related in previous articles Lynn, and I have had many encounters with the health care community over the past year—Oncologists, pathologists, radiologists, and orthopedic surgeons. All the nurses, doctors and technicians that have taken care of us have been outstanding. Competent, professional and many of them angry. This is important to bring up because much has been written about the general public’s dissatisfaction with medicine, but those in the healing professions also recognize the problems, and the problem is a managerial class that has exploited those working closest to patients, in order to leverage an economic advantage for themselves and their institutions.

From the general public’s point of view this sums up the current state of affairs from Pew Research:

“According to Pew research, the number of U.S. adults who place confidence in medical scientists to act in the best interests of the public declined from 40% in 2020 to 29% in 2022. A 2021 survey by the American Board of Internal medicine likewise found that one in six people—including physicians—no longer trust doctors, and one in three do not trust the healthcare system. Almost half the population does not trust our public health agencies to act in our interests.”

Doctors are leaving the profession in droves, prompting worries of a worsening physician shortage. According to the American Medical Association, one in five doctors plan to leave medicine in the next two years and one in three plan to reduce their work hours in the next year. Why is medicine today failing many of its brightest students and pushing large numbers of its best students into other fields of study?

Because physicians at the highest levels of influence in our medical schools and large community hospital systems have allowed managerial technocratic scientism to supersede the basic tenants of medical ethics and medical education. Never have so many words spoken by those in medical leadership, said so little. The idea that everything in a temporal world can be reduced and understood solely by technical means that are universally repeatable with repeatable endings, and that these means “with all things being equal “can be applied universally to all human beings in all clinical settings is specious in its predicate and in its’ application. The end result is that every clinical situation can be addressed via “protocols, clinical guidelines and best practices”. There is no room for clinical experience, or for evaluating the unique nature of each patient. One size fit all is precisely the problem we had with top-down clinical guidelines and mandates during Covid. Very few practicing physicians pushed back, and those that did were often times ostracized ridiculed and marginalized by their medical associates and most importantly by the institutions where they practiced

The practice of medicine is both deductive—general to specific and inductive specific to general. A physician is presented with a constellation of symptoms that they try to home in on and find a common denominator that causes those symptoms. He/she must evaluate any number of remedies to alleviate the cause and thus the symptoms. If people were robots’ algorithms could be applied universally as they are when a technician addresses issues with your automobile or your computer. But humans are far more complex and less linear than machines. The variation between one human and another is far greater than between two machines. The application and enforcement of “guidelines and protocols” serve the same function that mandates did during the pandemic when applied to a population of patients, They are merely a means to control behavior—clinical behaviors on the part of physicians, Many times these behaviors have an economic incentive that may or may not be in the interest of the patient or even known to the patient. Many times it is the large hospital systems or the drug companies who benefit the most.

Physicians have been reasoning from empirical evidence since the times of the ancient Greeks and Egyptians. Using only “evidence-based medicine” (EBM)and then assuming that this can be applied to “best practices” is a slight of syntax. Physicians have always used all the evidence to make decisions and define therapies. And who by the way is “the expert”. Somebody sitting in an Ivory Covered Laboratory that has never taken care of a patient, or the “meat and potatoes” family doctor sitting across from the patient in his office? Dr Fauci PHD or Dr. Joe Smith MD?

Marginalizing the skills of the practicing physician while at the same time scraping the discipline of epidemiology like what happened in our Covid response benefits the large pharmaceutical companies and the collaborators in government at government agencies, at all levels who are compensated via the back door with free trips to “the islands” or “dinners at the club”. Patients don’t benefit. Doctors and nurses don’t benefit, and we all know it. That is the reason we have become so skeptical and disillusion with medicine as it is practiced today.

Though I only agree With Robert Kennedy about 50% of the time, he is absolutely correct in his assessment of the “medical industrial complex” as was reposted to me from “X” by a fellow physician:

BREAKING: RFK Jr. says the DOJ under Trump will launch RICO investigations into the collusion between medical boards, medical journals, and Big Pharma, which led to many brave doctors getting fired for prescribing alternative treatments for Covid & other illnesses “The Justice Department should immediately call in the beginning investigation of the medical boards and the collusion between the pharmaceutical industry and the medical boards that are delicensing these physicians who actually try to heal patients and try to treat them.”

We have yet to have any out briefs or mortality and morbidity reviews from government agencies—actually CDC and NIH have done and published their reviews. The State of Idaho certainly has not, and the collusion that occurred with the Big Hospital Systems, The State Board of Medicine and the State Department of Health and Welfare (DHW) and the Governor’s Advisory Board will sadly be repeated again unless such a review is completed.

In fact, I truly believe that our Governor should issue a formal apology to Dr. Ryan Cole. Dr. Cole had the courage to speak out against “the experts”. None of whom by the way had his credentials—Air Force Academy undergrad, Georgetown Medical School, Mayo Clinic Pathology with a special Certificate in virology. Nobody in Idaho carried such Bona Fides and Credentials. Few had the guts to speak “truth to power”. He did!

Mr. Governor, with all due respect, please issue an apology to Dr. Ryan Cole.