12 minute read
THE MEDICAL ESTABLISHMENT
PAST REFLECTIONS AND HOPE FOR THE FUTURE
BY DR. CHAMINIE WHEELER
EDITORIAL OPINION
Our world has watched the unfolding of the trauma and lives lost in the last 2 years not only due to COVID19 but also due to the policies that were set in place to mange COVID19. Our nation has lost close to a million lives from or with COVID19. According to the National Alliance on Mental Health, 21% of U.S. adults experienced mental illness in 2020 (52.9 million people) and “suicide is the 2nd leading cause of death among people aged 10-34.” 1 All kinds of mandates that have crippled
the liberties of individuals have resulted in a movement by big tech, media and government agencies to coin a new word, “misinformation,” that has now become standard vocabulary among Americans. How have ideas that are challenged be coined as “misinformation?” Has censorship muzzled freedoms in our great nation at an unprecedented level? Can we rebuild trust in medicine?
According to the Oxford dictionary, science is “the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.” Discord is “strife and tension that arises when two sides disagree.” Thus, the gold standard for the advancement of science is this scientific discord process. Challenging accepted or what is deemed good propels the scientific process to its purity because those ideas must be proved and defended. Has the desire by some to censor and silence thoughts that go against accepted “standards” severed the discord process? Let us reflect on two such examples in history where scientific discord was shunned and silenced.
Mid 1800s was a time when the medical establishment rejected Dr. Ignaz Semmelweis’s revolutionary ideas of “hand-washing.” During this time, the mortality rate from childbirth was 25-30% if you delivered at the hospital and only 0.5% if the deliveries were performed by midwives or at home.2 The accepted reasoning for this variation in mortality rate by the medical establishment was “overcrowding, poor ventilation, the onset of lactation, or miasma.” 3 Dr. Semmelweis chose to question this narrative and “proceeded to investigate its cause over the strong objections of his chief, who, like other conventional physicians, had reconciled himself to the idea that this disease was “unpreventable” meaning that 25-30% mortality during childbirth was unavoidable.”3
Semmelweis observed that, among women in the first division of the clinic, the death rate from childbed fever was two or three times as high as among those in the second division, although the two divisions were identical with the exception that students were taught in the first and midwives in the second.4
As a scientist, Dr. Semmelweis developed a hypothesis that could possibly explain his observation of the difference in mortality rate. He hypothesized “that perhaps the students carried something to the patients they examined during labour.”4 Following the scientific process, he gathered data that led to the conclusion, “that students who came directly from the dissecting room to the maternity ward carried the infection from mothers who had died of the disease to healthy mothers.”4 In putting his findings to practice, Dr. Semmelweis “ordered the students to wash their hands in a solution of chlorinated lime before each examination.”4 This simple practice resulted in “the mortality rates in the first division dropped from 18.27 to 1.27 percent, and in March and August of 1848 no woman died in childbirth in his division.”4
Please note that the majority of physicians thought what Dr. Semmelweis was doing was heresy. He addressed several open letters to professors of medicine in other countries, but to little effect. At a conference of German physicians and natural scientists, most of the speakers, including the pathologist Rudolf Virchow, rejected his doctrine.4 Europe’s leading medical practitioners believed that childbed fever was a disease of the bowel and that purging was the best medicine for it.4 The scientific discord process between Dr. Semmelweis and the medical establishment was severed.
Years of rejection by his colleagues in medicine took a toll on him and his family. Semmelweis colleagues tricked him into visiting a mental asylum to “help a patient.” When he arrived, he was forcibly restrained, injured and put in a strait jacket. Dr. Semmelweis’s injuries became infected, and he died from infection only two weeks later in 1865. It was a lonely funeral in Vienna where only a few people attended because the medical community did not want to be associated with someone promoting medical care that was against the accepted standard by those in power. He was buried in Vienna. Only 2 years later in 1867, a Scottish surgeon named Joseph Lister, who had apparently never heard of Semmelweis, introduced carbonic acid to wash hands before surgery to prevent infection. It was nearly 30 years after Semmelweis’s death that his life legacy that promoted hand-washing was recognized by the medical community leading to a statue being erected in his honor in Budapest.4
Another example of the medical establishment rejecting thought that deviates from the mainstream medicine happened to Dr. Andrew Taylor Still, the founder of Osteopathic Medicine. Dr. Still was trained as an MD following his father’s footsteps. In 1858, Dr. Still and his brother donated 640 acres of land to build the first four-year university in Kansas named Baker University.5 He was an active abolitionist and enlisted in the Union Army as a physician. While treating the wounded, he started to recognize the shortcomings of conventional medical practices, and he started to wonder what could be changed to improve patient outcomes. These shortcomings were further magnified in Dr. Still’s life when in 1864, three of his children died from meningitis and his youngest daughter died from pneumonia.5
The cumulation of his medical experiences during wartime and the death of his children propelled Dr. Still to conclude that the orthodox medical practices that included drugs like arsenic, opium, mercury and castor oil were frequently ineffective and sometimes even harmful.5 Dr. Still acknowledged that common medical practices such as “purging, vomiting, blistering and bleeding often left patients in weakened condition or led to their deaths.”5 Thus, Dr. Still begin studying nontoxic, bioregulatory medical practices such as nutrition, hydrotherapy, magnetic healing and bone setting. He believed that movement of the “humors” of the body would allow the body to realign itself to health.5
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“He invented the word “osteopathy” by blending two Greek roots: osteon- for bone and - pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side effects of drugs. Dr. Still held a view common to early 19th-century proponents of natural healing and homeopathy supporting the idea that the body’s natural state tends toward health and inherently contains the capacity to self-heal. This view was opposed to that of the orthodox practitioner, which held that intervention by the physician was necessary to restore health to the patient.”5
Even though Dr. Still’s patient outcomes were far better than that of the orthodox practitioner, he was socially and professionally ostracized as well as financially ruined. In 1874, Dr. Still was publicly “read out” and formally removed from the Methodist Church for they believed that by “laying on of hands” on his patients to move the musculoskeletal system, he was trying to emulate Jesus.5 He was condemned for practicing voodoo by his colleagues, abandoned by his brothers for pursuing crazy ideas. When Dr. Still wanted to present his ideas to Baker University that he helped found, they refused.5 Again, there was “no room” for the scientific discord process at Baker University with Dr. Still.
Against all odds, Dr. Still continued to pursue this new holistic natural healing medicine. With time, because of superior patient outcomes, Dr. Still had more patients than he could take care of himself. He trained his own children and others to help him take care of the high volume of patients. This new medicine was not officially recognized until 1885, which was 21 years after the death of his children that had propelled Dr. Still to see what he could do to improve patient outcomes. In 1892, he opened the first Osteopathic Medical School in Kirksville, Missouri where both women and African-Americans were able to enroll unlike the traditional allopathic medical schools of that time.5
Is what happened to Dr. Semmelweis and Dr. Still similar to what is happening in medicine globally in the last two years? Physicians that have challenged the COVID “standard” have suffered much consequences. These physicians have lost their jobs, their medical licenses have been threatened and pharmacists have refused to follow physician orders to fill prescriptions for FDA approved drugs for off-label use, a practice that is as old as medicine itself. Here is one such example from March 2022:
“Dr. Paul Marik, founder of the Front Line COVID-19 Critical Care Alliance (FLCCC), was recognized on March 11 after the state’s House of Delegates unanimously approved a resolution for what lawmakers called “his courageous treatment of critically ill COVID-19 patients.” “Instead of playing it safe and going along with so-called conventional wisdom, Dr. Marik dared to take a truly scientific approach by questioning and innovating in an environment where both were not only frowned upon, but for which he was persecuted,” said Del. Dave LaRock, a Republican and the resolution’s primary sponsor. Just a few days later, Marik received a letter dated March 15 from the Virginia Department of Health Professions informing him he had until March 29 to respond to an investigation by the agency into his medical practices.6 What has allowed a culture where a physician can be both honored and investigated by the same state for the exact same work in the same month? What do these physicians in history and today have to gain by challenging the medical establishment? The answer is simple; they have nothing to gain but everything to lose including their professional standing and livelihood just like Dr. Semmelweis and Dr. Still. What compels these physicians today to swim against the current of all in authority reciting the exact same script? Again, the answer is simple; these physicians believe in the evidence of individual patients they have treated and want to do what they believe is in the best interest of their patients. Is is possible that we have not learned from history?
We must reflect and learn from our past. It took time, but the medical establishment of those days chose to look at the evidence of birth mortality approaching 1% with hand washing and that mainstream medical treatments using arsenic, opium, mercury and blood letting caused more harm than good. Hindsight is always 20:20 but these physicians that initially rejected Dr. Semmelweis and Dr. Still’s ideas later created space for the scientific discord process. It was this
scientific method in its purity coupled with humility that allowed conventional medicine to embrace Dr. Semmelweis and Dr. Still’s work. Modeling the examples of physicians that have gone before us, the only way forward to ignite the rebuilding of the broken trust in medicine today is to allow for the scientific discord process to flourish.
Could we create an environment of being quick to pause and listen and slow to criticize treatment options that are outside the “mainstream” medicine? If our colleague’s council deviates from the “standard,” does it mean that thought is wrong? It is the very essence of scientific advancement that questioning is encouraged. The bedrock of ideas and evidence on all sides should be analyzed and discussed so that true scientific advancement for handling the COVID19 pandemic and future pandemics can result. No matter what side of this “standard” we as physicians stand, we must be respectful enough to listen and analyze the evidence of the other side. One must always remember that the truth never minds being questioned, but a lie does not want to be challenged. If the evidence says that we are wrong, we must be humble enough to admit our mistakes. Because history has shown that truth can not be silenced or hidden, we must unite as physicians and rebuild trust in medicine.
As we continue to explore how to rebuild trust in medicine, let us turn to how financial transparency would add to such an endeavor. Even though every healthcare dollar in the US healthcare system’s “money pie” is generated by a physician service or a physician order, according to HCP Live, did you know that less than 7.5% of that revenue goes towards physician income?7 Where is the accountability for the other 92.5% of the revenue that is part of the Goliath system outside of the physician-patient covenant of trust? Given that every healthcare dollar is paid by the patient to the system’s “money pie,” our patients deserve transparency where the money actually goes. Did you know that in Pennsylvania, an out-of-pocket chest x-ray cost is $60, but if you have insurance, the cost can range anywhere from $100-$338 because that cost with insurance is applied towards the deductibles?8 It is because of consumer unawareness and the lack of transparency that this cost can be hidden. Such undisclosed costs produce that 92.5% revenue for the Goliath healthcare system. We as physicians need to unite to unveil that 92.5% of the “money pie” and work towards a financial transparency in medicine. Such an endeavor would mean consumer awareness and would naturally translate into another step towards rebuilding trust in medicine.
In addition to limiting scientific discord process and hindering financial transparency, another reason for the broken trust in medicine is the lack of physician autonomy. For example, medical decisions being made based on what an insurance company deems is needed or not or if a drug is covered or not have left both physicians and patients frustrated. We know that medicine is first and foremost a moral enterprise, grounded in the physician-patient covenant of trust. By definition, this is the cornerstone of the individualized relationship between the physician and the patient. We know that it is the responsibility of the physician to give good counsel and guidance, but it is the choice of the patient to choose to follow that advice. Patients in general follow the guidance of their physician because they trust their physician. Is it because of this broken trust as a result of the lack of physician autonomy that our patients are hesitant about the council we give? Regaining physician autonomy would be another step towards rebuilding the covenant of trust.
Therefore, let us unite and rebuild trust in medicine. Let us work towards creating a culture where scientific discord is encouraged, where financial transparency is central, and where authenticity of the physician-patient covenant of trust is the cornerstone. Our healthcare system would be transformed and grounded in trust… our hope for the future of medicine!
REFERENCES:
1. https://www.nami.org/mhstats
2. https://www.pbs.org/newshour/ health/ignaz-semmelweis-doctor-prescribed-hand-washing
3. https://www.npr.org/sections/ health-shots/2015/01/12/375663920/ the-doctor-whochampioned-hand-washingand-saved-women-s-lives
4. https://www.historylearningsite.co.uk/a-history-of-medicine/ ignaz-semmelweis/
5. https://www.biologicalmedicineinstitute. com/andrew-taylor-still
6. https://www.theepochtimes.com/ doctor-honored-and-investigated-by-samestate-for-samework_4360566.html?
utm_source=Morningbrief&utm_campaign=mb-2022-03-27&utm_medium=email&est=DhkbLbCVjNUWWjI5
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7. https://www.hcplive.com/view/ physician-pay-makes-up-about-8-percent-oftotal-healthcare-costs
8. https://affordablescan.com/x-ray/cost/ pennsylvania.
