Politics & Policy

The American Medical Community’s Credibility Problem

Dr. Greg Gulbransen hands a test for the coronavirus after taking a nasal swab from a toddler at his pediatric practice in Oyster Bay, N.Y., April 13, 2020. (Lucas Jackson/Reuters)
The AMA and other medical organizations have for decades chosen to politicize themselves. No wonder people don't trust them.

Doctors: “The government needs extraordinary emergency powers to deal with public-health crises.”

People: “Okay, so what about—”

Doctors: “Also, we have to gut the Bill of Rights, because gun violence is a public-health crisis.”

People: “. . .”

Doctors: “Also, we need to forcibly sterilize poor people, because overpopulation is a public-health crisis.”

There are a lot of people making a lot of bad decisions in regard to COVID-19. I wish they would make better decisions. But if some people do not seem to believe that they are getting a straight answer from the medical community about the pandemic, it may be because they remember not having got a straight answer from the medical community about gun rights, climate change, population control, abortion, and much else. If some people believe that the doctors and their organizations are playing politics with the pandemic, it may be because they remember the doctors and their organizations playing politics with a lot of other issues before.

For example: The efforts of the American Medical Association and similar organizations to medicalize the debate over gun control, part of a larger effort from progressives to pathologize dissent, is typical of the pattern. Doctors, like scientists, enjoy a great deal of prestige, much of it well-earned. That prestige is rooted in expertise that is specialized. But like the businessman-politician who argues that what’s needed is to run the IRS or OSHA as though it were a business, physicians mistakenly generalize their actual expertise and experience. It’s the same thing behind Michael Jordan’s baseball career: “I’m good at this, so I must be good at that.” And so a guy who belongs to a professional association in which there are other people who treat patients for gunshot wounds comes to believe that he has special knowledge about the questions of regulation and constitutional jurisprudence related to gun control, and that he has special moral and intellectual standing to speak on these questions.

And so it is, “Gun control is a public-health emergency,” “Population control is a public-health emergency,” “Climate change is a public-health emergency,” etc. But when the AMA speaks about climate change, it does not speak about the actual medical questions related to climate change; instead, it engages in simple, ordinary political activism, e.g., endorsing changes in the electricity-generating industry as though the world’s physicians collectively knew the first thing about operating utilities. Physicians are entitled to their opinion on this as citizens; but as physicians, they have a responsibility to invoke their medical authority only where it is actually applicable. To do otherwise is to damage the credibility of their profession — with the results that can be seen all around us right now.

The AMA asserts that “uncontrolled ownership and use of firearms, especially handguns, is a serious threat to the public’s health.” But it is not the “uncontrolled ownership” of firearms that results in all those murders — it is murderers and murderous intent. And so the AMA might as easily have written: “The failure to impose longer prison sentences on first-time violent offenders is a serious threat to public health” or, “The failure to create an actual police state is a serious threat to public health” or, “The failure to oogedy-boogedy is a serious threat to public health.” The policy preference comes first and the medicalized rationale comes after. And the policy is not the result of medical judgment but political judgment.

Usually, a public-health emergency is something that is getting worse, but the AMA pursued its anti-gun crusade even while violent crime (including homicides committed with firearms) was declining, as it did after the 1990s. Why? Because it is not a matter of public health but a matter of plain political activism.

If it were a matter of individual human lives’ being snuffed out, then the AMA might instead be focused on, say, abortion, which ends about 45 times as many American lives every year as people with guns do. Given that the violence of abortion is perpetrated very prominently by members of the AMA, the organization is uniquely positioned to do at least a little something about that. What happens in an abortion is as a medical question of less interest to the AMA than is abortion as a political question.

The AMA could be right about gun control. (It isn’t, but it could be, in principle.) It could be right about abortion (the AMA is engaged in outright abortion activism through litigation and other means) or climate-change policy. But these are political questions, not medical questions. A member of the AMA may have working knowledge about how to perform an abortion or treat a gunshot wound; that does not give him any special standing on the question of how these should be regulated or treated as a legal or moral matter. Pretending that it does is intellectual dishonesty, and it is a big part of why the public trust in medical expertise is politically qualified.

On such political questions, the AMA does not have an especially encouraging record. In the neo-Malthusian days of The Population Bomb and the overpopulation panic, the AMA went in for population control in a pretty big way, and it offered the familiar medicalized rationale: “The problems that related to human reproduction, including the need for population control, are more than a matter of responsible parenthood; they are a matter of responsible medical practice.” The AMA published this statement as though it were impossible to provide a mother with good medical care without also developing a political position about whether she and others like her should be having children — or whether this even should be permitted. The Journal of the American Medical Association was a leading voice of the eugenics movement in the United States, and its political positions were presented as matters of scientific fact: “It has been demonstrated beyond a doubt that a very large proportion of all criminals, degenerates, and perverts come from parents similarly affected. If it were possible to eliminate all habitual criminals from the possibility of having children, there would soon be a very marked decrease in this class.” That is from a JAMA article headlined “The Surgical Treatment of Habitual Criminals” — gun control is not the AMA’s first effort to medicalize the problem of crime. Planned Parenthood’s recent repudiation of its founder for her commitment to eugenics is, if a little peculiar — Planned Parenthood was founded to pursue a eugenics program under the “scientific” progressivism of the time, planned parenthood as in planned economy, and the organization really stands for almost nothing else — at least a welcome reminder that all the best people get it very wrong from time to time. We are fools to believe that this was the case 100 years ago but somehow isn’t today.

Medicine should be guided by medical criteria. When medicine is dominated by politics, horrifying things happen. Those who remember the Soviet Union’s weaponization of psychiatry to crush dissent must greet with some concern current efforts in the United States to treat certain species of political disagreement as though such dissent were a kind of mental disorder.

The memory of the Soviet example persists, as does the memory of the American experience with forced sterilizations and the like along with the horrifying legacy of “scientific” eugenics programs in Sweden and elsewhere in Europe. If Americans do not trust their doctors and scientists entirely when it comes to matters of public controversy, there is a reason for this. The AMA and other organizations got into the muck of politics on their own initiative, and it is not easy to get out.

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