When Doctors Become Political - The 2016 shift

Science and medicine must avoid naked partisan politics

One month before the 2016 presidential election, I was called to consult on a patient in the Oregon Veterans’ Hospital.

He had acute leukemia and had underwent several lines of treatment. A recent CBC showed that the cancerous blasts were rising fast in his blood. He had decided against further treatment, and his doctors wanted our team, heme-onc, to explain what might happen next, and answer his questions. We were happy to do that.

In Oregon, a large skybridge connects the main, university hospital and the Veterans building. It soars over massive pine trees and a deep gorge. On clear days, the bridge has gorgeous, sumptuous views of Mt. Hood, the stratovolcano. Its a calming place.

Crossing the bridge is also crossing political lines. Portland of course is deeply blue, while the rest of Oregon is dark red. We were leaving Hillary-Kaine territory and entering Trump-Pence country.

I was joined by a team of medical students, my fellow, and an internal medicine resident. Before we crossed over, we checked his labs. Indeed, the white count had been rising— faster and faster. It was not a good sign. I reviewed the treatment history in full, and his other medical problems, which were numerous. I felt it was reasonable for someone like him to decide on more therapy, but also just as reasonable to decide against any further therapy. If it were me, my choice would certainly be the latter.

We crossed the bridge, and located the man in his room.

He sat in the room facing the window, in a wheelchair. Across the back of the wheelchair was a huge Trump-Pence bumper sticker. Sunlight fell on his lap, which had a soft fleece blanket.

I pulled up a chair and started talking to him. He lived in southeast Portland (where I lived), and we shared some observations about the new road work project that we both disliked. Traffic was a disaster.

Then I talked to him about his leukemia, and discussed his wishes. He was certain that he wanted no further treatment. I asked him if he wanted to know what he might expect. He did, and we talked about it. At last, he thanked me for my time, and said this.

“I like you, Doctor. You are an honest man.”

I stood to go, and then he added, “Not like Hilary Clinton, that liar.”

I smirked. “Oh boy, sir, don’t get me started on those politicians,” I said with a neutral look, allowing his comment to dissipate, and leaving my own opinions out of it. He was pleased with the answer, and I turned to leave.

Then my resident interjected, “Actually, sir, it’s Donald Trump who is the liar!”

What the hell is going on, I thought, but she continued. The patient became visibly angry, as did the resident, and they exchanged heated words for the next minute. I worked hard to diffuse the tension, made some general comments to please all parties, and finally, with great effort, I got the patient calm, and the resident in the hall.

We walked back across the bridge. My initial shock had been replaced with bewilderment. What had I just witnessed? I was so lucky to have established a rapport with the patient and defused that conversation. And honestly, I needed to unpack this with some senior faculty. I had never seen anything like it. I have never seen a resident pick a fight with a patient about politics.

After a few minutes, when I was again relaxed, I decided I had to address it with her.

“So, if I might ask: why are you arguing with the patient about politics?” I said as neutrally and as slowly as I could.

She started to explain why Donald Trump was bad and how she supports Clinton. I nodded. This part I understood. She felt him voting for Trump was dangerous, and felt compelled to speak up.

“So, follow up question: do you think his vote will determine the election? In Oregon?” I asked— knowing the electoral map was solidly blue.

Again, she offered an explanation.

“Now, what do you think about his white count? Where do you think it be on election day?” I asked.

Then, as nicely as possible, I made the argument to her that our goal on this service was not to change votes, but to help people as much as we could. It was best that our patients didn’t know our political views, and vice versa.

We have to take good care of everyone, irrespective of their views. And more importantly, when someone is facing a dire prognosis, we shouldn’t create conflict for them, we should try to make their time better.

She conceded my points. I left it at that.

*

That was 2016, and something happened that year. To me, it marked the shift in medicine from something neutral to something increasingly nakedly political.

And at top universities, the politics is uni-directional. Most of the faculty and students are liberal, and the goals of the left are increasingly becoming the goals of medicine.

COVID19 of course exploded these tensions. Masking a 2 year old with a cloth mask is perhaps the dumbest thing anyone could do. And yet, it became pushed by extreme liberals in the CDC and AAP and Democratic party. Actual doctors recommended it, un-ironically.

School closure of course hurt poor, minority kids. A good liberal should have opposed it. But because Trump wanted schools open, liberals had to go the other direction. They have destroyed a generation of kids. Teachers unions and the democratic nominee worked to keep schools closed in 2020 and beyond. The harms are yet to be fully tallied.

Finally, affirmative action is a cause that liberals care about. Doctors are now generating evidence that black physicians lower the risk of death in black patients. This evidence cannot possible be true. The methods are unbelievably weak, and effect sizes too large. The flawed evidence is cited in op eds and the court, as I discuss in the link.

2016 was the moment that doctors increasingly began to feel justified that politics fell within our purview. That it is ok to scold a veteran dying of leukemia in a wheelchair that he shouldn’t support Trump. It was likely because Trump broke many brains.

Its ok for all people to hold political views, including doctors. But medicine and science should not become political. John Mandrola nicely explains why clinical medicine should not mix doctoring and politics in this video.

I worry that this problem is larger today than ever before. More and more questions are becoming political. The BMI is political now— liberals think it is biased, and conservatives think it has a role. Paxlovid is political. Lab leak is political. Whether a single black doctor can reduce the risk of death by a neonate by 50% (hello! massive) is political. Exercise is political.

Science and medicine must aspire to be less political and aspire for better evidence. If we continue in this direction, we are doomed. Sadly, many are along for the ride.