My mom is gone. She was diagnosed with breast cancer after an ER visit for shortness of breath. She was gone less than six months later. After the initial ER visit she did not see another physician for four months. She only agreed to see this doc because the fluid around her heart was making it impossible for her to breathe and he was a family friend of 20-plus years. He did a wonderful job of counseling her and helped her arrive at the decision to pursue immunotherapy. However, by then it was too little too late and she was soon placed on hospice due to worsening symptoms. Her cause of death is listed as breast cancer, but I am convinced her lack of trust in physicians and the medical field as a whole is what prevented her cure.
Mom was something of a health nut. We never had any of the sugary foods all my friends had in our house. She home-cooked meals practically every night for the 29 years she was a mother. She exercised regularly and encouraged her kids to do the same. Despite her interest in a healthy lifestyle, Mom did not go to the doctor. She didn’t vaccinate her kids and routinely refused X-rays at the dentist. With these beliefs in my childhood household, it is odd I still managed to find my way into medical school.
Mom may have been part of what we in the medical field affectionately refer to as “quackery.” However, she was not alone. A recent study published in JAMA finds just 40% of Americans trust physicians. The problem lies in the fact that not all of us have the time to understand the basics of renal physiology, let alone the nuances and mysteries of cancer biology. Instead, we divide our labor among our peers and allow mechanics to take care of cars, electricians to wire houses, and firefighters to put out fires. Society expects even more of physicians and asks them to heal both our physical, emotional, and mental infirmities. This expectation is founded on the deep and abiding proof of the scientific method. This method is taught across the nation’s schools to elementary students, but sadly, it is something that we in medicine have ceased following.
Despite being a busy medical student, I still prioritize time each morning to pursue my passion for running and weightlifting. My interest has even been detected by the algorithms and my Instagram feed is full of fitness gurus offering advice and motivation. I regularly see dudes with ripped physiques on my feed telling me that physicians have no understanding of nutrition and are just pill pushers for “Big Pharma.” While I have not yet received the “in the pocket of Big Pharma” lectures in medical school (maybe they come later on?), I have become aware of what seems to be a lack of commitment to scientific principles and instead religious devotion to a medical “priesthood.”
I did not discover this while dissecting a cadaver or listening to a lecture on hematopoiesis. For the most part, I have been pleased by the quality of education I have received. Instead, I have been reading Dr. Marty Makary’s newest book, “Blind Spots.” Dr. Makary points out many of the blind spots that we have as physicians, areas where we are devoted to dogma rather than data. For example, he lays out a truly depressing story of the Women’s Health Initiative RCT. In a nutshell, leaders of the NIH and NHS circumvented their own researchers and published a study that claimed hormone replacement therapy causes breast cancer. The problem with the study? It did not show any significance between HRT and breast cancer incidence. Sadly though, the dogma was set and thousands of women have suffered the damage.
Most of us with an internet connection can recall just a few years ago when many in our Facebook feeds expressed thoughts that sounded like conspiracy theories about mRNA vaccines. While many of us laughed at these individuals, it was during this era that Americans hit their tipping point with trust in the medical community. The CDC recommended the vaccine for all people ages 5 and older in May of 2022, despite having no outcome data with the recommendation. Pfizer itself admitted it did not know the efficacy of the booster. Yet, the experts decided that they wanted a clear message for the public and decided the recommendation must move forward. This did not reflect a good example of the hypothesis, experiment, and verification scientific model I learned in elementary school. Clarity and simplicity are scientific virtues, but should not come at the expense of truth.
Many governing medical bodies now know they have a public trust issue, but their understanding of the situation is a bit misguided. The AAMC put out an article titled “Why do so many Americans distrust science?” but from what I have seen, Americans do not mistrust science. They mistrust organizations and authorities who have been trying to pass off dogma as science.
Most of us in medicine enter the field because we love science and want to help people. While I do not call into question the motives of most medical professionals, I am becoming skeptical that many of us maintain a respect for science. Science is skeptical by its nature. It knows nothing can be proven. It has no ego. It only respects the data and the replication of data. Science is not an ideology, but a tool. It is bar none the most effective tool for promoting human flourishing. If the members of these governing bodies, and those not on them, do not return to a dedication to scientific principles, the public’s trust and confidence in medicine will continue to decline. Science is not the problem; we are. We must do our part to restore the public’s confidence in our devotion to science.
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