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Public Trust in Medical Profession, Especially in USA, Will Keep Dropping

September 14, 2018 11 comments

Long time readers, of this blog, know that I am highly skeptical and downright critical of anything pushed under the name of “science”, “scientific consensus” or “objective experts”. A good part of my skepticism and distrust on these issues comes down to the fact that I have a PhD in a STEM discipline, and have witnessed too many examples of people getting famous through what later turned out to be shitty or deceptive research. Furthermore, I have been around long enough to see multiple 2-4 year cycles of some new technology being hyped to the moon and beyond before being exposed as a very modest improvement over the previous status quo, at best!

Readers might also know that I have quite critical of what passes for research and standards of knowledge in medicine. In the past, I have also written a bit about why public trust in the medical profession (especially in USA) has taken a real beating since the mid-1990s. To summarize what I have said before: there are a number of interacting factors behind the significant and continuous drop in public perception of physicians (and surgeons) over previous two decades. Some of these are unrelated to the practice of medicine, per se.

For example, currently available drugs and medical technologies are that efficacious for treating chronic diseases in aging populations (USA in 2018) compared to acute and sub-acute conditions in younger populations (USA between 1950s and 1990s). Similarly, factors unrelated to practise of medicine such as financialism and managerialism in pharma sector has (permanently) ruined its ability to produce truly innovative drugs since mid-2000s. Not to mention the fact that most biomedical research published in top peer-reviewed journals, nowadays, suffers from poor reproducibility or is usually of dubious value- to put it charitably.

Having said that, some reasons are quite specific to the practice of medicine- especially in USA. And that is what I intend to focus on, in this particular post. But let me first talk a bit about conventional “explanations” for decline in public trust of the medical profession. These typically range from “dumb patients are looking up things on the internet”, “everyone thinks we are too greedy” to “I, alone, know the truth”. These so-called explanations are however nothing beyond reactive ad-hominem insults, for reasons that will soon become obvious.

So let us begin by talking about one of the most overlooked reason for decline in public trust in that profession. I bet many of you did not even consider this issue..

1] In a previous era (upto early 1990s), most people who went to medical school were clever nerds who wanted an upper-middle class lifestyle and some social respect. More importantly, they came from a far wider range of social classes than today. It was, for example, quite common to see people who grew up in working class or average middle-class families get into medical school and become doctors. Some accuse the older system of favoring a certain gender or race, and there is some truth to that- but because that is how everything else was during that era.

Somewhere in the 1990s, that changed.. a lot. Now it was no longer sufficient to be a fairly clever nerd. Now you had to be a self-promoter with a pretty big ego. Not sure what I am talking about? Well.. ask anybody in the know if you can get into medical school today without having done some sort of “volunteering to help the poor”, “extracurricular activities” or anything else which showed your “leadership potential”? But isn’t that a good thing, you might ask. Isn’t it good to have some “life experience”? Shouldn’t future physicians have a “more well-rounded personality”?

Well.. maybe in theory. In reality, only kids whose parents are already upper-middle class have the financial wherewithal to fund their kids useless volunteering work among some community, start some worthless and dishonest shell charity or get their into some unpaid internship through their own personal connections. This leaders to selecting people with an extra-large ego, penchant for bullshit and tendency for virtue signalling. In other words, you are now selecting dishonest and extra-shifty assholes instead of plain assholes.

This is why other well-educated and financially well off people are the most distrustful of medical profession. I mean.. they have grown up around those getting accepted in medical schools since mid-1990s and often know them in social settings. The fact that social and economic peers of physicians usually have the lowest opinion about their professional competence tells you a lot about the type of person graduating from medical schools since mid-1990s, especially in USA. And yes.. this is far less pronounced in west-european countries where medical schools still prefer the clever status-seeking plain nerd over an egoistical, bullshit-spewing fake persona.

But people will, you see, tolerate vain egoistical assholes- if they can deliver. And that brings us to the second problem.

2] Consider for a moment, how revolutionary the progress of medical science was between mid-1930s (introduction of sulfonamides) to the late-1980s (ability to cure almost any infectious disease, perform any surgery safely, a host of non-invasive imaging technologies and advanced life-support technology in ICU units). Since then, the pace of progress has been rather slow- to put it mildly. Sure.. there have advances related to better use of existing drugs and technology and a few major ones for uncommon diseases. But the ability to successfully treat common chronic diseases from osteoarthritis and chronic renal failure to Alzheimers and most forms of solid cancers is not significantly better than what it was in early 1990s.

Sure.. newer drugs are less toxic and our use of existing drugs and other treatment modalities has gotten better- but face it, we are as close to curing Alzheimers , Parkinsons, Type 2 Diabetes, most metastasized cancers and many other chronic illnesses as we were in the 1990s. To put it another way, we still suck at treating most chronic illnesses- which becomes a big issue since populations in developed countries are significantly older than they were in the 1960s and 70s. But why is that such a problem? After all, physicians are only human.. right?

Well.. it would not have been much of a problem if the “healthcare” system in USA resembled that of any other country in western Europe. But it doesn’t. More specifically, an important justification for the relatively high payscales of physicians in USA has been the implicit promise that they are the “best in the world” and “they will find a cure for X disease”. As many of you might have figured out by now, the lack of progress in those areas for almost three decades has pretty much demolished that justification. Even worse, the average life-expectancy in most European countries is 2-3 years longer than in USA.

But it gets worse..

3] Another way to justify the high pay of physicians in USA and cost of “healthcare” has been the obsession with endless tests, new drugs, new gizmos and pretty much anything which creates the appearance of doing something extra. As some of you might be aware, endless testing, use of the newest drugs and gizmos in the american system has not improved the outcome of treatment as measured by changes in life-expectancy. Indeed, in many chronic diseases such as most common cancers, there is evidence that the incidence of false positives in many early diagnostic tests lead to aggressive treatment which does not improve overall prognosis while costing a lot more than a conservative approach to diagnosing and treating such illness.

It certainly does not help that physicians have been associated with many other bad, but once fashionable, public health ideas in living memory. We all remember how the belief that dietary carbs were good while all fat was bad was the default dietary advice for many decades. Who can forget the ceaseless promotion of aerobic exercise over muscle-strengthening for better cardiovascular and overall health? Or what about the aggressive promotion of extra-low sodium diets based on dubious data? I could write an entire series or book about the bullshit promoted by physicians in USA for last few decades, but we have to move on.

We cannot also forget how drugs of questionable efficacy but high costs have been prescribed since the late-1980s. Just think of how easily doctors prescribed SSRIs to anybody with even mild reactive depression or anything resembling depression (regardless of whether it helped them) or how newer anti-psychotics were prescribed for everything from atypical depression, agitation in patents with senile dementias and children with ADHD- even if made them worse. Or what about prescribing anti-hypertensives without paying much attention to co-morbidities? Or statins for primary prevention of heart attacks in people at low risk at such an event. Once again.. I could go on and on about this sub-topic.

But we have to move on to what I think is the real clincher or proverbial straw..

4] Physicians, for better or worse, are the public face of “healthcare” in USA and everywhere else. To put it another way, most non-physician related problems within a healthcare system will cast an aura over public perception of physicians. So.. for example, surprise costs caused by being treated by out of network doctors will cause hurt their public perception. Similarly, the unwillingness of insurance companies to pay for certain drugs or surgeries will color public perception of them. Long story short, most of the problems caused by the peculiarities of what passes for “healthcare” in USA will hurt public perception of physicians.

And then there is the ghost of 2008, or more specifically what happened to job and income stability for most people in USA after the 2008 global financial crisis. Once again- to make a long story short, physicians were among the few well-known professions which did not suffer significant loss of income or job precariousness since 2008. It is as if the party continued for them- despite their questionable behavior, habit of promising too much, inability to deliver, being wrong on major issues and being associated with other groups than average people hate.

In other words, most people in USA now see physicians in the same light as banksters who totaled the economy in 2008 and got bailed out, corrupt pharma executives who incessantly raise price on old drugs resulting in suffering of patients or middle management in large anonymous corporations who facilitate daily abuse and humiliation of average workers to satisfy their superiors. That is not good company to be seen in.. Anyway, I might edit this post a bit later and insert a few links if necessary.

What do you think? Comments?