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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?

On the Connection Between ‘Hollywood’ and Establishment Democrats

November 8, 2017 7 comments

One interesting feature of the so-called “#resistance” formed in the aftermath of Donald Trump’s 2016 electoral victory concerns its highly skewed membership composition. Most readers might have noticed that almost every single person associated with that useless hashtag is from either the entertainment industry and mainstream media or is a political consultant of some sort.

While it is easy to figure out why opportunistic cocksuckers.. I mean political consultants.. have jumped on the “#resistance” bandwagon, the extensive support for such useless “activism” within the ranks of the entertainment industry and mainstream media is a bit harder to understand- especially since their fortunes have not been negatively affected by Trump’s election.

And yet, not a day (or hour) goes by without some “celebrity” from one of those two industries making some negative or controversial statement about Trump which is then widely circulated on Twitter, FaceBook and other social media platforms. This is followed by another “celebrity” doing something similar resulting in another wave of worthless online activism, seemingly ad infinitum.

To be clear, Donald Trump is a shitty president. However his actions and decisions to date have not been significantly different from his equally shitty predecessors such as Clinton42, Bush43 and Obama44, to name a few. He has yet to pass sweeping neoliberal “reforms” like Clinton42, start large disastrous wars like Bush43 or enable systemic abuses of the 99% by the 1% like Obama44.

So what is the real source of the profound hatred towards Trump from members of the entertainment industry and mainstream media? Why are they so anti-Trump? Also, why are they still pro-HRC and supportive of democratic party establishment? And why were so few of them pro-Bernie during the democratic party primaries or even after Trump defeated their anointed candidate aka HRC.

Now, it is well-known that the entertainment industry aka ‘Hollywood’ has always been a strong supporter of the post-1940s democratic party. But why is that the case? And has the nature of that support changed over time? Conventional explanations for this phenomena have ranged from percentage of Jewish people in that sector, the high degree of unionization within some parts of that industry to the republican party supporting socially regressive causes since 1968.

While there is some truth to all those common explanations, they cannot explain the incredibly high levels of support for the democratic party establishment (especially the establishment) within that industry. This level of support is especially apparent once you start looking at the amount of money contributed by people within that sector to the democratic party establishment. So why is that industry so eager and willing to support the democratic establishment?

In my opinion, a comprehensive explanation for this phenomena can be divided into two components. So let us begin with the first and easier component of the answer, namely why the industry favors the democratic party over its republican counterpart. The answer to that question is fairly easily and comes down to the profile of those who vote for republicans and the type of people they elect.

Simply put, average republican voters (despite what they might themselves believe) are not the sharpest tool in the shed. Almost nobody who works in an industry that is highly image conscious wants to be associated with fat, bland and mediocre white working class types or suburbanites. This is doubly so if the group in question also openly professes to belief in traditional religion, white supremacy and other retrograde beliefs.

The people elected by republican voters are no better. Have a look at both elected establishment republicans and tea-party types. Would anybody possessing even a moderate degree of image consciousness want to hang out with them? And what would you talk about with them, anyway? How about crowd pleasers such “jesus wants to ban abortion” or “let people die on the street because medical care is a privilege, rather than a right (as it is in every other developed country)”.

My point is that associating with republican voters or elected representatives is bad for your image especially in a sector as heavily dependent on image projection and public personas as the entertainment industry. So that explains why the entertainment industry does not spend much time trying to appeal to republicans. But why are they so willing to support the democratic party establishment?

One of the more amusing features of the 2016 presidential election was the degree to which “celebrities” supported the stale and unpopular neoliberal aka HRC over the democratic socialist aka Bernie Sanders. While it is true that a few celebrities did support Sanders the bulk of such endorsements and more importantly fundraising by Hollywood-types was directed towards the spectacular failure of the HRC campaign. But why did that occur? What did so many Hollywood types see in an unpopular neoliberal politician?

Alternatively, why were Hollywood types still so eager to promote the presidencies of Clinton42 and Obama44? Why did HRC have no problems raising tons of money from the entertainment industry? Why were so many Hollywood-types despondent after she lost on Nov 8, 2016? As I have pointed out in previous posts, the policies and actions of neoliberal democrats have not significantly better than their republican counterparts. Why the love for establishment democrats?

Well.. it comes down the fact that the entertainment industry aka ‘Hollywood’ was always a fair neoliberal place and has become more so in the previous two decades. The structure of that industry- from a few powerful gatekeepers, their flunkies, good unions for a small percentage of people in that industry on top of a large and poorly paid workforce which does most of the real work is a microcosm of neoliberal society.

The entertainment industry also promotes the false ideology of meritocracy, when in fact sucking the cock of somebody like Harvey Weinstein is what really makes your career. The neoliberal ideology of democratic party establishment is, therefore, a perfect mental fit for people who run ‘Hollywood’. Their mutual association allows for many cross promotion opportunities and allow both to feel important, current and popular. Because, let us face it, both groups are into promoting and celebrating neofeudalism which is a little less socially regressive than their competition.

What do you think? Comments?