Before I retired, I was engaged full-time in the practice of medicine for more than 30 years. In my practice, my primary responsibility was to my patients, not my own personal agenda. I needed to fine-tune my approach to each patient, based on my understanding of them, their medical condition and their values.
Medical care is called “practice” for many reasons. You might say that if “practice makes perfect” and we’re still practicing, it must not be perfect. That is true. Medical care will never be perfect, but the goal is to work toward that.
“Practice” implies a journey over many years involving countless steps. Practice takes years of schooling and postgraduate training, and that’s just the beginning. For me, my patients were my biggest teachers, followed closely by my colleagues, my wonderfully resourceful mentors and medical experts who dedicated their lives to researching diseases and treatment. I needed to listen carefully to all of these throughout my time in practice.
Going a step further, “practice” requires not only a commitment to the individual patient, but also a commitment to the larger community. If a patient’s condition made them unsafe to drive, I needed to make sure they didn’t get behind the wheel. If a patient’s condition affected their immune system, or if other factors made them susceptible to infectious diseases, I had to make sure they took the preventive measures necessary, for their sake and the sake of their neighbors. Public health experts were a crucial resource for that aspect of practice. I trusted their recommendations.
Importantly, “practice” implies open-mindedness and a willingness to learn. I didn’t have all the answers. I needed to turn to recognized experts, who, in turn, are constantly learning from rigorous scientific inquiries. They are not simply reaching a preferred conclusion supported only by cherry-picked data. They arrive at “best practices” by designing studies without a foregone conclusion, then analyzing many such studies and reams of data for statistically significant information.
Except in dire emergencies, double-blind placebo-controlled studies are used to assess the effectiveness and risk potential of specific interventions. And if it is actually a dire emergency, the data from that are carefully reviewed in real time by the experts to determine a best course for the future. The rollout of the mRNA vaccines during the pandemic is a perfect example of this approach. The safety and efficacy of these vaccines is now incontrovertible.
The current administration has turned the notion of medical practice guided by experts, and rigorous and dispassionate analysis of the data on its head. Wildly misguided and uninformed directives from our president are thrown together as executive orders, bypassing the usual checks and balances of the other branches of our government. Appointees are selected not on the basis of relevant skills and experience but on the basis of blind loyalty and willingness to do the president’s bidding.
In the case of our system of medical care, we have Robert F. Kennedy, Jr., a man who has no medical training, no regard for public health, no respect for expertise and evidently, is hell-bent on confusing and dividing the American people. Just as his boss would have him do.
Instead of pursuing truth, the secretary uses disinformation to advance his agenda. Instead of being open minded, he has already decided what his preferred outcomes are, and cherry-picks data to support his false claims. He fires panels of experts and replaces them with non-experts who will tell him what he wants to hear.
His blatant disregard for the truth is now on full display at the Centers for Disease Control and Prevention. This institution recently suffered a wanton act of violence and loss of life at the hands of a deranged man with a gun. Now Kennedy has just added insult to terrible injury by replacing the agency head, an experienced professional with a doctorate in microbiology, with someone who is neither a physician nor a scientist.
The acting head of the CDC is a man who has publicly supported such things as letting the public assume the risk of taking medications before their safety has been assessed by the Food and Drug Administration. And this is thanks to the man who wants to restrict mRNA vaccines because their real time demonstration of safety and efficacy during the pandemic is apparently not enough. Go figure.
In ordinary times, I would be practicing patience now that I am no longer seeing patients, but I simply cannot. I need to speak out. This man is dangerous, in the same way as the president who appointed him is. We need to call out these terrible people. And we need to vote out this terrible administration before its contemptuous disregard for truth and human dignity brings us all down. We need to practice speaking truth to power.
Millie LaFontaine is a retired neurologist who lives in Concord.