A couple of years ago, New Hampshire physicians were lambasted by opponents of gun control legislation for actively discussing the public health implications of unregulated access to firearms. As primary care physicians, ER docs and trauma surgeons testified to the lethality of firearms (nearly 47,000 deaths in 2023 according to data from the then functional CDC), Republican lawmakers wearing strings of pearls admonished physicians to “stay in their lane!”
Physicians who deal directly with the death and destruction of firearm violence were left wondering which lane that might be. Fortunately, and despite setbacks, physicians continue to work at the legislative level and within the exam room to counsel patients about firearm safety. Who, after all, would take advice from legislators wearing their strings of fake pearls with super wide ties, striped shirts, AR-15 lapel pins and plaid jackets? No common sense or fashion sense, to say the least.
Now, with the NIH and CDC purged of scientists and replaced by a clan of lesser primates, real physicians and health care providers need to counsel patients against the seriously dumbed down recommendations of the Advisory Committee on Immunization Practices. To be sure, there is no risk versus benefit profile anywhere which attributes net harm to vaccines protecting against COVID-19, influenza, rotavirus, hepatitis A, hepatitis B, meningococcal disease and RSV. And yet, ACIP no longer recommends their routine use.
Dr. Kirk Milhoan, RFK,Jr.’s newly appointed chair of ACIP, rode the crazy train further by proposing elimination of mandates for the polio and MMR vaccines, easily among the greatest public health triumphs of the past century. Even if the vaccines are eventually administered to children, these dangerous policies promote delay and threaten the thresholds of herd immunity needed to prevent outbreaks. In primary care, we live by the public health maxim “a vaccine missed is a lost opportunity.” The consequences of deferred or delayed vaccine administration are enormous.
Yet, according to recent study published in the Annals of Internal Medicine, some 90% of the CDC databases related to vaccines and infectious disease monitoring have been paused, leaving public health officials and the concerned public in the dark. Again, the message to real doctors is to “stay in your lane” and that the road ahead is closed to reason.
I submit that physicians can no longer circumvent discussion of politics in the exam room, as the well-being of their patients is directly tied into the destructive politics of our time. The Project 2025 playbook has ruthlessly usurped medical science, constitutional rights and social justice.
In general, physicians will engage in “shared decision making” with patients to foster better understanding of risks versus benefits of procedures, vaccines and medications. And physicians will go to bat for patients when insurance companies stand in the way of necessary care. There is a fine line between that sort of advocacy and frank discussion of political issues which impact patient care.
Given the time limitations of office visits, and perhaps repercussions from “higher ups” in their organizations, providers tend to stay in the lane of advocacy. Health care providers should take care not to exploit the trust or power inequality which exists in the office visit. But when a desperate patient is seen, wondering what options there might be when they are dropped from Medicaid or cannot afford their medications or increased ACA premiums, one needs to switch lanes and inform the patient that politicians are ultimately responsible for their despair, and that we all need to make better choices in that regard.
I would not recommend engaging in shouting matches or hand to hand combat with tongue depressors in the exam room, but would inform patients that the dysfunction of their health care delivery can be directly tied to certain politicians and the corporations who own them. Their anxiety tied to paramilitary troops on the streets, killing and abducting American citizens and legal immigrants, is there because of our bad choices which we have collectively made in the voting booth.
In a recent letter to the editor of the New England Journal of Medicine, a group of Minnesota physicians spoke to the fears and extreme hardship endured by patients in Minneapolis. Moreover, a pediatrician was turned away by federal thugs as she attempted to render aid to Alex Pretti, while a physician attempted to assist Renee Good in her last moments, only to be told by an ICE agent that “I don’t care.” But Minnesota physicians do care, calling for an immediate end to the violence inflicted upon their patients and communities by ICE. Further, they “implore all in our medical community to use the power of your voices as well to protect our patients and your own.”
So, docs, feel free to make that lane change.
Robert S. Kiefner is a retired family physician living in Concord.