“Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.”
Dr. John Mandrola, a so-called “medical conservative”, recently penned an essay titled Politics and Medicine is a Bad Idea. In it, Dr. Mandrola encouraged doctors to remain silent on political issues, at least when acting in their professional capacity. He wrote:
As private citizens, we can and should have ideas on policy. But our medical training provides us no expertise on policy.
Dr. Mandrola provided three examples where he feels doctors are fundamentally unqualified to publicly voice their thoughts: nuclear war, the environment, and gun violence. He wrote:
There are many downsides when healthcare professionals overstep our expertise. Spending time on things that have no bearing on learning and practicing the craft of medicine or public health distracts people from their actual job. People who get sick depend on their clinician to be trained in health and disease, not climate or nuclear policy. There is only so much time. Why not spend it on being better at helping sick people…
Another downside of these forays into policy is the possibility of reducing trust—which is already at a low level. Climate, gun, and nuclear issues are inherently political. Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.
Dr. Mandrola was not the only “medical conservative” to warn of blending politics and medicine. At the start of the pandemic, Dr. Vinay Prasad wrote an essay titled Scientists Who Express Different Views On Covid-19 Should Be Heard, Not Demonized in which he said:
Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics. The tensions between the two policy poles of rapidly and systematically reopening society versus maximizing sheltering in place and social isolation must not be reduced to Republican and Democratic talking points, even as many media outlets promote such simplistic narratives.
These critical decisions should be influenced by scientific insights independent of political philosophies and party affiliations. They must be freely debated in the academic world without insult or malice to those with differing views.
This is how Dr. Prasad sounds today:
“Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics.”
“Basically, he doesn’t like physicians advocating for *progressive* health policies.”
I was not the only person to notice that Dr. Prasad is not always a neutral, apolitical reporter of raw facts who declines to comment on policy. Our own Dr. David Gorksi responded to Dr. Mandrola’s essay by saying:
I’d take @drjohnm more seriously if he were to tell his buddies like @VPrasadMDMPH to stay out of politics too with respect to policy that impacts healthcare. Basically, he doesn’t like physicians advocating for *progressive* health policies.
Indeed, despite warning about “a risk even more toxic and deadly than Covid-19”, Dr. Prasad routinely mixes politics and medicine, nearly always with “insult and malice to those with differing views”. To pick one example amongst many, Dr. Prasad, an adult oncologist, has over 50 rageful tweets directed at teacher’s unions. “Teachers unions destroyed a generation,” he wrote in one typically dramatic pronouncement. After schools in Philadelphia went virtual for a single day, due to poor air quality from forest fires, Dr. Prasad said this:
“There are many downsides when healthcare professionals overstep our expertise.”
To be clear, I agree with much of what Drs. Mandrola and Prasad had to say in their essays. While I wouldn’t say it’s “even more toxic and deadly than Covid-19”, I completely agree that it’s an enormous problem when the conduct of science becomes indistinguishable from politics. Whether a vaccine works or not shouldn’t be a Republican or Democratic position, and people died because vaccines became political. This is horrible, and seems only likely to get worse.
Additionally, I agree that doctors, especially those with large platforms, need to be cautious and thoughtful when voicing political opinions. Dr. Mandrola wasn’t wrong when he said “There are many downsides when healthcare professionals overstep our expertise.” Most of my writing is about doctors whose political allegiances and willingness to overstep their expertise led them to embrace absurd positions, treating rare, usually mild vaccine side effects as a fate worse than literal death from COVID, for example.
However, I disagree with Dr. Mandrola when he wrote “Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.” Clinicians and scientists are, of course, persons. I’d further argue that it’s impossible to discuss many facets of medicine without discussing politics in some way. Medicine does not exist on a pure astral plane, utterly disconnected from messy politics.
So I won’t criticize Dr. Prasad for sharing his thoughts on teacher’s unions. He wants to “crush” and “destroy” them. He wants to replace them with charter schools and a voucher system. Like anyone else, Dr. Prasad is perfectly entitled to express his political opinions.
But make no mistake, these are absolutely political opinions.
“Thanks for reading David.”
However, in response to Dr. Gorski’s simple request, Dr. Mandrola replied only by saying:
Thanks for reading David.
Dr. Gorksi also asked Dr. Mandrola:
So are you going to tell your Sensible Medicine colleagues to stay out of politics in medicine and public health?
He received no reply.
And this exchange was extremely revealing. Dr. Mandrola had a real opportunity to demonstrate he actually believed his own words. He could have made some comment about Dr. Prasad’s incessant blending of politics and medicine. He could proved he really meant it when he wrote:
Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.
However, Dr. Mandrola refused to defend his own writing. Instead, he responded with a cutesy remark- Thanks for reading David– indicating he had no intention criticizing a of doctor whose extensive political commentary focused on topics other than nuclear war, the environment, and gun violence.
While it would have been a surprise had Dr. Mandrola thoughtfully weighed in on the “downsides” of Dr. Prasad’s prolific political pronouncements, his refusal to do so reveals an obvious truth: Dr. Mandrola isn’t bothered a bit by doctors who routinely mix politics and medicine, as long as he agrees with their politics.
When he wrote “Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists” he didn’t mean that applied to everyone. It’s perfectly fine for a medical “conservative” to repeatedly castigate Dr. Fauci, teachers unions, and “Dems”, while lauding Trump, DeSantis, and the Great Barrington Declaration. The political musing of medical “conservatives” don’t count. They can say whatever they want. They are totally different from trauma surgeons advocating for gun control! As Dr. Gorski said, “Basically, he doesn’t like physicians advocating for *progressive* health policies.”
“Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.”
Beyond this, Dr. Mandrola, who warned us “Another downside of these forays into policy is the possibility of reducing trust—which is already at a low level“, himself wrote articles such as How Myocarditis Influences Vaccine Mandate Decisions which said:
Now we can combine these statements to consider the decision to coerce young people to take additional vaccine shots—as is being done on many US college campuses and in the military…In 2022, SARS-CoV-2 vaccine mandates are wrong, and I oppose them.
Apparently, Dr. Mandrola doesn’t consider this a “foray into policy”, nor does he consider that his anti-vaccine misinformation and repeated false declarations the pandemic was over might have reduced trust in our profession.
“I used to think medicine could be separated from politics. Gosh. That was super dumb.”
While Dr. Mandrola’s “concern” about mixing politics and medicine is performative and disingenuous, essays such as his serve two purposes. The first is to make certain doctors embarrassed and afraid to voice certain political opinions. He lists these certain political opinions very explicitly: nuclear war, the environment, and gun violence. He feels these topics should be taboo and forbidden in medicine. He seeks to shame and silence certain doctors by making them think voicing certain political opinions is unprofessional and beneath the dignity of our profession. To again quote Dr. Gorski:
I mean, it seems that only one side bothers Dr. Mandrola, not all those right wing doctors lobbying for laws to weaken vaccine mandates, neuter state medical boards trying to rein them in, and give them a freer hand to prescribe quackery—excuse, me, “off-label prescribing.”
The second purpose is to pre-emptively discredit doctors who voice those certain political opinions. Dr. Mandrola wants the general public to believe that certain doctors who voice certain political opinions are bad doctors, who are distracted “from their actual job”. Though Dr. Mandrola took the time to pen an entire essay telling other doctors not to express political opinions, he suggests that other doctors are hurting their patients by not using every waking moment to study clinical medicine. “There is only so much time. Why not spend it on being better at helping sick people?“, he asked, about other doctors.
Dr. Mandrola is certainly right that time is a finite resource. Might he have learned a valuable clinical nugget- perhaps about COVID’s effect on the heart– in the time it took him to write his essay? Are patients really safe under the care of a cardiologist who spends so much time thinking and writing about the political opinions of other doctors? What about an oncologist who is fixated on “Dems” and teacher’s unions, instead of being better at helping sick people?
Dr. Mandrola ended his essay by saying:
Scientists and clinicians have important meaningful jobs. We harm our ability to succeed when we delve into matters of policy. It distracts and sows distrust. We should remain like a neutral judge. Always. The people can decide the best policy.
He obviously doesn’t believe this. So why should anyone else?
