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And Just Like That, Doctors Have Their Autonomy Back

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April 11, 2022


Physicians in America go through many years of training before they are ready to practice independently, often a decade or longer. This includes four years of medical school after four years of college, then a minimum of three years of residency training for primary care and up to six or seven years for many medical and surgical subspecialties.

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Medical knowledge changes rapidly, like the technology in your smart phone. According to Harvard Medical School,

In science, the term “half-life” refers to the time it takes for a quantity of a substance to reduce itself by one-half. Today, the half-life of medical knowledge is currently about 18-24 months, and it is projected that in about four years that half-life will be only 73 days.

This means that most of what medical students learn early in medical school will be obsolete before they graduate, the same for residents from the beginning to the end of their residency program. This is why physicians learn on the job, gaining wisdom from their observations and experiences, changing their practices accordingly.

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Hence the popularity of off-label treatments, reflecting new knowledge gained long after the on-label treatment was developed, or FDA approved. This is how physicians remain on the cutting edge, by innovating and growing in a thoughtful and scientific way, not simply doctors playing cowboy and experimenting on their patients.

The COVID pandemic brought this to light.  Diagnostic and therapeutic protocols were developed by the behemoth medical and government bureaucracies at the pace one would expect from such organizations. Where are we on early outpatient treatment, designed to keep early and mild cases out of the hospital and ICU, where the risk of death and disability rises dramatically? COVID has been with us for over two years now and there are no officially sanctioned early treatment protocols.

The National Institutes of Health, one of the “authorities,” published “General management of nonhospitalized patients with acute COVID-19.” After two years, all they can recommend is “supportive care” or “wear a mask, isolate the patient.”  In-person evaluation is for those already short of breath or with low oxygen saturations, chest pain, dizziness, or confusion, by which time the “early outpatient treatment” window has passed, and these patients may be headed toward the ICU.

Monoclonal antibodies may be a consideration, except in the multiple states where the Biden administration, rather than treating physicians, is making the decision to limit their use. Then there are off-label therapeutics such as hydroxychloroquine, ivermectin, fluvoxamine, and others, which may have benefit in treating early COVID.

This is not to argue for or against these therapeutics as there are studies showing benefit and others showing no benefit, but these are decisions which traditionally have been made between the physician and patient, the doctor exercising his or her autonomy based on ever changing medical knowledge.

Those physicians attempting to use their autonomy to offer what in their opinion is the best care for their patients, have been ridiculed, castigated, and threatened with loss of license or job. Here is one example, “A Texas doctor who defended ivermectin as a treatment for COVID-19 and criticized vaccine mandates has been suspended.”

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Or this, “A warning to doctors — spreading COVID misinformation could cost you your license.” Who decides what is “misinformation”? Especially in an era when, according to the Harvard article noted above, now five years old predicts, “That in about four years that half-life will be only 73 days.”

We are now at a time when half of medical knowledge is obsolete with each changing of the seasons, so what is “misinformation” versus the rapidly changing base of medical knowledge? And who makes that decision? President Biden? Dr Fauci? CNN?

For two years, physician autonomy has been not only frowned upon, but in some cases, criminalized, simply over doctors providing medically necessary and potentially lifesaving healthcare for the patients they serve. Pay attention to those last words.

White House press secretary Jen Psaki gave a press briefing the other day over the Alabama state legislature introducing, “An amendment that would prohibit classroom instruction or discussion on sexual orientation or gender identity for grades K-5.”

This is claimed to be a version of Florida’s inaccurately nicknamed by the media, the “don’t say gay” bill, which does not even mention the word “gay” but instead prohibits, “classroom instruction or discussion on sexual orientation or gender identity for grades K-5”, reserving such conversations for home, between parents and their children.

Psaki, speaking on behalf of the Biden administration, invoked physician autonomy for the first time in two years saying,

Republican lawmakers are currently debating legislation that, among many things, would target trans youth with tactics that threatens to put pediatricians in prison if they provide medically necessary, lifesaving healthcare for the kids they serve.

So with COVID, “medically necessary, lifesaving healthcare,” as in off-label therapeutics, is prohibited and potentially criminalized. But when applied to teaching young children about sexual orientation or gender identity, autonomy is encouraged, and any resistance is now criminalized. How does that work?

Are physicians to follow the medical science or the political science? Are thoughtful and reasoned approaches to treating COVID wrong but taking a similar approach with schools teaching young children about gender identity applauded and codified into law?

Physician judgement and autonomy must remain at the forefront regardless of the issue. Doctors should follow the Hippocratic oath, “In purity and according to divine law will I carry out my life and my art.” Devine law is from God, universal and eternal, not the latest social justice cause

Using physicians as pawns to promote political agendas demeans the entire medical profession, and not unexpectedly is causing patients to lose trust in their doctors, trust once lost difficult to recover.

Unfortunately, a heavy-handed government is corrupting the medical system, many professionals afraid to speak out or resist for fear of losing their reputations or their livelihoods. Who do we want as our doctors? Those acting as government controlled robots? Or the smart and caring professionals we have had for generations?

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Brian C Joondeph, MD, is a fully vaccinated physician and writer. On Twitter as @retinaldoctor. And on Truth Social as @BrianJoondeph.

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