There is a crisis of trust in America. One manifestation is in healthcare. For a century, the trust among Americans, their physicians, and institutions of public health built the most reliable healthcare system in history. Today that trust is being undermined, and the entire system is in danger of collapse. If we do not restore trust, we will suffer the reversal of a century\u2019s gains in medicine. <\/p>\n\n\n\n
The Youngest Science<\/em><\/a>, a collection of essays by Dr. Lewis Thomas<\/a>, traces medicine\u2019s journey from pre-twentieth century practices into the evidence-based practices of today. Before this transformation, medicine was an unreliable mixture of traditional treatments like blood-letting and fanciful concoctions like snake oil tonic. Transparency, empirical evidence, and patient collaboration were absent. <\/p>\n\n\n\n Although there were many well intentioned physicians before the twentieth century, greedy hucksters<\/a> and evil-doers thrived in this environment. Quacks with phony credentials wagoned into town hawking the one-and-only genuine medicinal potion that promised to cure whatever ailed you, often accompanied by craftily staged demonstrations. After selling as many worthless \u201ccures\u201d as possible, these predators escaped at night, leaving townsfolk poorer but in no better health. People naturally feared being duped again. Medicine could not progress in this environment.<\/p>\n\n\n\n In the twentieth century, trust changed all this. Beginning in 1906 with the Pure Food and Drug Act<\/a>, the federal government developed institutions like the FDA<\/a>, CDC<\/a> and NIH<\/a> to assure the safety and effectiveness of drugs and treatments. State governments licensed physicians and established standards of medical practice. Physicians organized, creating boards<\/a> to prevent frauds from entering their ranks and abusing the trust of their profession. By the end of the last century, healthcare providers were among the most trusted<\/a> professions in the nation. So much so that people were willing share intimate personal details with a stranger, as long as that stranger was a doctor or a nurse. <\/p>\n\n\n\n Now we see an erosion in the trust<\/a> at the foundation of the youngest science. When trusted institutions like the CDC and FDA give incomplete or misleading statements, physicians lose a resource for reliable information. This quickly translates to a loss of the trust that bonds patients and physicians. As employers and political leaders displace physicians by claiming to be health experts, people are unsure who to believe. We\u2019re back in the nineteenth century again.<\/p>\n\n\n\n It didn\u2019t have to be this way.\u00a0\u00a0We could have leveraged medicine\u2019s abundance of trust to lead us to recovery.\u00a0\u00a0\u00a0Our trusted institutions could have given physicians the tools needed to make meaningful risk-benefit calculations for patients.\u00a0\u00a0But this would have required the acknowledgement that\u00a0natural immunity<\/a>\u00a0is at least as good as vaccination in some COVID survivors, that vaccination is harmful to some individuals, and that vaccination does not prevent the spread of disease.\u00a0\u00a0We could have determined which groups receive the greatest benefit from vaccination, and which groups are most likely to suffer\u00a0adverse effects<\/a>.\u00a0\u00a0We could have guidance on measurable markers of immunity\u2014what are the minimum protective antibody concentrations, and what levels are toxic\u2014so that those at\u00a0greatest risk of death from COVID-19<\/a>\u00a0can determine whether they will benefit from vaccination or booster.\u00a0\u00a0We could have real data on adverse effects of vaccines by age and health status, and we could have balancing data on risk of death by SARS-CoV-2 infections.\u00a0\u00a0We are 18 months into the pandemic; we should have this information by now.\u00a0\u00a0Instead, our public health institutions have adopted an incredulously monolithic policy, saying universal vaccination is our only way out, even though we know this policy violates the oath of my profession: Do no harm.<\/p>\n\n\n\n Our trusted health institutions, like our trusted political institutions, have failed to communicate a clear, achievable objective for the pandemic. They have failed to demonstrate a connection between their policies and the achievement of this goal. As a result, we\u2019ve lost trust. This crisis of trust has created a crisis of healthcare.<\/p>\n\n\n\n We must restore trust, together. The health of our nation is at stake.<\/p>\n","protected":false},"excerpt":{"rendered":" There is a crisis of trust in America. One manifestation is in healthcare. For a century, the trust among Americans, their physicians, and institutions of public health built the most reliable healthcare system in history. Today that trust is being undermined, and the entire system is in danger of collapse. If we do not restore trust, we will suffer […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[13,3,9,6,8],"tags":[],"class_list":["post-1069","post","type-post","status-publish","format-standard","hentry","category-13","category-covid-19","category-ethics","category-science","category-vaccine"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":212,"url":"https:\/\/betterpathology.com\/?p=212","url_meta":{"origin":1069,"position":0},"title":"The Science of COVID","author":"Kevin Homer, MD","date":"January 5, 2021","format":false,"excerpt":"Spoiler alert: This essay contains an unpopular conclusion, and you may disagree.\u00a0\u00a0It\u2019s okay if you do, because you\u2019ll probably be in the company of many of my colleagues who disagree with me too.\u00a0\u00a0Today I\u2019m going to talk about when we can trust science.\u00a0\u00a0To do that, I\u2019m going to pretend to\u2026","rel":"","context":"In "2021"","block_context":{"text":"2021","link":"https:\/\/betterpathology.com\/?cat=13"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1539,"url":"https:\/\/betterpathology.com\/?p=1539","url_meta":{"origin":1069,"position":1},"title":"Medical Publications Bow to a Political Narrative Causing Loss of Public Trust\ufffc","author":"Kevin Homer, MD","date":"July 10, 2022","format":false,"excerpt":"Why Don't Physicians Speak Up?","rel":"","context":"In "Science"","block_context":{"text":"Science","link":"https:\/\/betterpathology.com\/?cat=6"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1218,"url":"https:\/\/betterpathology.com\/?p=1218","url_meta":{"origin":1069,"position":2},"title":"Doctors Be Doctors","author":"Kevin Homer, MD","date":"January 1, 2022","format":false,"excerpt":"Some physicians are scientists, but most physicians are practitioners like me.\u00a0\u00a0There\u2019s a difference.\u00a0\u00a0Right now, we need doctors to be doctors. Scientists study disease and test treatments by applying the scientific method to clinical trial enrollees.\u00a0\u00a0The more scientists know about individuals in their study, the more likely that bias creeps in\u2026","rel":"","context":"In "2022"","block_context":{"text":"2022","link":"https:\/\/betterpathology.com\/?cat=14"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1109,"url":"https:\/\/betterpathology.com\/?p=1109","url_meta":{"origin":1069,"position":3},"title":"Stop Calling It Science","author":"Kevin Homer, MD","date":"October 13, 2021","format":false,"excerpt":"Medicine is my professional life.\u00a0\u00a0Science is the language of medicine, or at least it used to be.\u00a0\u00a0I\u2019m not a scientist; I\u2019m a practitioner.\u00a0\u00a0But I love science, just like I love ideas.\u00a0\u00a0Ideas separate humans from other living organisms, and ideas are often played out in the arena of politics.\u00a0\u00a0I am not\u2026","rel":"","context":"In "2021"","block_context":{"text":"2021","link":"https:\/\/betterpathology.com\/?cat=13"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":217,"url":"https:\/\/betterpathology.com\/?p=217","url_meta":{"origin":1069,"position":4},"title":"The FDA and Its EUAs","author":"Kevin Homer, MD","date":"January 17, 2021","format":false,"excerpt":"We have learned that science is a method, not a product.\u00a0\u00a0Science begins with an educated guess which is proven true by a series of experiments designed to show that the guess is false.\u00a0\u00a0If the hypothesis cannot be proven false, it is accepted as true by the community of scientists.\u00a0\u00a0Now that\u2026","rel":"","context":"In "2021"","block_context":{"text":"2021","link":"https:\/\/betterpathology.com\/?cat=13"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1101,"url":"https:\/\/betterpathology.com\/?p=1101","url_meta":{"origin":1069,"position":5},"title":"A Physician\u2019s Descent into the Abyss","author":"Kevin Homer, MD","date":"October 4, 2021","format":false,"excerpt":"Next to my wife and family, medicine is my life.\u00a0\u00a0I go to work in a hospital almost every day, and while I\u2019m there, I\u2019m focused on the patients whose blood, fluids or tissues come to my attention.\u00a0\u00a0I give them the very best I can, not perfectly, but humanly.\u00a0\u00a0Many patients aren\u2019t\u2026","rel":"","context":"In "2021"","block_context":{"text":"2021","link":"https:\/\/betterpathology.com\/?cat=13"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/posts\/1069","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/betterpathology.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1069"}],"version-history":[{"count":2,"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/posts\/1069\/revisions"}],"predecessor-version":[{"id":1071,"href":"https:\/\/betterpathology.com\/index.php?rest_route=\/wp\/v2\/posts\/1069\/revisions\/1071"}],"wp:attachment":[{"href":"https:\/\/betterpathology.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1069"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/betterpathology.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1069"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/betterpathology.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1069"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}