NEJM opinion piece highlights how lawmakers are intruding into medicine – with little or no expertise
An opinion piece published in the New England Journal of Medicine highlights how lawmakers are interfering with the oversight medical boards are charged with overseeing.
The authors, Richard Baron, MD, and Carl Coleman, JD, explain how licensing boards are the legally established oversight instrument for physicians, charged with making sure physicians are qualified and that they follow well-established, evidence-based guidelines when caring for patients.
Covid-19 changed everything. Lawmakers, often with little or no medical evidence or expertise, acted on public pressure driven largely by social media misinformation, and began undermining medical boards’ ability to do their jobs. They point to North Dakota passing a law prohibiting the disciplining of physicians who dispense ivermectin for treatment of Covid and legislation in Tennessee prohibits medical boards from disciplining physicians for providing any Covid-related treatment unless they are following a rule approved by the state legislature.
The authors argue that these laws are just part of a larger movement to undermine the concept of expertise and the institutions that validate it, pointing to laws that take power away from the FDA and the EPA.
“In the context of this broader cultural attack, expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies,” the authors say. The general public may view medical boards as suppressing other approaches to healing – naturopathy, homeopathy, chiropractic – as the result of actions by organized medicine. The argument of “medical freedom” has been used for decades to oppose institutions meant to protect consumers, but the internet has made it much easier for consumers to get information and products, making gatekeepers seem like nothing other than barriers to patients.
But the biggest threat to medical expertise, the authors argue, is that the public is starting to believe that facts don’t exist, that everything is a matter of opinion, going against the very foundation of modern medicine.
“Constructive debates are possible only within a shared epistemic framework and with a commitment to the idea of verifiable facts. It’s incumbent on licensing and certifying boards to defend the existence of facts and to give the public a way to know when practitioners are making claims that are incompatible with reality,” the authors say.
While there are gray areas in medicine, there are some propositions that are just wrong, such as viruses don’t cause disease or that vaccines magnetize people – and medical boards need to be able to take action to support evidence-based medicine. Medical boards must be allowed to help the public differentiate practitioners who deal in fact-based medicine and those who do not.