RUTHFULLY YOURS

https://www.city-journal.org/article/the-association-of-american-medical-colleges-selective-research

Early last month, the Association of American Medical Colleges (AAMC)—the organization that oversees the Medical College Admission Test (MCAT) and cosponsors the accrediting body for all medical schools— published a story claiming that black patients fare better with black doctors, an idea that has become popular across the health-care establishment. That it was being amplified just as the Supreme Court prepared to hand down its landmark ruling on affirmative action was neither subtle nor coincidental. Woke activists are determined to sell the idea that race-based medical school admissions are noble and sensible to justify skirting bans on affirmative action. Justice Ketanji Brown Jackson even paid lip service to the purported benefits of doctor-patient race concordance in her dissent.

The notion that patients benefit from seeing doctors who share their race is dubious to the majority of us who know better than to essentialize race in our encounters with others. So is the implicit claim that lowering standards and elevating race in medical school admissions maximizes patient welfare. Indeed, the quality of the studies that AAMC cited to support these claims are as poor as one might expect.

Take, for example, a recent study published in JAMA Network Open. It observes that black life expectancy is longer in counties with higher proportions of black primary care providers (PCPs). But the researchers make no allowance for how their results are shaped by their modeling of the relationship between black representation among PCPs and life expectancy—including a curious decision to omit the roughly 50 percent of counties that don’t have any black PCPs. Data can be manipulated to reach just about any conclusion. The researchers’ failure to demonstrate that their results are robust, and not dependent on their very specific parameters, should leave readers deeply skeptical.

https://issuesinsights.com/2023/06/28/senate-democrats-take-one-more-step-toward-socialized-medicine/

It’s been less than a year since Democrats enacted the Inflation Reduction Act, which gives Medicare the power to set the prices of certain medicines. 

Those price controls have yet to go into effect. But Democrats already want more. They’ve introduced new legislation that would amp up those price controls — and even permit the government to refuse to cover drugs in order to drive a harder bargain with pharmaceutical companies.

As for the patients who would benefit from those drugs — or may even need them to stay alive? They may end up being collateral damage.

The Democrats’ new price control gambit is the SMART Prices Act, introduced by Sens. Amy Klobuchar, D-Minn., Peter Welch, D-Vt., and 23 of their colleagues. They say their bill would “build on” the IRA. 

That law, which President Biden signed last August, subjects 10 medicines to price controls under Medicare in January 2026. The government will set the prices for 15 more in 2027, another 15 in 2028, and 20 more per year in 2029 and beyond.

The SMART Prices Act would take things even further. It would empower Medicare to set prices for 20 drugs in 2026, instead of the current 10 under the IRA. In 2027, that number would jump to 40 — many more than the IRA stipulated.

The new bill would also subject medicines to price controls five years after approval by the Food and Drug Administration. That’s up to eight years quicker than under the IRA and significantly sooner than when generic or biosimilar competitors can enter the market.  

This provision would gut the generics industry. Generic firms face substantial upfront costs. They must create medicines that are bioequivalent to the innovative branded drugs they’re copying. And they have to build facilities in which to manufacture them. 

They recapture those investments by underpricing their wares relative to branded drugs and capturing a small margin on each sale. Patients, of course, benefit from those lower prices. 

But if Washington sets a rock-bottom price on a brand-name drug, there will be no incentive for a generics manufacturer to enter the market.

That’s problematic for several reasons. For starters, the government’s mandated price may not be as low as a competitive market could generate. So patients may end up paying more than they should. 

https://sciencebasedmedicine.org/update-on-gmos-and-health/

There is a lot of competition for our attention, and many issues that seem urgent and controversial. Sometimes important issues just fall off the radar because of this competition. Part of our goal at SBM is to keep tabs on relevant issues – antivaccine efforts, promotion of pseudoscience in medicine, weakening consumer protection laws, and many others. That is when a lot of harm occurs, when the public is not paying attention, and fanatics are tirelessly working in the background to subvert science and public health. So when an important issue has not been in the news recently, I like to take a look and see what’s going on.

GMOs (genetically modified organisms) is one of the topics I try to track carefully, even when it’s not making headlines. The first GMO food was approved in 1994 (a GMO tomato that is no longer on the market), so we are getting close to 30 years of GMOs. Opponents of GMOs falsely claim that they have not been studied enough (there is more evidence for their safety than other food products) and that there may be long term unknown risks. They were wrong 30 years ago, but it was at least true that GMO introduction into the food market and animal feed was new. But the “new” argument, by necessity, doesn’t age well. By now, if there were any actual risk to GMO foods, we would likely be seeing the result – and we are not.

The labeling of GMOs have been updated in the US, and while there is no evidence that this is useful information to consumers, there has been a reasonable improvement. The USDA now uses the term “bioengineered” to refer to any food product that has detectable levels of altered genetic material – genes that could not have results from usual breeding techniques. The term “GMO” now is restricted to those organisms with foreign DNA introduced, usually transgenic, from distant organisms, not possible with breeding. Whereas bioengineered can refer to a host of processes, such as using CRISPR to alter existing genes without introducing new genes.

As an aside, I find it ironic that a large number of available crops were produced over the last century through mutation breeding. This technique uses chemical or radiation to dramatically increase the rate of mutation (a thousand to a million fold) to increase the number of varieties to select from. But mutation breeding is not considered GMO or bioengineered. Many other crops are hybrids, even forced hybrids that would not occur in nature. But labeling such crops would be pointless, and banning them impossible, and they constitute virtually our entire agricultural industry.

https://issuesinsights.com/2023/06/22/uclas-3-wishes-program-captures-the-true-meaning-of-serving-patients/

During the years of my medical career when I treated patients (always in hospitals), I was one of those rushed doctors who focused on efficiently formulating and implementing diagnostic and treatment plans, rather than on the patient’s emotional needs. That was certainly true of “end-of-life care,” treatment and support given to people who are near the end of life and have stopped treatment to cure or control their disease. The goal then becomes controlling pain and other symptoms so the patient can be as comfortable as possible and includes physical, emotional, social, and spiritual support for patients and their families.

To a young, enthusiastic doctor, a dying patient is often seen as a failure, so somebody or something has to fill the gap, and a project at UCLA Health in Los Angeles is a stunning, munificent example.

The “3 Wishes Program” is a palliative care initiative in which clinicians inquire about and implement final wishes for patients who are expected to die imminently. As its mission statement says, “By celebrating lives and dignifying the dying process, the goal of the program is to improve the end-of-life experience for all stakeholders, including the patient, the family, and the clinicians.” It recognizes that in their final hours, most people have fears, regrets, and maybe a last, often simple request. The program has fulfilled almost 5,000 wishes for more than 1,400 patients.

I became aware of it by following on Twitter Dr. Thanh H. Neville, associate professor and intensive-care unit physician at UCLA Health. Some of the 3 Wishes stories are very affecting reminders of how meaningful small kindnesses can be.

https://www.city-journal.org/article/transgender-ideology-and-the-corruption-of-medicine

I have been engaged in an ongoing dialogue with a physician who works in a major children’s hospital in a blue city. This physician has witnessed firsthand how transgender ideology has captured the medical profession and jeopardized the first commandment of the healing sciences: do no harm.

He has now chosen to speak out, on condition of anonymity, because he is alarmed by the sudden corruption of the medical community. His colleagues, many of whom oppose transgender interventions, have so far chosen to stay silent. This interview has been edited for length and clarity. 

Christopher Rufo: Please begin by setting the scene. What’s it like in a major children’s hospital in the United States regarding transgender interventions for children?

Physician: I think the best way to answer that question is to talk about the cultural shift that happened in 2020, because transgender ideology and Covid are inextricably linked. Normally, doctors operate by the authority of the professional societies that govern our specific practice. That worked because the individuals in those institutions were reliable, intelligent, and thoughtful. But with Covid in 2020, we started getting medical decrees without peer review or evidence—you saw this with masks, social distancing, and emergency-use authorizations. These decrees were expressed as something that everyone had to do, without justification based on sound science. The other thing was censorship. If you were to ask questions or express doubt about these medical decrees, you would be ostracized within your department, and you stood a good chance of being publicly humiliated, severely reprimanded, or fired.

That’s when transgender ideology really took off. Within these academic institutions, so-called experts in the field of transgender medicine would simply declare that puberty blockers and other interventions were the gold standard of care. The evidence to support this is completely fraudulent, but no dissent was permitted. Everyone within the medical community knew that if he questioned transgender ideology, he would suffer the same type of repercussions that had happened during Covid. The best way to describe the environment would be as an authoritarian, censorious culture that discourages any meaningful debate and encourages the demonization of anyone who asks questions.

benefits-of-trans-procedures-for-children-n1703599

On Wednesday, Rep. Dan Crenshaw (R-Texas) grilled a so-called “expert” witness on the issue of transgender procedures for women, during which she failed to cite even a single study showing that cross-sex hormones, puberty blockers, or surgeries have any positive impact.

Dr. Meredithe McNamara, an assistant professor of pediatrics at the Yale School of Medicine, testified in a hearing in opposition to a provision that would block federal funding for hospitals that provide transgender services for minors.

“This is taxpayer money, and when 70% of taxpayers opposed these barbaric treatments on minors, then taxpayers should not fund it,” Crenshaw told her.

During the exchange, McNamara accused Crenshaw of cherrypicking data to support his position against transgender procedures for children.

“It is very unscientific and flawed to pick a single study or a single statistic and to discuss it in isolation,” she said.

“Totally agree,” Crenshaw said.

“All the medical experts are able to talk about all the evidence as a whole,” she added.

“Totally agree. So it’s good to look at systematic reviews right?” Crenshaw asked. “That’s the gold standard of evidence when you’re trying to understand whether something works or whether it doesn’t. So the British Journal of Medicine looked at 61 systematic reviews with the conclusion that, quote, ‘there is great uncertainty about the effects of puberty blockers, cross-sex hormones and surgeries in young people.’ Journal of Endocrine Society came up with the same conclusion. Even the American Academy of Pediatrics — all cite the lack of evidence.”

“So here’s the thing,” Crenshaw continued. “If you’re doing a therapy, and it’s you know, temporary, whatever, fine, maybe let’s try let’s see if it works. But when you’re talking about permanent physiological changes, do you not agree just from an ethical standpoint that you might want extremely strong evidence of the benefits and there is no systematic review, that that states that there is strong evidence of benefits?”

https://quadrant.org.au/opinion/covid/2023/05/the-curious-tale-of-hydroxychloroquine/

The discipline of medicine has changed. Its traditional cohesion and leadership have fractured into multiple disconnected specialty groups, allowing powerful commercial and political forces to increase control over both structure and function of medical practice. The COVID era burst through boundaries long taken for granted.

A major driver of opinion about COVID has been the World Health Organisation (WHO). Its Health Emergencies Programme in its proposed form, designed to strengthen disease-specific systems and capacities, including for vaccines, pharmaceuticals and other public health interventions, may be a serious threat to independent local health systems. Given it is an unelected body responsive to powerful lobbies, and a with a performance short of wide approval in its overarching role in the recent pandemic, there is reason to tread carefully.

I have practised as a physician in Australia for half a century. I recall when we knew (and revered) the name of the President of the Royal Australasian College of Physicians, while living in fear of their Chief Examiner as we sought qualification! They were great men and women and were the exemplars for ethical practice. Today they only occasionally question imperfect narratives or challenge the ethics of prevailing medical practice, risking being part of the problem rather than a solution.

Recently I was invited to speak at a symposium “Medicine at the Crossroads in the COVID Era”. I sought a topic that illustrates contemporary challenges to Western medicine. Few topics could be more relevant than threats to the doctor-patient relationship, and to science-based medicine seen in the COVID-19 pandemic. So I chose “The curious tale of hydroxychloroquine (HCQ)” as a metaphor for the distortion COVID imposed on clinical practise, driven by misinformation aimed at supporting a flawed narrative originating from the highest sources of medical influence.

I am a clinical immunologist. I have a special interest in chronic inflammatory disease and the immunology of the airway. Among the valuable drugs in my clinical practice was HCQ, for which I wrote approximately 20,000 prescriptions without any observed major side effect.  It proved to be a safe and effective medication that blocked antigen-promoting pathogenic immune responses in patients with autoimmune or hypersensitivity diseases.

COVID made HCQ a household name. No medication attracted more brutal and remorseless assault. It was subjected to derision and negativity by medical professionals and the public alike. HCQ presents the dilemma that embodies the extremes of the narrative and science of COVID. In this context and over the last three years, popular narrative and science have gone down quite different paths.

https://kffhealthnews.org/morning-breakout/doctors-having-to-ration-cancer-drugs-amid-shortages/

ABC News reports on impacts ongoing drug supply shortages are having on cancer treatments, with some doctors having to decide which of their patients to treat. Also, Pfizer said an experimental combination of antibiotics is effective at treating some drug-resistant bacterial infections.

ABC News: Cancer Drug Shortage Is Forcing Doctors To Decide Which Patients Get Treatment  Just six weeks ago, Greg DeStefano began a new chemotherapy combination. The 50-year-old, from Northbrook, Illinois, had recently been diagnosed with his fourth round of cancer and doctors were hopeful the medication would treat the tumors growing in his neck. DeStefano was responding well, but then, in late May, he got a call from his doctor and was told one of the three drugs he was receiving — carboplatin — was under a global shortage and because of the way the hospital had to prioritize treatments, he wouldn’t be qualified to receive it anymore. (Kekatos, 6/2)