COMMENTARY

Politics Are Sick. Time to Call a Doctor?

Jeffrey A. Lieberman, MD

Disclosures

May 25, 2017

Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape.

This talk could be called "Physicians and Scientists Awake." Although Medscape's goal is to disseminate information about scientific developments in medical research and healthcare, I have seen an increasing need to comment on the social and political environment as well. No matter what areas we may work in or career paths we pursue—whether it is academic research, teaching, becoming a clinician in private practice, working in the private sector, or engaging in entrepreneurial healthcare or medicine—we are all united by a common background and our desire to advance knowledge, improve the quality of care, and provide benefits to humanity. This is either enhanced or constrained by the legislation and policies that our governments establish. Increasingly, this has become more obstructive and even counterproductive; hence, the need to call attention to it and determine how we can work to alleviate these constraints.

Diagnosing the Problem

People who are trained in the life sciences and medicine, no matter what career course they pursue, have a common background in terms of their educational and training preparation. I believe that there is something about this which leads us to be evidence-based creatures of reason, as well as problem- and action oriented. In having to deal with human disease, suffering, and other problems people may experience, we have to make an assessment, come to a diagnostic impression, develop therapeutic planning, and carry it out. Your ability to do so determines your success and competence in these roles. You are measured by this, which leads to a way of thinking and comporting one's self in professional endeavors.

This is very dissimilar to what goes on in the government, where there's dysfunctionality in how crucial problems are solved, whether it is financing healthcare or biomedical research, developing policies regarding the use of stem cells or gene editing, or determining how expeditious or restrictive FDA regulations should be. This has really devolved into unenlightened thinking or political partisanship, or been subordinated to the self-interested political factions that comprise government.

We are in a mess. Funding for biomedical research is going down, and healthcare financing in general is so confused, inefficient, and chaotic that it is confounding medical practice. Even though the Affordable Care Act seems to be at least a foot in the door in terms of establishing some governing national policy, it is now being either repealed or replaced by something that doesn't appear to be much clearer or effective. There is something wrong with this.

Perhaps this is rooted in the background and discipline of the people that go into government. We all come from life science backgrounds, where you're looking at biology and chemistry and applying this in the context of medical care. Most of the people in government are not trained in science or medicine but come from a background in other disciplines, like political science, economics, or sociology. This orients them toward a different type of thinking, which they then bring to the governing process. Political affiliation and partisanship then adds another level that diverts from what should be an evidence-based and reasoned process. In any event, whatever the reason, it is not working.

Restoring Reason

Winston Churchill is famously quoted as having said, [and I paraphrase], "Democracy is the worst form of government, except for every alternative." I'm not going to get into what's the best form of government, because I'm not a political scientist and don't claim to have an enlightened or informed opinion of that. However, I think the approach that physicians and scientists have is one that can improve the government process and result in better legislation and policies. We need to find a way to bring this to government in a way that is reasoned, evidence based, action oriented, and problem-solving. Because goodness knows that we have a huge number of problems that are impairing the quality of life and success of the country.

This isn't a question of whose "enlightened' vision should dictate which policies the government should pursue, what the country should be, or how healthcare and medicine should be run. I am talking about dealing with the immediate issues that are troubling us. Although having a grand vision is great, when the house is falling down, you're just concerned with how to maintain the structure so that it can provide shelter. That is unfortunately where we are now, I believe. Whatever we're doing, in terms of who's getting into the positions of influence and authority within the government and orchestrating that process, is just not working.

I'm not advocating for any kind of radical or revolutionary political solution, but rather for an infusion of the kind of thinking that governs what we do as physicians, scientists, or even people in business in the areas of life science, therapeutics, discovery and development, and healthcare. It means that physicians and scientists have to become more engaged, not by funding the different professional associations and having armies of K Street lobbyists march on the Capitol to represent our interests, but by being directly engaged.

Prescriptions for Change

How can we do this? I do not claim to know exactly, but first and foremost, we all have professional associations which in turn have offices in Washington with personnel directed toward media outreach and government relations. These need to be used as platforms to express opinions and exert influence.

In addition, some individuals might feel the call to public service. There are some physicians and scientists in government, but the numbers are few at present. Some may be willing to pursue political office or government appointments. A big deterrent there is that you have to run the gauntlet on what it takes to be in office these days. This means that you have to raise a lot of money for campaigns. You have to get into the rough-and-tumble of political campaigns, with all the negative advertising and name-calling that it entails. Then you have to deal with diverse constituencies, all of whom you could never completely please. Nevertheless, more of us need to participate in public service.

Finally, another way to exert leverage in this process is through our patients. We treat patients, some of whom may be rich and powerful. But even if they're not, they are constituents. They have a vote; they can send communications to their representatives. Usually you do not mix medicine with politics, and you are not going to have political signs in your office or clinic. However, maybe there is a way to educate the patient population about how we're suffering. At the very least, they're aware of these issues through insurance constraints—not knowing who is in or out of network, what benefits they have, whether they offer adequate coverage, and so forth. Then there are other issues, like having to wait to see a doctor or not being admitted to a hospital because of overcrowding or lack of workforce. There are many reasons why patients would be interested and motivated to express their opinion to the political powers that be.

Through whatever combination of these options, I think it is really time for scientists, physicians, and healthcare providers to unite, stand up, and try to become more of a political force.

Recently the March for Science occurred across the country, and I participated in it locally. Because science is a broad area, this march touched upon issues like climate change and was not solely about biomedical research, medicine, and healthcare. The underlying idea, though, was that bringing together people trained in a certain educational way of thinking, whether the physical sciences or the life sciences, provides a different orientation to problems of governance, policy, and legislation that may currently be prevalent in our government. I think it is time for us to introduce those concepts in a more pervasive and influential way.

Thank you for listening. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

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