"Enviromental stewardship" is a very good one. Much better than many of the common fearmongering and everchanging ones.
The rest, 100% agree. But, I mean, the viewpoint sections of the main journals have been something as a one-sided politic column for a whille, so, saddly, nothing real new. Saddly.
The single most hypocritical article you've ever published. Prasad is a political ideologue. While claiming to be a "progressive", his flawed meanderings about Covid were initially funded by a libertarian thinktank. His political comments are solely to attack democrats, except for giving shade to RFKJr, who should be banned from any serious discussion about anything, period.
Speaking as a political scientist, the tragedy of the editorial on nuclear war is that absolutely nobody in that policy area will see it anyway, let alone care what the authors say or think. It's a complete waste of time, like demonstrating against Peruvian vaccination mandates in Timbuktu. The authors might as well have spent their time watching TV or picking their noses.
On the broader question, do you think that the many medical journal editorials about racism were also misplaced when they strayed beyond the topics of racism in medicine or the impacts of racism on medicine?
I agree that politics should not have a place in medical journals. However, nuclear war is without a doubt associated with death and large scale destruction and I think that not just physicians but other professions and society as a whole should raise it’s voice by any available means to prevent such a global disaster.
"There is only so much time. Why not spend it on being better at helping sick people."
One could use this argument to deny physicians the right to do anything unrelated to medicine.
Medical professionals are human beings who (generally) need to engage with the full spectrum of human activity to derive meaning and satisfaction. This spectrum includes – in addition to professional matters – things like family, culture, and politics.
“As private citizens, we can and should have ideas on policy. But our medical training provides us no expertise on policy.”
Agreed that clinical expertise does not necessarily translate to political/economic expertise, but this is not grounds for denying clinicians the right to take political stances. It is grounds for paying attention to the people who have the necessary expertise/skill (be they clinicians or not).
“Public health people might also claim climate change as their issue. I get it. Except, what expertise does your MPH give you in geothermal science? Or the negative externalities of different solutions?”
This argument would be sound if people were asking physicians about the physics of climate change or the economic implications of opting for one policy versus another. But they are not.
Most physicians who work on this do so with the aim of describing the impact of the climate on human health. They may do so well or badly. In the latter case, we should criticize the methodological quality of the work as we would any other scientific endeavor. But I do not see why we should criticize the mere attempt to analyze the public health implications of climate change.
“Another downside of these forays into policy is the possibility of reducing trust—which is already at a low level.”
Conversely, one could argue that a medical community divorced from the concerns and burdens of the society at large can be deemed irrelevant to, and removed from, the lives of everyday folk.
"Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.”
This is the fundamental disagreement I have. Are clinicians and scientists not persons? I don’t see how one can justify denying clinicians/scientists specifically the right to have (or take a stand on) political opinions.
“Of all the institutions in healthcare that must be neutral it is journals. This is where the evidence that drives decisions comes from.”
They should be neutral in so far as they should be willing to publish opposing viewpoints that are reasonably well argued and supported by evidence (derived from work done decently well).
But this does not mean that a medical journal should shy away from publishing articles that are directly relevant to human health (be that nuclear Armageddon or climate change) simply because they garner controversy or strong opposing opinions. It would, however, be perfectly sound to criticize these articles on the grounds of severe methodological flaws (if present).
I believe Dr. Mandrola has conflated two things that are very different: first, medical journals publishing opinions on issues which are directly relevant to human health and which also have political aspects; second, medical journals (or physicians or scientists) advancing poor science in support of a particular political position. The first is perfectly legitimate. In fact there is probably no topic relevant to human health which doesn't have its political aspects. The second is illegitimate.
I also disagree with Dr. Mandrola's contention that physicians have no special expertise or knowledge that might help educate the public about the threat of nuclear war to human health. One counterexample is knowledge about the effect of radiation on human health. After the atomic bomb was dropped on Hiroshima, physicians and other scientists learned a great deal about how the resulting radiation affected its victims. Even today that information is not common knowledge, and so it's entirely appropriate for physicians or other scientists to educate the public about this in the interest of promoting public health.
The same point is made in the JAMA editorial condemned by Dr. Mandrola. The authors say in relation to the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017: "International medical organizations ... had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war."
I didn't interpret Dr. Mandrola's post as discouraging doctors from providing input, but rather to not advocate for any specific policies. Policies are usually value judgements, as opposed to absolutes, that consist of trade offs. I'm not sure there's a policy that is all upside? This is where we don't have the expertise. We don't have the qualifications or the time to calculate the economic, environmental, social, etc effects against the DIRECT health effects of a given policy decision.
The role of science is to provide objective data that can be used to inform policy decisions. Policy-makers then interpret the data through the lens of society's values, evaluating the trade-offs, and make a decision. So there's nothing wrong with talking about the effects of radiation, but advocating for expansion of nuclear power, or a ban on nuclear power, is something different.
The second issue is the loss of trust by alienating people (patients) with the value judgements we make ("policy advocacy"). There has been some research supporting this concern, most recently the study by Floyd Zhang a few months ago. The impact of Nature expressing its support for one party resulted in the loss of trust in 50%, without a concomitant increase in trust on the other 50%. Trust, of course, is the foundation of a good therapeutic relationship.
I also don't buy the "everything is political argument". I think that one of medicine's great mistakes was embracing a political approach to solving challenges healthcare. I think that it is corrupting us as we make more and more decisions based on "optics", instead of what is best for our patients. The "Doctor Death Podcast" is only one (albeit extreme) example of the profession prioritizing optics over patients.
Why did the ingredients for what's inside those jabs consist of blank piece of paper... and I'll stop here.... it's a lot to take in... if you ever look it up anyway. Ignorance was bliss i can tell you that!
Then lookup chlorine dioxide, the deadliest chemicals only good for manufacturing... but not for us according to the cdc... This one is too much for some of you who still believe in doctors... Oh well.
Take a vector virus known to us like the common cold. Insert a segment from "the book of life" but from a foreign one known to be a cardio toxin . Inject it where nature would never have put it and have it, adenosine, be like a trojan horse, delivering this traitorous message to manufacture this cardio toxin in every nook and cranny of you. Then watch the immune system, so sorry to have betrayed the host's trust, you, it just might spend the rest of its life destroying every instantiation from that messenger... Even if that means forgetting about taking care of cancer cells, anything ending in -itis.... restraining the viruses, bacteria and fungus inside and on you, outnumbering your own cells by as low as 1to1 to as high as 10to1... Viruses. Bacteria fungus inside you outnumber you... Fuck fauci. The discoverer of "deadly novel" viruses, of which a drop of ocean contains billions...really novel to y'all. Think and say fuck fauci already!
The only thing between a doctor and you is your immune system. Why do ALL "medicine made for you" to quote bill gate, always hurt your immune system? Don't believe me. Look it up
Even though one cannot measure deceit from written words to some extent, i think you sound innocent. The fact that you differentiate the sceptic from the cynic is not good in this case since the affront was so clear and the brainwash powerful enough to hide some... Not all. Most was complavency and laziness in never finishing this old saying: trust but ... Verify. To your defense the brainwash is old. As ild as this mantra we never stopped using because... safe and efficacious... no not that saying but this one: hiv, the virus that causes aids... Forget that aids means nothing... because eternally changing reasons for having a low or bad immune system... what acquired immunodeficiency means, never say from what hence the mantra lol, and forget that an ever evolving syndrome means you can update it when people start questioning it, forget all that and ask yourself why this .."x the virus that causes y" is always used with viruses found by fauci and birx since the 80s. Look it up! Can't miss it... Ebola hiv zika covid... Look it up
M makkous asked what equity was and what it had to do with a doctor for each parts of you?
equity noun (VALUE) FINANCE & ECONOMICS
The value of a company, divided into many equal parts owned by the shareholders, or one of the equal parts into which the value of a company is divided:
He sold his equity in the company last year.
The rights give holders the opportunity to purchase additional equity interests in the company at a big discount.
Read this and tell me if you think you should listen to your doc. This is the Hippocratic oath...then tell me how far we are from any of it. Not too much to ask of them is there?
I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer's oath, but to nobody else.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.[6] Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.[5] – Translation by W.H.S. Jones.
You're right, that was uncalled for. A reaction to the combination of two words, doctor and trust...but not an excuse so I apologize for the nasty words. I a former burn tech in Arizona burn center though, will tell you trusting your doctor will be the death of you. How's this for cogent: any profession that claims to be in healthcare but actually has a vested interest in your continued dis-ease, is actually a disease care system. They always, by definition, instill a lack of ease, a dis esse, like priests and lawyers, to better fleece you.
"Enviromental stewardship" is a very good one. Much better than many of the common fearmongering and everchanging ones.
The rest, 100% agree. But, I mean, the viewpoint sections of the main journals have been something as a one-sided politic column for a whille, so, saddly, nothing real new. Saddly.
Thank you.
The single most hypocritical article you've ever published. Prasad is a political ideologue. While claiming to be a "progressive", his flawed meanderings about Covid were initially funded by a libertarian thinktank. His political comments are solely to attack democrats, except for giving shade to RFKJr, who should be banned from any serious discussion about anything, period.
Speaking as a political scientist, the tragedy of the editorial on nuclear war is that absolutely nobody in that policy area will see it anyway, let alone care what the authors say or think. It's a complete waste of time, like demonstrating against Peruvian vaccination mandates in Timbuktu. The authors might as well have spent their time watching TV or picking their noses.
On the broader question, do you think that the many medical journal editorials about racism were also misplaced when they strayed beyond the topics of racism in medicine or the impacts of racism on medicine?
I agree that politics should not have a place in medical journals. However, nuclear war is without a doubt associated with death and large scale destruction and I think that not just physicians but other professions and society as a whole should raise it’s voice by any available means to prevent such a global disaster.
"There is only so much time. Why not spend it on being better at helping sick people."
One could use this argument to deny physicians the right to do anything unrelated to medicine.
Medical professionals are human beings who (generally) need to engage with the full spectrum of human activity to derive meaning and satisfaction. This spectrum includes – in addition to professional matters – things like family, culture, and politics.
-------------------------------------------------------------------------------------------
“As private citizens, we can and should have ideas on policy. But our medical training provides us no expertise on policy.”
Agreed that clinical expertise does not necessarily translate to political/economic expertise, but this is not grounds for denying clinicians the right to take political stances. It is grounds for paying attention to the people who have the necessary expertise/skill (be they clinicians or not).
-------------------------------------------------------------------------------------------
“Public health people might also claim climate change as their issue. I get it. Except, what expertise does your MPH give you in geothermal science? Or the negative externalities of different solutions?”
This argument would be sound if people were asking physicians about the physics of climate change or the economic implications of opting for one policy versus another. But they are not.
Most physicians who work on this do so with the aim of describing the impact of the climate on human health. They may do so well or badly. In the latter case, we should criticize the methodological quality of the work as we would any other scientific endeavor. But I do not see why we should criticize the mere attempt to analyze the public health implications of climate change.
-------------------------------------------------------------------------------------------
“Another downside of these forays into policy is the possibility of reducing trust—which is already at a low level.”
Conversely, one could argue that a medical community divorced from the concerns and burdens of the society at large can be deemed irrelevant to, and removed from, the lives of everyday folk.
-------------------------------------------------------------------------------------------
"Taking a stand on a political matter is fine for persons, but it is not fine for clinicians or scientists.”
This is the fundamental disagreement I have. Are clinicians and scientists not persons? I don’t see how one can justify denying clinicians/scientists specifically the right to have (or take a stand on) political opinions.
-------------------------------------------------------------------------------------------
“Of all the institutions in healthcare that must be neutral it is journals. This is where the evidence that drives decisions comes from.”
They should be neutral in so far as they should be willing to publish opposing viewpoints that are reasonably well argued and supported by evidence (derived from work done decently well).
But this does not mean that a medical journal should shy away from publishing articles that are directly relevant to human health (be that nuclear Armageddon or climate change) simply because they garner controversy or strong opposing opinions. It would, however, be perfectly sound to criticize these articles on the grounds of severe methodological flaws (if present).
-------------------------------------------------------------------------------------------
I agree with Ahmed Sayed's comments.
I believe Dr. Mandrola has conflated two things that are very different: first, medical journals publishing opinions on issues which are directly relevant to human health and which also have political aspects; second, medical journals (or physicians or scientists) advancing poor science in support of a particular political position. The first is perfectly legitimate. In fact there is probably no topic relevant to human health which doesn't have its political aspects. The second is illegitimate.
I also disagree with Dr. Mandrola's contention that physicians have no special expertise or knowledge that might help educate the public about the threat of nuclear war to human health. One counterexample is knowledge about the effect of radiation on human health. After the atomic bomb was dropped on Hiroshima, physicians and other scientists learned a great deal about how the resulting radiation affected its victims. Even today that information is not common knowledge, and so it's entirely appropriate for physicians or other scientists to educate the public about this in the interest of promoting public health.
The same point is made in the JAMA editorial condemned by Dr. Mandrola. The authors say in relation to the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017: "International medical organizations ... had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war."
I didn't interpret Dr. Mandrola's post as discouraging doctors from providing input, but rather to not advocate for any specific policies. Policies are usually value judgements, as opposed to absolutes, that consist of trade offs. I'm not sure there's a policy that is all upside? This is where we don't have the expertise. We don't have the qualifications or the time to calculate the economic, environmental, social, etc effects against the DIRECT health effects of a given policy decision.
The role of science is to provide objective data that can be used to inform policy decisions. Policy-makers then interpret the data through the lens of society's values, evaluating the trade-offs, and make a decision. So there's nothing wrong with talking about the effects of radiation, but advocating for expansion of nuclear power, or a ban on nuclear power, is something different.
The second issue is the loss of trust by alienating people (patients) with the value judgements we make ("policy advocacy"). There has been some research supporting this concern, most recently the study by Floyd Zhang a few months ago. The impact of Nature expressing its support for one party resulted in the loss of trust in 50%, without a concomitant increase in trust on the other 50%. Trust, of course, is the foundation of a good therapeutic relationship.
I also don't buy the "everything is political argument". I think that one of medicine's great mistakes was embracing a political approach to solving challenges healthcare. I think that it is corrupting us as we make more and more decisions based on "optics", instead of what is best for our patients. The "Doctor Death Podcast" is only one (albeit extreme) example of the profession prioritizing optics over patients.
Why did the ingredients for what's inside those jabs consist of blank piece of paper... and I'll stop here.... it's a lot to take in... if you ever look it up anyway. Ignorance was bliss i can tell you that!
Then lookup chlorine dioxide, the deadliest chemicals only good for manufacturing... but not for us according to the cdc... This one is too much for some of you who still believe in doctors... Oh well.
Take a vector virus known to us like the common cold. Insert a segment from "the book of life" but from a foreign one known to be a cardio toxin . Inject it where nature would never have put it and have it, adenosine, be like a trojan horse, delivering this traitorous message to manufacture this cardio toxin in every nook and cranny of you. Then watch the immune system, so sorry to have betrayed the host's trust, you, it just might spend the rest of its life destroying every instantiation from that messenger... Even if that means forgetting about taking care of cancer cells, anything ending in -itis.... restraining the viruses, bacteria and fungus inside and on you, outnumbering your own cells by as low as 1to1 to as high as 10to1... Viruses. Bacteria fungus inside you outnumber you... Fuck fauci. The discoverer of "deadly novel" viruses, of which a drop of ocean contains billions...really novel to y'all. Think and say fuck fauci already!
The only thing between a doctor and you is your immune system. Why do ALL "medicine made for you" to quote bill gate, always hurt your immune system? Don't believe me. Look it up
Even though one cannot measure deceit from written words to some extent, i think you sound innocent. The fact that you differentiate the sceptic from the cynic is not good in this case since the affront was so clear and the brainwash powerful enough to hide some... Not all. Most was complavency and laziness in never finishing this old saying: trust but ... Verify. To your defense the brainwash is old. As ild as this mantra we never stopped using because... safe and efficacious... no not that saying but this one: hiv, the virus that causes aids... Forget that aids means nothing... because eternally changing reasons for having a low or bad immune system... what acquired immunodeficiency means, never say from what hence the mantra lol, and forget that an ever evolving syndrome means you can update it when people start questioning it, forget all that and ask yourself why this .."x the virus that causes y" is always used with viruses found by fauci and birx since the 80s. Look it up! Can't miss it... Ebola hiv zika covid... Look it up
You are the company and whomever is peddling DEI on purpose is a traitor.
Diversity equity and inclusion are the telltale signs of ESG traitors.
M makkous asked what equity was and what it had to do with a doctor for each parts of you?
equity noun (VALUE) FINANCE & ECONOMICS
The value of a company, divided into many equal parts owned by the shareholders, or one of the equal parts into which the value of a company is divided:
He sold his equity in the company last year.
The rights give holders the opportunity to purchase additional equity interests in the company at a big discount.
Oh... All this was for bjorn ironside
I just made this up again... Be harsh or don't be but listen deeply :)
A doctor for your nose
A doctor for your elbow
A doctor for your spleen
A doctor for your heart
A doctor for your weewee
Another altogether for your whowho
Have they met i wonder or is there
A doctor for your baby
A doctor for your momma
A doctor for every part of you
Geez this sound like i need
A doctor for my brain
A doctor for what goes on in my brain
A doctor too many! Why have they replaced
The only doctor that'd be,
Nature taking its course, while the
One doctor for all of me, holds my hand
And prays with me, that time is added not taken by
A doctor for my money and yours too.
Read this and tell me if you think you should listen to your doc. This is the Hippocratic oath...then tell me how far we are from any of it. Not too much to ask of them is there?
I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer's oath, but to nobody else.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.[6] Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.[5] – Translation by W.H.S. Jones.
You're right, that was uncalled for. A reaction to the combination of two words, doctor and trust...but not an excuse so I apologize for the nasty words. I a former burn tech in Arizona burn center though, will tell you trusting your doctor will be the death of you. How's this for cogent: any profession that claims to be in healthcare but actually has a vested interest in your continued dis-ease, is actually a disease care system. They always, by definition, instill a lack of ease, a dis esse, like priests and lawyers, to better fleece you.
you're a doctor...there you go. A shame of a man. All of the sudden with a voice. Right and wrong are yours. Have at it dumbass hahaha!