Corrupting Medical Education

In keeping with these GEITP pages sometimes discussing fraud and corruption in science — the attached article by Jane M. Orient, MD (who practices internal medicine in Tucson AZ, and serves as executive director of Assn Am Physicians & Surgeons and managing editor of the J.A.P.S.), is especially remarkable in that she brings together medical care and fundamental climatology, combined with how these fields intersect with public policy and (unfortunately) politics. Because this topic dovetails into GEITP discussions from last Sept (“Corrupting Medical Education”), we have included those articles and comments below.

A “climate emergency” has recently been declared by one segment of the population, and there are pressure groups — throughout the Western World [but, interestingly, not Asia, Africa or South America) — that are demanding radical change in all areas of life, including medical ethics. And there seems to be “no time” for reflection or the gathering or discussion of scientific evidence. Just this morning on The Weather Channel, there was an advertisement about “The Rush to Save the Planet.” Can this become even more hysterical and nonsensical than it is today?

According to the first of the A.A.P.S. Principles of Medical Ethics, “The physician’s first professional obligation is to his patient, then to his profession. His ethical obligation to his community is the same as that of any other citizen.” The AAPS motto “omnia pro aegroto” means “everything for the patient.” In recent decades, organized medicine — notably the Am Med Assn (AMA) and the Am Coll of Physicians (APS) — has introduced a fundamental transformation: Individual patient welfare has now become subordinate to a perceived collective benefit. The AMA states “there are multiple stakeholders, whose interests must be balanced.” Various groups seek to divert physicians’ energy and capitalize on their trusted status to promote a political agenda.

In the current widely promoted extreme view, “our ailing planet” is supposed to be our first priority. In a Nov 2019 N Engl J Med article, authors write: “We believe that the current imperative for climate action requires physicians to mobilize politically as they have before, again becoming fierce advocates for major social and economic change. A truly ethical relationship with the planet that we inhabit so precariously, and with the generations who will follow, demands nothing less.” Another article [see attached] wrote in the 1990 Ann Int Med: “global environmental change including, potentially, global warming, which is produced by the growing numbers and activities of human beings, threatens the habitability of the planet and the health of its inhabitants. Thus, it is socially responsible for physicians to use “their expertise about the environment” to try to prevent such change.”

In this 5-page Guest Editorial, Dr. Orient carefully lays out the problems with this naïve view: [a] If one studies and understands the actual atmospheric scientific data that exist, there is no climate crisis; [b] the UN International Panel on Climate Change (IPCC) even admits that proposed “actions to curb global warming” will have no measurable impact on climate; [c] It is impossible to replace the >80% of the world’s energy now generated by coal, oil, and natural gas — with wind or solar energy, given the requirements for land, metals, concrete, and energy-intensive manufacture (also, these ‘renewal energies’ actually cost more and create a larger ‘carbon footprint’ than fossil fuels); [d] Rising atmospheric CO2 levels claimed to be correlated with rising global temperatures actually show that warming ocean temperatures precedes the rise in CO2 levels, not the other way around; [e] Life on Earth is based on carbon, and CO2 is beneficial to plants (thus, to consider lowering CO2 is complete nonsense); [f] Ice-core data show ~115,000-year Glacial-Interglacial cycles — since coming out of our last serious Glacial Cycle ~11,500 years ago, it only makes sense that Earth must be warming, before it again cools; [g] The (‘consensus’) assertion that “97% of climate scientists agree with the apocalyptic climate scenarios” is completely bogus (the actual value is well under 20%, simply because most scientists are as illiterate as journalists sand politicians about climatology); and [h] Fossil fuel energy is correlated with better health — therefore, eliminating fossil fuels will negatively affect human health, and especially for those in poverty.

Those GEITPers who have an open scientific mind are urged to read carefully the attached article. 😊 Those GEITPers who cannot separate political agenda from science will probably delete this GEITP email without looking at the attached article. ☹

DwN

From: Nebert, Daniel (nebertdw)
Sent: Monday, September 23, 2019 3:48 PM
Subject: Corrupting Medical Education

We have one final episode on this topic. Among a number of comments to Professor Boat’s email, I have chosen three and we will keep them “anonymous.”

—DwN

From: Anonymous PhD professor
Sent: Thursday, September 19, 2019 10:03 AM

May I offer a different approach to this problem? If med schools need to be 5 or 6 years long – in order to cover all important material to teaching med students everything, well then that should happen. The amount of (increasing, exploding) information that is now relevant to health and well-being of our species (our planet) can probably never be covered in the short 4 years allotted now, nor in the ensuing years of internship and residence. If overall information has increased, and the educational needs are increased, then why not increase the length of time spent in medical school…?

From: Anonymous MD faculty
Sent: Thursday, September 19, 2019 4:21 PM

We “should be teaching gun control, social justice, racial inclusivity, health disparities, cultural diversity, and global warming in medical school?” Come on. Give me a break. Recently our own medical school curriculum decided to drop biochemistry, as a “course no longer needed for physicians.” What’s next – should we drop pathology? physiology? parasitology? microbiology?

Any reasonably intelligent child – who ultimately might attend medical school – should be able to learn all he needs to know about “social justice, racial inclusivity, health disparities and cultural diversity” during his childhood years within his own family, combined with his early school years, and church. I am reminded of Robert Fulghum’s book, decades ago: “All I Really Need to Know I Learned in Kindergarten.” If a child by age 12 does not “know” about these issues, what further can be learned by a college or medical school course in such topics?

“Gun control” and “global warming,” on the other hand, are absolutely 100% political issues, and certainly not related to any “medical education.” The extremely complex field of “climate change” (which has been occurring since Earth first formed) can be taught in middle school – if teachers are willing to teach the actual principles of atmospheric sciences.

From: Anonymous retired Jesuit Priest
Sent: Friday, September 20, 2019 4:12 PM

Rigorous scientific medical training should be the overwhelming goal of medical schools. All this “social reality promotion” is taken care of by other institutions (prior to medical school) in our general society; in fact, this is why new “social scientists” within the medical profession have become aware, in the first place, of these purported social problems. However, I do not want to go to a physician to hear him preach to me about social ills!

From: Nebert, Daniel (nebertdw)
Sent: Thursday, September 19, 2019 9:04 AM

Thank you for your email, Tom. This topic can easily “tip over into” polarizing politics of the “extreme left” versus the “extreme right.” In presenting this [see everything below], I’ve tried hard to stay in the “strait-and-narrow” — between medical education and politics. There were hundreds of online “comments” to those newspaper articles — which I chose not to share with GEITP, because many were inappropriate for these GEITP pages.

DwN

From: Boat, Thomas
Sent: Thursday, September 19, 2019 6:39 AM
To: Nebert, Daniel (nebertdw)
Subject: RE: Corrupting Medical Education

Dan— I am usually in agreement with your assessments. On this one, I cannot be more concerned about your position. If medicine does not engage health promotion and prevention and get more involved with mitigating social determinants of health as well as promoting behavioral as well as physical health, our nation will continue to be in a position of rescuing more and more adults whose health could have been improved through early life (0-5) attention to all dimensions of health promotion as a part of well child care. This effort must include attention to family well-being, but also school, community, state and national support and policies for improving environments in which children are raised. Medicine can be a direct participant and an advocate for these efforts.

See the recently released report from the National Academies of Sciences, Engineering and Medicine titled Fostering Healthy Mental, Emotional and Behavioral Development for Children and Youth. The social and economic welfare of our country is at stake — as increasing numbers of our children are hitting adulthood with behavioral disorders, chronic diseases, and inability to contribute to society by productively joining the workforce. If medicine does not do its part, shame on us. One further point, if these considerations are not a part of training, medicine is unlikely to contribute. This is not left wing thinking. Please do not make an important determinant of our economic future a polarizing issue. You can share this point of view with others if you wish.

Tom

[Emeritus; formerly Dean of the University of Cincinnati College of Medicine; formerly Director of Cincinnati Children’s Hospital]

From: Nebert, Daniel (nebertdw)
Sent: Wednesday, September 18, 2019 4:53 PM
Subject: Corrupting Medical Education

In the Sept 17 article “Corrupting Medical Education” [see far below], some of you told me that they cannot download the original Sept 12 article by Dr. Goldfarb — without a subscription to Wall Street Journal. Consequently, I am now pasting it below, for everyone’s reading pleasure. This article was in WSJ online evening of Sept 12, out in print morning of Sept 13. For your bedtime reading pleasure. One of the ongoing themes of these GEITP pages is to discuss fraud and corruption in science and medicine.

DwN

Take Two Aspirin and Call Me by My Pronouns
At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness.

By Stanley Goldfarb

Sept. 12, 2019 5:54 pm ET

The American College of Physicians says its mission is to promote the “quality and effectiveness of health care,” but it’s stepped out of its lane recently with sweeping statements on gun control. And that isn’t the only recent foray into politics by medical professionals. During my term as associate dean of curriculum at the University of Pennsylvania’s medical school, I was chastised by a faculty member for not including a program on climate change in the course of study. As the Journal reported last month, such programs are spreading across medical schools nationwide.

Why have medical schools become a target for inculcating social policy—when the stated purpose of medical education since Hippocrates has been to develop individuals who know how to cure patients?

A new wave of educational specialists is increasingly influencing medical education. They emphasize “social justice” that relates to health care only tangentially. This approach is the result of a progressive mind-set that abhors hierarchy of any kind and the social elitism associated with the medical profession in particular.

These educators focus on eliminating health disparities and ensuring that the next generation of physicians is well-equipped to deal with cultural diversity, which are worthwhile goals. But teaching these issues is coming at the expense of rigorous training in medical science. The prospect of this “new,” politicized medical education should worry all Americans.

The traditional American model of medical training, which has been emulated around the world, emphasizes a scientific approach to treatment, and it subjects students to rigorous classroom instruction. Students didn’t encounter patients until they had some fundamental knowledge of disease processes and knew how to interpret symptoms. They were expected to appreciate medical advances and be able to incorporate them into their eventual fields of practice. Medical education was demanding and occasionally led to student failure, but it produced a technically proficient and responsible physician corps for the U.S.

The traditional American model first came under attack by progressive sociologists of the 1960s and ’70s, who condemned medicine as a failing enterprise because increased spending hadn’t led to breakthroughs in cancer treatment and other fields. The influential critic Ivan Illich called the medical industry an instrument of “pain, sickness, and death,” and sought to reorder the field toward an egalitarian social purpose. These ideas were long kept out of the mainstream of medical education, but the tide of recent political culture has brought them in.

As concerns about social justice have taken over undergraduate education, graduate schools have raced to develop curricula that will steep future educators in the same ideology. Today a master’s degree in education is often what it takes to qualify for key administrative roles on medical-school faculties. The zeitgeist of sociology and social work have become the driving force in medical education. The goal of today’s educators is to produce legions of primary care physicians who engage in what is termed “population health.”

This fits perfectly with the current administrator-rich, policy-heavy, form-over-function approach at every level of American education. Theories of learning with virtually no experimental basis for their impact on society and professions now prevail. Students are taught in the tradition of educational theorist Étienne Wenger, who emphasized “communal learning” rather than individual mastery of crucial information.

Where will all this lead? Medical school bureaucracies have become bloated, as they have in every other sphere of education. Curricula will increasingly focus on climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness. And so will many of your doctors in coming years.

Meanwhile, oncologists, cardiologists, surgeons and other medical specialists are in short supply. The specialists who are produced must master more crucial material even though less and less of their medical-school education is devoted to basic scientific knowledge. If this country needs more gun control and climate change activists, medical schools are not the right place to produce them.

Dr. Goldfarb is a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine.

From: Nebert, Daniel (nebertdw)
Sent: Tuesday, September 17, 2019 1:37 PM
Subject: Corrupting Medical Education

This was recommended to me (to be shared with all of GEITP) by several Readers. This brief article appeared in the Wall Street Journal online, afternoon of Sept 15, out in print morning of Sept 16. It refers to an earlier article (by Dr. Goldfarb) from the week before, which can be clicked on and downloaded.

DwN

Corrupting Medical Education
The reaction to Dr. Goldfarb’s op-ed proves his point.

By The Editorial Board

Sept. 15, 2019 4:09 pm ET

Stanley Goldfarb knew what he was talking about. Last week the former associate dean of curriculum at the University of Pennsylvania medical school wrote in these pages that climate change, gun control and “other progressive causes only tangentially related to treating illness” were beginning to corrupt medical training. His piece spurred a social-media eruption that immediately proved his point.

Left-wing Medical Twitter —yes, there is such a thing—piled on, with virtue signaling that distorted Dr. Goldfarb’s argument. He didn’t write that doctors shouldn’t have opinions about political issues. He wrote that those issues shouldn’t interfere with the scientific and clinical training essential to producing doctors who can serve patients.

The most disappointing response came from Penn medical school, which sprinted for political cover. Dean J. Larry Jameson and Senior Vice Dean Suzanne Rose sent a letter to students and faculty that is a case study in progressive correctness:

“Please know that the views expressed by Dr. Goldfarb in this column reflect his personal opinions and do not reflect the values of the Perelman School of Medicine,” the letter said. “We deeply value inclusion and diversity as fundamental to effective health care delivery, creativity, discovery, and life-long learning. We are committed to ensuring a rigorous and comprehensive medical education that includes examination of the many social and cultural issues that influence health, from violence within communities to changes in the environment around us.”

Maybe we should begin to wonder about the quality of the doctors who graduate from Penn. Patients want an accurate diagnosis, not a lecture on social justice or climate change. Thanks to Dr. Goldfarb for having the courage to call out the politicization of medical education that should worry all Americans.

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