American Medical Lysenkoism
I am a Soviet refugee, and this fact affects my worldview.
Science in the Soviet Union was controlled by political ideology. The most infamous example was Lysenkoism. Championed by Trofim Lysenko, Lysenkoism was an ideological school of thought that rejected Mendelian genetics and natural selection as bourgeois science in favor of a theory congruent with Marxist-Leninist philosophy. Ignoring the foundational tenets of science -- such as rationality, observation and empiric thought -- the implementation of Lysenkoism to agriculture resulted in disastrous famine, all the while, the Soviet media celebrated Lysenko’s successes. In the face of reality and obvious calamity, real scientists, opponents to the further implementation of the ideology, were publicly humiliated, tried in sham public trials, sentenced to hard labor and executed.
Unfortunately, tenets of medical Lysenkoism are becoming pervasive in American medical science. We are seeing suppression of reasonable disagreement, ideological purity testing and attempts to legislate acceptable medical practice to conform to the desired ideological dogma. The areas in which examples are most evident are COVID-19 policy, topics related to diversity, equity, and inclusion (DEI) and management of gender dysphoria.
I was reminded of medical Lysenkoism when the California Legislature recently approved a bill that designates the providing of false or misleading information as unprofessional conduct and could result in disciplinary action by the state medical board. Such disciplinary actions include revoking the medical license of a physician found guilty of spreading information not considered appropriate under the law. The law, AB-2098 Physicians and Surgeons: Unprofessional Conduct, is now the first in the nation to legislate what is acceptable information in medical science. According to the bill, it was drafted to target misinformation and disinformation related to the SARS-CoV-2 pandemic. I fear, however, that the target of this bill will expand to cover the entirety of medical science.
The fundamental question raised by AB-2098 will of course be: who is the arbiter of what is and what is not mis or disinformation? Medical practice and medical policy making depend on the interpretation of medical evidence -- the application of evidence through a professional lens to the individual or the population. There are recommendations and practice guidelines published by professional medical societies, but it is the physician, in consultation with his or her patient, who ultimately determines the optimal course of treatment.
Let’s look at the three areas in which medical Lysenkoism seem most prominent. During the COVD-19 pandemic, scientific evidence evolved particularly quickly, therapies and treatments changed and individual physicians interpreted and applied available information differently to different cases. One rich example was cloth masking. A now famous study demonstrated that cloth masks were ineffective in preventing the spread of SARS-CoV-2. This result was eventually acknowledged by the Centers for Disease Control and Prevention (CDC) in January of 2022. Given that all States and the Federal Government had previously mandated cloth masking, there was a time that a physician who stated that cloth masks did not minimize the spread of SARS-CoV-2 (the truth) could have been liable under the disinformation law.
Mandating what is acceptable practice when there is a paucity of scientific evidence or, even worse, when the mandates contradict the body of published literature, is concerning. Most of medical practice is based on only a partial understanding of disease and therapeutics. I would like to believe that the authors of the California legislation drafted it in good faith. But the historical precedent for medical corruption, when merged with government power, is robust. My fear is that the law, as written, threatens to bring the medical establishment under the umbrella of the apparatus, arming them with a tool to propagate its Lysenkoist agenda.
A second example. Medical schools filter applicants for those who conform to a political ideology. The medical school application process involves a primary common application and secondary school specific applications. A recent report by the Do No Harm organization (an organization whose mandate is to “fight for individual patients – and against identity politics”) demonstrated how pervasive tests of ideological conformity are in the application process. The report found 72% of the top 50 medical schools (and 8 of the top 10 schools) use questions to test if applicants subscribe to the institution’s preferred ideology on race-based personnel actions. As one example, SUNY Downstate Medical Center-College of Medicine directly asks how the applicant has, is, or will be an advocate, an apparatchik, of their cause: “What in your current/future activity/activities have/will contribute to diversity, health equity and social justice?”
The goal of ideological conformity in American medical education, I fear, is to expropriate medical education from the imperfect, excellence-based standards in favor of training individuals to become “apparatchiks” of an ideological cause. In this case any skepticism, even empiric, must not be tolerated. The case of Dr. Norman Wang is an exemplary anecdote which reads like a “struggle session”. In 2020, Dr. Wang authored a white paper in the Journal of the American Heart Association (which cannot be linked as it has been retracted). Dr. Wang outlined the history of affirmative action and offered criticism, albeit mild, of DEI policies. He put forth such controversial ideas as, “Ultimately, all who aspire to a profession in medicine and cardiology must be assessed as individuals on the basis of their personal merits, not their racial and ethnic identities.” Predictably (in the current atmosphere) he was attacked on social media and the journal retracted the paper (against Dr. Wang’s objections). The Journal apologized, denounced the views expressed in the paper and stated that the article was a misrepresentation of the facts. The American Heart Association launched a formal investigation to “better understand how a paper that is incompatible with the Association’s core values was published.” In other words, to eliminate the possibility that other counter-revolutionary thinking might be published. Needless to say, the University where Dr. Wang was employed dutifully fired him and his colleagues publicly denounced him for his wrong-think.
Perhaps no other area that demonstrates medical Lysenkoism as well is the management of adolescents with gender dysphoria. In the US, the current politically acceptable approach to therapy is to accept the gender identity of the individual and utilize medical and surgical treatments to bring the body into congruence with the subjective gender. The alternate view sees current practice as running counter to established medical practice in which non-congruence between biological sex and gender identity as pathologic.
The debate around care of gender dysphoria in children and adolescents is a real one. On one side are patients and parents who truly feel that gender affirming care is in the best of interest of themselves and their children. It is a patient population at high risk for bias, ostracism and suicide. On the other side is a group who sees novel therapies, with lifelong impacts, being applied only recently and with little data. They note that the associated medical and surgical procedures have high complication rates and may commit patients to lifelong medical care. In addition, the evidence supporting a gender affirming approach is low quality and limited.
Given the lack of open debate, it is probably worth stating recent evidence and events in this field. Recently, there was the high-profile closure of the Tavistock gender clinic in the United Kingdom after a review by the UK National Health Service (NHS) cited studies contradicting the gender affirming approach. One example is a 30-year-long Swedish study which followed people after gender reassignment surgery and demonstrated a higher mortality rate for patients undergoing transition. Reviews by the UK’s National Institute for Health and Care Excellence evaluating medical management of “puberty blockers” and cross-sex hormones for children demonstrated that there was little or no changes in mental health or functioning and there was not enough evidence to form a policy decision. They stated that all evaluated studies were of low quality and there was no way to determine if these “treatments bring any benefit or harm to minors.” Finland’s Council for Choices in Health Care labeled “gender reassignment of minors as an experimental practice,” with gender dysphoria in childhood having a high-resolution rate.
In all these cases, disagreement seems increasingly unwelcome. Like the Soviet Lysenkoists who ignored the starving citizenry and purged the scientists who dared question their methods, supporters of gender affirming therapy seem unwilling to entertain an alternative view. Recent recordings of medical grand rounds at the Vanderbilt University Medical Center demonstrate the institution threatening retaliation against physicians who object to the medical transition of children and suggesting that they find other places for employment. The biologist Colin Wright was sanctioned for stating that sex was binary and not a spectrum.
Being a Soviet refugee, I see more and more signs that remind me of life in the Soviet Union where censorship and self-censorship were rife. Medical professionals often do not speak out in support of the truth, or at least civil debate, because of fear of retaliation. With doctors and scientists being censored and fired for debating debatable issues that do not align with the acceptable political trends, American medical science is sliding into Lysenkoism. Science is dissent, disagreement and discussion. If this process, born in the enlightenment, is subverted, we are no longer scientists or doctors. The censoring of views on social media (or the awareness of a need to self-censor) is unscientific and un-American. Tension in this realm is especially prevalent in the medical community for people who critique or disagree with COVID policies, DEI initiatives and the treatment of gender dysphoria.
To mitigate and reverse this slide we must be foundationally scientific. This involves using empiricism to reach conclusions, no matter how inconvenient they may be to our worldview. We must commit to not selecting data, regardless of how inadequate, to justify an ongoing commitment to ideology. We must encourage and promote dissent to ensure our conclusions and policies stand up to ongoing scrutiny as knowledge evolves. We must object to labeling any skepticism as “phobic” or “conspiratorial,” the modern-day Lysenkoist version of “wreckers, saboteurs, and counter-revolutionaries.” Ultimately, we must have courage: the courage to stand up for truth and the courage to stand up to the media that have successfully commandeered the truth and become apparatchiks curating information to mold society to their desired worldview. And we must have the courage to stand up to the social media mobs that succeeded in coercing multiple medical journals in retracting scientific papers considered unacceptable or subversive for the party-line.
We must continue to be vigilant to uphold and elevate empiricism and data and the ongoing dialogue with reasonable disagreement. The curtailment of scientific discourse is not acceptable for human flourishing. Historical precedent is noticeably clear, and it is our obligation prevent a Lysenkoist era in the United States.
Dr. Gary Levy is a practicing OB/GYN, Reproductive Endocrinologist, Residency Program Director, Associate Professor of OB/GYN and a Military Physician. He is a refugee from the former Soviet Union and is concerned about the similarities that are arising in science and medicine to the totalitarian aspects of Soviet society. The views expressed are the author’s and do not reflect the views of the Army Medical Department, the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.
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