I agree that everyone advocates for certain interests to some extent, but when this advocacy becomes disproportionate, defies reason, or contradicts medical ethics and safety, it crosses a line. Failing to address such imbalances makes one complicit in perpetuating inequities. To ensure medical policy is grounded in rigorous, evidence-based research, we need a clear separation between federal government influence and medical bureaucracy. This could involve:
Establishing robust systems to ensure medical research directly informs policy, free from undue external pressures.
Creating independent, thoroughly vetted mini-governing bodies to oversee research and policy alignment, ensuring no policy contradicts established medical science.
A secular division within medical governance would help safeguard the integrity of medical standards and prioritize patient safety over political or corporate agendas.
Sorry, I’m going to unsubscribe. You are simply too right wing, too wed to RFK type policies. Medicine has a responsibility to society, as do most learned professions. And you ignore years of tested science.
You are being way to mild. Medicine has lost its way. By singling out narrow values to advocate, it ignores others of greater import to patient care both in quality and distribution. It also has started with a premise that there are defined pathways to "success" with certain goals like equity without data behind it and with advocacy instead of science. With advocacy, people start with a view/ideology/conclusion and fit the data to prove it, with science one obtains data, verifies the methods used to obtain it and only then determines conclusions.
In keeping with the pathology of modern society, working for ideologic goals while ignoring goals like quality of performance, care, research etc, allows standards to be lowered Pseudoquality is defined by pseudoscientists based on adherence to ideology not data based outcomes. ( See the Canadian nursing test story, or the UCLA inservice test failure rate story as examples). Why is less than half of the appropriate population fit for military service? Why are there more grammatical and language errors in the NYT than ever? and Where is medicine on these topics?
All this belies the effects of business and government intervening in medical care to bring care quality down. Frustrated physicians, rendered impotent by these forces, like the "university protestors" who have achieved nothing material to help society, turn to ideological bullying to make up for their limitations/failures. We would never have accepted ideologically biased political use of medical journals which is now commonplace.
My first degree was in Classics - I was taught to read/present/argue the best arguments for each position, then navigate a conclusion... That's what I was taught as critical analysis. Simply amassing your side of the fence and tearing down a straw man of the opposition's perspective would fail you - back in the days when students did fail. Critical analysis seems to be a skill on the endangered list; I appreciate Sensible Medicine for providing a forum.
Incidentally, what about the journal articles of the significantly increased rates of neurodivergance in vaxxed versus unvaccinated kids? They do exist. That's a heretical perspective and while it's incredibly hard to get unconfounded data, the raw data is worth acknowledging...
Well said, Heather! You are a rare gem! Critical analysis was specifically targeted to be eliminated from our educational system for a reason - it is a danger to authoritarians.
Gennossen, who writes for prestige or any medical journal? Busy members of the profession lack the time, academics are consumed by woke PC rubbish and the end result is that the entire "credentialed classes" have been taken over by the crazy left who equate DEI with curing and healing. No shocker, given med school admits policies. DONOHARM.org is on target. Meanwhile, as we did back in East Germany, conform, keep quiet, repeat Party slogans ad nausea and no not question the wisdom of the Politburo. Alas, this raging infection is also consuming all branches of the sciences and law, etc. Movies, TV, media....totally in the tank too.
When I was a young physician, I bought a lifetime subscription to the NEJM. In retrospect, that was a wise investment and I still get it on line. I enjoy the published research and clinical cases. For decades, I have been appalled by the editorials and special articles on issues that are of a political nature like Vinay showed here. It has gotten WORSE over time and I really do not bother reading them. I do think that the political bias does reflect what has been going on at the leadership levels of our medical societies and medical schools. I am an enthusiastic dues-paying member of the new organization Do No Harm and encourage others to check it out on line and join up if you are like-minded.
Ethics and transparency in research—and in the publication of that research in biomedical journals—may have been lost as far back as the controlled clinical trial of streptomycin for tuberculosis in World War II veterans. At that point, the genuine uncertainty or equipoise that should underpin all research was perhaps replaced by an overriding “need” for every scientific study to yield positive results aligned with its pre-specified implicit purpose. Peer reviewers of research protocols and biomedical journals have proven particularly efficient in reinforcing this tendency. This lack of transparency has co-opted medicine and eroded—perhaps irreparably—the public’s trust in this noble profession.
As a physician from Alabama who has practiced for over 30 years, I find your articles reasonable and helpful. I pay for your Substack because it adds value to my practice of medicine. I must be old fashion because I believe in meritocracy and color blindness. There is not as much wokeness here in Alabama except for the universities which educate physicians and I do think twice when interacting with a physician who graduated after 2020.
LOSING TRUST IN ALL OF OUR INSTITUTIONS IS A REAL PROBLEM AND I AM NOT SURE IF IT CAN BE REBUILT.
Isn't this just a call for a return of Societies' Journals?
I'm a former academic (lots of top institutions including UChicago). I was very pro open access until I left academia, then I learned the downside. Publishing budgets!
The journals you mention are all on a treadmill driven by the publishing racket. That's the answer to pretty much every rhetorical question posed in this article.
The solution is not to open up the topics in those journals. As this would impact their commercial models. The solution, ugly though it may be, is to consider a return to Society Journals. (Isn't that what Sensible Medicine is in effect doing?)
PS. There are other solutions. I'm totally happy to remove the vanity metric side of academic tenure track, and just generally cut back on the incentives towards producing noise.
I agree that everyone advocates for certain interests to some extent, but when this advocacy becomes disproportionate, defies reason, or contradicts medical ethics and safety, it crosses a line. Failing to address such imbalances makes one complicit in perpetuating inequities. To ensure medical policy is grounded in rigorous, evidence-based research, we need a clear separation between federal government influence and medical bureaucracy. This could involve:
Establishing robust systems to ensure medical research directly informs policy, free from undue external pressures.
Creating independent, thoroughly vetted mini-governing bodies to oversee research and policy alignment, ensuring no policy contradicts established medical science.
A secular division within medical governance would help safeguard the integrity of medical standards and prioritize patient safety over political or corporate agendas.
I still get NEJM even though I canceled my subscription. The only thing I’ll *occasionally* read is the clinical problem solving.
Sorry, I’m going to unsubscribe. You are simply too right wing, too wed to RFK type policies. Medicine has a responsibility to society, as do most learned professions. And you ignore years of tested science.
Well said, particularly #7.
I am convinced that by NOT reading most articles and journals I'm improving my medical skills and knowledge. This furthers my bias.
You are being way to mild. Medicine has lost its way. By singling out narrow values to advocate, it ignores others of greater import to patient care both in quality and distribution. It also has started with a premise that there are defined pathways to "success" with certain goals like equity without data behind it and with advocacy instead of science. With advocacy, people start with a view/ideology/conclusion and fit the data to prove it, with science one obtains data, verifies the methods used to obtain it and only then determines conclusions.
In keeping with the pathology of modern society, working for ideologic goals while ignoring goals like quality of performance, care, research etc, allows standards to be lowered Pseudoquality is defined by pseudoscientists based on adherence to ideology not data based outcomes. ( See the Canadian nursing test story, or the UCLA inservice test failure rate story as examples). Why is less than half of the appropriate population fit for military service? Why are there more grammatical and language errors in the NYT than ever? and Where is medicine on these topics?
All this belies the effects of business and government intervening in medical care to bring care quality down. Frustrated physicians, rendered impotent by these forces, like the "university protestors" who have achieved nothing material to help society, turn to ideological bullying to make up for their limitations/failures. We would never have accepted ideologically biased political use of medical journals which is now commonplace.
Woe to the patients of the future.
Yep
Excellent!
My first degree was in Classics - I was taught to read/present/argue the best arguments for each position, then navigate a conclusion... That's what I was taught as critical analysis. Simply amassing your side of the fence and tearing down a straw man of the opposition's perspective would fail you - back in the days when students did fail. Critical analysis seems to be a skill on the endangered list; I appreciate Sensible Medicine for providing a forum.
Incidentally, what about the journal articles of the significantly increased rates of neurodivergance in vaxxed versus unvaccinated kids? They do exist. That's a heretical perspective and while it's incredibly hard to get unconfounded data, the raw data is worth acknowledging...
Well said, Heather! You are a rare gem! Critical analysis was specifically targeted to be eliminated from our educational system for a reason - it is a danger to authoritarians.
Efforts Towards Equity: Publishing Garbage Papers from People Who Never Learned to Think for Themselves.
Gennossen, who writes for prestige or any medical journal? Busy members of the profession lack the time, academics are consumed by woke PC rubbish and the end result is that the entire "credentialed classes" have been taken over by the crazy left who equate DEI with curing and healing. No shocker, given med school admits policies. DONOHARM.org is on target. Meanwhile, as we did back in East Germany, conform, keep quiet, repeat Party slogans ad nausea and no not question the wisdom of the Politburo. Alas, this raging infection is also consuming all branches of the sciences and law, etc. Movies, TV, media....totally in the tank too.
It works in Communist Countries and many Socialist Countries. Opinions are allowed as long as they comply with govt.
When I was a young physician, I bought a lifetime subscription to the NEJM. In retrospect, that was a wise investment and I still get it on line. I enjoy the published research and clinical cases. For decades, I have been appalled by the editorials and special articles on issues that are of a political nature like Vinay showed here. It has gotten WORSE over time and I really do not bother reading them. I do think that the political bias does reflect what has been going on at the leadership levels of our medical societies and medical schools. I am an enthusiastic dues-paying member of the new organization Do No Harm and encourage others to check it out on line and join up if you are like-minded.
Dear Dr. Prassad,
Ethics and transparency in research—and in the publication of that research in biomedical journals—may have been lost as far back as the controlled clinical trial of streptomycin for tuberculosis in World War II veterans. At that point, the genuine uncertainty or equipoise that should underpin all research was perhaps replaced by an overriding “need” for every scientific study to yield positive results aligned with its pre-specified implicit purpose. Peer reviewers of research protocols and biomedical journals have proven particularly efficient in reinforcing this tendency. This lack of transparency has co-opted medicine and eroded—perhaps irreparably—the public’s trust in this noble profession.
Jairo Echeverry-Raad. MD
As a physician from Alabama who has practiced for over 30 years, I find your articles reasonable and helpful. I pay for your Substack because it adds value to my practice of medicine. I must be old fashion because I believe in meritocracy and color blindness. There is not as much wokeness here in Alabama except for the universities which educate physicians and I do think twice when interacting with a physician who graduated after 2020.
LOSING TRUST IN ALL OF OUR INSTITUTIONS IS A REAL PROBLEM AND I AM NOT SURE IF IT CAN BE REBUILT.
Isn't this just a call for a return of Societies' Journals?
I'm a former academic (lots of top institutions including UChicago). I was very pro open access until I left academia, then I learned the downside. Publishing budgets!
The journals you mention are all on a treadmill driven by the publishing racket. That's the answer to pretty much every rhetorical question posed in this article.
The solution is not to open up the topics in those journals. As this would impact their commercial models. The solution, ugly though it may be, is to consider a return to Society Journals. (Isn't that what Sensible Medicine is in effect doing?)
PS. There are other solutions. I'm totally happy to remove the vanity metric side of academic tenure track, and just generally cut back on the incentives towards producing noise.