Question: what is going on with the incentives within the medical field—academic medicine in particular—that have led to this kind of thing becoming more and more of a problem?
My constant complaining about the injustices of school closures got me booted from Nextdoor. I live in one of the poorest states, NM, where the population is entirely blue. Education is the only way out of poverty. So the boards shut down the schools. NM finally scored below Miss on school performance. Our Gov got re-elected despite poor death counts, rabid shutdowns that killed many small family businesses and no effort to help special ed kids in our Title I schools of which we have a lot. "She did a great job" and the state legislature has made sure that a Republican can never get elected via suitable boundaries. We might be more like CA but without any real national businesses to swell the tax rolls. But we do have much oil except the state really hates that. Notably Los Alamos has the most educated people of any place in the US. They didn't care about kids outside of their area.
Angry beyond words. My kids, and g-kids and gg-kids live elsewhere <sigh>. I love our natural beauty but not our unaccountable leaders. Wasn't always like this and not clear what has changed.
Virtue signalling has run amok, and entering medicine now. As Bill Maher said of the Overton window, “my politics haven’t changed”. It’s not a great time to be a classical liberal these days.
The fixation with “equity”/equality of outcomes is one of the root causes of societal malaise, in and outside of medicine. The list of the “best medical educators” need not be governed by equity; just as the list of “fastest humans”, or “best sopranos”, need not have “equitable” representation. To suggest or insist that they do would be to ignore reality, and is idiotic.
Let's face it--we seldom have true concern/understanding for people who are not in our socio-economic bracket unless we consciously, deliberately associate with them in real life. A lot of middle/upper income people view the lockdowns, masking, the vax, through the media they consumed without question and never thought about how these things affect kids and families who are hanging by a thread already. Thank God that parents of some of those kids have recall of ways the government has historically used them for medical experimentation and didn't comply with unnecessarily shooting up the kids with something that wasn't proven to have any benefit for them. Unfortunately, if/when we're faced with a disease in the future, if there is an actual cure, many will perish because of the paranoia fomented by the government during the past several years.
Oh Vinay, such a mischaracterization of conservatives! I proudly wear the label and care every bit as much as you about poor and minority children just profoundly disagree with progressives on how to get there. The old canard that liberals think conservatives are bad people and conservatives think liberals are good people with bad ideas that don’t work is so true here. Many of us decried school closures from the gitgo, decried lockdowns as disproportionately affecting lower socioeconomic groups and recent immigrant populations. Take the red pill, Vinay. It does not turn you into a wine swilling mansion habitue.
Like Vinay, I used to see myself as liberal (but with a strong libertarian streak). However, between covid McCarthyism and woke McCarthyism, I've turned strongly to the right. In truth, caring for children's welfare and bucking the system still feels extremely anti-establishmentarian, with an overlay of left wing sensibility. Amazingly, supposed liberals consider this "right wing"!
Interesting take on “conservative” and “progressive”. I like challenging the definitions as Vinay and the commenters have. It helps me see where and who I really am and not where social media would put me.
As an addiction treatment provider, I was a big fan of holding everyone of our patients accountable, something rarely seen in treatment centers around here at the moment. ORT management was not a first resort; rather a last, and just like with chronic noncancer pain management, everybody was weaned slowly but for a good amount of time to allow the brain to heal. I learned this in working with chronic noncancer pain, where in the late 90’s opioids ruled, addiction was not diagnosed and created an epidemic. I saw this long before the rest of the world did and as such I was often seen as a “conservative who didn’t care about saving people’s lives.” I was an abstinence based pain guy and also an abstinence based addictions guy.
So many people would never label me progressive, if you will, because I did not follow the public health harm reduction model. After seeing how chronic pain got hijacked, I didn’t wanna see it happen again with addiction. It did.
Based on Vinay’s definitions it seems I fit more in the center. I never supported painful withdrawal; rather I liked to focus on slow weaning. But I also can’t stand the thought of people being on an opioid or even a psych med prematurely prescribed for the rest of their lives unnecessarily. The way things seem to be today with Pharma, medicine in general, research, etc. once you factor in the money things become very clear.
I’ve developed an immense respect for Dr. Prasad over the past year. His intellect and the honesty of his writing is refreshing with every read. I am troubled, however, by his characterizations of progressives and conservatives. The idea that the desire for poor children to have access to healthcare, food, and shelter makes one a “progressive” has the correlative that “conservatives” don’t want that. Perhaps conservatives could better be defined as former progressives who realized they wanted the same thing but were doing it wrong. The desire to improve life for both individuals and society is a common feature of both groups, but conservatives have recognized that the methods used by progressives invariably make things worse, over and over again, throughout history, because they’re proposing the wrong solutions. The common thread woven through all progressive movements is the desire to help the underdog. Nothing wrong with that. But with this as the raison d'etre, a lack of victims becomes an existential threat. The insatiable maw will always find another victim. it must. For years, women, minorities, and gay and lesbian individuals have undoubtedly benefited from fights against oppressive majorities. But as their plights have improved, the maw has grown hungry, looking for others. Transgender individuals, obese patients, failing students, “immune-suppressed” individuals, even criminals have taken starring roles as victims for the machine. Previously oppressed groups that would like to move on from victim status are told in ever more convoluted ways that they are, in fact, still victims. For every victim there must be two other characters – an oppressor, and a savior. If an oppressor is not at once obvious, one will be identified. Playing the savior role (always the progressive) generates the true precious commodity of this machine – self-aggrandizement, with its twin offspring of virtue signaling and cancel culture. Over time, grandchildren arrive as censorship, propaganda, and coercion. This “family” must protect its own, recursively, to ensure the continued production of the commodity – self-aggrandizement. Thus the “progressive” ideology leads directly to the numerous problems Dr. Prasad so persuasively calls out in his work. The conservative desires the same outcome. They examine the results of progressive actions, noting that the problem has worsened, and new problems have appeared – the frequent outcome of incorrect solutions. The recognition that the “victim” may share any responsibility for their situation, and that individual agency may have a larger effect on the outcome, results in the disastrous consequence of the victim ultimately helping themselves without the need of a savior. Unthinkable! We used to call this “tough love” – but love, nonetheless. None of this is new or surprising. A lifetime of brilliant scholarship and writing by Dr. Thomas Sowell – especially in his works, The Quest for Cosmic Justice, and The Vision of the Anointed have solved many of these puzzles for us. Dr. Prasad’s brilliant and honest writing, in my mind, classifies him as a conservative.
Fabulous, sadly I have to say courageous.. and keep this type of critical thinking/commenting coming. Stakes are very high, opposition and ignorance very loud and aggressive.
I love this so much Vinay!!! You have to come and see my clinic in San Jose - I can show you how a clinic can confront SDOH-affecting things like school closures and bureaucratic closures of community centers in poor neighborhoods. Come see the other way... Healinggrove.org
Medicine has been hijacked by a thirst for social media recognition and praise instead of open discussions about the problems that actually need to be solved. It is so much easier to pat ourselves on the back for following the political medical field than to acknowledge that we are doing damage to our society by walking around with blinders. As someone who has taught medical students and residents for the better part of 30 years I strive to discuss with them what is important for us as physicians (teachers/leaders) to be involved in. Instead of wasting our time on whether masking is worthless(it is) or vaccination for the 5th time(abhorrent) we should be making a difference in every patients life. In addition we need to be advocates for those who need us to care for them socially, physically and emotionally. It is hard and not taught in most institutions so I hope my discussions with them over the years will yield some medical leaders who will take the reins and make a difference. Vinay, you have certainly done that and I commend you for that. Thanks.
Powerful and true. I really have lost a lot of respect for the medical associations who didn’t advocate harder for patients - and instead “towed the line”
I think your post hints at a misunderstanding many “progressives” have about “conservatives.” For example, all the strongest social science for decades is clear that the single greatest risk factor a child faces for unhappiness/misery/suicide/abuse/addiction as an adult is… not being born poor, or being born a minority, but… being born outside a married two parent home. So, when conservatives try to celebrate marriage, it’s not because they’re heartless jerks who hate poor black kids, it’s because they genuinely believe this will help the very children you’re worried about!
Most conservatives understand that liberals care about children, just believe they go about it the wrong way, for example with government payments that incentivize fatherlessness. But liberals genuinely don’t believe that conservatives care about kids, they just think conservatives are evil heartless monsters. Maybe further reflections like yours above will help change that dynamic…
Question: what is going on with the incentives within the medical field—academic medicine in particular—that have led to this kind of thing becoming more and more of a problem?
My constant complaining about the injustices of school closures got me booted from Nextdoor. I live in one of the poorest states, NM, where the population is entirely blue. Education is the only way out of poverty. So the boards shut down the schools. NM finally scored below Miss on school performance. Our Gov got re-elected despite poor death counts, rabid shutdowns that killed many small family businesses and no effort to help special ed kids in our Title I schools of which we have a lot. "She did a great job" and the state legislature has made sure that a Republican can never get elected via suitable boundaries. We might be more like CA but without any real national businesses to swell the tax rolls. But we do have much oil except the state really hates that. Notably Los Alamos has the most educated people of any place in the US. They didn't care about kids outside of their area.
Angry beyond words. My kids, and g-kids and gg-kids live elsewhere <sigh>. I love our natural beauty but not our unaccountable leaders. Wasn't always like this and not clear what has changed.
Virtue signalling has run amok, and entering medicine now. As Bill Maher said of the Overton window, “my politics haven’t changed”. It’s not a great time to be a classical liberal these days.
The fixation with “equity”/equality of outcomes is one of the root causes of societal malaise, in and outside of medicine. The list of the “best medical educators” need not be governed by equity; just as the list of “fastest humans”, or “best sopranos”, need not have “equitable” representation. To suggest or insist that they do would be to ignore reality, and is idiotic.
Let's face it--we seldom have true concern/understanding for people who are not in our socio-economic bracket unless we consciously, deliberately associate with them in real life. A lot of middle/upper income people view the lockdowns, masking, the vax, through the media they consumed without question and never thought about how these things affect kids and families who are hanging by a thread already. Thank God that parents of some of those kids have recall of ways the government has historically used them for medical experimentation and didn't comply with unnecessarily shooting up the kids with something that wasn't proven to have any benefit for them. Unfortunately, if/when we're faced with a disease in the future, if there is an actual cure, many will perish because of the paranoia fomented by the government during the past several years.
Oh Vinay, such a mischaracterization of conservatives! I proudly wear the label and care every bit as much as you about poor and minority children just profoundly disagree with progressives on how to get there. The old canard that liberals think conservatives are bad people and conservatives think liberals are good people with bad ideas that don’t work is so true here. Many of us decried school closures from the gitgo, decried lockdowns as disproportionately affecting lower socioeconomic groups and recent immigrant populations. Take the red pill, Vinay. It does not turn you into a wine swilling mansion habitue.
Like Vinay, I used to see myself as liberal (but with a strong libertarian streak). However, between covid McCarthyism and woke McCarthyism, I've turned strongly to the right. In truth, caring for children's welfare and bucking the system still feels extremely anti-establishmentarian, with an overlay of left wing sensibility. Amazingly, supposed liberals consider this "right wing"!
Interesting take on “conservative” and “progressive”. I like challenging the definitions as Vinay and the commenters have. It helps me see where and who I really am and not where social media would put me.
As an addiction treatment provider, I was a big fan of holding everyone of our patients accountable, something rarely seen in treatment centers around here at the moment. ORT management was not a first resort; rather a last, and just like with chronic noncancer pain management, everybody was weaned slowly but for a good amount of time to allow the brain to heal. I learned this in working with chronic noncancer pain, where in the late 90’s opioids ruled, addiction was not diagnosed and created an epidemic. I saw this long before the rest of the world did and as such I was often seen as a “conservative who didn’t care about saving people’s lives.” I was an abstinence based pain guy and also an abstinence based addictions guy.
So many people would never label me progressive, if you will, because I did not follow the public health harm reduction model. After seeing how chronic pain got hijacked, I didn’t wanna see it happen again with addiction. It did.
Based on Vinay’s definitions it seems I fit more in the center. I never supported painful withdrawal; rather I liked to focus on slow weaning. But I also can’t stand the thought of people being on an opioid or even a psych med prematurely prescribed for the rest of their lives unnecessarily. The way things seem to be today with Pharma, medicine in general, research, etc. once you factor in the money things become very clear.
I’ve developed an immense respect for Dr. Prasad over the past year. His intellect and the honesty of his writing is refreshing with every read. I am troubled, however, by his characterizations of progressives and conservatives. The idea that the desire for poor children to have access to healthcare, food, and shelter makes one a “progressive” has the correlative that “conservatives” don’t want that. Perhaps conservatives could better be defined as former progressives who realized they wanted the same thing but were doing it wrong. The desire to improve life for both individuals and society is a common feature of both groups, but conservatives have recognized that the methods used by progressives invariably make things worse, over and over again, throughout history, because they’re proposing the wrong solutions. The common thread woven through all progressive movements is the desire to help the underdog. Nothing wrong with that. But with this as the raison d'etre, a lack of victims becomes an existential threat. The insatiable maw will always find another victim. it must. For years, women, minorities, and gay and lesbian individuals have undoubtedly benefited from fights against oppressive majorities. But as their plights have improved, the maw has grown hungry, looking for others. Transgender individuals, obese patients, failing students, “immune-suppressed” individuals, even criminals have taken starring roles as victims for the machine. Previously oppressed groups that would like to move on from victim status are told in ever more convoluted ways that they are, in fact, still victims. For every victim there must be two other characters – an oppressor, and a savior. If an oppressor is not at once obvious, one will be identified. Playing the savior role (always the progressive) generates the true precious commodity of this machine – self-aggrandizement, with its twin offspring of virtue signaling and cancel culture. Over time, grandchildren arrive as censorship, propaganda, and coercion. This “family” must protect its own, recursively, to ensure the continued production of the commodity – self-aggrandizement. Thus the “progressive” ideology leads directly to the numerous problems Dr. Prasad so persuasively calls out in his work. The conservative desires the same outcome. They examine the results of progressive actions, noting that the problem has worsened, and new problems have appeared – the frequent outcome of incorrect solutions. The recognition that the “victim” may share any responsibility for their situation, and that individual agency may have a larger effect on the outcome, results in the disastrous consequence of the victim ultimately helping themselves without the need of a savior. Unthinkable! We used to call this “tough love” – but love, nonetheless. None of this is new or surprising. A lifetime of brilliant scholarship and writing by Dr. Thomas Sowell – especially in his works, The Quest for Cosmic Justice, and The Vision of the Anointed have solved many of these puzzles for us. Dr. Prasad’s brilliant and honest writing, in my mind, classifies him as a conservative.
Wow. Hard & true, Vinay like a boss always.
All because of a lack of confidence … fragility of our priors … that’s what we get for training “pathways” instead of concepts and critical thinking
Fabulous, sadly I have to say courageous.. and keep this type of critical thinking/commenting coming. Stakes are very high, opposition and ignorance very loud and aggressive.
I love this so much Vinay!!! You have to come and see my clinic in San Jose - I can show you how a clinic can confront SDOH-affecting things like school closures and bureaucratic closures of community centers in poor neighborhoods. Come see the other way... Healinggrove.org
Leave the virtue signalers to eventually eat themselves from within. How best can individuals help the kids?
Medicine has been hijacked by a thirst for social media recognition and praise instead of open discussions about the problems that actually need to be solved. It is so much easier to pat ourselves on the back for following the political medical field than to acknowledge that we are doing damage to our society by walking around with blinders. As someone who has taught medical students and residents for the better part of 30 years I strive to discuss with them what is important for us as physicians (teachers/leaders) to be involved in. Instead of wasting our time on whether masking is worthless(it is) or vaccination for the 5th time(abhorrent) we should be making a difference in every patients life. In addition we need to be advocates for those who need us to care for them socially, physically and emotionally. It is hard and not taught in most institutions so I hope my discussions with them over the years will yield some medical leaders who will take the reins and make a difference. Vinay, you have certainly done that and I commend you for that. Thanks.
Powerful and true. I really have lost a lot of respect for the medical associations who didn’t advocate harder for patients - and instead “towed the line”
Well said, thank you!
I think your post hints at a misunderstanding many “progressives” have about “conservatives.” For example, all the strongest social science for decades is clear that the single greatest risk factor a child faces for unhappiness/misery/suicide/abuse/addiction as an adult is… not being born poor, or being born a minority, but… being born outside a married two parent home. So, when conservatives try to celebrate marriage, it’s not because they’re heartless jerks who hate poor black kids, it’s because they genuinely believe this will help the very children you’re worried about!
Most conservatives understand that liberals care about children, just believe they go about it the wrong way, for example with government payments that incentivize fatherlessness. But liberals genuinely don’t believe that conservatives care about kids, they just think conservatives are evil heartless monsters. Maybe further reflections like yours above will help change that dynamic…
Gaty.substack.com