Healthcare Leaders Should Focus on Making Medicine Better Rather than Issuing Press Releases on Geopolitical Issues
We are the recipients of the curse, “may you live in interesting times.” With the wars in Ukraine and the Middle East, climate change, a global pandemic, urban gun violence, racial reckoning, the Dobbs decision, and economic disparities, among other issues, we have our share of “interesting” and divisive topics on our mind these days.
Like all members of an open society, physicians have opinions on the important topics of the day. Some of them share their opinions privately, others advocate for their positions. Both actions are appropriate. Physicians are particularly equipped by their training, experience, and social standing to advocate strongly for positions in which they believe. Other physicians feel their duty is to advocate for their own patients and feel less comfortable taking public stands.
On November 8th, JAMA published an article by Matthew Wynia, MD, MPH titled Health Professionals and War in the Middle East.
In the article, Dr. Wynia notes the imperfect record of physician’s standing up against human rights violations and, in fact, occasionally participating in them. He writes,
In the Nazi era, innumerable health professionals and institutions took leading roles in developing and implementing racist, antisemitic programs of mass murder. These actions were an explicit and profound betrayal of the core values that should govern health care and our expected social roles, and this history led to several specific ethical responsibilities that should guide health professionals today.
He then lists three statements that he believes health professionals should commit to:
Health professionals should condemn dehumanization and acts of genocide.
Health professionals should vigorously oppose both antisemitism and anti-Muslim hatred.
Health professionals have special responsibilities to speak out against certain war crimes.
It is hard to argue with any of these statements though, of course, the devil is in the details.
Dr. Wynia goes on to ask if “leaders in the health professions” should respond to events like the war in Gaza.
Any doctor who works for a large organization knows that the accepted answer to Dr. Wynia’s question these days seems to be yes. He or she has gotten emails from the Dean, Chancellor, Chair, President, or CEO. These emails acknowledge sadness and frustration in the community because of recent geopolitical events or turmoil. Over the last few years, emails have been about the killing of unarmed black people by police, the Ukraine war, or the current war in Gaza. Leadership spent time crafting these statements, reworking them, and considering if the word choice might offend someone. They hit send, and, at times, if they got the tone or wording wrong, they pay a price.
We answer Dr. Wynia’s question differently. Apart from the broad, inarguable types of statements like those above, and acknowledging that physicians are free to express and advocate for their personal beliefs and values, we think it is wrong for “leaders” — be they hospital CEOs, journal editors, or society presidents — to take anything other than a personal stand on issues.
In 1967, the Kalven Committee at the University of Chicago was charged with preparing "a statement on the University's role in political and social action." The resulting Kalven Report affirmed that the role of the University was to assure the academic freedom of “faculty and students in the face of suppression from internal and/or external entities while also insisting on institutional neutrality on political and social issues.” The expectation set by the report is not an easy one to satisfy, but it has served the university well during periods such as these.
Much like a university, medical centers, specialty societies, and medical journals are made up of people with a range of views. Our diversity is a strength as it factors into taking care of a diverse patient population. Individuals must have broad freedom to support a range of views and positions and be able to argue for their view. Institutions, meanwhile, should generally stay out of issues for a few reasons.
First, if you want to craft a statement on a controversial issue that would satisfy everyone — and offend no one — that statement will be, by definition, profoundly banal. "We stand in favor of the health and well-being of all humans." (Dr Wynia refers to these as "generic talking points.”)
“We oppose bigotry, genocide, and war crimes.” Of course! All sensible people oppose that!
Second, hospital leaders have a job that frankly, they could be doing better. They are tasked with managing hospitals in which staff are suffering from burnout and poor morale and where vigilance is always required to assure that vast sums of money are not mismanaged. Last we checked these issues are getting worse. Less time writing press releases and more time trying to fix things might be worthwhile.
Third, it would be presumptuous to assume that the leadership of a medical center, specialty society, or journal has something productive to say. These people are not experts in politics, diplomacy, history, or military strategy. They merely try to write the most tepid statement they can in order to avoid the criticism that they are ‘saying nothing’ or that their ‘silence implies’ that they support whatever people think is bad.
Fourth, controversies are always arising. There is always a new issue that divides people. Hospital CEOs could devote more and more time to their statements. 10 years ago, we rarely got an email about the day’s news. Now it is monthly. What about in 5 years? Will we get a daily email?
Fifth, these statements don’t change anything. Statements by hospital CEOs have – to our knowledge – never actually made the world better.
Are there times when institutions should issue statements? The Kalven report provides a guide:
“From time to time instances will arise in which the society, or segments of it, threaten the very mission of the university and its values of free inquiry. In such a crisis, it becomes the obligation of the university as an institution to oppose such measures and actively to defend its interests and its values.”
These are exceptional instances, but they do exist and “leaders in the health professions” might rarely need to take a stand on a “hot button” issue.
Here are two examples: One could imagine a medical center calling attention to the epidemic of gun violence in American cities that is draining the resources of trauma centers and exhausting the teams called upon to care for the injured. In fact, journal editors did just this in 2017. While the leaders surely have no extra insight on policy solutions, they may be singularly able to identify problems.
Another exceptional instance in which medical leaders could and should speak publicly is about threats to freedom of speech. At the core of medical science is debate. For instance, during the pandemic, doctors and scientists expressing even well-considered views opposing the accepted policies were either discouraged, censored, or fired. Freedom of ideas is, we believe, an area in which medical leaders and professional societies should support publicly.
Finally, you might be asking: Are there really medical centers, journals, specialist societies taking stands on political issues? We think the answer to that is obvious.
Let doctors and professors do the research and publish well-considered essays and editorials.