John Mandrola is Wrong about Political Activism

A few weeks ago John Mandrola broke twitter (as we used to say) with this tweet.

I’ll admit that nothing I have ever said or written has every garnered 4.5M views. He followed it up with an article. Vinay Prasad took a swipe at him. Far be it from me to pass up the chance to comment on something this hot¹ and, because I lack my own Substack, I’m posting it here. I’m beginning to think that I can satisfy my Sensible Medicine commitments just by telling my colleagues that they are wrong.  

I have a history with this topic. Years ago, I was the target of a twitter mob when I posted my side of an academic debate organized to consider the question: Is it a physician’s professional duty to advocate politically? I argued that it is not a professional duty. I argued that a physician’s duty is to care for, and advocate for, her individual patients. While some doctors are motivated to, and skilled at, advocating politically, it is not a professional duty.

I stand by that argument but I also disagree with John that we should shy away from advocacy and public, political stances. I do think, however, that if a doctor chooses to engage politically, it needs to be done cautiously and thoughtfully.

Reasons that physicians should not stay apolitical in the public sphere.

1. We live in a democracy that demands participation. Just because we chose to be doctors, does not mean we should be freed of this responsibility.

2. So much of what we do in medicine is affected by politics. I don’t need to list the hot-button issues of the day. It is hard to imagine being apolitical when decisions by local, state, and federal governments affect the health of the patients for whom we care.

3. Given doctors’ training and experience (and sometimes research), they may be uniquely equipped to advocate about certain issues.

4. Deciding to stay apolitical is a political stance in itself -- one that supports the status quo. Taking this stand would therefore be especially fraught for someone like me.²

5. Working as a doctor, there is an army of people advocating for your interests, an army led by the AMA. Many of us disagree with the stances of our advocates. Not advocating allows others to advocate against us.³

6. Dr. Mandrola is a bit hypocritical. Much of his public persona is advocacy; advocacy for thoughtful, conservative, measured medical care. I don’t imagine he will drop this around election time. (That’s not the ad hominem attack, that comes later.)

Dr. Mandrola is a wise and thoughtful person from whom I constantly learn. There are important reasons that physicians might want to stay apolitical. He considers these issue weightier than the the ones I list above. He describes them well in his post. I’ll outline the reasons I dip my toes into politics and advocacy cautiously.

1. My ultimate professional goal is to be a trusted doctor to ALL of my patients – including those who fervently disagree with me politically. I care for many of those people. It is easier to reach this goal if I am quiet about issues that my patients and I disagree about. Working at a university, caring for people in leadership positions, has made 2023/2024 an especially fraught academic year for me.

2. Physicians need to attend to their position in society; the respect we garner and privileges we receive are not guaranteed. Sometimes, with how nasty politics can be, taking a political stand risks sullying our reputations.

3. When patients come to the doctor, they are coming for medical care, not proselytizing. The visits should be about them. They should not have to run the gauntlet through protests or receive care from people wearing T-shirts supporting their mission of choice.

4. I do feel strongly that academic medical centers should not expand their mission to include political advocacy. We have covered this on Sensible Medicine — one of the few “editor post” we have written. We have also posted pieces by other authors on the topic.

   I take guidance here from the University of Chicago’s Kalven Report, which affirmed that the role of the University 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.”  

   Much like a university, academic medical centers are made up of people with a range of views. The diversity of the staff of a medical center enables us to care for a diverse population with a range of needs. Individuals must have broad freedom to support a range of views and positions and be able to argue for their view. Institutions should generally stay out of issues for a number of reasons. For me, the most salient, is that trying to get your institution to speak with one voice is selfish and assumes broad agreement on issues – agreement that rarely, if ever, exists. In order to satisfy all stakeholders, statements generally end up being banal to the point of meaninglessness. 

   If doctors want their medical centers to be politically active, I suggest they encourage their centers to support their right to express themselves (away from patient care). 

This has been a little too kind. I even managed to compliment Dr. Mandrola. So, an ad hominem attack. Does he really think anyone is going to watch La Vuelta in the doctor’s lounge?

1. Though well after the fact since my day job tends to get in the way sometimes.

2. I own the center of this figure.

3. This was a point made articulately by my debate opponent.