Medicine and Public Health Have an Obsession, and It Is Not Health

On the rise of political advocacy in medicine and public health, where it leads us astray, what it costs the public, and the case for a return to political neutrality.

I took my 70-something dad to the cardiologist. He is a retired bi-vocational farmer and truck driver who has chronic heart issues since a childhood bout with rheumatic fever. Our visits usually center on whether it is time for another surgical referral. This time something else took center stage.

My dad started to say, “my wife is worried about…” The doctor slipped in “your partner.”

My dad was confused. He did not go to Harvard and therefore did not appreciate the substance and importance of the correction. “No, my wife,” he said. “She couldn’t make it today.”

The doctor cut him off, and this time delivered a performance worthy of an Amazon Studios production about the importance of inclusive language, how words have meaning, and how these words impact health outcomes for millions of people.

My dad went quiet. He disconnected from the visit entirely — not because he is an evil misogynist, but because he could not work out why we were not talking about his heart.

I tried to mediate and steer us back to clinical care. It did not take. To that doctor, the correction seemed to be the most important work she did for any patient that day. Nothing clinically important was addressed.

We had to find a new cardiologist. His care was delayed about three months.

It Is Not One Doctor

Dad’s visit is emblematic of political leakage into the clinic, and medicine and public health’s growing obsession with politics.

Researchers matched primary care physicians to their voter registration records and then put clinical vignettes in front of them. Democratic and Republican doctors differed substantially in how seriously they rated some health problems and in what they recommended, which included the expected health issues Republican doctors might care more about than Democrats (e.g., cannabis) but also the unexpected (e.g., obesity). The gap held after adjusting for physician age, sex, religion, patient characteristics, and geography. Their conclusion, published in the Proceedings of the National Academy of Sciences: “Physician partisan bias can lead to unwarranted variation in patient care.”

Careers in our field are increasingly rewarded when you treat medicine and public health as the side hustle and a political agenda as the main work. A large share of work by trained physicians and epidemiologists now focus on areas that are rather distant to health.

• The American Medical Association asks physicians to add a question to the visit: are you registered to vote?

• The Association of American Medical Colleges published a style guide instructing medical schools to use “oppressed” when describing minority populations and even replace “minority” with “historically marginalized” in teaching materials.

• Multiple major societies now treat emissions reduction itself as a clinical responsibility: the American Academy of Family Physicians, American Academy of Pediatrics and other organizations explicitly encourage physicians to counsel patients on low-carbon lifestyle choices such as plant-forward diets and walking or cycling, instead of driving to work or medical appointments. To which JAMA published a piece urging clinicians to consider moving asthma and COPD patients off their metered-dose inhalers because of the propellant’s greenhouse emissions.

• Major obstetrics organizations and health system style guides now instruct clinicians and scientists to replace “pregnant woman” or “mother” with “pregnant person,” “birthing person,” or similar terms.

• Medical and public health schools embed a host of politically related training, rebranded as structural competency.

All of it under chants of “this is our lane.” Which means my father’s cardiologist was not freelancing. She was doing what her mentors, medical education, health systems, and professional associations had told her to do: elevate politics above medicine.

The shift has been so pronounced that the New England Journal of Medicine broke a 208-year silence to weigh in on the 2020 presidential election, although stopping short of a formal endorsement. Scientific American made the first official endorsement in its 175-year history, and Nature followed.

This past month the American Journal of Public Health published a study describing a get-out-the-vote campaign. In it health professionals and providers in “federally qualified health centers, hospitals, and medical schools” were supplied QR-code badges to wear that patients could scan to participate. Patient data provided in the QR-code response was then shared with TargetSmart, which bills itself as “the leading data, research, and media buying provider for Democratic campaigns.” Oddly enough the university institutional review board deemed the whole thing “not human research” exempting it from any ethical review.

What the Obsession Costs

You might think all of this is performative, academic theater that no one takes seriously, and it will never actually matter. You’d be wrong.

Medical and public health institutions have lost tremendous amounts of trust. In a survey of US adults, the share reporting substantial confidence in physicians and hospitals fell from 71.5% in April 2020 to 40.1% in January 2024. Concurrently, two-dose MMR vaccine coverage among American kindergartners fell from 95.2% during the 2019/20 school year to 92.4% during the 2025/26 school year.

A preregistered randomized trial told 4,260 Americans one of two things: that Nature had endorsed Joe Biden, or that Nature had redesigned its website. Among Trump supporters, learning about the endorsement sharply reduced trust in the journal, reduced trust in scientists generally, and made them 38% less likely to want to learn what Nature had to say about Covid-19 vaccines during a forced break in the experiment. Among Biden supporters it bought the journal nothing: they were no more likely than before to want to learn what Nature had to say about vaccines. The endorsement turned Republicans off without turning Democrats on. It signaled that Nature had entered partisan politics, and when participants were given the opportunity to engage with its scientific content, their behavior rightly reflected that signal.

This was not one journal in one election. Three experiments with 6,281 Americans tested similar endorsements from the 2020 and 2024 election cycles. Trust in science fell across every dimension measured: the field’s perceived impartiality, its competence, even its benevolence. And the decline was, in part, driven by moderates, the people science should appeal to because of their baseline impartiality.

Moreover, the harms of these political efforts are about to be baked in. The medical and public health literature is the training data for the new wave of AI clinical and patient support systems and AI scientists. As journals, associations, and medical schools publish more political content, the AI systems built on that literature absorb it. Open AI recently disclosed that “every week, more than 230 million people turn to ChatGPT for help with health and wellness questions.” Could there be a scenario where a medical AI frames inhaler choice as a climate decision, nudging a user toward the climate-smart option when they are requesting information during an asthma attack? I hope not but it is possible.

We spend the public’s trust on gestures that turn the public against us and might even harm them.

What It Costs to Point Out the Error

The craziest part is that even pointing this error out comes with the cost of political retribution by medicine and public health’s ruling guard.

During the COVID-19 pandemic when I published a study in JAMA Internal Medicine about the dangers of promoting unproven therapies like Hydroxychloroquine I got emails praising me for standing up to the evil duo of Donald Trump and Elon Musk.

When I published about the rising rates of panic attacks during the COVID-19 pandemic, in the same journal, I got emails raising concerns that I was potentially undermining the importance of lockdowns.

Finally, when I wrote about how children in 2022 needed to attend school regardless of their adherence to reusable cloth masking mandates that had failed all evidentiary standards in randomized controlled trials I got emails asking why I had turned against science and many of my colleagues called for me to be dismissed from my faculty appointment.

In none of those cases was the objection that I was wrong. The objection was that I was on the wrong side. Following the data where it leads has become dangerous. When the crowd is motivated by partisanship over evidence being a good scientist signals you will not “always be with us.”

So let me be as clear as I can. I am not arguing that health disparities are unreal or unworthy of study, I have actively contributed to this subject on many occasions, including issues that have policy and political implications like abortion and gun violence. I did that work by providing evidence but without any value statements about what ought to be. I am arguing that a field, which has made political positioning a central product, has stopped being good at its actual job, and that the people who pay for that are the patients and public we swore to serve.

I also want to be sensitive to the people who pushed for a political agenda. It was not malicious. Many of them carry scars from a history where medicine did terrible things: Tuskegee, forced sterilizations, and more. But what actually produced those wrongs? Sterilization, for example, happened because a political movement decided which Americans should reproduce and physicians carried it out as good partisans. In every case the harm arrived the same way: a political agenda from outside decided what the patient was, and then medicine and public health followed.

That is not a story about politics being absent from the clinic. It is a story about politics being present. The remedy is not a better form of politics and/or more of it. It is less.

Neutral Ground

Neutrality is written into the physician’s pledge: “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” It is written into the laws of war as well. Under the First Geneva Convention a field medic is required to treat the enemy soldier who was shooting at him moments earlier. That is the standard this profession set for itself under the worst conditions humans can encounter. If a medic can manage that in a trench, a cardiologist can manage it in an exam room for a patient who says wife.

I cannot even guess the political affiliation of my childhood pediatrician, all my research partners of more than a decade, or my professional heroes. Why would I ever need to know? Some will be Democrats, some will be Republicans, and some will be apolitical…but the work and calling we share is agnostic to politics. Politics follows the timeline of fads. The scientific method is meant to be more eternal.

None of this asks anyone to stop caring. Neutrality is not coldness; it is the harder form of caring, the discipline that lets a physician treat a patient she disagrees with or a scientist chase a question whose answer she may not like or choose for herself. Advocacy asks only for conviction, but we are called to a higher purpose, one that requires restraint.

Institutions owe the same discipline. A journal that endorses a candidate has decided it is no longer impartially pursuing evidence-based medicine. A funder that rewards the politically fashionable question has decided political findings should exist. An organization that leads with the conclusion it prefers rather than the evidence it has (or seeks) has decided the public cannot be trusted with truth.

Serving your friends is easy. Serving everyone is hard. Everyone includes the people who have said ugly things, who did not vote the way we voted, who have done real harm, sometimes even to us. A profession that cannot manage that has not become more moral. It has only replaced principle with tribalism and ultimately become more amoral.

My father’s cardiologist could have spent that visit on his heart. She spent it on a word triggered by a career spent working in a politicized profession. It cost him three months.

It is costing patients everywhere far more than that. Not one kind of patient. Every kind: white and brown, rich and poor, red state and blue state, urban and rural.

There is no illness that checks your politics before it takes you. There should be no clinic, no journal, and no health organization that does either.

John W. Ayers PhD MA is a computational epidemiologist focused on getting the public back in public health by harnessing new technologies for clinical and scientific translation: www.johnwayers.com