Excellent piece. ER doc for 30+ years and worked through all of Covid. Could not communicate with the patients due to pappers, mask, garb, no visitors, patients couldn’t hear w no hearing aids, they couldn’t read lips, it was painful. One day made the executive decision took it all off and never looked back. Wore blue jeans, no mask, did every single procedure in our profession including airways without the nonsense. I never had so much as a runny nose, never tested positive ever, never missed one day of work through Covid nor in my entire career. Meanwhile, I had younger partners that called in sick because their cousin tested positive. Fools follow other fools off a cliff.
Wow. Appreciate you sharing your story, doc. I still feel the loss 6 years later when I was unable to be with my then 92-year-old dad in the hospital when he died (unsuccessful valve replacement while waiting for a bowel obstruction to resolve). No reason at all that I shouldn't have been able to be by his side.
I love and respect my many doctors- I'm so thankful for them- but this policy was criminal. You're right; we don't trust the bureaucrats. At all. They haven't proved to be trustworthy.
Medicine since then has not been doing a good job with “gender affirming” medication and surgeries either. The AAFP and others adopted the language, and even now, the number one thing that shows up under a patient’s name is “gender identity” in Epic. This is a radical adoption of an ideology and practice without much, if any, evidence on its side.
The go-along to get-along is partly to blame. The true experts are silenced while the charlatans are given the podium. How many instances of “ nutraceuticals “ claiming benefits on cholesterol or ED have been proven to have statins or sildenafil respectively and how were these companies sanctioned ? Are the three-letter agencies still trying to protect the public? $$$$$ makes monkey dance ?
These are great points, but I think the problem runs much deeper. COVID policy nonsense has led more and more people to question the reliability of healthcare as a whole. What can we really believe? A team of scientists, including John Ioannidis, analyzed over 1,600 Cochrane reviews and found that only 5.6% of medical services can be shown to be effective, based on high-quality evidence. They also found high-quality evidence that 8.1% are harmful, possibly as high as 36.8%. Cochrane reviews are considered the gold standard in evidence-based medicine. The healthcare system is eroding the standard of living for the working class, taking almost 20% of our national income. And what do we get?
On masking, a patient put it in very simple terms : “ you mean to tell me y’all are trying to keep mosquitoes out with a three strand barbed wire fence ? “
Great write up. But you were too kind. With the recent revelation of Fauci's illegal activities, we now know for a fact (we all knew...) that he almost single-handedly created C19 via Ecco health+Wuhan.
And the TDS addled medical associations fell in line with the Leftists agenda. I used to respect doctors. I used to respect CDC/FDA. I used to think pharma was here to help. I used to think vaccines saved lives. I used to think teaching was an honorable profession. I used to think peer reviewed research was sacrosanct. I used to think MSM lied but not too much. BOY WAS I WRONG.
The *great* thing about COVID was how it opened my eyes. Gov't lied. Fauci lied. DOJ lied. FDA lied. CDC lied. Intel agencies lied. FBI lied. Facebook/Twitter/Google/YouTube lied.
But you did get one thing wrong. You said "people remember" (re:Newsom eating at French Laundry and don't forget sending his kids to private school that didn't close). But you're wrong. Californians voted again and again to keep him around. And you know what? California and every blue state Leftists voters deserve the politicians they elect.
The party line used to be conservative vs liberal. GOP vs. Dem. The line is now good vs evil. You don't have to be a republican, but you cannot be a Lunatic Leftists.
CA residents, legal or illegal can print their own ballots under the “remote access” program, ballot harvesting is legal, and questioning outcomes is literally illegal. IDK how much you can blame the voters.
Seems that old Army Reserve recruiting slogan has been appropriated and modified by some : instead of “ Be all that you can be “, it is now “ Be, whatever you claim you are “
Debate is always healthy when not done to obstruct and destroy. Facts are facts when not manipulated.
I used to think that lying was common but there was some truth. What we have learned is that it is all 100% lies, 100% of the time. If the truth sneaks through, it is just an accident. This is not necessarily true of all individuals. But it is absolutely true of all governments and government actors. It is absolutely true of all captured media. (And here I believed "And that's the way it is" was the truth...captured even then.) The medical trade associations, many of which I have joined over the years, lie when economically or socially convenient and do not bat an eyelash.
Of course trust is lost. People may be disinterested but they are not stupid. We have all learned that it is 100% about the money, 100% of the time. (Right up there with the lying statistics.) If it is not grift it is graft, and the only things that look like they are not money driven are the things where one has not yet found the money.
Will the new skepticism get anyone anywhere? -- probably not. But it is surely better than the alternative.
I think there are doctors whose humanity hasn't been beaten out of them. Actually, I *KNOW* there are....my cardiologist for one. And the doctors on this very substack. But I agree with you for the most part. It's no wonder transgender surgery took off so fast. I'm told that it's the biggest money maker for the hospital/surgeons. What a damn shame. Chopping up children to make a buck. I never thought I'd see the day.
excellent piece right on! The problem with science is even the research , NIH,FDA and journals have now been compromised so its hard to evaluate data and trust anything you see ---
I think he’s missing the larger point. The greatest reason people don’t trust medicine is because medicine is nuanced while all the advice one receives via healthcare influencers on social media and youtube speak with absolute certainty. People want certainty. They don’t like uncertainty. Unfortunately in medicine we’re almost always operating in the “grey” as very little is black and white. So people will trust the eloquent, confident, good-looking influencer over the less certain MD/DO.
I'm a retired ICU RN. My father and grandfather were MDs. I've lost my faith. How could I not? In Dec 2020 it was known the mRNA shots were not tested to see if they stopped transmission or hospitalization. Yet the PSAs, Fauci, and the medical community confidently proclaimed them "safe", "effective" and "the only way out." In June 2021 when I told my doctor I didn't want it because the platform had not been adequately tested and it looked like the spike was pathogenic, she looked confused and asked me if I had any specific questions. When I said, "Why are they censoring doctors?" she looked like she was considering a psyc eval so I dropped it. The mRNA platform and Spikeopathy are still an issue. Here's one older paper on this, in case someone is unaware. https://mdpi-res.com/d_attachment/biomedicines/biomedicines-11-02287/article_deploy/biomedicines-11-02287-with-cover.pdf?version=1718880673
Agree agree agree!! Throughout it all the hypocrisy was evident. I am a family doc, was on the local school board during Covid, and was highly torn between trying to follow CDC guidance and the AAP and my own understanding and observation about mild illness and children, and the importance of people being together, particularly after the first two vaccines were widely taken up. I fully understand why people might not trust information coming from us or our government after that debacle, and I do agree that acknowledging where we may have been misled can go along way to helping people trust us again. Scientists are nothing if not people who are able to change their minds based on new information.
There were no experts during the pandemic. No one had experience with administering a novel vaccine platform against a novel virus during an active pandemic. None. Yet we failed to collect rigorous data during that time. I worked in public health then and pushed for that but was refused. Yes it was politicized. The Teachers Union fought the return to classrooms. No where are the unions more powerful than in California where the school system ranks lower than 40 out of 50. As to the California Medical Association, they are a feckless tool to the Sacramento agenda. They do not represent physicians. As to loss of trust in doctors we have to view it from a patient’s perspective. The majority of physicians in California are now employed by large hospital systems. That has resulted in no longer having control of the physician patient interface. Operations and policy is dictated to employed doctors by a corporate administration with a focus on ROI. The patient sees a huge health system made up of big buildings full of automatrons that churn them from one test or lab to another all within their self serving system. This same system failed to convey the nuance of COVID vaccines, prevention and treatment because they were controlled. It was bound to happen by design thanks to the ACA and to CMAs being in bed with the state government and not us. As mentioned the laws California passed during the pandemic that sought to silence decent or fire a HCW who chose not to get the jab were appalling. That shit is on CMA as much as it’s on Newsom or Biden.
Spot on! I'm a cardiologist and was in a very high-level admin position in a very large medical system in Southern California during the peak of COVID. We, the physicians in very large medical systems, had the opportunity to push back on the anti-science that we all so very clearly witnessed. But we cowered, we shut up, we caved. At a time when our patients & the public needed courageous physicians, we failed. None of us, including me, was willing to risk our livelihood to go against the "science" that was handed down from our highest, most respected institutions - the NIH & CDC. This is how coercion always works - threats to your ability to earn a living are very powerful. I guess writing about this now feels good to all of us on this post, but, frankly, it really amounts to nothing. No one has been held accountable. Why do we think it won't happen again?
January 2023, my mother-in-law with COPD/HF in the second half of her 80's, was hospitalized. Medical staff told my wife they wanted to start Remdesivir. My wife knew two things. One, there is a statutory requirement for informed consent. She was provided with none. Two, the CDC and WHO had different perspectives on Remdesivir. My wife called her sister, an ENT, and they discussed their mothers condition. The condition including that their mother was tired of the disease, and most importantly, that they didn't know if she had covid or not. Together they decided against Remdesivir. The medical staff, more than once, told my wife, "If she dies, it's on you".
My mother-in-law was discharged from the hospital without a covid diagnosis and would live another 2-1/2 years. Trust lost.
Remdesivir was known to have a >50% mortality rate when it was tried for Ebola, yet our govt’s wrote it into every ironclad Covid protocol. Hospitals were given extra $ bonuses per patient injected.
There is an important distinction between physicians who care for individual patients and public health officials who develop policies for entire populations.
Most physicians are trained primarily to diagnose and treat patients, not to critically evaluate epidemiologic data or assess population-level policy decisions. Medical education places a strong emphasis on memorization and pattern recognition, while statistical reasoning and critical appraisal of the literature often receive far less attention.
As a result, many physicians rely heavily on clinical guidelines without fully understanding the underlying evidence, assumptions, and methodological limitations that shaped those recommendations.
It is relatively easy to create a workforce of physicians who can accurately recite guidelines. It is much harder to develop physicians who can independently evaluate the evidence, understand the statistical principles behind the recommendations, and recognize when guidelines may or may not apply to a specific patient or circumstance.
Thank you for this piece. I was curious, so I found and read the op-Ed you referenced.
Op-Ed: Who invited them to my doctor’s appointment?
I agree with Dr. DiGiorgio’s critique of the Op-Ed.
It seems Dr. McDonald is too focused on external factors instead of ways medicine can work internally to improve trust.
A few thoughts for our profession:
-be humble and admit error. The coverup is always worse than the “crime”
-abandon the noble lie (this caused much of the problems in loss of trust during the pandemic), it is not a useful tool in the current Information Age
-police ourselves more effectively (adhere to robust evidence base data even when not popular) so lawmakers don’t feel compelled to step in with legislation to protect constituents when medical professionals have fallen prey to fads with a paucity of quality evidence to justify their practices
-quit being quick to judge patients who ask questions. Ask them the right questions to find out what they are afraid of / skeptical of and why. “Anti-vax” patients/parents have been around long before the pandemic…how soon we forget…all of those patients deserve a space without judgement and the best information we have at the time.
The core of the problem is that mythical entity known as public health. Medical care is probably as individualistic an activity as exists. Collectivist thinking inevitably invites government intervention and it is all downhill from there. Practically all the advances ascribed to public health are simply due to improvements in the standard of living. The bureaucratization and rigidification that comes with government and quasigovernmental institutions are inevitable. A necessary first step towards improvement would be the abolition of public health agencies at every level---federal, state, and local.
This piece is on point, to the extent of what is in question here. But the muck runs much farther and wider.
The same paternalism and “guidance in the absence of evidence” exemplified by some of the Covid stuff described here is now pervasive in numerous guidelines (at least in cardiology….i’m simply not familiar enough with evidence in any other field to have an opinion on whether other guidelines are driven by hubris to comparable degrees).
State what you know. Admit what you don’t know. Offer guidance accordingly. It’s not a difficult concept, but one that many leaders du jour seem to fail to grasp. And that’s before one even considers whether anything pernicious or nefarious drives their inability to do so.
Excellent piece. ER doc for 30+ years and worked through all of Covid. Could not communicate with the patients due to pappers, mask, garb, no visitors, patients couldn’t hear w no hearing aids, they couldn’t read lips, it was painful. One day made the executive decision took it all off and never looked back. Wore blue jeans, no mask, did every single procedure in our profession including airways without the nonsense. I never had so much as a runny nose, never tested positive ever, never missed one day of work through Covid nor in my entire career. Meanwhile, I had younger partners that called in sick because their cousin tested positive. Fools follow other fools off a cliff.
Wow. Appreciate you sharing your story, doc. I still feel the loss 6 years later when I was unable to be with my then 92-year-old dad in the hospital when he died (unsuccessful valve replacement while waiting for a bowel obstruction to resolve). No reason at all that I shouldn't have been able to be by his side.
I love and respect my many doctors- I'm so thankful for them- but this policy was criminal. You're right; we don't trust the bureaucrats. At all. They haven't proved to be trustworthy.
Medicine since then has not been doing a good job with “gender affirming” medication and surgeries either. The AAFP and others adopted the language, and even now, the number one thing that shows up under a patient’s name is “gender identity” in Epic. This is a radical adoption of an ideology and practice without much, if any, evidence on its side.
The go-along to get-along is partly to blame. The true experts are silenced while the charlatans are given the podium. How many instances of “ nutraceuticals “ claiming benefits on cholesterol or ED have been proven to have statins or sildenafil respectively and how were these companies sanctioned ? Are the three-letter agencies still trying to protect the public? $$$$$ makes monkey dance ?
These are great points, but I think the problem runs much deeper. COVID policy nonsense has led more and more people to question the reliability of healthcare as a whole. What can we really believe? A team of scientists, including John Ioannidis, analyzed over 1,600 Cochrane reviews and found that only 5.6% of medical services can be shown to be effective, based on high-quality evidence. They also found high-quality evidence that 8.1% are harmful, possibly as high as 36.8%. Cochrane reviews are considered the gold standard in evidence-based medicine. The healthcare system is eroding the standard of living for the working class, taking almost 20% of our national income. And what do we get?
https://pubmed.ncbi.nlm.nih.gov/35447356/
On masking, a patient put it in very simple terms : “ you mean to tell me y’all are trying to keep mosquitoes out with a three strand barbed wire fence ? “
Great write up. But you were too kind. With the recent revelation of Fauci's illegal activities, we now know for a fact (we all knew...) that he almost single-handedly created C19 via Ecco health+Wuhan.
And the TDS addled medical associations fell in line with the Leftists agenda. I used to respect doctors. I used to respect CDC/FDA. I used to think pharma was here to help. I used to think vaccines saved lives. I used to think teaching was an honorable profession. I used to think peer reviewed research was sacrosanct. I used to think MSM lied but not too much. BOY WAS I WRONG.
The *great* thing about COVID was how it opened my eyes. Gov't lied. Fauci lied. DOJ lied. FDA lied. CDC lied. Intel agencies lied. FBI lied. Facebook/Twitter/Google/YouTube lied.
But you did get one thing wrong. You said "people remember" (re:Newsom eating at French Laundry and don't forget sending his kids to private school that didn't close). But you're wrong. Californians voted again and again to keep him around. And you know what? California and every blue state Leftists voters deserve the politicians they elect.
The party line used to be conservative vs liberal. GOP vs. Dem. The line is now good vs evil. You don't have to be a republican, but you cannot be a Lunatic Leftists.
CA residents, legal or illegal can print their own ballots under the “remote access” program, ballot harvesting is legal, and questioning outcomes is literally illegal. IDK how much you can blame the voters.
Sure, that's probably all true. But it's also true that VAST VAST majority of big city Californians keep voting for Newsom.
Seems that old Army Reserve recruiting slogan has been appropriated and modified by some : instead of “ Be all that you can be “, it is now “ Be, whatever you claim you are “
Debate is always healthy when not done to obstruct and destroy. Facts are facts when not manipulated.
Not sure if this is for me or a general comment. If it was for me, please let me know which facts that I wrote about are not true.
General comment.
I used to think that lying was common but there was some truth. What we have learned is that it is all 100% lies, 100% of the time. If the truth sneaks through, it is just an accident. This is not necessarily true of all individuals. But it is absolutely true of all governments and government actors. It is absolutely true of all captured media. (And here I believed "And that's the way it is" was the truth...captured even then.) The medical trade associations, many of which I have joined over the years, lie when economically or socially convenient and do not bat an eyelash.
Of course trust is lost. People may be disinterested but they are not stupid. We have all learned that it is 100% about the money, 100% of the time. (Right up there with the lying statistics.) If it is not grift it is graft, and the only things that look like they are not money driven are the things where one has not yet found the money.
Will the new skepticism get anyone anywhere? -- probably not. But it is surely better than the alternative.
I think there are doctors whose humanity hasn't been beaten out of them. Actually, I *KNOW* there are....my cardiologist for one. And the doctors on this very substack. But I agree with you for the most part. It's no wonder transgender surgery took off so fast. I'm told that it's the biggest money maker for the hospital/surgeons. What a damn shame. Chopping up children to make a buck. I never thought I'd see the day.
excellent piece right on! The problem with science is even the research , NIH,FDA and journals have now been compromised so its hard to evaluate data and trust anything you see ---
I think he’s missing the larger point. The greatest reason people don’t trust medicine is because medicine is nuanced while all the advice one receives via healthcare influencers on social media and youtube speak with absolute certainty. People want certainty. They don’t like uncertainty. Unfortunately in medicine we’re almost always operating in the “grey” as very little is black and white. So people will trust the eloquent, confident, good-looking influencer over the less certain MD/DO.
But here the eloquent influencer is the AAP, etc.
I'm a retired ICU RN. My father and grandfather were MDs. I've lost my faith. How could I not? In Dec 2020 it was known the mRNA shots were not tested to see if they stopped transmission or hospitalization. Yet the PSAs, Fauci, and the medical community confidently proclaimed them "safe", "effective" and "the only way out." In June 2021 when I told my doctor I didn't want it because the platform had not been adequately tested and it looked like the spike was pathogenic, she looked confused and asked me if I had any specific questions. When I said, "Why are they censoring doctors?" she looked like she was considering a psyc eval so I dropped it. The mRNA platform and Spikeopathy are still an issue. Here's one older paper on this, in case someone is unaware. https://mdpi-res.com/d_attachment/biomedicines/biomedicines-11-02287/article_deploy/biomedicines-11-02287-with-cover.pdf?version=1718880673
So to clarify, you’re upset with Trump and Operation Warp Speed regarding vax approval?
Agree agree agree!! Throughout it all the hypocrisy was evident. I am a family doc, was on the local school board during Covid, and was highly torn between trying to follow CDC guidance and the AAP and my own understanding and observation about mild illness and children, and the importance of people being together, particularly after the first two vaccines were widely taken up. I fully understand why people might not trust information coming from us or our government after that debacle, and I do agree that acknowledging where we may have been misled can go along way to helping people trust us again. Scientists are nothing if not people who are able to change their minds based on new information.
There were no experts during the pandemic. No one had experience with administering a novel vaccine platform against a novel virus during an active pandemic. None. Yet we failed to collect rigorous data during that time. I worked in public health then and pushed for that but was refused. Yes it was politicized. The Teachers Union fought the return to classrooms. No where are the unions more powerful than in California where the school system ranks lower than 40 out of 50. As to the California Medical Association, they are a feckless tool to the Sacramento agenda. They do not represent physicians. As to loss of trust in doctors we have to view it from a patient’s perspective. The majority of physicians in California are now employed by large hospital systems. That has resulted in no longer having control of the physician patient interface. Operations and policy is dictated to employed doctors by a corporate administration with a focus on ROI. The patient sees a huge health system made up of big buildings full of automatrons that churn them from one test or lab to another all within their self serving system. This same system failed to convey the nuance of COVID vaccines, prevention and treatment because they were controlled. It was bound to happen by design thanks to the ACA and to CMAs being in bed with the state government and not us. As mentioned the laws California passed during the pandemic that sought to silence decent or fire a HCW who chose not to get the jab were appalling. That shit is on CMA as much as it’s on Newsom or Biden.
Spot on! I'm a cardiologist and was in a very high-level admin position in a very large medical system in Southern California during the peak of COVID. We, the physicians in very large medical systems, had the opportunity to push back on the anti-science that we all so very clearly witnessed. But we cowered, we shut up, we caved. At a time when our patients & the public needed courageous physicians, we failed. None of us, including me, was willing to risk our livelihood to go against the "science" that was handed down from our highest, most respected institutions - the NIH & CDC. This is how coercion always works - threats to your ability to earn a living are very powerful. I guess writing about this now feels good to all of us on this post, but, frankly, it really amounts to nothing. No one has been held accountable. Why do we think it won't happen again?
January 2023, my mother-in-law with COPD/HF in the second half of her 80's, was hospitalized. Medical staff told my wife they wanted to start Remdesivir. My wife knew two things. One, there is a statutory requirement for informed consent. She was provided with none. Two, the CDC and WHO had different perspectives on Remdesivir. My wife called her sister, an ENT, and they discussed their mothers condition. The condition including that their mother was tired of the disease, and most importantly, that they didn't know if she had covid or not. Together they decided against Remdesivir. The medical staff, more than once, told my wife, "If she dies, it's on you".
My mother-in-law was discharged from the hospital without a covid diagnosis and would live another 2-1/2 years. Trust lost.
Remdesivir was known to have a >50% mortality rate when it was tried for Ebola, yet our govt’s wrote it into every ironclad Covid protocol. Hospitals were given extra $ bonuses per patient injected.
https://www.nejm.org/doi/full/10.1056/NEJMoa1910993
And limited benefit:
https://pubmed.ncbi.nlm.nih.gov/32941437/
There is an important distinction between physicians who care for individual patients and public health officials who develop policies for entire populations.
Most physicians are trained primarily to diagnose and treat patients, not to critically evaluate epidemiologic data or assess population-level policy decisions. Medical education places a strong emphasis on memorization and pattern recognition, while statistical reasoning and critical appraisal of the literature often receive far less attention.
As a result, many physicians rely heavily on clinical guidelines without fully understanding the underlying evidence, assumptions, and methodological limitations that shaped those recommendations.
It is relatively easy to create a workforce of physicians who can accurately recite guidelines. It is much harder to develop physicians who can independently evaluate the evidence, understand the statistical principles behind the recommendations, and recognize when guidelines may or may not apply to a specific patient or circumstance.
Thank you for this piece. I was curious, so I found and read the op-Ed you referenced.
Op-Ed: Who invited them to my doctor’s appointment?
I agree with Dr. DiGiorgio’s critique of the Op-Ed.
It seems Dr. McDonald is too focused on external factors instead of ways medicine can work internally to improve trust.
A few thoughts for our profession:
-be humble and admit error. The coverup is always worse than the “crime”
-abandon the noble lie (this caused much of the problems in loss of trust during the pandemic), it is not a useful tool in the current Information Age
-police ourselves more effectively (adhere to robust evidence base data even when not popular) so lawmakers don’t feel compelled to step in with legislation to protect constituents when medical professionals have fallen prey to fads with a paucity of quality evidence to justify their practices
-quit being quick to judge patients who ask questions. Ask them the right questions to find out what they are afraid of / skeptical of and why. “Anti-vax” patients/parents have been around long before the pandemic…how soon we forget…all of those patients deserve a space without judgement and the best information we have at the time.
The core of the problem is that mythical entity known as public health. Medical care is probably as individualistic an activity as exists. Collectivist thinking inevitably invites government intervention and it is all downhill from there. Practically all the advances ascribed to public health are simply due to improvements in the standard of living. The bureaucratization and rigidification that comes with government and quasigovernmental institutions are inevitable. A necessary first step towards improvement would be the abolition of public health agencies at every level---federal, state, and local.
This piece is on point, to the extent of what is in question here. But the muck runs much farther and wider.
The same paternalism and “guidance in the absence of evidence” exemplified by some of the Covid stuff described here is now pervasive in numerous guidelines (at least in cardiology….i’m simply not familiar enough with evidence in any other field to have an opinion on whether other guidelines are driven by hubris to comparable degrees).
State what you know. Admit what you don’t know. Offer guidance accordingly. It’s not a difficult concept, but one that many leaders du jour seem to fail to grasp. And that’s before one even considers whether anything pernicious or nefarious drives their inability to do so.