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Politicization, Polarization & Power Asymmetry
The Sinister Triad Affecting Modern Medicine
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Politicization, Polarization & Power Asymmetry
The Sinister Triad Affecting Modern Medicine
Thera are three major challenges facing medical community and general public today:
Politicization of every aspect of life, including medicine. The politicization of medicine and science has converted them into powerful political weapons. Those disturbing phenomena interfere with individual clinical care, affect public health and fan the flames of the cultural war.
Political Polarization has divided previously one nation into two hostile to each other opposing political blocks: Progressives vs Conservatives. Those two adversarial tribes have nothing in common and are locked into hermetic bubbles.
Power Asymmetry: Progressive block has the enormous advantage over conservative block in all areas of administrative and managerial influence from: Federal and State administration, through mainstream media and entertainment to Academia and Science. Both progressives and conservatives are in denial about it.
Politicization of medicine is the inevitable consequence of the current political polarization and reflects the asymmetry of power between two opposing political blocks. With the ongoing escalation of the political strife - the politicization of medicine is not going away any time soon.
Phenomenon of Politicization
Term “politicization” can be easily misunderstood since it is used to describe various types of socio-political phenomena (Mazuca & Santarelli, 2022). For the purpose of this discussion - we will use it to denote:
“the undue encroachment of (partisan) politics into neutral or non-political arenas, institutions, activities and realms, such as sport, religion, the arts, science, the civil service, etc.” (Jenkins L, 2011)
Politicization of Medicine
As defined above, politicization is not the passive, descriptive trait - like the political character. Politicization is the active, improper and intrusive process that reshapes the object of its invasion to achieve the specific political goals. In this context, the politicization of medicine is especially perilous. This process causes the epistemologically precarious partiality of the field that should be impartial.
“Politicization” should not be confused with “political character”. Humans are political, ideological and religious beings. Medicine is practiced by humans who treat human patients. Therefore, certain specific aspects of medicine are bound to have political, ideological and religious dimensions. Issues like abortion and euthanasia are examples of medical matters with clear religious, ideological and political aspects.
Yet, maintaining impartiality is a condition sine qua non for the delivery of the effective clinical care and for development of sensible public health programs. Politicization removes that essential ingredient. It transforms the medicine from the neutral tool which purpose is to detect the disease and to cure it - into the partisan weapon designed for manipulation and coercion. As discussed below the consequences of this process are far reaching and terrifying.
Origin of Politicization of Medicine
Concerns about the politicization of medicine in the US have been expressed for a long time. Some authors argued that Americans always had a tendency to politicize public health, at least partially (Follett C, 2020). However, recent years marked by pervasive political polarization and tribulations of COVID-19 pandemic have ushered the era of the relentless politicization of medicine. Lets describe briefly how this regrettable stage has been reached.
Politics is an adversarial process by its very nature. The essence of politics is a competition between the opposing partisan groups for administrative power and control over the financial resources (Eiseman M, 2003). The tensions between the competing parties are low when they have more of the common than opposing ideological views and the economic resources are abundant. In such settings partisan rivalry is civil and courteous. Such political adversaries are not hateful foes. They are mutually respectful contenders who do not need to resort to dirty tricks such as politicization.
Such stable scenario lasted for relatively long time in the US. Unfortunately with time, the economic situation deteriorated and sharp ideological and cultural differences between main political parties started to emerge. Ultimately, the two opposing partisan groups started to perceive each other as mortal enemies who have very little if anything in common. Politics became polarized and divisive as virtually never before (Dimock & Wike, 2021). In the atmosphere of extreme partisan hostility - any type of the political weapon became acceptable. As a result - the politicization of medicine has joined the political armament and became the omnipresent element of life.
Brief History of Polarization
As described above, with time American public became increasingly polarized along the line separating two main ideological mindsets. The names given to those two opposing partisan camps vary and are not always precise. Most frequently those two opposing political wings are referred to as Conservative (Right Wing) and Progressive/Liberal (Left Wing). Since most Conservatives belong to Republican Party and most Progressives/Liberals belong to Democratic party - vernacularly term Republican is used to describe Conservative, while term Democrat to denote Progressive/Liberal.
The increasing political chasm between Americans has been confirmed by numerous research studies including extensive Pew Research Center surveys ( PRC, 2014 ; PRC, 2017 ; PRC, 2022). The stronger adherence to the political partisan principles has been associated with the increase of partisan antipathy - manifested by the anger, hostility and contempt for the members of the opposing party. And the intensity of this mutual animus is stronger than ever before. Those antagonistic trends have expanded beyond political sphere into every aspect of life - including medicine.
Effect of Polarization: Two Hostile Nations instead of One
Differences between Conservatives and Progressives became so deep that they are no longer members of the same nation - who simply disagree on policy matters. The concept of “E pluribus unum” is no longer applicable. The national unity is gone. Instead, there are many hostile tribes assembled against each other in two adversarial nations or “blocs”. Those two camps have the opposing cultural, economic, religious and moral views.
Two Nations Interspersed within one Territory
There is no common ideological ground between those political rivals. However, for now they do share the same vast territory within which - their walled-off partisan silos are interspersed. Conservatives are congregate more in rural areas while Progressives mostly dwell in the large coastal cities.
Irreconcilable Cultural & Moral Differences preclude any Dialog
Despite living within the borders of the same country - Conservatives and Progressives diverge on the most basic matters. They differ in opinions about how to dress, what to eat, in which type of environment to work and live, what kind of people to be around and with whom to start a family. Marriages between Conservatives and Progressives became very rare (Wang W, 2020 ).
The cultural and moral difference between Conservatives and progressives are so deep and irreconcilable that they make any type of communications between those two alien nations impossible. Members of those two nations despise each other so deeply that they do not want to have any interactions.
Partisan Silos, Bubbles and Echo Chambers
Due to their irreconcilable differences the majority of members of those two groups live within well demarcated communities - where they are surrounded by people who share their political views. They read same newspapers, watch same news programs, belong to the same Social Media groups, going to same churches or social gatherings. In other words they live inside their own echo chambers. This almost perfect separation from each other - give them the impression that their group “has to be in majority” and hence “it has to be right”. They rarely interact with the members of the opposite party and they do not want to.
Belief that the Opposing Side is Unworthy of Being in Power
The best illustration of the depths of this divide is the change in the opinion on the results of the elections. It used to be that majority of Americans were ultimately willing to accept the results of the elections - even when the winner represented the opposing party. This has changed in the last decades.
It is now a common knowledge that no matter who prevails at the ballot boxes - the majority of the losing party will regard the official outcome as illegitimate. Both sides will accuse each other of being “the ultimate election deniers or election thieves”.
This reaction is emotional and bound to happen independently of the presence or absence of proofs of election interference, stealing votes, electoral fraud, etc. Facts will not matter - since each half of the electorate is firmly certain that the other half is too dangerous and too irresponsible to wield any powers of the state. Hence, neither half of the electorate will accept that the victory of their opponents can be legitimate.
Tragically, such an emotionally charged climate increases the tendency to simultaneously strongly believe in the electoral fraud and to actually perpetrate it. When the opposing party is perceived as evildoers - it is consistent to believe that they won because the election was stolen. At the same time it is also inevitable to come to conclusion that perhaps stealing the election from the evildoers is morally justified since the country has to be saved from the barbarians per fas et nefas. This emotionally driven circular reasoning creates yet another cycle of the constantly spinning vicious circle of partisan antipathy.
Total Separation: No Mutual Understanding or Respect
Clearly the partisan divide is deep and it getting worse. Both sides stopped seeking mutual understanding or respect. They approached the point in which they do not care any more what the other side thinks of them. Accusations of quackery have little meaning if one does not seek the affirmation of the members of the other group. Who cares to be liked or disliked by the sworn enemy. People seek affirmation and acceptance by the members of their tribe and care little what the other tribe thinks.
Rejections of Independents
There were always hardcore Progressives and hardcore Conservatives, but there were also Independents. Before polarization the Independents could enjoy the benefits of two words. They were disliked by the extremes but found many allies among moderates in both sides. Polarization caused a tragedy for Independents since in the climate “if you are not with us you are against us” the Independents became automatically the enemies of both Progressive and Conservative. Even worse: both Conservatives and Progressive don’t want to acknowledge the existence of Independents. They see them as the useless traitors.
The Illusion of Common Institutions
The uninformed observer can claim that in addition to the living space - the members of two opposing blocks also share the same representative government, same administration, same court system, same academic institutions, same press and same entertainment industry. However, as explained below this is an illusion - since there is a clear power asymmetry between two blocks within these essential institutions .
Talking about two opposing blocks in the contest of “the half of the electorate” implies some type of the power balance in terms of numbers and amount of influence they can wield. While the two blocks maybe indeed similar in size - there is no equivalency between them regarding ability to project the various types of powers.
Tacit observations and independent research demonstrate that major institutions which are crucial for the operation of the state are dominated by the Progressives. Those institutions include:
Federal and State Administrative Apparatus including FDA, DEA and Medical Boards.
Legal System including part of Police.
Academia including Medical Schools.
Industry including Pharmaceutical Industry.
Large parts of the Organized Religion.
Large parts of the Military.
Progressive Academic Supremacy
The phenomenon of the “disappearing conservative professoriate” in Academia described by Jon Shields illustrates the process of nearly total replacement of conservative faculty by progressive professors. Shields points out that based upon the reliable surveys the ratio of liberal to conservative professors has increased by about 350% (three hundred fifty percent) since 1984 - despite the fact that no such political shift has been observed among the general public at that time. Ultimately, with exceptions of a very few embattled holdouts the conservative voices have disappeared from Academia including Medical Schools.
Traditionally, American physicians including academic physicians were considered to be aligned more with Conservatism than with Progressivism (Shaywitz D, 2020) . However, the reversal of this pattern started to take place since the 90s. The elegant research utilizing analysis of political contribution performed by Bonica et al. has demonstrated the dramatic shift in political donation made by physicians from Republican side into Democratic side between years 1991-2012 (Bonica A, 2014). The authors did not divide physicians into academic and non-academic physicians; instead they analyzed their political donations by the employment in for profit (mostly non-academic) and nonprofit (mostly academic) organizations. Expectedly, the deviation toward donating to Democrats was faster and more pronounced among physicians employed in nonprofit institutions (including academic institutions). Ultimately the liberal take over of academia was completed.
Dominance of the Progressive faculty in medical schools and in the biomedical disciplines had major impact on the three essential areas of academic medicine: teaching, clinical care and research.
Denial of Asymmetry
Interestingly, the obvious power asymmetry tends to be frequently denied by both Conservatives and Progressives. It is an interesting paradox. Conservatives which are objectively weak will keep denying their weakness. Progressives who are objectively strong will keep denying their power.
For a long time many Conservatives were either in denial of power asymmetry, ignored its significance or were unaware of its existence. This is understandable. Human beings have a hard time to acknowledge that they are weak. Especially when weakness may be construed as the result of their negligence. And there are voices claiming that Conservatives have allowed the transfer of critical powers to Progressives due to complacency. Moreover, many Conservatives were indeed shielded from the results of power asymmetry due to the fact that they were protected from it by thick walls of their partisan silos. The COVID-19 pandemic with its mandates was a rude awakening for many of them.
Majority of Progressives will deny any liberal bias and negate any claims about the Progressive Supremacy. This denial is frequently expressed along the lines: “There is no liberal bias! - believe our narrative not your lying eyes.” Such attitude is understandable as well. The ideology which is built around the claims of fighting the supremacy simply can not acknowledge the fact that it has become a supremacy in its nature as well (Ornstein, 2014 ; Linker D, 2021;).
Effects of Politicization of Medicine
Politicization of medicine is not a disconnected process. It is a part of the widespread penetration of partisan politics into many aspects of life. Hence, the results of politicization of medicine are frequently common with the outcomes of political pressures in other areas. Therefore, the effects of politicization of medicine are numerous. For the sake of brevity we will focus on two most deleterious effects of politicization of medicine:
Unsound medical decision making.
Crisis of medical expertise.
Unsound Medical Decision Making
The most detrimental effect of politicization is its negative impact on medical decision making (Fig.). A plethora of scholarly treatises have been written about the formulating the correct medical opinions. All of them concluded the obvious: to make the best diagnostic and therapeutic choice - clinicians shall use a sound, unbiased analytical process while relying on the objective evidence.
While concept of EBM has been perverted by the corporate medicine - the premise of basing the medical decision on the most certain facts is still valid. It is understandable that the scientific knowledge evolves but at a certain time point the set of facts available to clinicians should be as objectively certain as possible - and not biased by political agendas.
In the 21st century physicians are not only medical decision makers. The shared decision making concept has been introduced - expanding the model of the informed consent to treatment. Patients became de facto partners of clinicians in medical decision process. Therefore all patients should also have an access to verified objective data.
Politicization of medicine interferes with both clinicians and patients ability to make the sound medical decisions. It impairs their analytical skills by making them susceptible to partisan bias. It removes the objective evidence and replaces them with the skewed data - that conveniently fit into the politically driven narrative.
Consequently, the politically preferred but harmful and ineffective medical modalities are chosen, while safe and effective interventions are discarded. Furthermore, the evidence of harm caused by those politically motivated choices are being hidden and ignored.
Since all of this is occurring on the massive scale - the societal harm is enormous. Number of victims is growing exponentially but nothing is being done to effectively stop this calamity - since the powerful political forces are too strong to be opposed - despite the best efforts of those who are concerned about this situation.
Crisis of Expertise.
Fall of the orthodox experts.
Hippocrates famously observed:
Ars longa, Vīta brevis, Occāsiō praeceps, Experīmentum perīculōsum, Iūdicium difficile.[Medical art is long, Life is short, Opportunity fleeting, Experimentations perilous, Judgment difficult.]
This brilliant aphorism still rings true today. It takes a long time to acquire medical knowledge and perfect clinical skills - but one has a short lifetime to do so. Few can master well some narrow segments of parts of medicine but no one can absorb it all. Despite all the advancements in the information technology, the studious and experienced medical experts are still indispensable.
Before politicization medical experts were expected to be the impartial skilled consultants. Their role was to guide less qualified colleagues, reassure the general public, and advise the policymakers about the rational public health policies. Politicization of medicine has perverted this mission. Politicized medical experts are the political factotums doing the biddings of their masters. They are charged with the duty of rubber stamping of the medical treatments and policies which while harmful and ineffective - are favored for the political reasons. The primary function of such “experts” is to deceive their colleagues and general public.
However, as the old saying attributed to Abraham Lincoln goes: one can fool all the people some of the time and some of the people all the time, but one cannot fool all the people all the time. Indeed, many started to question the sincerity of recommendations made by the politicized experts. The universal trust in the previously highly respected medical experts has crumbled. The substantial part of general public and even medical community became disillusioned with orthodox experts and rejected their authority.
Loss of credibility by an expert is typically the complete and irreversible process. A principle: falsus in uno, falsus in omnibus (false in one thing, false in everything) is typically applied. The expert who has been caught lying once will never be believed - even if he would start telling the truth. People who caught him lying in the past - will assume that he is lying anyway. Such a fallen expert may still appeal to a group of loyal believers. However, those will be typically highly politically motivated individuals who would believe in any political lie - without the confirmation by an expert. Hence the usefulness of the politicized experts for his masters is variable. It can be significant in a short term, but is rather limited in the long run.
Naturally, the biggest problem here is that as explained above, expert are indispensable for medical community and public. The politicized expert who lost credibility becomes virtually non-existent. Hence, politicization removes the indispensable medical resource from the society which depends upon it. This is a devastating effect.
Variable quality of the alternative experts
Because credible experts are so vital for medicine - the fall of the traditional experts created a vacuum. This void had to be filled by the new medical authority figures.
The rejection of the politicized experts who betrayed their role of impartial arbiters was a positive development. However it would be naïve to assume that anyone who self-identifies as “a credible expert” and seems to questions certain politicized narratives - has to be the honest, impartial and well qualified person.
As discussed above, there are many bad actors in the midst of the legitimate opponents of politicization of medicine. Ironically, some of such unsavory characters push their own politically motivated narratives - under the guise of fighting the politicization of medical field. Others are there for pecuniary gains by any means and they are ready to exploit unscrupulously any opportunity related to the crisis of the official expertise.
A robust cottage industry has developed on the internet - around the concept of providing the allegedly apolitical medical expertise. Numerous individuals with more or less legitimate medical credentials are offering the medical solutions, contradicting those endorsed by the politicized official experts. Unfortunately the quality of this newly founded industry is variable. There is a lot of speculation, misinformation, propaganda and outright lies which are inter-mixed with genuinely true information. It is very hard to separate the wheat from the chaff in the midst of such informational chaos.
The noisy battle of competing politically and greed driven narratives further muddies the water and imperils the quest for the objective truth. And knowing the truth is essential for the successful clinical care and sensible public health policy.
As discussed above the politicization of medicine is an extremely dangerous phenomenon. This malignant process causes numerous casualties while enabling and enriching variety of evildoers. Unfortunately, due to current socio-political circumstances this calamity is here to stay - as long as those circumstances will continue.
There are no fast and easy solutions to neutralize the negative impact of politicized medicine. However, there are some simple solutions which can at least reduce some of its harms. Those include:
Exposing Politicization. Politicization is a process affecting many in the unconscious way. The most malignant feature of politicization of medicine is its stealth nature. Hence, becoming aware about the true nature of this process and making other conscious as well are the two most relevant steps in attempts to reduce harms of this calamity.
Being apolitical when possible but fighting politics with politics when necessary. It is imperative for the benefits of patients, colleagues and the society to remain as objective as possible instead succumbing into the partisan politics all the time. However, there will be times when the especially egregious acts of politicization have to be confronted with the strong political means.
Being reasonably skeptical and teachable. The best way of seeking the truth in the epoch of narratives is to abandon the tendency to automatically accept any information without scrutinizing it - even if the information comes from a favored source. Instead of uncritically believing in one version of the story, one should start to assign probabilities to all its potential variants. In this process, it is necessary to leave the comfort zone of absolute certainty. One cannot know everything all the time, and certain things will remain unknown. Yet, despite this uncertainty, one’s diligent guesstimate about what is going on will be more accurate than a made-to-order narrative prepared by manipulative experts or media.
Being realistic. It is crucial to understand that many people will remain strongly politicized and non persuadable. This realism should allow us to develop strategies allowing to either by-pass such agents of politicizations or effectively shield our patients and fellow physicians from their negative influences.
People are political creatures, and they should be allowed to take politically based decisions. Including decisions related to their own health.
However, it is unacceptable for that democratic society to coerce everyone to follow one set of politically motivated rules presented under the guise of the “benevolent” Public Care Policies or “scientific” Medical Care. Ideally, the politicization of medicine should be stopped and abolished for ever.
This us however unlikely to occur as long as the heated political climate combined with economic crisis will favor the deployment of the powerful partisan weapons such as politicization. While awaiting for the better and more harmonious times all what people of good will and conscience can do is try to expose and oppose the politicization of medicine by all available to them means.
References and Suggested Further Readings:
Abbas AH. Politicizing the Pandemic: A Schemata Analysis of COVID-19 News in Two Selected Newspapers. Int J Semiot Law. 2022;35(3):883-902. doi: 10.1007/s11196-020-09745-2. Epub 2020 Jul 3. PMID: 33214736; PMCID: PMC7332744.
Bolsen, T., & Palm, R. (2022). Politicization and COVID-19 vaccine resistance in the U.S. Progress in Molecular Biology and Translational Science, 188(1), 81. https://doi.org/10.1016/BS.PMBTS.2021.10.002
Boschele M. COVID-19 Is a Crisis in Planetary Health and Politics of Expertise: Time to Think Critically and Innovate Both. OMICS. 2021 May;25(5):279-284. doi: 10.1089/omi.2021.0038. PMID: 33961517.
Mazzuca, C., & Santarelli, M. (2022). Making it abstract, making it contestable: politicization at the intersection of political and cognitive science. Review of Philosophy and Psychology 2022, 1–22. https://doi.org/10.1007/S13164-022-00640-2
Schmid-Petri, H., Bienzeisler, N., & Beseler, A. (2022). Effects of politicization on the practice of science. Progress in Molecular Biology and Translational Science, 188(1), 45–63. https://doi.org/10.1016/BS.PMBTS.2021.11.005
Office of the Surgeon General. Confronting Health Misinformation. US Department of Health and Human Services; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK572169/. Accessed Oct 23, 2022.
Roozenbeek J, van der Linden S. How to combat health misinformation: a psychological approach. Am J Health Promotion. 2022;36(3):569-575. Available at: doi:10.1177/08901171211070958/ASSET/IMAGES/LARGE/10.1177_08901171211070958-FIG3.JPEG. Accessed Nov 7, 2022.
Johnson SS. The urgent need for coordinated and comprehensive efforts to combat misinformation. Am J Health Promotion. 2022;36(3):559-561. doi:10.1177/08901171211070957A.
Resneck J. Turning the tide against medical disinformation will take all of us. American Medical Association. AMA Leadership Website; Oct 5, 2022. Available at: https://www.ama-assn.org/about/leadership/turning-tide-against-medical-disinformation-will-take-all-us. Accessed Oct 23, 2022.
Roll-Hansen N. The Lysenko effect: undermining the autonomy of science. Endeavour. 2005 Dec;29(4):143-7. doi: 10.1016/j.endeavour.2005.10.003. Epub 2005 Nov 4. PMID: 16271764.