By Marilyn M. Singleton, MD, JD., of the Association of American Physicians and Surgeons
Trust in our government was a mere 19 percent in 2013, according to the Pew Research Center. Not surprisingly, 56 percent of Americans think it is not the government’s responsibility to provide a health-care system. Waivers, favors, off-the-cuff rule changes and the bungled launch of the Affordable Care Act website validate that distrust. Bureaucratic incompetence and cronyism are not the only reasons we should be wary of government involvement in our medical care.
The federal government has a checkered history when it comes to medical judgments. We now cringe at the words of the revered Supreme Court Justice Oliver Wendell Holmes in the 1927 case, Buck v Bell, upholding Virginia’s sterilization law for the institutionalized “feeble-minded.” “[Carrie Bell's] welfare and that of society will be promoted by her sterilization. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. … Three generations of imbeciles are enough.” In fact, Carrie’s mother was a prostitute, but not feeble-minded. After Carrie’s release, she maintained a job as a domestic worker and became an avid reader. Her “feeble-minded” daughter was on her school’s honor roll.
Let’s recall the appalling Tuskegee Syphilis Study lasting from 1932 to 1972. The U.S. Public Health Service used 400 mainly poor, illiterate, black sharecroppers with syphilis as lab animals. They were told they had “bad blood,” but not that they were actually suffering from a serious but treatable disease. All subjects succumbed to untreated syphilis so our government could track the natural progression of the disease.
The U.S. Navy sprayed the presumably harmless bacterium, serratia marcescens, over San Francisco in 1951 in a biological warfare test. Numerous residents contracted pneumonia-like illnesses resulting in at least one death. The experiments came to light in the 1977 Senate hearings on Health and Scientific Research. Two-hundred, thirty-nine populated areas, including Minneapolis, St. Louis, the Washington, D.C., National Airport and New York’s subway system, had been contaminated from 1949 to 1969 when President Nixon terminated the program.
In 1989, a Centers for Disease Control and Prevention sponsored study tested an experimental measles vaccine on 1,500 six-month old black and Hispanic babies in Los Angeles. The CDC admitted in 1996 that parents were never informed that the vaccine was experimental.
According to the Department of Health and Human Services, lax oversight at the Stratton Veterans Affairs Medical Center in Albany, N.Y., allowed cancer research coordinator Paul Kornak from 1999 to 2003 to “dishonest[ly] handle research records and demonstrate a complete disregard for the well-being of vulnerable human subjects under his care.” Kornak pleaded guilty to criminally negligent homicide.
In another vein, the degree of political underpinnings in government health policies is unknown. Agencies such as the United States Preventive Services Task Force, self-described as an “independent panel of non-federal experts in prevention and evidence-based medicine,” submit recommendations to the HHS Secretary. Even assuming the recommendations are grounded in science, the secretary is an arm of the executive branch, so in creeps politics.
This leads us to the question of whether we can always trust “evidence-based medicine.” Reporting bias is systemic in medical literature. A 2012 Cochrane independent review found that company-sponsored trials were more likely to report favorable efficacy results compared with non-industry sponsored studies. Even in academic studies, positive results are more likely to be published. A 2009 analysis of 18 surveys by multiple authors found 34 percent of researchers admitted to “questionable research practices.”
Recently, a large analysis of “secure” studies found the European guideline recommending liberal use of peri-operative beta-blockers for non-cardiac surgery in fact caused a 27 percent increase in mortality or some 800,000 deaths over five years. The guidelines were based on trials tainted by scientific misconduct by the principal investigator, Don Poldermans, who was also chairman of the committee that drafted the guideline.
Government intervention in medicine can be harmful to your health. Rigid rules and restrictive drug formularies are advanced based on consensus, leaving no room for individualized treatments. We want physicians who we can trust to be open, honest critical thinkers, not “providers” who are government puppets.
Marilyn M. Singleton, MD, JD, is a board-certified anesthesiologist and sits on the Board of Directors of the Association of American Physicians and Surgeons. She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed two years of surgery residency at UCSF, then her anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then assistant professor of anesthesiology and critical care medicine at Johns Hopkins Hospital in Baltimore, Md., before returning to California for private practice. She attended U.C. Berkeley Law School, focusing on constitutional law and administrative law.