In medieval times, it was believed that pregnancy and certain medical conditions were caused by the demons Incubus and Succubus that would invade the body during sleep. As bizarre as it may seem, the role of spiritual demons influencing human reproduction was recently championed by a medical group leader with other physicians standing nearby in nodding approval.
In a few months, a recently passed law will go into effect in Florida that would not only allow medical practitioners in Florida to espouse such dangerous myths and beliefs without recourse but also deny medical care based on personal beliefs — no matter how outrageous or wrong.
Yet, if a state-certified teacher used some of the writings of Pulitzer and Nobel Prize-winning author Toni Morrison, for example, speaking to high-school students about understanding community diversity and the impact on public health, that person could be subject to disciplinary action if a parent of a student in the class objects.
The regulation and practice of medicine have been held in high esteem by the public and scientific community for millennia. More than 2,000 years ago, Hippocrates framed principles of medical practice, which are foundational. At medical school graduations across the country, the Hippocratic Oath or its modifications will be recited stating that we shall care for all:
“If it is given me to save a life and save life wherever possible within reason; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”
In the U.S., there are rigorous standards for the educational curriculum of those in medicine. Students in health care must pass special exams and medical board standards to graduate, helping to ensure that the individual is competent in their discipline. For those training to be physicians, post-medical school rigorous residency and fellowship training occurs, and exams to certify competency in the specific specialty. To practice in specific states, the individual will undergo a review of their credentials and need to satisfy licensing requirements. In circumstances where practitioners are employed by hospitals and health care systems, additional measures may need to be satisfied for that individual to practice. This rigorous process helps ensure that the public will be cared for by a competent practitioner following typical standards of care.
During the pandemic, at a time when the public was clamoring for COVID-19 treatments, nonproven interventions including hydroxychloroquine and ivermectin were proposed for use by some members of the medical community. Surprisingly, even in the face of clinical studies showing their lack of efficacy and potential harm, some physicians continued to advocate for their use, provoking critical comments from the Food and Drug Administration and different medical societies.
The anti-vaccine stance of some physicians also drew the ire of the collective medical community. Leading medical organizations have advocated for licensing and credentialing bodies to take action against those giving potentially harmful advice publicly. In some circumstances, the conduct of physicians was referred to state medical boards. In some states, legislation was passed authorizing the potential discipline of physicians making inaccurate and potentially harmful statements related to COVID-19 care. However, such legislation was often challenged by members of the medical community and legally overturned.
In other states, we have seen a very different approach in which medical boards and credentialing authorities are prohibited from taking action against a physician for publicly stating things that are incorrect and at variance with standard medical practice, under the guise of protecting physician free speech.
In medicine, one cares for the patient in front of them irrespective of race, gender, gender identity, immigration status or political views. However, tied in with the notion of protecting physicians’ free speech is now the notion that medical practitioners have the option of not providing care based on their own personal beliefs. This has made its way into legislation in the form of so-called physician “right of conscience” bills in several states that go beyond bills related to abortion.
Some of these bills specifically state that practitioner care may not be denied based on race, religion, or sex, but many legislators do not consider gender identity in their definition of sex, a belief that is at variance with federal law. Thus, care could be denied based on a person’s gender identity or the practitioner’s view of the patient’s lifestyle practices. At a time when we are facing major shortages in the healthcare sector across the country, and alternate care providers are not available, this may lead to denied healthcare access.
We also need to recognize that this type of legislation is being introduced at a time when restrictions are being placed on the classroom discussion of topics related to diversity, inclusion, race and lifestyle. Under the guise of trying to protect children from exposure to material of sexual or lifestyle nature, we are seeing educational censorship and books being banned in school and public libraries, including writings by renowned authors.
It is interesting that a very small number of individuals are behind such national efforts. Almost daily, we are also learning of teachers being disciplined or brought before educational boards after objections from a parent, including objections to a Disney movie with a gay character being shown in a classroom, students being shown images of Michelangelo’s sculpture David or restrictions placed on a poem read at President Biden’s inauguration.
Individuals who think that they can control what children are exposed to by banning books in schools, especially at a time when fewer children are reading, need to realize that children are exposed to hours of unregulated social media and internet content daily. Fifteen percent of children 10 years and younger and 50 percent of those younger than 13 years have seen pornography online. The impact of this exposure has recently led the U.S. surgeon general to issue an advisory about social media use by children.
Historically, medical professionals have been among the most revered and respected members of society and those who we turn to in times of greatest need. In part, this is due to how we regulate and practice medicine.
We now must ask ourselves what the consequences will be when there are no guardrails to protect the public against false and harmful information from physicians who have a large social media megaphone. And why do we think it is so harmful to members of our incredibly diverse society to be exposed to literature and art and have teachers be penalized for doing so when children are exposed to hours of uncontrolled social media and internet content per day?
Why should a physician be allowed to preach and practice medicine believing in Incubus and Succubus, but teachers are not allowed to discuss the writings of Toni Morrison with students?
Scott A. Rivkees, M.D. is a professor of practice at the Brown University School of Public Health. He is the former state surgeon general and secretary of health of Florida.