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Drug Mandates, Coerced Compliance, Institutionalized Cognitive Dissonance contribute to Moral Injury among Medical Physicians {Essay PDF}

 

The paradoxical discord of studying medical sciences while avoiding adverse effects of medicines

Among the many topics insufficiently detailed in medical school and post-graduate medical training is that of adverse drug effects, except for those adverse effects that might appear on medical licensing exams, with those in particular being rather bland and of low consequence, e.g., reversible constipation resulting from certain calcium-channel blocking drugs. Rather than avoiding the topic of risk, I propose here that Medicine (as an educational process, a discipline and a profession) should embrace the truth of risk, obviously but not simply for the benefit of our patients, for the inner peace and intellectual clarity that such a relationship to truth can provide.

Drug mandates void Medicine’s claim to professionalism: Per the Nuremburg Code, “the voluntary consent of the human subject is absolutely essential.” Doctors cannot torture, cannot experiment on people, cannot use coercion, intimidation, fraud, deceit, or threats. Shuster E. New England Journal of Medicine 1997

 

Focusing on false dichotomies distracts us from better options

More and more, public "news" and professional conversations (journals, continuing education programs) about certain classes of drugs are failing to account for risks of harm, risks of inefficacy and risks of distraction.[1-12] While risks of harm are clear and concrete (see hyperlinked citations below) and can be calculated as real numbers (assuming the researchers are honest and the numerators and denominators are accurate[13]), the distractive risks of inefficacy of medical interventions hardly receive discourse other than the bipolar extremes of "it works" or "it doesn't work."

Is Drug X better than placebo? How will we ever know if the researchers used a fake placebo[14], the journal accepted their overt lies[15] and subtle absurdities[16] for publication then refused to publicize disclosure of the grossest error[17], and then the story was repeated ad nauseam throughout the pharma echo chamber[18] via news and headlines that directly impacted more than 10 million people? If Medicine allows the degradation of the very science that underlies and supports the profession[19], then medical journals function as nothing more than drug catalogs[20] and Medicine as a profession has allowed itself to be rightly denounced as a cult of drug-pushers.

Between and beyond the false dichotomies of placebos/interventions and efficacy/inefficacy is a conversation that matters: discussing options, some of which may be far superior to the treatment being discussed in terms of availability, safety, affordability, efficacy and collateral benefits, such as those common to nutritional interventions, such as using the amino acid (acetyl)cysteine in the prevention and treatment of viral infections (recently reviewed in video presentation[21]). Would not the study and practice of Medicine be more satisfying and efficacious if we empowered ourselves with detailed knowledge of how to provide maximum benefit by giving the patient what he/she needs, rather than whatever drug correlates with whatever diagnostic code and pharma-friendly demographic?

 

Lost in a Sea of Pro-Pharma Oversimplification

Medicine as a profession, especially in America, is increasingly lost, inefficient, depressed, suicidal[22], "morally injured"[23], industry-controlled[24], overly attached to electronics[25] and catastrophically detached from its ethical core—multifaceted yet singular—mission of

1) Beneficence: providing benefit,

2) Non-maleficence: do no harm,

3) Autonomy: acknowledging the patient's the freedom to choose the course of their healthcare),

4) Education, informed consent: patients are free to choose only if/when they have been fairly educated about the treatment risks, benefits, and alternatives; the education of the patient is the responsibility of the physician,

5) Respect for human rights, The Nuremberg Code: doctors cannot torture people, cannot experiment on people, and cannot use coercion, intimidation, fraud, deceit, or threats,

6) Justice: ensuring fairness, such as with the distribution of resources, and

7) Confidentiality. 

How many practicing physicians can even name the pillars of medical ethics? How many medical students are crushed and overworked within an inch of their lives by the educational steamroller that is medical training and yet have never had a single impactful lecture on medical ethics? Medical ethics is not a dry abstraction; ethics is ultimately respecting the person in front of us. Remove any of the main pillars—beneficence, non-maleficence, autonomy, human rights—and the doctor has turned the patient into a manipulable object, degrading not only the patient but also the potential and purpose of the therapeutic relationship and ultimately the doctor's own profession, work, life and (for those capable of reflection) self-image.

Stated more plainly: When doctors passively genuflect to pharma-bribed politicians[26] and obviously fraudulent research (yes, even when published in big journals, i.e., following the logical fallacy of submission to authority, e.g., the genetic/source fallacy), they are denying their own autonomy and intellectuality, in effect converting themselves into slaves for an obviously corrupt machine. This is self-degradation—the mind insulting itself for the sake of compliance, submission to authority, and the ease of not having to think but rather just follow orders. This is self-inflicted moral injury.

 

No medical student and no physician was ever inspired to practice Medicine under the rule and dictate of pharma-bought “research” and pharma-bribed politicians.

Further to this self-insult is the simultaneous degradation of the patient, who is now reduced to an object to be drugged and medicated without respect, without care, and without the connection that is inherent to interpersonal responsibility. In other words, as medical physicians (“MD”) submit to function as Medical Dispensers and patients are turned into living and breathing drug targets, the medical profession contributes to its own depression and despair by eliminating the most intimate, rewarding, and reciprocally-sustaining aspects of Medicine. The irony is that when physicians mindlessly follow pharma-bought protocols and mandates, they are not practicing Medicine but avoiding the practice of Medicine by practicing Mindlessness, which is inherently self-degrading. As stated by Branden[27], "If we do not bring an appropriate level of consciousness to our activities, if we do not live mindfully, the inevitable penalty is a diminished sense of self-efficacy and self-respect. We cannot feel competent and worthy while conducting our lives in a mental fog. Our mind is our basic tool of survival. Betray it and self-esteem suffers. The simplest form of this betrayal is the evasion of discomfiting facts. ... Consciousness that is not translated into appropriate action is a betrayal of consciousness; it is mind invalidating itself. Living consciously means more than seeing and knowing; it means acting on what one sees and knows.”

Nuremburg Code—the most important document in the history of the medical ethics:

"The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision." Shuster E. New England Journal of Medicine 1997

 

As I stated in 2005/2006, “A clinician who is unaware of the political forces that shape healthcare policy and research is analogous to a captain of an oceangoing ship not knowing how to use a compass, sextant, or coastline map. Medical science and healthcare policy are influenced by a myriad of powerful private interests which are motivated by their own goals, at times different from the stated goals of medicine, which purports to hold paramount patients’ welfare. Scientific objectivity and the guiding ethical principles of informed consent, beneficence, autonomy, and nonmalfeasance are subject to different interpretations depending upon the lens through which a dilemma is viewed. When this “dilemma” is the whole of healthcare, what first appears as order and structure now appears as the disarrayed tug-of-war between factions and private interests, with paradigmatic victory often being awarded to those with the best marketing campaigns and political influence with less importance given to safety, efficacy, and the economic burden to consumers. To be ignorant of such considerations is to be blind to the nature of research, policy, and our own biased inclinations for and against particular paradigms, assessments, and interventions.”—quote from Dr Alex Vasquez, Inflammation Mastery: Textbook of Clinical Nutrition and Functional Medicine, quote originally excerpted from Vasquez A. Web-like interconnections of physiological factors. Integrative Medicine 2006.[28]

Conclusion

Medicine needs to right its ship, re-prioritize the patient, and honor the pillars of medical ethics that distinguish the Medical profession from drug sales. Embracing the truths of biomedicine can help alleviate the institutionalized cognitive dissonance (forced upon medical trainees) and self-inflicted moral injury to produce more competent, flexible, and happy (or at least less suicidal) physicians, and I am quite sure this will help physicians to provide better and more ethical care to their patients.

Citations

1.     "We believe that adverse ocular effects of vaccines in general are far more prevalent than reported in the literature." Adverse ocular effects following influenza vaccination. Eye 1999;13:381–382 https://www.nature.com/articles/eye1999101.pdf

2.     "A patient is reported in whom bilateral optic neuritis developed following an influenza vaccination. From complete blindness (absence of light perception) in one eye, the patient's vision returned to normal following steroid treatment." Reversible blindness in optic neuritis associated with influenza vaccination. Ann Ophthalmol. 1979 Apr;11(4):545-50 https://www.ncbi.nlm.nih.gov/pubmed/453752

3.     "In this child, no infectious, vascular, granulomatous, viral or immune-related cause of optic neuritis was identified. This case provides compelling evidence that supports the nasal flu vaccination as a cause of optic neuritis." Reversible blindness in bilateral optic neruritis associated with nasal flu vaccine. Binocul Vis Strabolog Q Simms Romano. 2012;27(3):171-3 https://www.ncbi.nlm.nih.gov/pubmed/22989339

4.     "A 68-year-old man developed bilateral sequential non-arteritic anterior ischaemic optic neuropathy, each episode occurring with a close temporal relationship to influenza vaccination." Bilateral Sequential Non-Arteritic Anterior Ischaemic Optic Neuropathy Following Repeat Influenza Vaccination. Case Rep Ophthalmol 2014;5:267-269 https://doi.org/10.1159/000366472

5.     "A previously healthy 6-year-old girl developed bilateral vision loss 1 week after receiving the intramuscular quadrivalent (inactivated influenza vaccine." Bilateral Reversible Optic Neuropathy After Influenza Vaccination. Journal of Neuro-Ophthalmology 2019;39:496–497 https://journals.lww.com/jneuro-ophthalmology/Citation/2019/12000/Bilateral_Reversible_Optic_Neuropathy_After.9.aspx

6.     "We report a 61-year-old woman with bilateral optic neuritis and loss of vision following influenza vaccination. The patient had good recovery of vision following steroid treatment." Bilateral Optic Neuropathy Associated with Influenza Vaccination. Journal of Neuro-Ophthalmology 1996;16:182-184 https://journals.lww.com/jneuro-ophthalmology/Abstract/1996/09000/Bilateral_Optic_Neuropathy_Associated_with.4.aspx#pdf-link

7.     "This case provides compelling clinical evidence that implicates influenza vaccination as a cause of optic neuritis." Optic neuritis after influenza vaccination. Am J Ophthalmol. 1997 Nov;124(5):703-4 https://doi.org/10.1016/s0002-9394(14)70918-3

8.     "We present evidence for a causal relationship between optic neuritis and the nasally administered live attenuated influenza vaccine." Retrobulbar Optic Neuritis and Live Attenuated Influenza Vaccine. Journal of Pediatric Ophthalmology and Strabismus. 2013;50(1):61 https://doi.org/10.3928/01913913-20121108-01 https://www.healio.com/ophthalmology/journals/jpos/2013-1-50-1/%7B0a16e033-9329-4e6f-a3bb-4a3f0c603e57%7D/retrobulbar-optic-neuritis-and-live-attenuated-influenza-vaccine

9.     "We report a case of acute macular neuroretinopathy (AMN) following routine annual inactivated influenza vaccination." Acute macular neuroretinopathy associated with influenza vaccination with decreased flow at the deep capillary plexus on OCT angiography. American Journal of Ophthalmology Case Reports 2018;10:96-100 https://doi.org/10.1016/j.ajoc.2018.02.008

10.   "The authors describe a rare case of bilateral asymmetric optic neuritis with leptomeningeal enhancement on magnetic resonance imaging (MRI) in a previously healthy young woman who received inactivated influenza vaccination 2 weeks before the onset of symptoms." Atypical Optic Neuritis After Inactivated Influenza Vaccination. Neuroophthalmology. 2017 Aug 17;42(2):105-108. doi: 10.1080/01658107.2017.1335333 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858858/

11.   "RESULTS: Our patient developed bilateral optic neuritis on two occasions, 1 year apart. No evidence of neuroretinitis, syphilis, or systemic lupus erythematosus was identified. Influenza vaccination was given 2 weeks before the onset of each episode. CONCLUSION: This case provides compelling clinical evidence that implicates influenza vaccination as a cause of optic neuritis." Optic neuritis after influenza vaccination. Am J Ophthalmol. 1997 Nov;124(5):703-4 https://doi.org/10.1016/s0002-9394(14)70918-3

12.   "Two patients, 39 and 23 years of age, were seen with acute optic neuritis 1 month and 2 weeks, respectively, after anthrax booster vaccination and successfully treated with intravenous methylprednisolone. The first patient had a typical presentation and course of unilateral retrobulbar optic neuritis with excellent visual recovery. The second patient had a bilateral anterior optic neuritis and has required chronic immunosuppression to maintain his vision. Retinal and optic nerve autoantibodies were present in the second patient. No cross-reactive epitopes between anthrax vaccine and retina/optic nerve were identified." CONCLUSION: Optic neuritis is a potential adverse reaction of anthrax vaccination. Optic neuritis after anthrax vaccination. Ophthalmology. 2002 Jan;109(1):99-104 https://doi.org/10.1016/S0161-6420(01)00844-2

13.   Video Critique: Acute Encephalopathy Followed by Permanent Brain Injury Death with Further Attenuated Measles MMR 1998 Pediatrics https://vimeo.com/322315232

14.   Brief Critique of "Effects of n3 Fatty Acid Supplements in Diabetes Mellitus: ASCEND Study" New England Journal of Medicine 2018 Aug https://www.academia.edu/37329403

15.   Video Critique of “Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus: ASCEND Study” N Engl J Med 2018 Aug https://vimeo.com/287650812

16.   Video Critique: Bad Science in Medical Nutrition: Politics of Fish Oil. https://vimeo.com/314997927

17.   Comment on Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus: ASCEND Study. N Engl J Med 2018 Aug [rejected]. https://www.academia.edu/37964035

18.   Pharma Echo Chamber, Sociopolitical Matrix, and Power Vortex: A Diagram-Centric Conceptualization. Int J Hum Nutr Funct Med 2019 https://www.academia.edu/38476348

19.   Vasquez A, Pizzorno J. Concerns about the Integrity of the Scientific Research Process Focus on Recent Negative Publications Regarding Nutrition, Multivitamins, Fish Oil and Cardiovascular Disease. Integ Med 2019 https://www.academia.edu/39907759

20.   Vitamins Against Viruses: Implausible Pro-Vaccine Publications Contrasted Against Ignored Public Health Campaigns and Double-Blind Placebo-Controlled Clinical Trials. Journal of Orthomolecular Medicine 2019 https://www.academia.edu/39406350

21.   Video presentation “Exploring DrV's Antiviral Nutrition Protocol Let's Look at L-Cysteine” available at https://www.inflammationmastery.com/antiviral with a short excerpt available at https://www.bitchute.com/video/Yrd3Jr0uhSlw/

22.   "Each year, more than 1 million Americans lose their doctors to suicide. Across the country, our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels. It's medicine's dirty secret and it's covered up by our hospitals, clinics, and medical schools." Why Doctors Kill Themselves— TEDMED talk by Pamela Wible, MD. https://www.medpagetoday.com/tedmed/tedmed/82008

23.   "At the same time, physicians are overworked, pressured with productivity targets, and stymied by regulations and rules. Today's healthcare system often prevents physicians from being able to deliver the care that they feel is right and best for the patient. ... Some have called it a "moral injury" that is being inflicted upon physicians."Kane L. How Healthcare Is Causing 'Moral Injury' to Doctors. Medscape March 13, 2019 https://www.medscape.com/viewarticle/910309. "Doctors are dissatisfied and demoralized with how they are required to practice today, and as a result physician burnout is taking a huge toll on medicine. Innumerable surveys show that more than 50 percent admit to at least one symptom of burnout and that many are relocating in hopes of finding a better practice climate, or exiting clinical practice through early retirement, moving to administration, or simply leaving medicine altogether. But we contend burnout is an inaccurate diagnosis for the condition and instead, that physicians are experiencing moral injury." Talbot SG, Dean W. Medical Economics 2019 March 15 https://www.medicaleconomics.com/med-ec-blog/beyond-burnout-real-problem-facing-doctors-moral-injury 

24.   Smith R. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2005 May;2(5):e138 https://doi.org/10.1371/journal.pmed.0020138

25.   Devit M. Study: EHRs Contribute to Family Physician Stress, Burnout. 2019 Jan 16 American Academy of Family Physicians https://www.aafp.org/news/practice-professional-issues/20190116ehrstudy.html

26.   "Critics of Senate Bill 277, which would eliminate the personal belief and religious exemptions for schoolchildren, accuse the measure’s supporters in the Legislature of doing the bidding of donors who make vaccines and other pharmaceuticals. ... Receiving more than $95,000, the top recipient of industry campaign cash is Sen. Richard Pan, a Sacramento Democrat and doctor who is carrying the vaccine bill. In addition, the industry donated more than $500,000 to outside campaign spending groups that helped elect some current members last year. Leading pharmaceutical companies also spent nearly $3 million more during the 2013-2014 legislative session lobbying the Legislature, the governor, the state pharmacists’ board and other agencies, according to state filings." Miller J. Drug companies donated millions to California lawmakers before vaccine debate. Sacramento Bee 2015 Jun https://www.sacbee.com/news/politics-government/capitol-alert/article24913978.html

27.   Branden N. The Six Pillars of Self-Esteem. 1994

28.   Web-like interconnections of physiological factors. Integrative Medicine 2006 https://www.academia.edu/40917714

 

About the author and presenter: Alex Kennerly Vasquez DO ND DC (USA), Fellow of the American College of Nutrition (FACN), Overseas Fellow of the Royal Society of Medicine: An award-winning clinician-scholar and founding Program Director of the world's first fully-accredited university-based graduate program in Human Nutrition and Functional Medicine, Dr Alex Vasquez is recognized internationally for his high intellectual and academic standards and for his expertise spanning and interconnecting many topics in medicine and nutrition. Dr Vasquez holds three doctoral degrees as a graduate of University of Western States (Doctor of Chiropractic, 1996), Bastyr University (Doctor of Naturopathic Medicine, 1999), and University of North Texas Health Science Center, Texas College of Osteopathic Medicine (Doctor of Osteopathic Medicine, 2010). Dr Vasquez has completed hundreds of hours of post-graduate and continuing education in subjects including Obstetrics, Pediatrics, Basic and Advanced Disaster Life Support, Nutrition and Functional Medicine; while in the final year of medical school, Dr Vasquez completed a Pre-Doctoral Research Fellowship in Complementary and Alternative Medicine Research hosted by the US National Institutes of Health (NIH). Dr Vasquez is the author of many textbooks, including Integrative Orthopedics (2004, 2007 2012), Functional Medicine Rheumatology (Third Edition, 2014), Musculoskeletal Pain: Expanded Clinical Strategies (commissioned and published by Institute for Functional Medicine, 2008), Chiropractic and Naturopathic Mastery of Common Clinical Disorders (2009), Integrative Medicine and Functional Medicine for Chronic Hypertension (2011), Brain Inflammation in Migraine and Fibromyalgia (2016), Mitochondrial Nutrition and Endoplasmic Reticulum Stress in Primary Care, 2nd Edition (2014), Antiviral Strategies and Immune Nutrition (2014), Mastering mTOR (2015), Autism, Dysbiosis, and the Gut-Brain Axis (2017) and the 1200-page Inflammation Mastery 4th Edition (2016) also published as a two-volume set titled Textbook of Clinical Nutrition and Functional Medicine. "DrV" has also written approximately 100 letters and articles for professional magazines and medical journals such as TheLancet.com, British Medical Journal (BMJ), Annals of Pharmacotherapy, Nutritional Perspectives, Journal of Manipulative and Physiological Therapeutics (JMPT), Journal of the American Medical Association (JAMA), Original Internist, Integrative Medicine, Holistic Primary Care, Alternative Therapies in Health and Medicine, Journal of the American Osteopathic Association (JAOA), Dynamic Chiropractic, Journal of Clinical Endocrinology and Metabolism, Current Asthma and Allergy Reports, Complementary Therapies in Clinical Practice, Nature Reviews Rheumatology, Annals of the New York Academy of Sciences, and Arthritis & Rheumatism, the Official Journal of the American College of Rheumatology. Dr Vasquez lectures internationally to healthcare professionals and has a consulting practice and service for doctors and patients. DrV has served as a consultant, product designer, writer and lecturer for Biotics Research Corporation since 2004. Having served on the Review Boards for Journal of Pain Research, Autoimmune Diseases, PLOS One, Alternative Therapies in Health and Medicine, Neuropeptides, International Journal of Clinical Medicine, Journal of Inflammation Research, BMC Complementary and Alternative Medicine (all PubMed/Medline indexed), Integrated Blood Pressure Control, Journal of Biological Physics and Chemistry, and Journal of Naturopathic Medicine and as the founding Editor of Naturopathy Digest, Dr Vasquez is currently the Editor (2013-) of International Journal of Human Nutrition and Functional Medicine and Editor (2018-present) of Journal of Orthomolecular Medicine, published for more than 50 consecutive years by the International Society for Orthomolecular Medicine.