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Words of healing: Physicians must restore the integrity of medicine… : Emergency Medicine News


epistemology, professions, misinformation


Ivermectin is symbolic. If a large, multicenter, randomized, placebo-controlled trial with no conflicts of interest were published in a peer-reviewed journal with sound methodology and statistics concluding that it was beneficial for COVID-19, that would not change the symbolic role and social behavior that existed before such a study.

Ivermectin has not assumed symbolic power “because we just don’t know if it works”. We have lots of data, and the methodological best of these non-definitive data does not provide evidence of any benefit. But I want to focus on ivermectin as a symbol, flag of a medicalized American militia that is waging a self-defense revolution to take the hill from our profession (and some members of that militia are doctors).

Epistemic privilege

Epistemology is the study and use of methodologies by which we consider knowledge to be a justified belief in relation to an opinion. Epistemic privilege is the honor of the authority given to an expert to proclaim knowledge as true or false (or uncertain or indeterminate). Some people are trusted authorities in a field of knowledge, including medicine. American physicians in the modern professional field of medicine have had the epistemic privilege of using the primary instrument of the scientific method, that is, evidence-based medicine.

This privilege was initiated within the medical community with the Abraham Flexner report of 1910 which attempted to eliminate the anecdotal, n out of 1, and personal testimony characterized by the widespread use of alternative therapies (chiropractic therapy, homeopathy, naturopathy, vitamins, acupuncture, phytotherapy). therapy, magnetic therapy, dietary therapy, etc.) prevalent in the quasi-religious medicine spectacle of the late 1800s. This privilege came with the professionalization of American medicine in the early 20th century; gained ground with the advent of antibiotics, the discovery of insulin and the accumulation of effective vaccines; and later won victories with intensive care units, trauma care, and hip replacements, to name a few technological advancements.

The government gave legal authority to the scientific method in the Drug Efficacy Amendment (1962) and the Medical Device Amendments (1976) which required independent scientific proof by the Food and Drug Administration before use and sale of legal therapies and medical procedures. The creation of professional educational standards using the scientific method instilled by rigorous didactic and experiential training, the embrace by an American culture that could understand and see the benefits of this medicine and desired to have a relationship of trust with it, and a government that understood the community value, above economic or political values, of retesting a pharmaceutical product or business procedure independently before allowing it to operate in a free market economy, were the safeguards and strength of the medical profession American.

Replacement of doctors

Anxiety is mounting among American doctors, including those in emergency medicine, who fear they may be out of work in the future. It seems paradoxical that there is less need for a doctor at a time in our history when health care has reached religious fervor in the midst of a catastrophic infectious pandemic.

Several other health practitioners also replace the professional physician physically as the one who administers health care goods and services and culturally as the trusted authority:

  • The nurse practitioner, who has evolved into a “medical care provider”. Holders of a doctorate in nursing will compete for the title of “doctor” (and have legally obtained this status in several states).
  • The Physician Assistant, also promoted to ‘Medical Provider’, is now vying to be crowned ‘Associate Physician’.
  • Chiropractor using spinal adjustment, considered unethical medicine due to lack of plausible biological mechanism and inability to establish solid empirical evidence, re-entered American medicine based on a legal ruling of economic commercial practice (1987). Now, chiropractors (along with acupuncturists and naturopaths) have been granted epistemic privilege by state boards and some insurers.
  • The nurse without an advanced degree is the “clinician” of telemedicine with Amazon Care, which will decimate primary care, mental health practices and minor urgent care structures (and their jobs) in the same way as Amazon wiped out malls and retail stores. Amazon Care is the leviathan that will attract employers and engulf small telemedicine companies and further exhaust available nurses. Amazon Care was tested last year and now exists in 24 cities.
  • The employee doctor who plays the game to survive and says, “I just show up, check the boxes, do my part, not mess with the paperwork and take my paycheck home until I can retire.” which will not need to be completed by a doctor. Non-physician practitioners are less fiery in their independence and much cheaper!
  • The doctor who plays the game to survive takes his own medicine show on the road. He becomes a Dr. Oz-wannabe who uses his legitimate degree to peddle soft science or simply quackery, pretending, out of arrogant ignorance or nefarious greed and fame, that these “complementary medicines” have met the rigors of good science.
  • Individuals who, with their own electronic device, believe they can make complex medical decisions on their own by using “medical experts” on the Internet to reinforce their cognitive biases or who wish to autonomously operate technology that quantifies with health data. They fail miserably to understand the difference between acquiring data and drawing valid conclusions. Hard data is not synonymous with valuable data, and neither equals human value.

A therapeutic response

The exchange of rigorous scientific methodology for personal electronic solipsism causes community professional medical experience to dissolve into a vote for private opinion. Self-selected data should never be more reliable than embodied knowledge.

Reducing health to a business depreciates the human body and life to a monetary measure. Physicians have lost their epistemic privilege because they have lost their epistemic duty.

A different approach, if integrity is to prevail, must begin with better training of our own battalion. We need a Flexner moment to train doctors who aren’t properly trained in clinical statistics and ship those who have lost their ethical professional base camp. The proper use of statistics is an ethical necessity because it affects human life.

Statistics and philosophy of science cannot be short courses limited to medical school grades, but must be living medical knowledge that struggles and breathes through every word to give patients the integrity of medicine that can save the life.

Dr. Mosleyis an emergency physician in Wichita, KS.