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September 9, 2009
Exclusive: Hi, I’m Uncle Sam, and I’ll be Your New Doctor
Mutual trust is central to all doctor/patient relationships – the patient must confess the possible source of that nasty little rash while the physician must be equally forthright in prescribing a scientifically sound cure. Whether this confidence will continue as the world of Marcus Welby MD gives way to Uncle Sam, MD is, however, hardly settled. Personal dishonestly is not the issue; the problem is one of shifting incentives as relationships evolve from periodic face-to-face encounters to far more bureaucratic, long distance relationships where bad medical advice may be personally inconsequential. After all, Dr. Uncle Sam need not worry that his misdiagnosis of Ozzie’s “harmless little” rash will bring an outraged Harriet to his office demanding to know how she got the clap.
It is too early to tell whether less personal, more bureaucratic medical relationships can be trusted but the harbingers suggest caution. Government dictated medicine may not even be all that scientific. A recent CDC report about soaring obesity rates, especially among African Americans and Hispanics may foretell this future corruption. The facts are simple enough: blacks have an obesity rate 51 percent higher than whites, and this corpulence is a major factor in heart disease, hypertension, diabetes, certain cancers, even asthma and osteoporosis. Overall, in 2008 some $147 billion was spent to treat obesity-related health problems and these figures can only expand since youngsters are especially prone to chubbiness (the national obesity rate in 2008 was 26.1 percent).
What does Dr. Sam have to say to all these tubby folk, especially African-Americans who often cannot afford the expensive medical consequences of their condition? Unfortunately, Liping Pang, the lead author of the CDC study, offers a diagnosis not all that different than telling Harriet that she contracted the clap from an infected toilet seat and she should be more careful about using public restrooms. According to Pang, higher black obesity results from their faulty environment, namely the absence of supermarkets selling fresh fruit and vegetables, the over-abundance of neighborhood fast-food eateries with their fatty burgers and fries, and a shortage of exercise opportunities since their crime-infested neighborhoods make walking too dangerous. The study also suggests that plumpness may not be all that bad for black and Latina women since they were comfortable with their body image. So, what might Pang prescribe to “cure” these potentially life-threatening conditions? The CDC is silent here but any local board-certified community activist can write the script: demonstrations demanding government subsidized fruit stands, taxing the local Burger Kings, and root cause social welfare initiatives to rid neighborhoods of alienated youth harassing 300 pound pedestrians.
Pang’s diagnosis is, obviously, utter nonsense, and embarrassingly so. It is the lack of demand for fresh produce, not its supply that explains its absence. Doubters should visit any dirt-poor Asian immigrant community to see hordes of sidewalk-crowding vendors hawking veggies at rock bottom prices. Are local merchants clueless on supply and demand? If so, the local Burger Kings would have abdicated decades ago. Is walking in dangerous neighborhoods the only available exercise option? (Conceivably, a hefty populace encourages street crime by supplying abundant immobile victims.) Why not replace cable TV with an exercise machine or just watch the current version of Richard Simmons to tuck those tummies?
A little thought will clarify this mendacity: the truth could hurt, and government-supplied medical advice must often honor the political gods. Better not offend voters and their pandering elected officials.
Dishonesty hardly stops here. The CDC is painfully aware that this racial pattern might be genetic (seehere). That is, blacks disproportionately carry genes (the “thrifty genotype”) that pre-dispose them (and to a lesser extent, Latinos) to obesity and thus blacks might be encourage to pursue of “race-sensitive” diet. But, this well-intentioned guidance, regardless of its wisdom, raises the dangerous specter of genetic differences in blacks and whites, and as is true for such differences more generally, the less said the better regardless of the collateral human damage.
What about the imperatives of scientific evidence? Only partially true. As the current debate over global warming shows, political pressure can creep into anything when Washington foots the bill. Politics will always shape what research is funded and who will be given the public forum. So long as research requires millions in funding, some projects, no matter how worthy, will die for lack of political protection. Just try requesting NSF funds to study how the brains of men and women differ in doing math.
The refusal to supply prudent counsel may be just beginning in health care, but politically driven mendacity already prospers in public education and health care maybe next. The left’s imposition of anti-Americanism and vacuous multiculturalism is well-known. Recent New York City newspapers stories told how 97 percent of the city’s elementary and middle schools were rated “B” or better and only two of 1,058 schools received an “F.” Even more popular is to dumb-down tests so that scores skyrocket, a tactic particularly popular since few have the inclination to investigate this educational sausage-making. Sad to say, such corruption of pedagogy and cooking-the-data tales have become commonplace. In politics, killing-the-messenger flattery will get you everywhere.
This is far less outright falsification than politically sensitive spinning and, of the utmost importance, a rational response to inescapable pressures. When lying down with the Leviathan you get up with political fleas. CDC officials know that their agency’s budget must navigate the congressional gauntlet and issuing “insulting” press releases about overweight African Americans gorging themselves on Doritos only invites Black Congressional Caucus ire (a similar sensitivity occurred during the AIDS epidemic when the CDC tactfully played down the role of repeated unprotected anal intercourse or, conversely, re-classifying certain illnesses as “AIDS” to extort yet more government funding).
This is not to argue that doctors will blow with the political winds on your next office visit. Rather, the overall context of medicine, everything from what is defined as a “treatable illness” to building the research literature to what sicknesses require expensive attention will increasingly be decided by government bureaucrats whose primary constituency is not the here and now patient. Crackpot explanations of illness – Ken’s depression results from society’s homophobia – may be imposed thanks to political pressure (recall how homosexuality went from a medical condition to a mere preference thanks to intense politically lobbying).
Imagine a cautious MD in this new politically infused climate trying to treat a seriously overweight black teenager. Stern and highly sensible advice, e.g., stop eating junk food, etc. etc. might now be judged “culturally offensive” according to newly published government “best practices” for treating historically exploited minority group members (this is no different than imposing a “white curriculum” on blacks). Our anxious doctor might instead recommend boycotting local grocers until they stocked low-priced kiwi and, just to be sure, sue McDonald’s as an environmental hazard targeting people of color. Admittedly horrific advice, but in a world where savvy practitioners judiciously treat the record, not the patient, this makes perfect sense. It will, moreover, reduce the cost of political malpractice insurance and hardly burden the drug plan. Voilà patient “cured” and cheaply so. Isn’t politically driven medicine wonderful?
FamilySecurityMatters.org Contributing Editor Robert Weissberg is emeritus professor of political science, University of Illinois-Urbana and currently an adjunct instructor at New York University Department of Politics (graduate). He has written many books, the most recent include The Limits of Civic Activism,Pernicious Tolerance: How teaching to "accept differences" undermines civil society and the forthcoming, Bad Students, Not Bad Schools: How both the Right and the Left have American education wrong (early 2010). Besides writing for professional journals, he has also written for magazines like the Weekly Standard and currently contributes to various blogs.
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