Out of Eighteenth and Nineteenth Century progressive reforms came the collectivist notion that disease could be eradicated with government-compelled one size fits all treatments without need for reliance on individual doctor-patient relationships. Physicians would become mere functionaries of the public health establishment. That collectivist conception gave rise to what is an oxymoron, “public health.” Truth be told, there is no such thing as “public health;” only individuals are diagnosable, and each has a unique physiological state for which a tailored treatment is almost always the best.
The notion of a discernible “public health” drove creation of public health bureaucracies, like FDA, CDC, and HHS, together with state health bureaucracies, like the medical and health specialty licensing boards. Over the years, ever more voluminous public health directives have de-emphasized and undermined individual freedom of choice in health care, exercise of individual professional judgment, and the doctor-patient relationship.
Today, physicians are routinely vexed when the treatment they believe best based on education, experience, and training is effectively disallowed by proxies for government overseers. It is those proxies’ treatment preferences that take precedence, deviation from them causes physicians to suffer an array of costly sanctions from Medicare and Medical Boards. For example, a physician who believes it in the best interests of a COVID-19 patient to treat him or her with hydroxycholoroquine or ivermectin will today be disabused of that exercise of professional discretion by Medicare providers and state licensing boards, despite convincing evidence that the treatments are effective in reducing symptoms and preventing hospitalization and death in patients who have recently contracted the illness. Not following the course set by the public health regime for COVID-19 (i.e., not insisting on COVID-19 vaccination and on treatment with select, approved agents like Paxlovid) invites the rebuke of peers and suspension or revocation of medical licenses.
The more government proceeds in favor of “public health,” the less assurance we have of best treatment. As government increasingly emphasizes “public health,” it deemphasizes and disempowers individual choice in health care and the exercise of independent professional judgment. That is a lesson Americans may have learned from the government COVID-19 mandates. The lesson applies equally to all other “public health” mandates, such as school vaccine schedules.
Vaccination operates on the false premise that everyone will benefit from injections variously designed to alter body chemistry to evoke an immune response. But we know from history that some will not benefit at all and, indeed, some will suffer injury, severe injury or death following vaccination. Ought not we be encouraging medical science and practitioners to identify all individual characteristics that make vaccines, like the COVID vaccine, inadvisable for patients? Doesn’t the public health establishment owe each patient full information on the risks he or she may face from vaccination? But disclosure of full adverse event information would tend to prove the lie of “public health” and would expose the reality that individual freedom of choice is unfairly sacrificed by public health regimes. Instead, government advocates of public health emphasize in typical progressive fashion a vital need for universality of treatment, deeming harms inflicted on individuals the price that must be paid for achievement of an amorphous and – particularly in the case of COVID -- very elusive “public good.” Consequently, some states, like California, have eliminated all manner of exemptions from vaccination mandates, even medical exemptions. The stark reality, as many have realized from the COVID jab, is that people respond differently to vaccines depending on their unique physiology. For some, a vaccine may appear to carry with it benefit and for others a vaccine may be more likely to induce reactions, even death. In every case, “public health” mandates deny the individual the freedom to choose even when life is at stake, overruling that freedom with compulsion that supplants intelligent, well-reasoned medical dissent.
From the outset, the idea of “public health” has been a fiction, a costly one. Each of us differs in our relative health and susceptibility to disease and treatment. There is no blanket treatment capable of avoiding injury in every person. Without knowing the precise physiological state and medical history of a particular patient, government through mass treatment necessarily include those apt to experience adverse reactions. So it is that each year federal and state governments condone harm to children and adults who are variously required to be vaccinated against their will, oftentimes overruling sound medical grounds indispensable to patient health.
Moreover, the public health establishment rejects the need for any serious consideration of unique biological differences that make particular treatments of greater risk to particular individuals. Indeed, while the law ordinarily requires health care practitioners to advise patients of potential adverse drug effects, in the ordinary course physicians under pressure from public health authorities rarely if ever disclose risks before administering or prescribing drugs. Informed consent is largely non-existent in medicine delivered under the aegis of public health. That is not a coincidence. For example, many who were given the COVID-19 jab when it was only allowed for experimental use were never apprised of any, let alone all known, potential risks. Rather, people were most often vaccinated with little or no risk awareness. To the contrary, they were assured that the vaccines were “safe,” an inherently deceptive claim for any drug.
Perhaps the greatest harm caused by “public health” is the destruction of meaningful doctor-patient relationships. Patients expect their physicians to perform careful diagnoses and select treatments tailored to the patients specific conditions. Few realize that there is almost always an invisible third person in the room that can veto physician preferences (the government in the form of agents for health insurers or medical boards). Every moment of every day physicians nationwide second guess their own judgments to ensure conformity with government preferences. A person recovering from a heart attack that a physician believes might peculiarly benefit from a longer period of physical therapy and rehabilitation than is customary may nevertheless avoid that recommendation in favor of the government preferred “standard of care.” A particular person who would best be treated with a drug other than that commonly prescribed for the general class of ailment diagnosed may be denied the best drug because it might appear as an “outlier” and open the physician or hospital to a Medicare or Medical Board audit. A patient for whom a physician believes it more beneficial and less costly to be treated with a dietary supplement, e.g., fish oil, or an off-patent drug, e.g., colchicine, may nevertheless prescribe a drug with greater risk of harmful side-effects because the more harmful drug, not the supplement, is favored by the bureaucrats. Virtually nothing physicians do today in the diagnosis and treatment of disease proceeds independent of a Kafkaesque system of bureaucratic second-guessing, a system that makes itself, rather than the patient, the most important factor for every physician who values his or her medical practice.
There is, of course, a far better alternative to the public health system now dominant in the United States, one which celebrates and protects individual patient freedom of choice; encourages physicians to exercise their professional judgment calculated to provide the best possible care to each patient; and removes government second-guessing such that physicians remain patient-centric, not government-centric, in patient care. That is a free market in health care. Imagine if instead of unleashing big government control over treatment and censorship over dialog about COVID-19, we had instead entrusted physicians to deal with each patient’s condition and invited all manner of scientific inquiry, publication, and debate to flourish about treatments. Undoubtedly, we would have today a plethora of treatment options available and in use and reliance on means tailored to each patient’s needs. In short, we would be healthier not because of “public health” but in spite of it.
Until we return to a free market in health care wherein patients are given the freedom to choose what they think best, we will continue to be robbed of superior care, of innovations in medicine and medical practice, and of discoverable cures in favor of politically imposed orthodoxies. In medicine, as in the marketplace in general, Ronald Reagan was right: "Government is not the solution to our problem, government is the problem."