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Stop Passing Off Politics as Evidenced-Based Medicine

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As political campaigns have increasingly targeted medical practice issues, there have been a spate of articles and op-eds about the apparent corruption of medicine by politics. The American Medical Association believes it is a significant problem, because it has proposed a solution to keep politics out of medicine. Nevertheless, it seems as though doctors and other healthcare workers have been steamrolled by the political system into surrendering their autonomy and medical decision-making.

I was reminded of this grim reality when Mehmet Oz, MD, said that a woman’s right to an abortion was between herself, her doctor, and her local politicians. It’s bad enough that physicians’ political views and party affiliations affect their treatment decisions, but do we really need politicians meddling in the doctor-patient relationship?

It’s no surprise that medical professionals have been guided by their own political ideology to either combat elected officials or join them — depending on the issue. And therein lies the real problem. We have abandoned science and scientific reasoning to further our personal agendas on “the issues,” leading the medical profession into an internecine war and causing further divisiveness among physicians and the practice guidelines and standards promulgated by them.

For example, Florida has effectively banned physicians from aiding in the “transition” of transgender youth in Florida, creating considerable animus and essentially taking the matter out of the hands of practicing physicians. The Florida Board of Medicine plans to codify into law its own uniquely derived standards for the treatment of gender dysphoria.

It doesn’t matter that Florida’s standards deviate widely from those of a half-dozen medical societies and organizations. The point is, other than providing comments to the Florida Board of Medicine, practicing physicians will have no real input into the final version of the treatment standards. Instead, those who serve on the Florida Board of Medicine will call the shots — and we can’t ignore the fact that all physicians who are board members are appointed by the governor.

Make no mistake, it is not uncommon to become ideologically blind to science when working for powerful people and even weaker sources of influence. Physicians believed pharmaceutical salespeople did not affect their choice of therapy, but studies proved them wrong.

Do No Harm, a non-profit organization, is a key proponent of Florida’s ban on gender-assisted therapy. In a letter to the Florida Board of Medicine, Stanley Goldfarb, MD, founder and chairman of Do No Harm, accuses the medical establishment of refusing “to side with science.” But whose version of science are we talking about: those in the medical profession who cite favorable outcomes following gender transition therapy, or those who point to its possible harmful and irreversible effects?

The debate reminds me of how two (or more) scientific societies can review the extant medical literature and relevant scientific studies, yet propose vastly different practice guidelines, as was the case with Lyme disease a decade ago. The Attorney General of Connecticut had to intervene to help align the discordant guidelines so that patients could be properly treated. Once again, because of our internal struggles to understand science, its limitations, and applications to medical practice, autonomy and self-determination were stripped from us.

The founder of Do No Harm was troubled by the impact of racial reckoning on medical practice, specifically, he was concerned about claims that systemic racism is responsible for disparities in health outcomes. The issues identified by Do No Harm on their website and in the news are perhaps the most vexing in medical education and practice today: affirmative action admission policies; mandatory anti-racism training; and divisive and possibly race-based discriminatory practices at universities and medical schools that violate academic freedom.

My hope is that we can discuss these (and other) topics without politicians in the exam room. I want to engage in passionate (not over-heated) discussions about social determinants of health, the injection of identity politics into medical research and education, and the validity of implicit bias and whether it contributes to microaggressions. I want to hear more from workers on both sides of the aisle who voiced reasoned opposition to what they perceived as contradictory and unjust COVID-19 policies and later faced recrimination.

I strive to be tolerant of individuals who hold opposing views rather than participate in walk-outs, threaten violence, or snub colleagues by calling them “woke” and other derogatory terms. “It just tells us how terrible our culture is becoming, that we can’t have an honest scientific debate about the things we disagree on,” remarked Georges Benjamin, MD, executive director of the American Public Health Association (APHA). Benjamin recently made that statement after public health expert Leana Wen, MD, was forced to cancel her panel discussion at the APHA annual meeting due to credible threats against her life — and she’s not alone.

Doctors, not politicians, need to pave the way for crucial civil discourse and the resolution of controversial issues that impact healthcare and our patients’ ability to receive it — issues ranging from reproductive health to mental health to environmental health. We should reject predetermined political frameworks for interpreting evidence to explain differences in outcomes. It’s time we learned to differentiate politics from science and quash political initiatives attempting to pass as evidenced-based medical principles.

Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.

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‘Disgraceful:’ N.S. Tory leader slams school’s request that military remove uniform

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HALIFAX – Nova Scotia Premier Tim Houston says it’s “disgraceful and demeaning” that a Halifax-area school would request that service members not wear military uniforms to its Remembrance Day ceremony.

Houston’s comments were part of a chorus of criticism levelled at the school — Sackville Heights Elementary — whose administration decided to back away from the plan after the outcry.

A November newsletter from the school in Middle Sackville, N.S., invited Armed Forces members to attend its ceremony but asked that all attendees arrive in civilian attire to “maintain a welcoming environment for all.”

Houston, who is currently running for re-election, accused the school’s leaders of “disgracing themselves while demeaning the people who protect our country” in a post on the social media platform X Thursday night.

“If the people behind this decision had a shred of the courage that our veterans have, this cowardly and insulting idea would have been rejected immediately,” Houston’s post read. There were also several calls for resignations within the school’s administration attached to Houston’s post.

In an email to families Thursday night, the school’s principal, Rachael Webster, apologized and welcomed military family members to attend “in the attire that makes them most comfortable.”

“I recognize this request has caused harm and I am deeply sorry,” Webster’s email read, adding later that the school has the “utmost respect for what the uniform represents.”

Webster said the initial request was out of concern for some students who come from countries experiencing conflict and who she said expressed discomfort with images of war, including military uniforms.

Her email said any students who have concerns about seeing Armed Forces members in uniform can be accommodated in a way that makes them feel safe, but she provided no further details in the message.

Webster did not immediately respond to a request for comment.

At a news conference Friday, Houston said he’s glad the initial request was reversed but said he is still concerned.

“I can’t actually fathom how a decision like that was made,” Houston told reporters Friday, adding that he grew up moving between military bases around the country while his father was in the Armed Forces.

“My story of growing up in a military family is not unique in our province. The tradition of service is something so many of us share,” he said.

“Saying ‘lest we forget’ is a solemn promise to the fallen. It’s our commitment to those that continue to serve and our commitment that we will pass on our respects to the next generation.”

Liberal Leader Zach Churchill also said he’s happy with the school’s decision to allow uniformed Armed Forces members to attend the ceremony, but he said he didn’t think it was fair to question the intentions of those behind the original decision.

“We need to have them (uniforms) on display at Remembrance Day,” he said. “Not only are we celebrating (veterans) … we’re also commemorating our dead who gave the greatest sacrifice for our country and for the freedoms we have.”

NDP Leader Claudia Chender said that while Remembrance Day is an important occasion to honour veterans and current service members’ sacrifices, she said she hopes Houston wasn’t taking advantage of the decision to “play politics with this solemn occasion for his own political gain.”

“I hope Tim Houston reached out to the principal of the school before making a public statement,” she said in a statement.

This report by The Canadian Press was first published Nov. 8, 2024.

The Canadian Press. All rights reserved.

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Saskatchewan NDP’s Beck holds first caucus meeting after election, outlines plans

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REGINA – Saskatchewan Opposition NDP Leader Carla Beck says she wants to prove to residents her party is the government in waiting as she heads into the incoming legislative session.

Beck held her first caucus meeting with 27 members, nearly double than what she had before the Oct. 28 election but short of the 31 required to form a majority in the 61-seat legislature.

She says her priorities will be health care and cost-of-living issues.

Beck says people need affordability help right now and will press Premier Scott Moe’s Saskatchewan Party government to cut the gas tax and the provincial sales tax on children’s clothing and some grocery items.

Beck’s NDP is Saskatchewan’s largest Opposition in nearly two decades after sweeping Regina and winning all but one seat in Saskatoon.

The Saskatchewan Party won 34 seats, retaining its hold on all of the rural ridings and smaller cities.

This report by The Canadian Press was first published Nov. 8, 2024.

The Canadian Press. All rights reserved.

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Nova Scotia election: Liberals say province’s immigration levels are too high

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HALIFAX – Nova Scotia‘s growing population was the subject of debate on Day 12 of the provincial election campaign, with Liberal Leader Zach Churchill arguing immigration levels must be reduced until the province can provide enough housing and health-care services.

Churchill said Thursday a plan by the incumbent Progressive Conservatives to double the province’s population to two million people by the year 2060 is unrealistic and unsustainable.

“That’s a big leap and it’s making life harder for people who live here, (including ) young people looking for a place to live and seniors looking to downsize,” he told a news conference at his campaign headquarters in Halifax.

Anticipating that his call for less immigration might provoke protests from the immigrant community, Churchill was careful to note that he is among the third generation of a family that moved to Nova Scotia from Lebanon.

“I know the value of immigration, the importance of it to our province. We have been built on the backs of an immigrant population. But we just need to do it in a responsible way.”

The Liberal leader said Tim Houston’s Tories, who are seeking a second term in office, have made a mistake by exceeding immigration targets set by the province’s Department of Labour and Immigration. Churchill said a Liberal government would abide by the department’s targets.

In the most recent fiscal year, the government welcomed almost 12,000 immigrants through its nominee program, exceeding the department’s limit by more than 4,000, he said. The numbers aren’t huge, but the increase won’t help ease the province’s shortages in housing and doctors, and the increased strain on its infrastructure, including roads, schools and cellphone networks, Churchill said.

“(The Immigration Department) has done the hard work on this,” he said. “They know where the labour gaps are, and they know what growth is sustainable.”

In response, Houston said his commitment to double the population was a “stretch goal.” And he said the province had long struggled with a declining population before that trend was recently reversed.

“The only immigration that can come into this province at this time is if they are a skilled trade worker or a health-care worker,” Houston said. “The population has grown by two per cent a year, actually quite similar growth to what we experienced under the Liberal government before us.”

Still, Houston said he’s heard Nova Scotians’ concerns about population growth, and he then pivoted to criticize Prime Minister Justin Trudeau for trying to send 6,000 asylum seekers to Nova Scotia, an assertion the federal government has denied.

Churchill said Houston’s claim about asylum seekers was shameful.

“It’s smoke and mirrors,” the Liberal leader said. “He is overshooting his own department’s numbers for sustainable population growth and yet he is trying to blame this on asylum seekers … who aren’t even here.”

In September, federal Immigration Minister Marc Miller said there is no plan to send any asylum seekers to the province without compensation or the consent of the premier. He said the 6,000 number was an “aspirational” figure based on models that reflect each province’s population.

In Halifax, NDP Leader Claudia Chender said it’s clear Nova Scotia needs more doctors, nurses and skilled trades people.

“Immigration has been and always will be a part of the Nova Scotia story, but we need to build as we grow,” Chender said. “This is why we have been pushing the Houston government to build more affordable housing.”

Chender was in a Halifax cafe on Thursday when she promised her party would remove the province’s portion of the harmonized sales tax from all grocery, cellphone and internet bills if elected to govern on Nov. 26. The tax would also be removed from the sale and installation of heat pumps.

“Our focus is on helping people to afford their lives,” Chender told reporters. “We know there are certain things that you can’t live without: food, internet and a phone …. So we know this will have the single biggest impact.”

The party estimates the measure would save the average Nova Scotia family about $1,300 a year.

“That’s a lot more than a one or two per cent HST cut,” Chender said, referring to the Progressive Conservative pledge to reduce the tax by one percentage point and the Liberal promise to trim it by two percentage points.

Elsewhere on the campaign trail, Houston announced that a Progressive Conservative government would make parking free at all Nova Scotia hospitals and health-care centres. The promise was also made by the Liberals in their election platform released Monday.

“Free parking may not seem like a big deal to some, but … the parking, especially for people working at the facilities, can add up to hundreds of dollars,” the premier told a news conference at his campaign headquarters in Halifax.

This report by The Canadian Press was first published Nov. 7, 2024.

— With files from Keith Doucette in Halifax

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