About 6 weeks ago I hosted a conversation with doctors Adam Cifu, Vinay Prasad, and John Mandrola that was originally posted on Sensible Medicine.
The conversation took place about a week after the election and I had been thinking about this topic a lot in the weeks and months leading up to it. I have mixed emotions about the “make America healthy again” or MAHA movement and I wanted to host this conversation to elicit these guys thoughts to questions swirling in my own mind because I respect each of them a great deal and we were all involved in the original Medical Conservative article from 2019.
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To me, Medical Conservatism, is a philosophy for medical care that combines scientific skepticism and independent critical appraisal with a patient-centered motivation for consuming medical care, which allows for individual differences in preferences and values but is ultimately anchored by economic reality. The physician’s job is to essentially be the patient’s guide.
Medical conservatives resist hype and appreciate the duality of interests between individual patients and private industry. In that regard, I have been attracted to many of the arguments offered by MAHA enthusiasts that seek to limit the undue influence of private industry on medical care coverage and physician adoption and utilization of new products.
On the other hand, I’m bothered about the part of MAHA that seems to elevate alternative modes of medical care and natural cures and remedies above '“traditional” medicine. While these enthusiasts can level strong and, in some cases, disciplined critiques against over-prescribing of standard medicines like statin drugs and anti-depressants (Medical Conservatives do the same), they seem to have no angst whatsoever in promoting exhaustive searches for vitamin deficiencies and encouraging use of unproven products like cyclodextrin for plaque regression (Medical Conservatives would say “wait a second”).
In my opinion, the philosophy of Medical Conservatism, laid out in our original article, is the optimal approach for medical care. We should support MAHA enthusiasts when they embrace common causes of Medical Conservatives, like tackling conflicts of interest, but remain critical of their less disciplined tendencies for promoting “alternative remedies” and we must always remain committed to nuance as highlighted by Adam, Vinay and John’s perspectives on vaccines.
I wish everyone a happy and healthy new year and look forward to being a little more active on my personal Substack page in 2025. Some topics I am looking forward to writing about this year include:
Medical care cost ratchet
Intervention bias in medicine
Psychology of medical decision making (medical maximizers and minimizers)
Thank you to everyone for following my page.
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