Are you a medical liberal or a conservative?

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative practitioner?  I’m not referring here to fiscal policy or legalizing recreational marijuana use.  Consider the following hypothetical scenario and the two physicians’ approach from opposite sides of the medical philosophical spectrum. Which physician would you choose?

The patient:  She is a 50-year-old female with chronic fatigue syndrome (CFS).  She is only able to work part time because of her condition.  She has consulted with an internist, an infectious disease specialist and a naturopath, but her fatigue persists.

A new treatment for CFS has just been launched by a reputable herbal supplement company.  Two well-designed studies suggest symptomatic improvement in afflicted patients after 6 months of treatment.  As the product is an herb, there is no formal Food and Drug Administration (FDA) oversight.

Physician #1: “I’m reluctant to recommend this product, despite the optimistic preliminary results from two medical studies.  These studies were funded by the herb company and there may be bias present.  Moreover, it is very typical in medicine for initial results to be favorable, with unforeseen side effects and complications emerging later when after more widespread use of a drug.  I’m concerned that the FDA had no role in validating that the drug is safe and effective for its intended use.  Additionally, there is evidence that the active ingredient in the product disrupts the immune system, which may have serious future consequences that may not become manifest for several years or longer.  While CFS is decreasing your quality of life, your condition has been stable and will never threaten your life.  I recommend holding off until we have an FDA approved medicine for CFS or the herbal supplement has been used long enough that we have a better sense of its safety and efficacy.”

Physician #2: “I recommend that you try this new herbal product.  It is completely natural and showed promising results in two medical studies.  Importantly, no serious side-effects developed in either study.  Of course, we have no long term data on safety, but the vast majority of herbal supplements on the market are safe.  No other treatment thus far has been successful for you, and your condition is adversely affecting your professional and personal lives. The choice is to try something new or to continue suffering as you have been.  Try it for 6 months and then we’ll reassess.”

So, that’s my herb blurb.  This is a common situation in the medical world where medical advice must pass through the prism of risks and benefits.  These analyses are limited when the risks and benefits are unclear or disputed.  Treatment acceptance also depends heavily on the patient’s risk tolerance.  What if the herb referenced above had a 5% risk of cancer?  What if the herb needs to be taken indefinitely? Clearly, when the disease poses a serious medical threat, the patient may be willing to accept greater risk of new or investigational therapies.

So, which of these physicians would you choose for yourself?  Are you a medical liberal or a conservative?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower

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  • QQQ

    “More ObamaCare woes: Congress must act to block health insurance bailout”

    http://www.foxnews.com/opinion/2014/08/08/more-obamacare-woes-congress-must-act-to-block-health-insurance-bailout/

    • Lisa

      What the heck does this rant have to do with the topic being discussed? You use any chance to rant against Obamacare and it gets old fast.

  • John C. Key MD

    Not that simple. I’m a religious right wing redneck conservative tea partier, but have always been an “early adopter” of new treatment modalities, friendly to alternative and holistic therapy. I’m not sure if that makes me a medical liberal or conservative. Maybe just crazy.

    • retired FP

      I was surprised as well. I could echo this answer. Maybe the “politically” conservative physicians are more “libertarian” and willing to let people try things that are not overtly harmful and do not rely on government to make you safe. Or, perhaps we’re just crazy. That, too.

    • Lisa

      I am politically liberal and I would also consider my self medically liberal. I think conventional medicine can handle many things, but it does not help to deal subtle problems.

      I have chronic pain issues after a bilateral mastectomy. My choices are to treat it with drugs (neurontin or the equivalent) or to use alternative modalities, such as acupuncture. As the drug has known risks and makes me drowsy, I’d much rather treat it with alternative modalities and see how I react. If I had CFS, I’d go with the second doctor.

      I don’t like the idea living with a condition because western medicine can’t offer an effective treatment if there are reasonable alternatives.

      • QQQ

        “I am politically liberal and I would also consider my self medically liberal.”
        ——————————————————————————————
        “If you’re not a liberal at twenty you have no heart, if you’re not a conservative at forty, you have no brain.”

        -Winston Churchill-

    • Eric Strong

      It’s been my observation that there is no association between political leanings and how one practices medicine.

      • Patient Kit

        I used to think that the personal politics of my doctors didn’t matter to me. And they shouldn’t. But then I found myself in my GYN’s exam room being told — while I was positioned in stirrups that (a) I likely had ovarian cancer and needed surgery and needed to “find the money somewhere” and (b) that if I voted for Obama I would get what I deserved. My doctor could not keep her ACA hate out of the exam room, not even while she was diagnosing me with cancer when she knew that I was just about to lose my BCBS insurance. Ironic that she was so upset about the ACA, which was the only thing that would help me going forward after she sent me out into the world with a newly diagnosed pre-existing condition. And no, I swear, it was not me who brought the subject up. I was distracted from the politics of the day by my pelvic exam and new cancer dx. I was in shock trying to process the word “cancer”. But it was Election Day and my doc was distracted by her ACA hate. It’s a doctor experience that I doubt I’ll ever totally shake.

    • Ava Marie Wensko George

      You know, I am a Progressive liberal who read both of those examples above and did not have a problem with either one…I think the physician, no matter if they are conservative or liberal, takes into consideration the patient that is in front of them and makes the best decision based on what they know about the medicine and patient. I did not see one or the other as liberal or conservative.

      • rbthe4th2

        Try having a doctor that is so conservative they leave you in pain for months. I changed my tune about the doctor being paternalistic and choosing the treatments.

  • SteveCaley

    I dislike the use of “liberal” and “conservative,” often used as though these were some sort of vital essentials of things (think the humoural theory of medicine, for example.)
    The best treatment for the patient is that which treats the patient best. One’s own prejudices are always detrimental, no matter how cherished they might be.

  • Eric Strong

    “…What do compilations of traditional knowledge say about this plant’s safety?…”

    “Compilations of traditional knowledge” are worthless when it comes to determining the merits or risks of a medical intervention. Traditional ideas, even those enshrined in Western medicine culture, often fall apart when examined scientifically.

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