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February 4, 2021

When Physicians Engage in Practices That Threaten the Nation’s Health

Author Affiliations
  • 1Departments of Pediatrics and Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
  • 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
  • 3Department of Medicine, Stanford University School of Medicine, Stanford, California
  • 4Stanford Law School, Stanford, California
JAMA. 2021;325(8):723-724. doi:10.1001/jama.2021.0122

In December 2020, less than a year after severe acute respiratory syndrome coronavirus 2 was identified as the cause of the coronavirus pandemic, an extraordinary collaboration between scientists, the pharmaceutical industry, and government led to 2 highly efficacious, safe vaccines being approved by the US Food and Drug Administration to prevent coronavirus disease 2019 (COVID-19) infection.1,2 Had the US been in its expected role as a global leader in medicine and public health, this would have been a fitting capstone of US commitment to science and how that can change the course of morbidity and mortality related to a frightening new disease.

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    5 Comments for this article
    Double Standard?
    Steven Zeitzew, MD | West Los Angeles V.A. Healthcare Center, and Department of Orthopaedic Surgery, David Geffen UCLA School of Medicine
    I advocate basing all of the treatments we recommend on the best available scientific evidence.

    The authors are correct to recommend high scientific standards, but their own institution does not live up to that standard. Stanford University hosts the Stanford Center for Integrative Medicine, which one the authors is affiliated with. Integrative medicine is, by definition, an integration of alternative medicine, medical ideas not well supported by robust scientific evidence, with scientific medicine. Stanford, and virtually every other major medical school, teaches and sells unscientific medicine to patients. The Stanford Center for Integrative Medicine website makes it clear
    their offerings include treatments not well supported by evidence, including acupuncture treatment for infertility (which one JAMA article showed ineffective (1)). 

    The AMA ethical guidelines they cite also suggest that physicians should not sell or profit from treatments not supported by good scientific evidence.

    We are entitled to differ in our interpretations of evidence. It is clear the best evidence supports masks and social distancing. The best evidence also suggests that Stanford should divest itself of the Center for Integrative Medicine and stop profiting from selling treatments not well-supported by good science. Stanford loses credibility because it offers and endorses treatment that is well known to not be supported by the best available scientific evidence, under the guise of Integrative Medicine

    This article would be more persuasive if the authors explicitly supported the idea that all medical treatment recommendations should be based on the best scientific evidence, and that ethical physicians should not recommend and ethical medical schools not teach alternative medicine.

    Where has the Stanford Faculty Senate been up until now? What has happened to Stanford in the quarter century since Dr. Wallace Sampson started the Scientific Review of Alternative Medicine journal?


    1. https://jamanetwork.com/journals/jama/fullarticle/2681194

    Hemant Hegde, MD | Eau Claire Hospital
    It's about time. Thank You.
    Michael Bryan, MD |
    It's interesting to note that the authors write authoritatively about using science to drive decisions regarding the management of the Covid 19 pandemic yet the entire reference list are political and opinion pieces, along with references to governing body documents they feel provide them some sort of moral superiority. Where are the references to particulate size and mask efficacy with respect to viral transmissibility, and where are the epidemiology studies that support their positions? Where is the acknowledgment and analysis of the management of the pandemic in countries that are not strict adherents to the protocols that are inferred by the authors to be effective? Where are the demographic, sociologic, and logistical analyses that compare the successful management of pandemic spread to the relative geographic size, international travel policies, numbers of portals of entry, and volume of transient movement of non-tested individuals into and out of the population of the different countries who the authors cherry pick to support their opinions? I could go on, but the overwhelming gestalt of the piece is vitriol toward another physician's opinion who the authors have a declared conflict with, within their own university. I am aware it is in a section entitled "Viewpoint", but the irony of the lack of "science" in the references is hard to miss and, in my opinion, diminishes the journal as much as the authors.
    The Appeal to "Authority" to Suppress Opinion
    Wm Prendergast, MD | Retired physician
    I second the comments of Dr. Bryan above. I would suggest that one reason no scientific articles are cited is that, as we all know if we follow this, the science on these evolving topics is hardly settled and one can cherrypick studies as needed to support one's opinion.

    One error that is often made these days when supporting arguments with "science" is that writers, even well qualified scientists with impressive bibliographies, tend to confuse "science" with "scientific opinion."

    We in clinical medicine ought to be pretty clear about the difference, since for the most
    part we've practiced our entire careers guided by scientific opinion about science that is ever changing and rarely if ever "settled."

    One clear example of this would be the evolving science of the pathogenesis and therapeutic practice in peptic ulcer disease during the 53 years since I graduated from medical school.

    In view of this, I have to say I am alarmed to hear physicians, who I am sure are well meaning, taking the common approach we're hearing so much nowadays from the progressive wing of our society to demand that "authorities" "crack down" on dissident opinion and suppress divergent viewpoints.

    One only has to read a little about the history of Lysenkoism in the Soviet Union to realize that this is a path we do not want to see medicine go down in the US.
    Questionable Facts
    Adolfo Talpalar, MD, PhD | Karolinska Institutet, Sweden
    The authors select countries that show low contagion and mortality during the pandemic and authoritatively attribute such success to factors like use of face masks, lock-down, isolation, etc., whose efficacy in the long run is yet not evident. Countries like Czech Republic, Belgium, Portugal or the UK (among many others) promoted all of them, and are among the countries with highest mortality and contagion rates for number of inhabitants. How do they explain that? They can't choose example countries selectively and associate the results freely.