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Why Bother Sending People to Medical School? [1]
['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.']
Date: 2023-07-02
There is a very disturbing article in the New York Times Magazine: They Followed Doctors’ Orders. Then Their Children Were Taken Away. There’s no neat quote to start this off with, so I’ll just summarize: A woman who had been addicted to opiods was taking Subxone (also known as Buprenorphine), a prescription medication that blocks withdrawal symptoms. She then found out she was pregnant, but her health care professional (emphasis added) assured her it would not harm the fetus — a position taken by the American College of Obstetricians and Gynecologists. The CDC says the same thing. (Links were provided by the NYT article.) None of this made any difference to an Arizona social worker:
On their eighth day in the hospital, while [Diaz’s partner] Bieniasz was at work, [Department of Child Safety investigator] Pugliese made a surprise visit to Dass’s room, accompanied by a nurse and a security guard. She handed Dass an emergency order to surrender the baby to temporary state custody. “The parents are using illicit substances,” Pugliese had written in support of her petition, discounting multiple drug tests to the contrary.
The focus of the article is on the problems in the child welfare system and the ways it’s making life worse for the child as well as the parent (warning: reading the full article will induce feelings of rage). But I want to use it to illustrate a broader problem, one highlighted by the description of the social worker as a “recent college graduate” who apparently has no medical knowledge or training. Nor is this uncommon:
Despite consensus within the scientific and medical communities that Suboxone is safe, child-protection authorities often disavow the drug, treating it like an illegal substance. [emphasis in original]
Another example from the NYT story:
In one 2019 case, a West Virginia judge allowed the state to cut off payment for a mother’s Suboxone, prompting her to relapse, and then terminated her parental rights. “I always have a problem with people being on Suboxone to begin with, and that’s my position,” the judge said during one hearing.
We are all, unfortunately, way too familiar with the way politicians routinely override medical consensus and expertise when it comes to areas of divisive political interest, mainly abortion and LBGTQ+ rights. This case may not have originated with malicious intent:
The law also included a one-word change to federal child-welfare policy that would have monumental consequences. Federal law had long required newborns vaguely identified as “affected by” illegal drugs to be flagged to child protective services. In this new iteration, lawmakers removed the word “illegal.” Now, hospitals in the states receiving certain federal funds to support child-abuse programs — a total of 48 states, Washington, D.C., and Puerto Rico — were required to notify authorities any time a newborn was “affected by” any substance, legal or illicit. The federal law made clear that notifications are not the same as reports of child abuse or neglect, which automatically trigger investigations. [emphasis added]
I saw “may not have” because drafting legislation is a complex exercise which often leads to unintended consequences, and without seeing the legislative history, I can’t impute motive to the change. What I will say is that this change opens a door for people with no medical training to substitute their uninformed judgment for that of medical experts.
This is a common pattern in the history of the United States. We Americans have this conceit that any person’s (more usually, any man’s) judgment is as good as another. How dare you tell me I’m wrong just because you spent 12 years studying the subject when all I had to do was check the internet? Why should your concern over an ectopic pregnancy (whatever that is) override my belief that life is sacred from the moment of conception? Look at the flack Dr. Fauci took, and is still taking, for insisting on a medically rational response to the Covid epidemic.
Expertise is any field is not, I admit, a guarantee of having the right answer all the time. Fauci got a lot of things wrong about Covid at the start (and was perfectly willing to admit it, another mark of an honest expert). But experts have a far better shot at getting it right than someone who just browses the internet at random, or, worse, is following what the preacher said last Sunday.
This is yet one more existential problem that the US is going to have to deal with: the belief that not only is my opinion as good as yours, it’s better than yours (because I’m White, or male, or have God on my side, etc. . . . it really doesn’t matter what the excuse is).
There was once at least some respect given to those who had spent a lifetime in gaining their expertise. That respect has been deliberately dismantled by those who want to act in ways that experts have proven don’t work, that fix nothing, that make things worse. Their approach, one that has been tried many times in history, eventually runs up against reality, which has never cared what people think about it, and usually at a very high cost.
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