Medicine on a Grand Scale
Politics and healthcare are inseparable. This relationship is epitomized by Virchow’s oft-quoted declaration, “Medicine is a social science, and politics is nothing more than medicine on a grand scale.” Through most of the modern age—and certainly during our lifetimes—this has been a beneficial relationship, despite the vicissitudes of electoral politics. Apart from fringe movements, the progress of medical science has been endorsed, regardless of party affiliation. Unfortunately, there are alarming signs that the political consensus on the benefits of immunization is imperiled
Medical students learn of German physician Rudolf Virchow (1821-1902) by way of his eponyms: Virchow’s node, the harbinger of gastric malignancy, and Virchow’s triad, the factors that provoke thromboembolism, a term he invented. Virchow’s other accomplishments include the development of cell theory and the coining of numerous medical terms—from agenesis to zoonosis. For these achievements, Virchow is considered the father of modern pathology. However, we are indebted to him for much more than his contributions to our lexicon, for he was more than a physician. He was an anthropologist, a politician, and the father of social medicine.
Despite his many contributions to our understanding of cellular pathology, Virchow rejected the reductionist view that microscopic pathogens are the ultimate source of human suffering. He believed the actual cause of disease was a “deficiency in society.” In 1848, after serving on a commission investigating a typhoid epidemic, he issued a scathing report that blamed the outbreak on governmental neglect, poverty, religious exploitation, and illiteracy. His prescription gave birth to the view that healthcare professionals should look beyond treating pathogens in individual patients. Physicians should also engage in political action to address the cultural, economic, and social causes of disease.
Immunization programs exemplify the ideals of social medicine. A successful program depends on a political consensus between scientists, healthcare professionals, the government, and the public. The American consensus on vaccines emerged during the Revolutionary War. When a smallpox outbreak forced the Continental Army to retreat during the Battle of Quebec, General Washington was faced with the prospect of widespread desertion. Recognizing that smallpox was a greater threat than “the sword of the enemy,” Washington ordered that the entire army be inoculated. This was our nation’s first public health mandate.
During the 19th Century, many states adopted vaccine mandates. There was a smattering of opposition, but courts consistently upheld these laws as legitimate exercises of state police power. In the landmark case Jacobson v. Massachusetts (1905), the Supreme Court upheld the constitutionality of compulsory vaccination laws for adults, and Zucht v. King (1922) upheld laws requiring vaccination for school attendance. By the 1970s, every state—regardless of the party controlling the state house and governor’s mansion—had adopted school immunization requirements.
In the 1980s, when unsubstantiated vaccine injury claims threatened to drive manufacturers out of the market, President Reagan signed the National Childhood Vaccine Injury Act, ensuring the stability of vaccine supplies. Congress had passed the law with bipartisan support.
In recent years, especially since the beginning of the COVID-19 pandemic, the bipartisan consensus on vaccines has fractured. According to the National Conference of State Legislatures, over 600 vaccine-related bills have been introduced this year. Many of these bills would prohibit COVID-19 vaccines as well as other routine vaccines required by schools and employers. Other bills would criminalize mRNA vaccines and ban vaccinated people from donating blood.
This unfortunate politicization of public health can have deadly consequences. Data from the year following the release of COVID-19 vaccines show that over 230,000 deaths could have been prevented with timely vaccination. A recent analysis published in JAMA Internal Medicine reveals significant differences in COVID-19 mortality that clearly break down by party affiliation.
A Kaiser Family Foundation poll in August found even more cause for alarm. It documents widespread belief in false information about COVID-19 vaccines and other health-related information. One-third of Americans believe COVID-19 vaccines have caused “thousands of sudden deaths” in otherwise healthy people. One-in-four GOP voters falsely believe COVID-19 vaccines have killed more people than the virus.
Even more alarming is the fact that three-quarters of the public are uncertain of the veracity of commonly spread false information. Psychologists refer to this phenomenon as the “illusory truth effect,” the tendency for even logical people to give credence to false information after repetitive exposure. Although most people have not completely bought into conspiracy theories, the well of information has been poisoned, leaving many uncertain about who and what to believe.
Fortunately, the survey is not all bad news. Ninety-seven percent of Americans recognize that spreading false information about health issues is a major problem, and a solid majority believes the federal government should be doing more to fight it (unfortunately federal courts have blocked the government from taking this very action). Though there are partisan differences, most Americans trust the CDC and FDA to make the right recommendations. Best of all, ninety-five percent of both Democrats and Republicans still trust their doctor.
The Surgeon General’s Advisory on Building a Healthy Information Environment recognizes the unique role physicians play in combating health misinformation. The advisory urges physicians to proactively engage patients on health misinformation by listening with empathy and correcting misinformation in personalized ways. It also encourages physicians to use technology and media platforms to share accurate information with the public. Through our professional organizations, like the SCAFP and AAFP, we can collectively serve as trusted messengers on the benefits of vaccines and rebuild the political consensus.
Many physicians lament the intrusion of politics into the day-to-day practice of medicine. At the other extreme, we hear the refrain that physicians should leave policy to the politicians. Both views are wrong. Physicians have a duty to “participate in activities contributing to the improvement of the community and the betterment of public health.” This weighty commission is not optional. It is a tenet of our Code of Ethics.
William Osler, a contemporary of Virchow, honored the man with the following observation:
We dwell too much in the corners and consumed with petty cares of a bread-and-butter struggle. The lesson which should sink deepest into our hearts is the answer which a life, such as Virchow’s gives to those who today, as in past generations see only pills and potions in the profession of medicine, and who utilizing the gains of science, fail to appreciate the dignity and the worth of the methods by which they are attained.
Medicine is indeed more than pills and potions. We should not squander the precious trust our patients have bestowed upon us by shirking our duty to oppose misinformation and politicization. Virchow inspires us to come out of the corner and practice medicine on a grand scale.
- Silver, GA. Virchow, The Heroic Model in Medicine: Health Policy by Accolade. American Journal of Public Health. 1987; 77(1):82-88.
- Flanagan-Klygis, E. Policy Forum: School Vaccination Laws. American Medical Association Journal of Ethics. 2003; 5(11):514-517.
- Wallace J, Goldsmith-Pinkham P, Schwartz JL. Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic. JAMA Intern Med. 2023;183(9):916–923.
- Fazio, LK, Brashier, NM, Payne, BK, & Marsh, EJ. Knowledge does not protect against illusory truth. Journal of Experimental Psychology: General. 2015; 144(5):993-1002.
- Health Misinformation Tracking Poll Pilot. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/poll-finding/kff-health-misinformation-tracking-poll-pilot/. Accessed 16 Sep 2023.
- Politicization of Science. American Bar Association. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-truth-about-science/politicization-of-science/. Accessed 12 Sep 2023.
- State of Vaccine Confidence Insights Report. Centers for Disease Control & Prevention. https://www.cdc.gov/vaccines/covid-19/downloads/SoVC-Quarter-1-2023.pdf. Accessed 29 Sep 2023.
- Office of the Surgeon General (OSG). Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment. Washington (DC): US Department of Health and Human Services; 2021.