Bill of Health

> And if you think they're saying something else in private then let's see proof. This is not a place for baseless conspiracy theories. With all due respect, not everything that lacks proof is a conspiracy theory. I've spent a bunch of time in discussions with physicians. There's a consensus that AMA is largely ineffective and it's implied that it's ineffectiveness is valuable for inflating physician salaries. This is a great write up that highlight how the AMA created the situation to begin with: https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… ------ I did find a great example of AMA's double speak on this issue. A bunch of states have started looking for alternatives for providing care to their populations. Some states are now loosening regulation to allow mid-levels to practice. 6 states are now allowing physicians to practice (in certain fields) without completing residency. That sounds great right? All of these groups have completed 3 to 4+ years of graduate medical education. They might not be as skilled as a physician, but they can certainly provide basic care. AMA doesn't think that's great. > The AMA opposes enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice of medicine and…

>It does not stand to reason, since care provided by residents is quite cheap to hospitals from the perspective of labor. The AMA represents doctors, not hospitals, and doctors benefit from scarcity. Hospitals benefit from residency grants, existing doctors do not. >Do you have evidence of this lobbying? Here is a source [1] >Hospitals have no obligation to hire the residents they produce, so an optimal behavior would seem to be training many residents and not hiring them. Optimal only if they can make money from the residents. Due to the bizarre natures of US medical reimbursement, resident physicians do not bill for their services [2]. While they may provide value in other ways, they are viewed as cost on the balance sheet. This is further complicated by the fact that hospitals dont want to bear this cost if they can get a grant, or simply hire a doctor away from another hospital. Getting rid of the grants would be a step in the right direction. https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… https://thesheriffofsodium.com/2022/02/04/how-much-are-resident-physic…

EUA can be applied to many different product categories including diagnostics (basically every single PCR and antigen test in the US up to very recently was initially released under EUA), therapeutics (for example the FDA granted an EUA on chloroquine for threatment of COVID), other medical devices (for example PPE) and vaccines. The EUA rules for each category is different in how they differ from the categories baseline. For vaccines the gulf between EUA and full process was relatively small - the clinical dataset was basically equivalent. I found this article to be a better summary of the differences between EUA and BLA (https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-differenc… I think you are right - the diagram from the OP is somewhat misleading. There is absolutely nothing stopping a company from manufacturing whatever they want before they get a BLA - they just can't market it. In real terms, it looks like the two big time savers was reducing long-term effects follow up from 6 months to 2 months, and well as probably an abbreviated review of manufacturing processes.

Also https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… This mistake made some 20 years ago is a festering problem today.

Which leads back to the supply of doctors, which depends on the limited number of med schools available and residency slots, and scope-of-care restrictions. (Eg, see https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-t… and https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… )

The AMA doesn't have direct control over it, I was wrong about that. But they heavily influence it: https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi…

In the late 1990s, the AMA lobbied to reduce available residency positions and residency funding. https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi…

Yes, here it is. With citations: https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi…

> Your comment sounds vengeful to the very people you'd turn to if you were facing a medical crisis. No, it's vengeful to the cartel that restricts the number of doctors that are allowed to exist[1]. Now there aren't enough radiologists[2]. If AI can solve this problem and get everyone the needed care, I'm all for it. The end that society is pursuing is a healthy population that isn't crippled by medical costs. If you're able to earn a living solving that problem, wonderful. If you're not, I'm sorry, but the medical field shouldn't primarily be a welfare system that incidentally provides health care. [1] https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… [2] https://www.acr.org/Practice-Management-Quality-Informatics/ACR-Bullet…

https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… They created the problem. Just because they’re now trying to fix it means nothing

The AMA's actions were undesirable, but that just goes to show the power it wielded on behalf of its members, and the occupation it represented. Imagine if the IEEE/ACM could lobby for SWEs as effectively. Also, perhaps in the present or future, the AMA could use its own power to undo the mistakes it made in the past: https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi…

Is the risk alone a "very big" risk? Or are you saying the difference in risk of this happening with a cop vs. a medical person is a "very big" difference? Are cops not also able to commit someone involuntarily? Why are you talking about objective "very big risk" without comparing it to the current situation and what is different about this? I did a google search for "can a police officer commit someone to a mental ward" and this is the first result, from harvard: https://blog.petrieflom.law.harvard.edu/2014/11/25/short-term-emergenc… This says that a police officer is also able to commit someone in most jurisdictions. Why didn't you also mention this fact? FUD

Doesn't the AMA administer the MCAT and facilitate the applications for not just medical schools but also residencies for Dermatology? I think excluding that while including that they're not literally the organization that does accreditation and licensing is misleading. They're one of the largest lobbying groups in America with disastrous consequences. They have a consistent history of empty promises, including their rhetoric on expansion which hasn't been successful despite the years they've had and the political leverage during the national health emergency. https://www.zippia.com/advice/largest-lobbyist-groups/ Here's a differing opinion from yours where "The American Medical Association (AMA) bears substantial responsibility for the policies that led to physician shortages". https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… I hear about how wealthy and powerful the medical community is yet they shift the blame at every opportunity. I hope medical schools require students have a spine too.

We already regulate many things for harm, by age (alcohol, tobacco, firearms, recreational drugs), and broadly without regard to age (meth, fentanyl, etc). I think you are confused with regards to current state vs the way you wish the world was. The discussion is adding additional items to that regulatory list. > If something changes the pathways in our brains and damages our health — and if it does so to Americans on a vast scale — it should be regulated as a threat to public health. https://blog.petrieflom.law.harvard.edu/2021/12/03/regulating-out-of-t… https://www.mcleanhospital.org/essential/it-or-not-social-medias-affec… https://health.clevelandclinic.org/is-it-possible-to-become-addicted-t… It’s still democracy even when you aren't happy with the outcome. You got the vote. That’s the democracy part, not the winning.

You are both correct. Back in the 80s and 90s, it was projected that there would be a physician surplus about 10 to 20 years down the road, so the AMA advocated cutting the number of residency positions [1, 2]. But those predictions didn't bear out, and in recent years (about the past 10 years), they have advocated increasing the number of positions [1, 3] In my opinion, a lot of the talk about artificial physician scarcity is BS. We have more physicians per capita than the UK, Australia, or New Zealand, but fewer than most EU countries. So we are roughly in the middle of the pack for developed nations. The problem is not a lack of physicians, but the fact that the US has a much larger rural area than most other nations and that you need a certain density of physicians in those areas. But you can't fix that simply by training more physicians -- you train more, and they'll predominately move to the cities too for the same factors. [1] https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… [2] https://www.openhealthpolicy.com/p/medical-residency-slots-congress [3] https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate…

https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… The lack of residency positions is the result of lobbying by the AMA. What it the American medical association? In there words: "The American Medical Association, founded in 1847, represents more than 190 state societies and medical specialty associations, including internal medicine, family physicians, obstetricians and gynecologists, pediatric and emergency medicine. The AMA is the largest association of physicians—both MDs and DOs—and medical students in the U.S. Our mission is to “promote the art and science of medicine and the betterment of public health.” It's a doctors old boys club and you can join if you're a doctor. Here's more evidence: https://med.fsu.edu/sites/default/files/news-publications/print/USA%20… The low supply of doctors is not a free market phenomenon. It is the result of deliberate cartel policies of the AMA for self interest. Keep in mind an over supply of doctors is generally a good thing for society. Not a good thing for doctors who want to be super rich.

> Medical school class sizes are not artificially restricted. Schools limit class sizes to ensure that almost all graduates can find a residency program slot. This is paradoxical. Class sizes are limited by the school, but not artificially limited? Medical school class sizes are artificially restricted by outsized requirements for admissions. For example, the requirement of an undergraduate degree in order to enter medical school is not something that exists in Europe. Or that the admissions and exam requirements are much less hyper-competitive in Europe, than the U.S. This is, of course, “to restrict the supply of residents, so each one can find a job.” It’s still artificial restriction, rather than a natural bottleneck. The same AMA that “Twenty years ago, the AMA lobbied for reducing the number of medical schools, capping federal funding for residencies, and cutting a quarter of all residency positions,”[0] is now asking for support in reversing its schemes? That’s rich. The same AMA that makes hundreds of millions in revenues, by speculating in securities[1]. Like an alma mater asking you to donate to its investment coffers after it’s shackled you with debt. [0] https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… [1] https://www.epsilontheory.com/ama-bitfd/

> Min wage. changes the supply, not demand. If you raise the price of something–anything–it lowers demand. That's why minimum wage laws create unemployment. > It may or may not yield less employment depending on elasticity. If you're earning your employer $10/h and the minimum wage rises to $11, you will not have a job. Either right away if the employer realizes it, or eventually when they go out of business if they don't. Adding elasticity to the equation unnecessarily complicates this. Some things have elastic demand, others have inelastic demand. Why focus only on the relevant case for the point you're making? The overall effect of a price increase is decreased demand. > If businesses are flush with profits, then they'll eat the higher labour input and that's it Profits have nothing to do with it. If a business has employees at some wage and the minimum wage rises above that wage, they will, at least eventually, replace the low-wage employees with new ones (or with automation) that add at least as much value as they are paid (or cost). Profits don't magically make businesses waste money on inexperienced employees where they could otherwise be more efficient with more experienced employees at the same price or with automation. > Otherwise, prices may rise Not without an associated drop in demand. > You can see this more acutely in healthcare, where there are stronger regs, because the power asymmetry is bigger aka the supplier has the power of 'life or death' over…

> Guess you deleted this part. It detracted from the overall point. But yes, I do look forward to the day artificial intelligence mostly replaces humans in this industry. I think the benefits are self-evident. > If a better system existed given the current set of parameters, I believe it would have come into existence. One of these "parameters," as your call them, includes the AMA and doctors restricting the number of new doctors who can be trained in the past https://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage… , actively fighting against allowing Nurse Practitioners and other trained providers from providing routine services that would lessen the requirement of doctors https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practi… , fighting against collection of misdiagnosis data (as mentioned above), lobbying against banning pharmaceutical companies from giving money or gifts to doctors (in fact, the majority of doctors say that accepting these gifts is OK, despite research repeatedly showing that these nudges change behavior and lead to practises like overprescribing opiates — https://www.statnews.com/2020/12/04/drug-companies-payments-gifts-affe… ), refusing to adopt practises that reduce mortality (see: the checklist example from above) and on and on. This trend is not unique to the US. Similar efforts exist everywhere doctors do. The profession was associated with status in the past (and…

It’s not just the cost of college that limits the supply of doctors. There is an explicit limit on how many people can become doctors each year in the US: http://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practic… In addition, in many states in the US you have to get permission to open a new medical facility: https://en.m.wikipedia.org/wiki/Certificate_of_need Often the people on the board own existing medical facilities, so you literally have to get permission from your potential competition to compete with them. https://www.justice.gov/archive/atr/public/press_releases/2008/237153a… For example from the above link: “ In 2006, the Antitrust Division alleged that a hospital in Charleston, West Virginia used the threat of objection during the CON process, and the potential ensuing delay and cost, to induce another hospital seeking a CON for an open heart surgery program not to apply for it at a location that would have well served Charleston consumers.”

Disclaimer: this is not legal or medical advice, but an encouragement to read the research for yourself and accumulate an understanding of the issues for your decision making. If you know any good studies or criticisms, please add them. Emergency Use Authorization (EUA) and Biologics License Application (BLA) description: https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-differenc… There are already lawsuits challenging EUA vaccine mandates. They’d be moot, though, after FDA approval, since the Supreme Court has upheld states’ vaccination mandates (cf. Jacobson v. Massachusetts) Some issues around BLA/FDA approval: First, a BLA has some implications. It would likely force the FDA to revoke EUAs to all other candidates (one of the conditions for an EUA is that no other viable approved treatments exist. Some of the controversy around ivermectin and off label use is related to this condition). This would impede development of other treatments, current and future. Second, the history of SARS-cov vaccines is promising, but incomplete. Many previous trials showed good progress (high antibody titre levels, etc.), but tended to fare poorly on later virus challenges. eg https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035… Third, sometimes, side effects might not be sufficiently analyzed until well after authorization, eg “Dengvaxia”: a dengue fever (R0=65, CFR=20-30%) vaccine that was…