Get AACN-CMC Exam practice test containing 100% valid test questions.

Assuming you are stressed, How to breeze through your Medical AACN-CMC Exam. With the help of the ensured Medical AACN-CMC practice test questions and test system, you will sort out some way to utilize your insight. The greater part of the specialists starts perceiving when they observe that they need to show up in IT certificate. Our Exam Braindumps is done and direct. The Medical AACN-CMC Latest Questions make your creativity and knowledge significant and help you parts in direction of the authorization test.

Exam Code: AACN-CMC Practice exam 2023 by team
AACN-CMC Cardiac Medicine Subspecialty Certification

CMC® is a subspecialty certification for certified nurses who provide direct care to acutely/critically ill adult cardiac patients. Nurses interested in this certification may work in areas such as cardiac care units, medical ICUs, telemetry, progressive care, heart failure clinics, home care, interventional cardiology, cardiac cath labs and/or electrophysiology units.

A current, unencumbered U.S. RN or APRN license is required.

An unencumbered license is not currently being subjected to formal discipline by any state board of nursing and has no provisions or conditions that limit the nurses practice in any way.

A current nationally accredited clinical nursing specialty certification, to which the CMC credential will be attached, is required.

Candidates must complete one of the following clinical practice hour requirement options:

Two-Year Option

Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill adult patients during the previous two years, with 875 of those hours accrued in the most latest year preceding application. Of those 1,750 hours, 875 need to be in the care of acutely/critically ill adult cardiac patients.


Five-Year Option

Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill adult patients, with 144 of those hours accrued in the most latest year preceding application. Of those 2,000 hours, 1,000 need to be in the care of acutely/critically ill adult cardiac patients.

Must be completed in a U.S.-based or Canada-based facility or in a facility determined to be comparable to the U.S. standard of acute/critical care nursing practice.

Are those spent actively providing direct care to acutely/critically ill adult patients or supervising nurses or nursing students at the bedside of acutely/critically ill adult patients, if working as a manager, educator, preceptor or APRN.

Are verifiable by your clinical supervisor or professional colleague (RN or physician). Contact information must be provided for verification of eligibility related to clinical hours, to be used if you are selected for audit.

For complete eligibility requirements.

Cardiac Medicine Subspecialty Certification
Medical Certification exam plan
Killexams : Medical Certification exam plan - BingNews Search results Killexams : Medical Certification exam plan - BingNews Killexams : 15 Medical Certifications That Are In Demand No result found, try new keyword!A certificate only medical career offers great wages, opportunities, and low barrier to entry. It can take anywhere from 2-24 months to kick-off that new career as a healthcare worker. In this article ... Fri, 11 Aug 2023 04:08:00 -0500 en-us text/html Killexams : What To Expect During Your First Women’s Wellness Exam

During a well woman exam, your doctor will review all of your current medical issues and determine if there is anything missing from care, says Dr. Marchand. It is important to note that medicine is constantly changing, so treatment that is recommended can vary a lot in just one year, he adds. The doctor should examine you from head to toe, check your vital signs, and assess if you are due for any vaccines. The visit generally includes the following:

Health History and Physical Examination

Upon arrival, you will undergo a routine physical exam that includes taking your weight, pulse and blood pressure. A urine trial may be requested to test for sexually transmitted diseases (STDs) and rule out urinary tract infections, says Dr. Alagia. “You will be asked to change into a gown after being left alone in the examination room. Once your health care professional enters the room, they should take a few moments to review the exam they are planning to perform and explain the reason for the specific exam,” he says.

You’ll have time before, after and during the exam to ask and answer any questions you and your health care provider might have. It’s useful to prepare a list of questions in advance.

The questions that your doctor asks will be tailored to your age and medical history, says Dr. Swarup. For example, they may ask if you smoke, use drugs or alcohol, have any allergies or infections and whether you’ve had any surgeries, he says––all of these factors can affect your reproductive health.

Your doctor may ask the following questions, according to Dr. Swarup:

  • How long ago was your last period?
  • How often do your periods occur and how long do they last?
  • Is there spotting between your periods?
  • Is there any vaginal itching, pain or discharge?
  • Are you experiencing any medical concerns?
  • Do any members of your family have medical issues?
  • How often are you sexually active, and do you have a new partner?
  • What type of sex do you have? Is it painful? Do you ever bleed after?
  • Do you use birth control?
  • Are you concerned you might be pregnant?
  • Are you trying to get pregnant?
  • What do you use to prevent sexually transmitted diseases (STDs)?

It’s important to be completely honest in your answers because the questions are to benefit your health, says Dr. Marchand. “Remember that a doctor can never share any personal information about your visit (doing so could easily lead to medical board discipline or loss of licensure),” he says. Doctors can share your information with other members of their health team if it is necessary to provide your care or coordinate your care. Doctors can also share your information with your permission. Doctors can also share your information with law enforcement to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public. Dr. Alagia adds that having an honest dialogue with your health care professional helps them recommend guideline-based care such as STD screening, cancer screenings and other services.

You should also expect questions about your diet, life stressors and exercise habits, says Dr. Marchand. “Since screening for depression and anxiety is very important for all patients, you should be ready for questions about how you’re feeling,” he says.

Breast Exam

Starting at the age of 20, a breast exam may be conducted every one to three years to identify any irregularities or lumps, says Dr. Swarup, but recommendations vary. For example, the ACOG advises that clinical breast examinations may be offered every one to three years in women ages 25 to 39, and once a year in women over the age of 40.

The American Cancer Society does not recommend clinical breast exams nor self breast exams at all due to lack of evidence that it contributes very little to early breast cancer detection when mammography is available. Currently, mammograms (x-ray images of the breast) are recommended annually in women over the age of 45 and once every two years in women over the age of 55.

The ACOG that women between the ages of 25 and 39 be offered a clinical breast exam every one to three years, and that women over the age of 40 be offered them annually. In either case, the ACOG recommends women make the decision that’s best for them.

If your practitioner conducts a clinical breast exam, you will be asked to lift one arm behind your head, explains Dr. Alagia. This allows your doctor to better examine each breast, applying gentle pressure in circular movements. “They will look for abnormal lumps or cysts. If any lumps are discovered, a biopsy will be ordered to determine if they are cancerous or not,” says Dr. Alagia.

Pelvic Exam

A pelvic, or internal exam, is performed to check the vulva, vagina, cervix, fallopian tubes, ovaries and rectum for abnormalities. Adolescents don’t need a pelvic exam unless they are experiencing abnormal bleeding, discharge, or pelvic pain. It’s unlikely that you’ll have a pelvic exam before the age of 21 unless such symptoms are present. Although the exam may be uncomfortable, it should not be painful. Keeping your body relaxed will help minimize discomfort.

During a pelvic exam, your doctor will also examine your vulva and rectum for irritation, redness or other signs of anything concerning, says Dr. Swarup. A lubricated speculum is placed into the vagina to look inside it, allowing the cervix to be evaluated for signs of disease. After removing the speculum, your doctor will gently insert one or two fingers (using a lubricated glove) into your vaginal canal while placing gentle pressure on the lower abdomen, explains Dr. Alagia. This allows them to check for abnormalities in the size, shape, and position of the uterus and ovaries.

You can expect to feel pressure, says Dr. Alagia, adding that it’s important to communicate any feelings of pain, heaviness, bloating or tenderness––this helps your doctor understand potential causes for concern.

Cervical Cancer Screening

Depending on your age, you may undergo cervical cancer screening via a Pap smear and/or human papillomavirus (HPV) test during your pelvic exam. A Pap smear looks for cellular changes in the cervix that may turn into cervical cancer, and an HPV test checks for the presence of the human papillomavirus, the virus responsible for causing these changes.

Current U.S. Preventive Services Task Force guidelines advise that women between the ages of 21 and 29 be screened every three years with a Pap smear alone; women ages 30 to 65 may be screened every three years with a Pap test only, every five years with HPV testing only or every five years with both.

For both HPV and Pap tests, your health care practitioner will insert a lubricated speculum into your vaginal canal to view your vagina and cervix, explains Dr. Alagia. “They will swipe your cervix with a swab and send it to a lab to ensure there are no signs of cervical cancer and ensure your cervix is healthy,” he says.

Sexually Transmitted Disease (STD) Screening

Even if you think you are not at risk, you should discuss STD screening with your doctor, says Dr. Alagia. Currently, the Centers for Disease Control and Prevention (CDC) recommends the following testing schedule for STDS:

  • All adults and adolescents ages 13 to 64 should be tested at least once for HIV.
  • All sexually active women younger than 25 should be tested for gonorrhea and chlamydia yearly, and women over 25 with new or multiple sex partners or a sex partner with an STD should be tested yearly.
  • Pregnant women should be tested for syphilis, HIV, hepatitis B and hepatitis C early in their pregnancy, and those who are at risk (new or multiple sex partners) should also be tested for chlamydia and gonorrhea.

Your Hormones-Free Birth Control and Fertility Tracker

Natural Cycles is a FDA cleared birth control app backed by science that uses your body temperature to detect and predict ovulation based on your unique cycle.

Sun, 13 Aug 2023 22:48:00 -0500 en-US text/html
Killexams : How SLU student conquered to top the medical technologist exam

CAVITE, Philippines – Sam Jeffrey Tiongco, 22, dreamed of becoming a medical technologist and a doctor, but the journey towards this dream has been a challenge. 

He was having a typical day at Saint Louis University (SLU) when his friend showed him the August 2023 Medical Technologists Licensure Examination results. 

That time akala ko inedit niya, kasi ‘yun ‘yung trip ng mga kaibigan ko (At that time I thought it was edited by my friend to prank me),” he said.

“So when he showed me that it was actually the PRC (Professional Regulation Commission) board, I was really shocked, I dropped my pen and then I cried [out] of joy, ” Tiongco added in a mix of English and Filipino. 

Tiongco scored 93.30%, placing first among 3,982 passers out of 5,401 examinees. His alma mater Saint Louis University also ranked first among schools with students taking the exam nationwide.

While everyone saw Tiongco fulfill one of his dreams, only few knew how physically and emotionally draining his preparation was towards this result.

“I pressured myself into delivering the best results thinking I could ignore the physical hardship because I was used to sleepless nights anyway, but it wasn’t the case,” said Tiongco in his Facebook post.

Life as a student in SLU

Tiongco moved to Baguio City, where he studied senior high school at SLU Basic Education School. He later enrolled at SLU for his undergraduate degree in medical technology. 

“When I was in high school, I fell in love with blood bank, especially blood typing, so I intended to pursue medical technology,” Tiongco shared.

He was an active student leader in SLU. When asked how he managed his time, he said, “Very difficult siya. Actually nung high school hanggang 2nd year college, BS major in org (organizations) talaga ako, hindi ako BS major in medical technology.

(It was very difficult. From high school until 2nd year college, I was actually a BS major in organizations, not a BS major in medical technology.)

He served as student council executive president when he was in Grade 12. In college, he served as a secretary, secretariat head, and academic committee head at SLU KASAMA

Despite this, Tiongco, just like every other student, struggled in school. “First year pa lang mahirap na talaga yung subjects, i-te-train ka na talaga nila. Ang hirap ng mga quizzes namin, super (The subjects are already difficult in my first year because the university is training us. The quizzes were super difficult.),” he said. 

He also admitted that he barely passed the university’s comprehensive exam. “Sobrang hirap niya to the point na meron din akong line of seven [na grade] (It was very hard, to the point that I received a grade with a line of seven)

Such events would have discouraged other students, but Tiongco did not let it get through him.

Honestly hindi masama ‘yung feeling ko, at the very least pasado ako. Hindi ko na kailangan ulitin ‘yung process kasi grueling ‘yung process tapos uuliit ka nanaman (Honestly, I did not feel bad, at the very least I passed. I don’t need to repeat the process because the process is grueling for me to only do it once more),” he said. 

The setbacks

Studying for the board exam was not child’s play for Tiongco. He even had few people around him doubting him. 

Very contradictory ‘to doon sa [Facebook] post ko, sinabi ko roon na walang nagdoubt sa akin pero meron at meron talaga (It’s very contradictory to my [Facebook] post, I said that no one doubted me but there actually were.), ” he said. 

Tiongco admitted experiencing several breakdowns before the board exam. “One month before the board naka-apat or limang breakdowns yata ako. Sinabi ko na hindi ko kaya [pumasa], baka bagsak ako. (A month before the board exam, I think I had four or five breakdowns. I said I can’t pass, I might fail.)”

Tiongco originally intended to take the board exam in March 2023. “Unfortunately, ‘yung TOR namin late na na-release (Unfortunately, my transcript of records was released late),” he said.

Medyo masakit sa feeling, kasi I had plans for the entire year. Sabi ko nga after ng March magtuturo ako sa mga schools tapos magpapaopera pa ako ng mata ko kasi yung grado ko sobrang taas na,” he said. 

(It was a bit painful, because I had plans for the entire year. I planned to teach after March and then I planned to undergo surgery to fix my blurry eyesight.)

But these setbacks did not stop Tiongco from achieving his dream. He started reviewing again from April to August.

During those times sila [family] ‘yung nagbubuhat sa akin, pagkain [and] everything para makapag-focus ako sa review ko (During those times they supported me, they gave me everything so that I can focus on my review.),” he said. 

Na-postpone ‘yung plan ko pero kailangan tanggapin kasi ‘yun talaga eh, pero at least nagpayoff ‘yung mga desisyon ko,” Tiongco said.

(My plan was postponed but I have to accept it because that’s how it is. At least my decisions paid off.)

Aside from his family, his motivation to make his alma mater proud kept him going throughout the review process.

“I really wanted to deliver for our institution. I wanted to supply the best results that I can,” he said.

And delivered he did. Tiongco is currently a first year medical student at SLU and is on his way to supply back to the people who believed in him. – Allysa Areglo/

Allysa Areglo is a Cavite State University student pursuing a bachelor’s degree in journalism. She is a digital communications intern at Rappler.

Wed, 23 Aug 2023 11:47:00 -0500 en-US text/html
Killexams : ADT Medical Alert Systems: Reviews And Costs (2023)

ADT’s three medical alert systems provide emergency assistance for older adults and other customers in need of protection. However, there are significant differences to consider when deciding which option might be best for you or your loved one. While some devices offer coverage specifically in the home, others offer a wider range of monitoring, such as the ADT Medical Alert Plus, which covers up to a 600-foot range. ADT’s On-the-Go device, meanwhile, gives users peace of mind anywhere there is cellular coverage.

For the best user experience, follow the set-up, installation and testing instructions according to your device’s user manual. Place the base unit in a central part of your home, near an electrical outlet and away from noisy appliances.

When you need medical assistance from ADT, press the button on your pendant or wristband to speak to an ADT agent using your base unit’s two-way talking feature. The agent then calls the appropriate emergency response team to send to your home.

If you can’t hear the agent’s voice (or they can’t hear yours) from the base station, ADT will call the phone number you have placed on file. If they still can’t get in touch to determine the nature of your emergency, an emergency response team, such as a police or fire dispatcher is contacted for help.

If you’ve added fall detection to your ADT Medical Alert Plus or On-the-Go system, you’ll receive a separate pendant to automatically monitor falls.

Place the fall detection pendant around your neck so that it is outside your clothes at chest level. Test the pendant as instructed in the user’s manual. If you fall, the pendant interprets your movement as a fall within 20 to 30 seconds of the incident. A recorded voice from the base station or mobile device prompts you to press and hold the button on your fall detection pendant if a fall has occurred. If the alarm isn’t canceled in 20 seconds, the device contacts ADT’s emergency response center.

Tue, 22 Aug 2023 22:40:00 -0500 en-US text/html
Killexams : PCC adds short-term medical coding program in time for fall semester No result found, try new keyword!WINTERVILLE—For the first time, Pitt Community College will offer short-term, non-credit instruction to prepare individuals for work as credentialed medical coders in various health care settings, ... Wed, 16 Aug 2023 06:00:27 -0500 en-us text/html Killexams : Dr. Naik, Owner Of Survivors Courses, Shares How Survivors Course Can Prepare Students For The Usmle Test No result found, try new keyword!survivors courses dr. vijay naik survivors course dr. naik, owner of survivors courses, shares how survivors course can prepare s ... Wed, 23 Aug 2023 10:18:00 -0500 Killexams : Malaysia's medical officers deserve better

All health systems can only function with healthcare professionals (HCPs).

The attainment of the health component of the Sustainable Development Goals (SDGs) and universal health coverage is dependent on the availability, accessibility, acceptability and quality of HCPs.

The healthcare workforce has a vital role in the ability of a health system to respond to natural or man-made disasters, as well as related environmental, technological and biological hazards and risks.

The consequences of the Covid-19 pandemic were devastating, with Malaysia having the highest death rate per capita of the population in Asean.

Not only that, the illnesses and disabilities from long Covid-19 have yet to be quantified.

Malaysians owe a mountain of debt to the sacrifices of the junior doctors who provided them care, whether in hospitals or clinics for Covid-19.

Junior doctors faced very challenging personal and professional conditions, like long working hours in personal protective equipment (PPE), trying to protect themselves and their families from potential illness; having to adapt to new ways of working; and lack of training opportunities and examination postponements.

The sacrifices of the junior doctors were critical in containing the pandemic; some junior doctors even gave their lives for their fellow citizens.

Yet it appears that many people, particularly decision-makers and politicians, have forgotten the critical contributions of these doctors during Malaysia’s worse public health disaster.

This memory lapse was reflected in reports of the Health Ministry’s management of the transfers of its junior doctors, who were offered permanent positions, over the past two months.

Various unflattering adjectives have been used to describe the exercise including “KKM treats its doctors like slaves”, written in an op-ed published on a health news website by a government doctor using a pseudonym (as they are not allowed to make media statements).

A hot mess

It is difficult to dispute that the transfer exercise was a mess, which included, among others:

  • Lack of communication between Putrajaya and state health departments – This resulted in major hospitals, with heavy workloads, being short of doctors, with the consequential disruption and/or suspension of healthcare service delivery, which had to be announced to the public.

    A doctor group estimated that the waiting times in emergency departments for admissions at major hospitals would increase by 50-100% with all its attendant consequences for patients.

    There were also allegations that patient safety was compromised due to the shortage of medical officers.

  • Doctors were not eligible for transfer claims – This resulted in some having to pawn jewellery, withdraw monies from their savings accounts, etc, in order to foot the bills resulting from uprooting and moving to a new town.
  • The financial loss incurred by doctors transferred to Sabah and Sarawak from Peninsular Malaysia were particularly high.
  • Doctors posted to Sabah and Sarawak instructed to return to Peninsular Malaysia at short notice – One example posted on X (formerly called Twitter) was a medical officer who was posted to a Sarawak hospital from Negri Sembilan, only to be told the next day after reporting for duty on a Monday that the result of their appeal, posted the Friday before at 4.45pm, had changed their posting to a hospital in Johor.

    They were told to report to Johor as soon as possible.

  • Doctors posted to facilities that had no more vacancies for medical officers
  • Doctors posted to a hospital still under construction
  • Disruption of speciality training – Doctors preparing for, or in the, Masters specialisation training were transferred to other healthcare facilities, even though their training necessitated them to be in specified facilities.

    Some appeals were rejected, while others were subsequently instructed to report back to their original facility.

  • Issuance of transfer instructions on the weekend prior to reporting for duty
  • Not permitting mutual exchange of postings.

The contract doctor issue has been around since 2016 and transfers are a norm in the Health Ministry.

Yet, 2023 was the first occasion that such messiness came into the public domain.

Who was responsible for this mess?

Was it poor communication, poor coordination, incompetence, irresponsibility, or a combination of these factors?

Were there other factors?

Suggested improvements

The healthcare workforce, particularly the junior doctors, have a critical role to play if the country is to achieve its health and developmental objectives in the next few decades.

A paradigm shift has to be adopted with strategies to plan, educate, deploy, manage and reward the healthcare workforce, particularly junior doctors.

It is critical that urgent steps are taken to Improve the working lives of these doctors.

This would include, among others, some of those listed below.

> Addressing burnout

It is an immediate priority to address burnout, which has been described by the World Health Organization (WHO) as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed and characterised by three domains: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism relating to one’s job; and reduced personal efficacy.”

Burnout is associated with adverse personal behaviours, like drug misuse/abuse, relationship breakdown, and consequential effects on patient care, as doctors who suffer from burnout are more likely to be involved in adverse patient incidents.

> Providing fair compensation

The fair financial compensation of junior doctors and certified has been a long-standing issue.

The on-call allowances of junior doctors per hour have been reported to be less than that of fast-food staff.

The unkindest cut of all were reports of delays in payments of on-call allowances.

One wonders whether other civil servants are treated in this manner.

With the rising cost of living, accommodation, etc, the issue of financial compensation contributes to the poor morale of junior doctors.

> Clarifying specialist pathway

Speciality training is through the Masters programmes of local universities or the Royal Colleges examinations (also termed the “parallel” pathway).

Selection for the Masters programmes can be described as opaque, to say the least.

Some contract doctors, who have difficulties in entering local Masters programmes, have taken the parallel pathway examinations on their own.

However, there is no clear pathway for these contract doctors to be absorbed into permanent service as specialists.

Many politicians who exhort the Health Ministry to deploy more certified into hospitals in their constituencies have strangely been silent about this administrative logjam.

Nurturing resilience

The Health Ministry response via a media statement on Aug 4 (2023) were general statements that did not address the impact of doctor shortages on patient safety and quality of care.

The Health Ministry claimed that “through these new placements, officers will obtain more exposure about the healthcare system and can develop their own capacities.

“This experience will make officers more mature, empathetic and tougher (berdaya tahan) in surviving their career as a public servant.”

Resilience is desirable of all junior doctors as they have substantial responsibility for patients’ lives and wellbeing, work long hours, encounter difficult situations, and have to try to balance personal and professional challenges.

However, resilience is not an innate attribute in everyone.

It often needs to be nurtured by various means like good physical and mental health, recognising and managing conflict situations in the workplace, and maintaining strong personal relationships – all of which would be enhanced by mentorship and other support mechanisms, as well as resilience and leadership training programmes, which are sadly lacking in the Health Ministry.

The gratification from doing a good job is an important factor in keeping junior doctors resilient.

Doctors who experience joy in work are happier, more secure, have greater job satisfaction and greater career fulfilment, and consequently, provide higher quality and safer patient care, which is what the public wants.

The goal has to be joy at work, which was stated succinctly by the institute for Healthcare Improvement: “The most joyful, productive, engaged staff feel both physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.”

The current junior doctor mess has to be cleared up urgently for the sake of healthcare in Malaysia.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Mon, 21 Aug 2023 16:20:00 -0500 en text/html
Killexams : New York State civil service: These are the salaries for exams open in August No result found, try new keyword!STATEN ISLAND, N.Y. — The New York State Department of Civil Service (DCS) has released its August application schedule for New York’s entry-level civil service exams, and some jobs pay better than ... Sun, 13 Aug 2023 11:51:00 -0500 en-us text/html Killexams : Medical Colleges Set Up From 2024-25 Session Allowed To Have Max 150 Seats

The distance between college and hospital shall have a maximum 30 minutes travel time. (Representational)

New Delhi:

Medical colleges established from 2024-25 academic session onwards shall have a maximum of 150 undergraduate seats, provided the institute follows the ratio of 100 MBBS seats for 10 lakh population in that state.

Colleges seeking increased number of seats cannot exceed 150 MBBS students from 2024-25, the National Medical Commission (NMC) said in its newly-issued "Guidelines for Under Graduate Courses under Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses and Assessment and Rating Regulations, 2023."

Any additional permitted seat quota for admissions shall be within the number of seats granted for admission to that college, the guidelines notified on August 16 stated.

With the exception that colleges who have applied for academic year 2023-24 for increased seats but failed to get the same, can ask for the same number (totalling 200 or 250) that was in their previous application for one time in the year 2024-25 only.

After 2023-24, letter of permission for starting of new medical colleges shall be issued only for annual intake capacity of 50/100/150 seats, the guidelines stated.

Every hospital seeking permission to start medical college after the publication of this amended regulation shall comprise of the medical college, the attached teaching hospital and the hostels for the students and interns, with or without the residential area for faculty and other staff of college or hospital.

The medical college, hostels for students and interns and the teaching hospital or institution shall be either in a unitary campus or maximum of two campuses, the guidelines said.

According to the guidelines, the distance between the plots of college and hospital shall have a travel time of maximum of 30 minutes. The hospital shall have at least 220 beds.

For every hospital seeking permission to start medical college, the medical college shall have rural health training centres/community health centres/urban health centres affiliated to it; according to the geographical location of the college, which shall be used for internship training.

The guidelines state that every medical institution shall have a skills laboratory where students can practice and Improve skills pre-specified in the curriculum. The skills laboratory attempts to recreate the clinical environment and tasks which future healthcare workers have to perform with various levels of complexity and fidelity. Skills lab is only to prepare the student for clinical exposure. It shall not replace or be used for compensating any hands-on clinical training or conducting examination. Six weeks of skills lab training including evaluation before the students are posted to the wards for clinical training shall be mandatory. The skills laboratory shall have a total area of at least 600 sq. m for intake up to 150 MBBS students annually and 800 sq.m for intakes of 200 and 250 MBBS students annually, the guidelines said.

The buildings of the medical college and hospital will have to conform to the prevailing building codes and local building byelaws/norms.

The hospitals should have fire-safety measures, including patient evacuation plans according to local byelaws and regulations. They must also comply with the requirements for providing access and facilities to those who are disabled.

It shall be mandatory to have at least 75 per cent attendance of the total working days (excluding vacations) for all faculty and resident doctors. During vacation period, other than sick leave or leaves availed due to emergency situations, the faculty on duty shall not be availing any leave.

The college or institution shall provide furnished accommodation for at least 75 per cent students, interns, and resident doctors.

It is desirable that hostel rooms are double accommodation facilities. Adequate recreational, dining and 24x7 security facilities shall be provided at the hostels. However, those who do not wish to avail of the hostel facilities shall be allowed to choose their own residential facilities without the college collecting 'hostel fees', the guidelines stated.

The guidelines specified other criteria in terms of campus, library, journals, lecture theatres, laboratories, biomedical waste management, research facility, college website, departments and close circuit camera among others.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

Sat, 19 Aug 2023 05:57:00 -0500 text/html
Killexams : Sensible Medicine: Medical Misinformation and Medical Groupthink From the Medical Establishment

Sensible Medicine is a monetized Subtstack that spreads overt anti-vaccine misinformation. Though the doctors who run it claim to be “medical conservatives”, they mostly took a medically radical approach to a new, mutating virus, treating it as an overhyped, predictable entity from the pandemic’s earliest days. As the pandemic progressed, they repeatedly declared it over and encouraged the mass infection of unvaccinated youth by spreading blatantly bogus statistics and treating abnormal lab values after vaccination as a fate worse than death from COVID.  A latest article there by Dr. Marty Makary gives us an opportunity to delve into their more pernicious misinformation techniques.

Dr. Makary’s article was ironically titled Does Anyone Still Care About Data? Though it was about new treatments for Alzheimer’s disease, it contained the following paragraph:

America’s Lost Art—the Critical Appraisal of Research

We witnessed similar medical groupthink during Covid. Throughout the pandemic, the medical establishment never talked about Covid’s leading modifiable risk factor—obesity. Instead, they had a singular, albeit important, pharmaceutical solution. They indiscriminately told everyone to get multiple vaccine doses, regardless of whether a person already had high levels of Covid antibodies from natural immunity, or if a healthy young male already had three vaccine doses. During Covid we saw naked allegiance to political figures, regardless of the data. Doctors and the public alike were quick to cite studies to support their ideas, even if the methodological quality would not meet entry criteria for a 7th grade science fair contest. Conversely, research that did not support a forgone conclusion was downplayed, ignored, or censored.

It may not seem that way, but there’s a lot to unpack there. It’s full of misinformation, and every accusation is a confession. Its aim is to create mistrust and resentment, not to inform and educate. Get comfortable and we’ll examine it one piece at a time. I apologize for the fact that:

The amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it.

First note that Dr. Makary wrote in the past tense, about events “during Covid”, as if the virus is gone. Of course, this is false. While hospitals and morgues haven’t been overwhelmed in a long time, SARS-CoV-2 is infecting, injuring, and killing people every day. Dr. Makary, who still discusses the pandemic constantly, has been predicting the end of the pandemic since at least December 2020 when he said, “we may only need to get an additional 20% of the population immunized by February or March to really hit those 70% herd immunity levels.” He’s never wavered from this position. In February 2021 he penned as essay titled “We’ll Have Herd Immunity by April,” and another the next month titled “Herd Immunity Is Near, Despite Fauci’s Denial“. In May 2021, he said he was right, claiming that “most of the country is at herd immunity”. He wrote articles in the NY Post that month titled, “Risk of COVID is Now Very Low — It’s Time to Stop Living in Fear: Doctor” and “Don’t Buy the Fearmongering: The COVID-19 Threat is Waning“.  Dr. Makary later referred to the Omicron variant as “omi-cold” and “nature’s vaccine.” Anyone who cared about data knew that Dr. Makary was wrong about all this.

Does anyone still care about data?

Dr. Makary also sets the stage by signaling that he’s a brave, maverick doctor, while his critics are sheep, incapable of independent thought, just “groupthink”. There’s a grain of truth here. Though we at SBM are not afraid to disagree with each other in public, we all have biases, including in-group loyalty. It’s often trivial to see such bias in others, though nearly impossible to see in oneself. As such, it’s both easy and dangerous to imagine that only those who disagree with you are afflicted by groupthink, while you are perfect beacon of independent, rational thought- along with everyone who agrees with you.

Though the doctors behind Sensible Medicine portray themselves as immune to “groupthink”, they largely marched in lockstep during the pandemic, objecting to most measures to control COVID and minimize its dangers. To pick one example amongst many, they were united in their belief that the pandemic was ending in early 2021, and that ridicule was an appropriate response to anyone who disagreed. Their sarcastic mockery occurred even during the pandemic’s deadliest month, January 2021, while over 3,000 Americans were dying of COVID daily, and even on what turned out to be the literal peak of the deadliest wave, January 16, 2021. Over 700,000 Americans have since died of COVID.

Medical groupthink during COVID

When herd immunity failed to arrive, Sensible Medicine doctors only further encouraged groupthink by repeatedly shaming and pathologizing the small number of nonconformists who take measures to avoid repeated infections. When the Omicron variant emerged, Dr. Makary was fearful of a “wave of fear”, saying it could fuel a “pandemic of lunacy”. Dr. Prasad, who started the pandemic saying personal attacks were “worse than COVID”, similarly weaponized mental illness to stigmatize cautious people. In June 2023 he said:

Medhi Hasan is an idiot. Of course we have to learn to live with covid. Everyone is living with it. That is precisely what happened. No one gives a shit about COVID anymore & no one sane is taking any precautions. It even bores me & I know fully how wrong the establishment was.

Talk about groupthink.

Dr. Prasad, who also still discusses the pandemic constantly, even formalized his dedication to groupthink by asking his followers to publicly pledge to refuse more COVID vaccines. A request for a written, public display of conformity is a classic influencer technique, described by Robert Cialdini who said:

Commitments are most effective in changing a person’s self-image and future behavior when they are active, public, and effortful.

Medical groupthink during COVID

“Throughout the pandemic, the medical establishment never talked about Covid’s leading modifiable risk factor—obesity.”

Next, Dr. Makary signals that he’s an outsider, and therefore not responsible for our pandemic disaster in any way. Parroting Dr. Prasad, who said “I know fully how wrong the establishment was”, Dr. Makary also wants his audience to believe he’s not part of the “establishment”. I’m with you, not them.

Talk about groupthink.

Of course, this is false. Dr. Makary is the Mark Ravitch Chair in Gastrointestinal Surgery at Johns Hopkins School of Medicine, and teaches public health policy as Professor of Surgery and Public Health at the Johns Hopkins Bloomberg School of Public Health. In 2018, he was elected to the National Academy of Medicine. He was well-known before the pandemic, particularly for his claim, debunked by Dr. Prasad, that medical error is the third leading cause of death. He has 234,000 Twitter followers, and was a ubiquitous media presence this pandemic. He was on Fox News hundreds of times, declaring the end of the pandemic and spreading anti-vaccine misinformation.  According to an article from Media Matters from December 2021 about these appearances:

Makary has been described as “a darling of the anti-vaxxers” for contradicting current vaccine consensus among medical professionals. Makary has also written that there is “no compelling case” for vaccinating “healthy” children and claimed that he is “not aware of a single healthy child in the U.S. who has died of COVID-19 to date” – discounting all cases that involved disabled children with underlying health conditions.

Despite Makary making numerous false predictions (saying, for example, that the United States would reach herd immunity by April) and being called out by other public experts for downplaying the risk of infectious disease, Fox regularly invited him back on-air in 2021 to undermine public health efforts:

  • In March on The Story with Martha MacCallum, Makary predicted there was low risk of new variants causing COVID-19 surges, and on Your World with Neil Cavuto, he accused public health experts of “cry[ing] wolf” over the threat of new variants.
  • In June on America Reports, Makary went so far as to complain that discussion of new variants is “fearmongering” to “manipulate people to get vaccinated,” saying, “I’m for vaccines, but this has turned into a tool to try to coax people into it.”
  • In June on Special Report, Makary claimed it’s time to “move on and live a normal life” comparing COVID-19 cases to influenza: “right now we’re about at 150th the daily cases of a regular seasonal flu in the middle of that flu season. So people have a distorted perception of risk.” According to Makary’s own employer, Johns Hopkins, COVID-19 has a mortality rate 10 times higher that of the flu.
  • On Your World with Neil Cavuto in November, Makary undermined efforts to vaccinate children, saying kids with natural immunity should not be vaccinated. He went on to fearmonger about potential side effects of vaccinations.
  • On Fox News Primetime in November, Makary claimed to be pro-vaccine but said he stands against “obsolete” vaccine mandates, especially for children. Makary falsely asserted that “public health officials have brushed under the rug the fact that kids have died from the vaccine, it’s rare” citing myocarditis occurrences in young boys. (However the real risk of myocarditis is from COVID-19, not vaccines, and most people who develop myocarditis recover quickly.)

Dr. Markary was also the editor of Medpage Today and spread his misinformation message in the Wall Street Journal, New York Post, and Washington Post. He testified before Congress on more than one occasion and had private audiences with Republican congressional doctors. He was the COVID advisor to the Governor of Virginia.  You can even hire him to speak for $20,000-$30,000.

He is definition of the medical establishment.

Medical groupthink from the medical establishment

Having falsely told his readers he’s not part of the “establishment”, Dr. Makary then claims they “never talked about Covid’s leading modifiable risk factor—obesity”. Of course, this is false. The CDC listedSevere obesity (body mass index [BMI] of 40 or higher)” as a risk factor for severe COVID as early as April 2, 2020 and they later published studies on the subject got that widespread media attention. They said:

As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity.

They were not alone. As early as March 2020, Dr. Anthony Fauci said:

It’s so clear that the overwhelming weight of serious disease and mortality is on those who are elderly and those with a serious comorbidity: heart disease, chronic lung disease, diabetes, obesity, respiratory difficulties.

He elaborated in 2021, saying:

The other thing I believe, is that obese people, particularly morbidly obese people, have a much higher rate of the other underlying comorbidities, which get a serious outcome. That’s diabetes, hypertension, heart disease—the incidents in a morbidly obese person of those other diseases is much higher than the general population.

Similarly, Dr. Francis Collins, the former director of the NIH, said in June 2020:

We also know that chronic illnesses play a role in who’s going to have a severe case. Certainly hypertension and diabetes and obesity are in there as well.

In fact, a simple Google search returned around 100 articles by the “establishment” on obesity and COVID from throughout the pandemic. My university published an article on April 16, 2020 titled “The New York Times: Obesity Associated with Severe Coronavirus Disease, Especially in Young Adults“. One from Dr. Makary’s university on June 1, 2020 was titled “Obesity a Major Risk Factor for COVID-19 Hospitalizations.”  Harvard, Yale, Stanford, UCSF, The University of Chicago, and dozens of other medical schools wrote about obesity and COVID.  So did the American Medical Association, the American Academy of Pediatrics, the American Heart Association, the Endocrine Society, and numerous other medical organizations. Major newspapers discussed it. I also discussed obesity as a risk factor for severe disease in children, noting that nearly all who perished from the virus were robbed of decades of life. It’s hard to find examples of the “establishment” who completely ignored the relationship between obesity and COVID

“Throughout the pandemic, the medical establishment never talked about Covid’s leading modifiable risk factor—obesity.”

Maybe the “establishment” should have talked about obesity more- Dr. Makary has just seven Tweets on the topic, the first from December 2020, the last from May 2022 -but it wasn’t exactly a top classified secret that it posed a risk for severe COVID. Nonetheless, Dr. Makary imagines that a large number of obese people were totally unaware of this risk, and that many of them could have have lost weight, if only the “establishment” had been more vocal on the topic. One overweight friend reacted to Dr. Makary by telling me:

Do people really think fat people don’t know they are fat and would instantly be thin just because some doctors says, “Oh, you should lose weight”?

People do actually think that, and it’s absurd. I’ve talked to literally thousands of patients considering bariatric surgery. They were not ignorant of obesity’s health risks, and nearly all tried everything for years to lose weight. While weight-loss is crucial and possible for many people, it’s not easy or instant for anyone, and a bit more encouragement from the “establishment” was not the secret sauce anyone was missing. Protecting obese people, who could not lose weight instantly three years ago is one reason we went to such lengths to control the the virus. 42% of Americans are obese, their lives are not expendable, and the “establishment” could not have reversed obesity on a dime in March 2020.  If Dr. Makary disagrees, then he should explain why he failed to cure obesity in Virginia during his stint as that state’s COVID advisor.

And let’s pause and look what Dr. Makary has communicated in just two short sentences. He’s signaled that COVID is over, denigrated his critics as the “establishment”, and claimed they were incapable of independent thought. He absurdly implied that obese people were ignorant of their condition, and that “Covid’s leading modifiable risk factor” could have been drastically improved if not for the apathy of the “establishment”. Moreover, he disrespected his readers by spreading easily-refutable misinformation, claiming that “Throughout the pandemic, the medical establishment never talked about Covid’s leading modifiable risk factor—obesity.” Throughout the pandemic!  Never! Either Dr. Makary didn’t bother with basic fact checking or he didn’t care that he was spreading a blatant falsity. However, his goal wasn’t to communicate accurate information. Like most Sensible Medicine writers, his aim was to trigger anger and groupthink.

Throughout the pandemic!  Never!

Of course, legitimate criticisms of the “establishment” are necessary and vital, and we here at SBM don’t shy away from criticizing medical boards, regulatory agencies, academic fraud, problematic drug approvals, as well as many individual “leaders” of American medicine. Some of the best work in this area comes from those truly outside the medical establishment, such as the Death Panel Podcast. However, while mistakes were made and some bad faith actors purposefully undermined all efforts to contain the virus, the vast majority of public health officials were people you’ve never heard of, working on the ground, doing the best they could to save lives in an unprecedented situation. Whatever their errors, it wasn’t easy to have real-world responsibility during the pandemic. As the bodies piled up, tough decisions had to be made in real-time with incomplete information. The right answers weren’t always obvious. This was everyone’s first pandemic and SARS-CoV-2 was a new virus, after all.

Moreover, public health agencies hadn’t been showered with cash and resources prior to the pandemic. Quite the opposite, actually. Public health officials couldn’t have done everything that’s now being demanded of them. When morgues were overflowing, they didn’t have the resources to launch a nationwide obesity awareness campaign.

However, asinine claims that the “establishment” could have tackled obesity in March 2020 have a broader purpose. They are part of a larger movement to rewrite history and minimize the enormous challenges the “establishment” faced at the pandemic’s start. Of course, this is just another way to minimize COVID itself. Some influential people want everyone to forget that refrigerated trucks were needed to store dead bodies outside my hospital. Doctors who greatly underestimated the virus at the start and who never treated COVID patients themselves, now seek to absolve their calamitous errors by blaming the “establishment” for not fixing every societal ill in March 2020. It’s no big deal that I said we’d have herd immunity by April. People just needed to stop being fat, and the establishment is to blame for that, not me. Unsurprisingly, the original COVID minimizer Dr. John Ioannidis, pioneered this deflection technique in 2021, creating a list of what “really caused” millions of COVID deaths. In 2023, Dr. Makary parroted his exact language, calling obesity a “modifiable risk factor” to similarly imply it “really caused” many COVID deaths.

Talk about groupthink.

Dr. John Ioannidis on what “really caused” COVID deaths

With the “establishment” and obese people there to take the blame, these doctors then seek to convince us that all measures to control the virus were an overreaction, a position many of them formulated in March 2020, when they thought fewer than 40,000 Americans would die. For example, demonstrating yet more groupthink by parroting the doctors behind the Great Barrington Declaration, Dr. Prasad said in March 2022:

Masks, distance, lockdown, test often don’t work, if they work, only delay the inevitable great harm.

Of course it’s unambiguously good that measures to control the virus delayed the inevitable and allowed countless millions of people to avoid it until after they were vaccinated and medical care had improved. The vaccines aren’t perfect, but a fully vaccinated person who contracts COVID today has much better odds of a good outcome than someone who contracted it in April 2020 when hospitals were deluged and we had no idea how to treat it.  According to one modeling study:

From December 2020 through November 2022, we estimate that the COVID-19 vaccination program in the U.S. prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths.

An obesity awareness campaign wouldn’t have had this impact.

In lieu of legitimate criticisms of the “establishment”, Sensible Medicine makes blatantly false statements about them and makes very difficult, even impossible tasks sound trivial. They want their readers to believe the “establishment” could have done nearly anything, but they were too stupid or apathetic to do many easy and obvious things. This too has a broader purpose. Their main goal is to get people to stop trusting the public health “establishment”, and you don’t have to take my word for it.

Unfortunately, Sensible Medicine is very successful in getting their audience to stop trusting the public health “establishment.” One commentator on Dr. Makary’s article said:

So sad. Medical community has gone crazy – and evil – since covid pandemic emerged.

This unbridled rage is par for the course for the grossly misinformed readers of Sensible Medicine, and that really matters. I encourage you to read the comments on an article titled “A Public Health Worker Looks Back at the Pandemic and How We Reacted to It,” by Matthew Brignall, a public health worker who was brave enough to work on the ground during during the pandemic and even braver to share his experience on Sensible Medicine. He wrote:

State and local health policies suppressed the spread of COVID-19 until we could develop an effective vaccine and get it into the arms of the most vulnerable people.

His reward for making sensible statements on Sensible Medicine was hundreds of comments calling him a “biofascist scum” and someone who helped “usher in tyranny around the globe.” Dr. Adam Cifu, a founder of Sensible Medicine, knew his readership and tried to prepare him for the backlash, but even Mr. Brignall was taken aback by the fury and groupthink, saying:

To be fair, Adam warned me, and I chose not to turn off the comments. But yeah, that shit was a cesspool. I think it is instructive to see how quickly the internet goes to lynch mob when the opinion is challenging.

Indeed, Sensible Medicine excels at creating a cesspool of resentment. I previously discussed an article there that lambasted the “establishment” for not doing an absurd, utterly impossible randomized-controlled trial (RCT) of hospital visitation policies at the pandemic’s start. Predictably, their readers, consumed by groupthink, responded not by agreeing to volunteer for future RCTs, but by sharing their fury and retribution fantasies against the “establishment”.  “It was a purposeful dictate designed to wreck humanity,” said one. “These people need to be held accountable”, said another.  “It was criminal in my mind”, said another. Another said:

 To the MD that wouldn’t let her go “home” on her birthday, may he be forever riddled with guilt. May he suffer the loss of a loved one in the same manner. May he die alone.

Charming stuff. Meanwhile, Dr. Cifu, who was very concerned about the “tone” of those who corrected the factual errors of his Sensible Medicine colleagues, also appeared in the comments and said to its author, “Wonderful. Thank you so much Ben“.

All of this anger and mistrust had consequences in the real-world, and none of it was “wonderful”. RCTs require volunteers who trust clinical trialists, AKA the “establishment”. I was in a vaccine RCT and because I actually want them to be successful, I always spoke positively about them. In my first article this pandemic, I discussed my experience and said:

Having argued for years that vaccines are properly tested, I jumped at the chance to participate in a vaccine trial myself. I’ve always believed that people who participate in medical research are doing a noble thing. If no one volunteered for such research, medicine would never advance.

In contrast, I don’t recall a Sensible Medicine doctor ever promoting an actual RCT or encouraging their audience to enroll in one. However, advancing actual RCTs is not their goal, which is a shame. Some very simple RCTs couldn’t even get off the ground due to low enrollment. It turns out that actually doing an RCT is a lot harder than writing “do an RCT”, and podcasting doctors who excoriated the “establishment” for not doing RCTs of everything, made it harder for anyone to do an RCT of anything.

Beyond this, many public health officials, AKA the “establishment”, were threatened, harassed, and attacked during the pandemic, leading many to quit. One public healthcare worker sent me the following message:

To shield themselves from similar vitriol, Sensible Medicine doctors falsely portray themselves as outsiders, wryly observing the “groupthink” of the “establishment” from a distance. Though they absolutely are part of the “establishment”, they don’t consider it their job to solve obesity, run an RCT, or seemingly do much of anything, besides commenting from the sidelines, blaming others for not doing everything they imagined. “If only they’d listened to me, things would have been just fine,” they say in articles that should be titled “What I Would Have Done“.

Of course, none of us have to wonder what we would have done this pandemic. What you actually did is exactly what you would have done.

Having poisoned the well against the “establishment”, Dr. Makary then pivots to his standard anti-vaccine blather. According to Dr. Makary, the brainless drones who chose not to cure obesity, had a “singular” focus on vaccines. This is partially true. Dr. Fauci, an avid jogger himself, encouraged exercise in the summer of 2020. He also took a medically conservative approach to the vaccines, saying in February 2021:

But even if you’re one of the lucky few to have gotten a Covid-19 shot, it will be important to continue wearing a face covering until researchers can determine whether the vaccines prevent people from spreading the virus to others who aren’t vaccinated.

However, for over a year, the “establishment” has abandoned all measures to control the virus, aside from their singular focus on vaccines. Put another way, the “establishment” adopted essentially all the positions of Sensible Medicine doctors, who are, of course, the “establishment”. Indeed, it was the doctors at Sensible Medicine who had a “singular” focus on vaccines, claiming they obviated other measures to contain the virus almost immediately after they came out. Dr. Markary said in March 2021:

If anyone hears of a person hospitalized or dead from Covid-19 after full vaccination, please let me know. The data show that vaccines confer near perfect protection against death and hospitalization from Covid. Can’t we be honest about that?

Dr. John Mandrola said in March 2021, “The pandemic is essentially done….The vaccine squelches severe cases.”  Later that year he said, “Have the vaccines not transformed SARSCOV2 into just another regular respiratory virus?”  Though he later said such comments were the “worst misinformation” Dr. Prasad said in January 2021:

You will be less infectious, dramatically less infectious, less of a threat to others after vaccination. Of course, no surprise, that’s why we’re vaccinating, right?

In February 2021, just after the deadliest month of the pandemic, Dr. Prasad mocked the New York Times for suggesting that vaccines alone might not end the pandemic. “It was just completely off, and just another squeeze of fear,” he said. That same month he said, “we know the vaccine is 100% effective against protecting against bad outcomes for grandparent,” and in May that year, he claimed:

For somebody who’s already been fully vaccinated, they can wear the mask out of solidarity or in a symbolic sense, but their wearing a mask indoors is not benefiting anyone else. There’s an infinitesimally low probability of even having an infection that can be detected on a PCR test, let alone being able to spread it to someone.

This was pure groupthink from establishment doctors who rejected medical conservatism and now blame the “establishment” for their words. Thankfully, I avoided this groupthink and rejected a singular focus on vaccines. In April 2021, I said,

Im very very optimistic vaccines will cut transmission of disease. I’m not certain of it. This is why I wear a mask still in public and when treating covid patients.

A singular focus on vaccines

Notice too how Dr. Makary calls vaccines a “pharmaceutical solution”. While this obviously isn’t wrong, this framing was a conscious choice to spread fear and doubt.  If you think I’m overstating the case, consider the subtitle of an essay of his that spread misinformation about the COVID vaccine in pregnancy:

The Agency (CDC) did exactly what big Pharma wanted, using groupthink instead of insisting on data for their recommendations.

That sentence could appear on anti-antivaccine site about any vaccine. It’s standard anti-vaxx balderdash. It’s no secret that many Americans distrust the pharmaceutical industry, often with good reason. However, by telling people vaccines = pharma, Dr. Makary sought to reinforce this negative association for his readers. It worked. One of his commentators said:

Pharma won’t allow lifestyle change to trump sales, so we can’t depend on them. Many health organizations make $ only when there are patients, so we won’t see preventatives from whole organizations. Thank god for individuals who ignore the business model and want to help individual patients.

Dr. Makary could have said vaccines are an “immunological solution” and presented the copious evidence they reduced grave outcomes. But having greatly oversold them in 2021, Sensible Medicine doctors are loathe to frame them in a positive light today. Of course, by decreasing hospitalizations, COVID vaccines saved the healthcare system enormous sums of money, including a large amount spent on pharmaceutical products. Those of us are actually opposed to mere “pharmaceutical solutions” to COVID, embraced vaccines while being honest about their flaws.  At least Dr. Makary conceded vaccines are “important”.

Dr. Makary then claims “they indiscriminately told everyone to get multiple vaccine doses”. Of course, this is false. You may feel the “establishment” should have left more unvaccinated people vulnerable to the virus, but they didn’t come to their policies on a whim. The Advisory Committee on Immunization Practices (ACIP) had multiple lengthy, public meetings to review the data and discuss every vaccine dose. In fact, the “establishment” disagreed on boosters initially. In September 2021, CDC director Dr. Rochelle Walensky overruled the ACIP, which had voted 9-6 against suggesting boosters to health care workers and other frontline workers. Several vaccine regulators voiced their opposition in the Washington Post and ultimately resigned in protest, something Dr. Makary celebrated on social media.

So much for groupthink.

Moreover, many people felt the “establishment” dragged its feet in authorizing pediatric vaccines. There was a real price to paid for “precaution”.  Of course, unless the “establishment” ran a massive RCT for every tweek to the vaccine, Sensible Medicine doctors would always accuse them of acting “indiscriminately”, as if only the vaccine posed a threat, never the virus.

The belief that the virus was essentially harmless for all but the most vulnerable people may explain why Sensible Medicine doctors indiscriminately told everyone to contract it multiple times. Even though no RCT shows this is safe, Dr. Prasad said in 2023, “Repeat infections are inevitable. More the longer you live. Nothing can be done about it.” Dr. Cifu expressed the exact same sentiment in May 2022, saying:

We now need to accept that this is here to get infected with again and again.

Talk about groupthink.

Notice as well that Dr. Makary views “antibodies from natural immunity” as a valid reason to forego vaccination. Sounding like a pre-pandemic anti-vaxxer gushing over measles, Dr. Makary acted like cheerleader for SARS-CoV-2 much of the pandemic – “natural immunity wins again“- claiming that vaccines and “natural immunity” would usher in herd immunity by April 2021. Even after this prediction failed miserably and immune-evading variants arrived, he continued to lament that “policymakers” did not glorify “natural immunity”. “It’s okay to have an incorrect scientific hypothesis. But when new data proves it wrong, you have to adapt”, he wrote, scolding people who didn’t claim herd immunity arrived in May 2021.

Of course, the power of “natural immunity” was that it killed over a million Americans. “Natural immunity” injured millions more, and isn’t as powerful as hoped for these survivors. Moreover, there is evidence that vaccination after infection was beneficial at limiting hospital admissions and severe disease. Sensible Medicine readers won’t know this.

Beyond this, Dr. Makary implies there’s something nefarious about “multiple vaccine doses”, though he doesn’t say what that is. Of course, most vaccines require multiple doses. Children receive four polio vaccinations by the time they are six. They receive five doses of the DTaP vaccine by this age. The flu vaccine is given annually. Does Dr. Makary blame the “establishment” for this?

Though it would have been great, there was never any guarantee that the first two COVID doses would provide lifelong protection against a new, mutating virus. However, even if the “establishment” ended up suggesting a vaccine dose to someone who didn’t need it, they had to make recommendations with less-than-perfect data in the middle of a rapidly changing pandemic. That’s medicine. It’s a fantasy to imagine that we will always have a tidy RCT to resolve every question. The risks will not always be perfectly known and letting children, especially unvaccinated ones, repeatedly get COVID is an example of an unknown risk.

Nonetheless, it’s true that some people got a vaccine dose they probably didn’t need. However, Dr. Makary didn’t explain why, in a pandemic where 1.1 million Americans died and millions more were injured, this was such a cause for concern. Why was it really so disastrous if a healthy young male chose to get a 4th dose? I’ve discussed the risks of the vaccine many times previously, and while tragic, catastrophic reactions, including deaths, have occurred, they are literally less than one in a million events. In contrast, a study from May 2022, estimated that nearly 319,000 deaths could have been prevented if all American adults had gotten vaccinated. Dr. Makary did not bemoan the fate of the people who suffered needlessly because they refused a vaccine dose they did need- including the first booster and bivalent booster– and the deceased are not here to extol the power of “natural immunity”.

The power of “natural immunity”

Dr. Makary was not wrong about this, nor was he the only Sensible Medicine doctor to portray himself as floating above the political fray. Dr. Prasad and Dr. Jeffrey Flier shared a similar concern at the start of the pandemic in an essay titled “Scientists Who Express Different Views on Covid-19 Should be Heard, not Demonized“.  This authors said they were “concerned with personal attacks and general disparaging comments” and concluded.

Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics.

In an article titled “Politics and Medicine is a Bad Idea” Dr. Mandrola similarly warned of the dangers of mixing politics and medicine.  He said, “our medical training provides us no expertise on policy”.  “There are many downsides when healthcare professionals overstep our expertise.” he added.

Talk about groupthink.

Dr. Mandrola ended his essay by saying:

We should remain like a neutral judge. Always. The people can decide the best policy.

Despite this clear, unambiguous conclusion, Dr. Mandrola did not mention his Sensible Medicine colleague Dr. Prasad. This is not for lack of opportunities. Dr. Prasad, an adult oncologist whose medical training provided him no expertise on policy, repeatedly compared school closures to the Iraq War and wrote over 50 pugilistic Tweets on the evils of teachers unions. When schools in Philadelphia closed a Friday due to poor air quality from forest fires, he said:

I really hope that in return for your repeated failure to do what is right for children we move to a voucher system that crushes your failed district and destroys your union system that always places adult interests over children.

The schools reopened Monday.

Dr. Prasad also frequently villainized “Democratic cities”, “left wing politics” “NYTimes reporters” “liberal cities” and “Fauci” . One of many emotive Tweets attacking “dems” said:

Dems have become the corporatist party. Pfizer basically writes EUA orders based on mice data.  At the worst moment of the pandemic Dems abandoned kids, esp poor minority kids to side with teachers unions. Instead of hearing criticism, they preferred to censor Twitter & YouTube.

Though I won’t say that his behavior was “more toxic and deadly than Covid-19”, Dr. Prasad also revelled in demonizing scientists who expressed different views. He said that RFK Jr, a presidential candidate and anti-vaccine crank with a body count, would “destroy”, “flatten” and “obliterate” Dr. Peter Hotez, a highly-respected vaccine scientist who received anti-semitic death threats and was harassed at home for wisely refusing to perform a verbal joust with RFK Jr. on a podcast.

Talk about the conduct of science becoming indistinguishable from politics.

The conduct of science becomes indistinguishable from politics.

RFK Jr. was not the only anti-vaccine politician to receive praise from Dr. Prasad. In May 2023 he said that:

DeSantis Florida had the best COVID-19 policy in the United States. Balancing competing risks and freedom.

The data argues otherwise. A latest article titled The Steep Cost of Ron DeSantis’s Vaccine Turnabout shows how anti-vaccine doctors with naked allegiance to political figures ignored the data, costing thousands of young Floridians their lives.  It said:

At the same time, though, the governor was embracing more extreme views, including those of Dr. Scott W. Atlas, a Stanford neuroradiologist with no expertise in infectious diseases. Dr. Atlas was a frequent commentator on Fox News when Mr. Trump named him to his Covid task force in August 2020.

Both he and Dr. Bhattacharya argued that people who were not at risk of severe consequences should not face Covid restrictions. If they were infected, they would develop natural immunity, which would eventually build up in the population and cause the virus to fade away, they said….

Dr. Atlas, however, argued that the virus was not dangerous to an overwhelming majority of Americans. Both he and Dr. Bhattacharya said the Covid death rate for everyone under 70 was very low. Dr. Atlas claimed that children had “virtually zero” risk of death. Neither man responded to requests for comment…

While Florida was an early leader in the share of over-65 residents who were vaccinated, it had fallen to the middle of the pack by the end of July 2021. When it came to younger residents, Florida lagged behind the national average in every age group.

That left the state particularly vulnerable when the Delta variant hit that month. Floridians died at a higher rate, adjusted for age, than residents of almost any other state during the Delta wave, according to the Times analysis. With less than 7 percent of the nation’s population, Florida accounted for 14 percent of deaths between the start of July and the end of October.

Of the 23,000 Floridians who died, 9,000 were younger than 65. Despite the governor’s insistence at the time that “our entire vulnerable population has basically been vaccinated,” a vast majority of the 23,000 were either unvaccinated or had not yet completed the two-dose regimen.

The two images below, just six weeks apart, summarize the largely preventable tragedy well.

DeSantis Florida had the best COVID-19 policy in the United States

The unchecked spread of the virus also meant many schools couldn’t stay open in Florida. “It’s just not sustainable when you don’t have the people to run the school,” said one principal. Another superintendent said during the Delta wave:

COVID numbers are currently on the climb and having an impact on students, teachers, and on the support staff on whom we rely so heavily – particularly our food service workers and bus drivers.

This is the state and governor that Dr. Prasad said had “best COVID-19 policy in the United States”.

Dr. Prasad even defended the Surgeon General of Florida, Dr. Joseph Ladapo, saying his critics of his anti-vaccine data fraud were “stupid.”  “Ladapo is closer to correct than his critics”, he said about a doctor who altered data to make the vaccine appear more dangerous than the virus.

Talk about naked allegiance to political figures, regardless of the data.

Naked allegiance to political figures regardless of the data

Dr. Makary then laments that “Doctors and the public alike were quick to cite studies to support their ideas, even if the methodological quality would not meet entry criteria for a 7th grade science fair contest.” Again, he’s not wrong. Many bad studies were published this pandemic, and Sensible Medicine doctors were eager to amplify those that supported their ideas. For example, Drs. Prasad and Makary both promoted a horrible, retracted anti-mask study written by anti-vaccine activists, and Dr. Makary’s enthusiastic Tweet about it remains uncorrected to this day.  He said:

Kids need fresh air! A new JAMA study describes consequences of elevated carbon dioxide levels in kids and hypercapnia from inhaled air from the dead space a mask creates.

Dr. Makary did more than amplify bad studies that supported his ideas, he authored one himself. In an editorial tilted “Think Twice Before Giving the COVID Vax to Healthy Kids“, Dr, Makary said:

In reviewing the medical literature and news reports, and in talking to pediatricians across the country, I am not aware of a single healthy child in the U.S. who has died of COVID-19 to date. My research team at Johns Hopkins partnered with FAIR health to study pediatric COVID-19 deaths using approximately half of the nation’s health insurance data. We found that 100% of pediatric COVID-19 deaths were in children with a pre-existing condition, solidifying the case to vaccinate any child with a comorbidity.

Dr. Makary’s report was titled “Risk Factors for COVID-19 Mortality among Privately Insured Patients: A Claims Data Analysis”. It was published as a “white paper,” not in a medical journal. Though he claimed it was a study of “pediatric COVID-19 deaths”, the words “child,” “children,” and “pediatrics” do not appear in it, though there is a discussion of Alzheimer’s disease in relation to COVID. The paper reported on 2,753 people who died of COVID from April 1, 2020, through August 31, 2020. Of these, 0.11% deaths occurred in children under 18-years. This means Dr. Makary’s supposed study of “pediatric COVID-19 deaths” reported on just three deceased children. It presented no data about them beyond noting they were under age 18 years and had some underlying condition.

Would a 7th-grader at a science fair use a trial size of three to claim that zero healthy children had died of COVID in the entire country? If they did, they’d be wrong. Sadly, healthy children had died of COVID when Dr. Makary made his false claim, something a 7th grader could have easily discovered with a simple Google search.

Of course, the lives of vulnerable children are not less valuable than healthy ones.

Dr. Makary was not wrong to say that “research that did not support a forgone conclusion was downplayed, ignored”. I’ve written previously (here, here, and here) on how Sensible Medicine writers cherry-pick information to minimize COVID’s impact on children, as well as to fear monger about the vaccine and hide its benefits. I previously said

If ten data points are needed to understand the risks and benefits of the vaccine, they cherry pick the three that support their position.

Indeed, most Sensible Medicine doctors started with the conclusion that unvaccinated children should contract COVID, and worked backwards to selectively present the “evidence” only that supported their mass infection. To my knowledge, Dr. Makary has never shared any of the dozens of studies showing the vaccine has helped limit rare, but grave harms in children. Sensible Medicine doctors pretend these studies do not exist.

Dr. Makary ends with conspiracies, though he does not say which research was “censored”. In fact, his paragraph didn’t contain a single link to support any of his claims. However, in March 2022, he complained that the “establishment” rejected his findings on obesity and COVID.  He said:

Unfortunately a lot of medical journals were heavily curating the establishment narrative. Our Hopkins study showing obesity was a major risk factor for Covid mortality was ready for publication in July 2020 but was rejected at 7 medical journals over a 1.5 year period.

What does Dr. Makary think the “establishment” has to gain by covering up a link between obesity and severe COVID. Why does he think the editors of multiple medical journals agree to suppress such an important finding?

If indeed the “establishment” did seek to “curate” medical journals to hide this link, they did a poor job of it. In addition to the articles I linked to previously, on April 1, 2020 the editors of the journal Obesity wrote an editorial titled “COVID 19 and the Patient with Obesity – The Editors Speak Out” in which they said:

Persons with obesity around the world are already at high risk for severe complications of COVID-19, by virtue of the increased risk of the chronic diseases that obesity drives.

The New York Times wrote an article in April 2020 titled “Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients” that referenced research at NYU.  It said:

One of the largest U.S. studies to identify obesity as a prominent risk factor analyzed data from more than 4,000 Covid-19 patients who sought care at NYU Langone Health between March 1 and April 2.

It also discussed:

Another NYU Langone study, which focused on patients under the age of 60, found that those with obesity were twice as likely to be hospitalized and were at even higher risk of requiring critical care.

In fact, by July 2020, enough data had accumulated that to allow for an review on the course titled “The Potential Impacts of Obesity on COVID-19“.  By this early date, the author was able to reference several papers and conclude:

Obesity has been found to be a strong independent risk factor for hospitalisation in COVID-19, and to cause or exacerbate a variety of comorbidities which have been proven to be associated with increased morbidity and mortality among COVID-19 patients.

In September 2020, Science published an article titled “Why COVID-19 is More Deadly in People with Obesity—Even if They’re Young“.  It quoted a doctor who said:

These were otherwise healthy, hard-working people. Their major risk factor for getting this sick was obesity.

Maybe seven medical journals rejected Dr. Makary’s paper for reasons that had nothing to do with censoring the link between obesity and COVID.

Let’s return to the title of Dr. Makary’s article, Does Anyone Still Care About Data? Many people do, and Sensible Medicine doctors taunt them by robotically levelling the same juvenile accusation of “groupthink”. This, of course, is just medical groupthink from the medical establishment.

And if the doctors behind Sensible Medicine want to prove me wrong, they have my blessing to publish this essay on their site.

Medical groupthink from the medical establishment.
  • Dr. Jonathan Howard is a neurologist and psychiatrist who has been interested in vaccines since long before COVID-19. He is the author of "We Want Them Infected: How the failed quest for herd immunity led doctors to embrace the anti-vaccine movement and blinded Americans to the threat of COVID."

Thu, 10 Aug 2023 19:18:00 -0500 Jonathan Howard en-US text/html
AACN-CMC exam dump and training guide direct download
Training Exams List