At the ADA Research Convention several members trying to pass out information were forced out after the police were called. They were ADA leaders who wrote an editorial blasting the current Presidential administration for cuts in research funding. Everyone agreed with their stance, just not their tactics. The press labels this as censorship. But is it? The ADA is primarily funded and controlled by the pharmaceutical industry, the very industry that funds and sponsors the very research it seeks to continue. It has historically pushed drugs over lifestyle, dispensing with any data that suggests that their policy statements are erroneous, which typically they are. They invented prediabetes and are responsible for pushing normal sugars so low as to cause potential harm. And if doctors question their views or provide contrary data--of which there is an ample quantity--they seek to suppress it. So where is the medical censorship, and do we really care about a small scuffle between leaders of an organization that needs a real revolution to make it relevant to care.

Both Andy and Alan have been reported to their respective medical boards, both have had to hire lawyers, both have had to fight for their right to speak and to practice medicine. The Board of Physicians is an extrajudicial entity, operating in each state to monitor and discipline physicians. Most courts have said that doctors do not have the right to free speech or free choice. Even if what doctors do and say is based on good data and their own experience, even if what they do or say is done is done to save lives or improve the medical system, if their actions or words clash with specialist and drug company protocols the doctor can be disciplined, censored, even lose his/her license to practice. Such Boards were established at the dawn of modern medicine, intended to assure that all doctors follow the script written by the AMA and corporate foundations after the Flexner Report enshrined the AMA as the singular regulatory entity in healthcare. During that time, doctors who, for example, did not endorse Eugenics or racial medicine could be disciplined, as too could all African American and women doctors. Today's doctors are tied to a corporate-specialist orchestrated set of protocols that often fall in the face of good data or appropriate patient care, especially for older patients, but none of that matters to the Board. Doctors have no recourse when the Board declares them to be in violation of specialty protocols, and most Board members are specialists. This is yet one reason primary care doctors are handcuffed and often cannot use their common sense, experience, critical thinking skills, and research to care for patients, especially when such behavior challenges protocols. Profits always trump patient care, and the Boards seek to assure that caveat is never challenged.

Alan and Andy work in different medical environments. Alan works in one of the poorest neighborhoods in the county, one with many who are uninsured, undocumented, who have to work multiple jobs, who have limited food options, and who had the highest COVID mortality in the world. Andy works in a middle class environment filled with tech-heavy white collared people, where good nutrition and exercise is common, smoking rates are among the lowest in the country, and the COVID death rates were extremely low. In many ways, as Alan and Andy discuss, COVID put a microscope to how our nation's health inequities and profit-driven health priorities impact different people. The haves tend to prosper, the have-nots are neglected. Sometimes, as the Dartmouth Health Atlas shows us, the haves can be harmed by excessive specialization and medicalization; areas of the nation with the most specialists have a generally lower life expectancy, likely from over-reliance on doctors rather than lifestyle. But the decision of our health care funders to finance high-cost low-yield medicine at the expense of health equity, nutrition, and basic care has led to a slanting of outcomes that is entirely preventable, where the have nots suffer from the very opposite problem: inadequate care and life style betterment. We discuss how to fix this American made mess!