The Dynamic Duo, demanding that I take them to the dog park

Gotta confess — I was raised a doctor’s brat (an actual colloquial term) and as such, have been on the inside of a medical community for my young life, at least.

But times have changed relationally. And the downstream of this is what we are seeing now, which is a collapse of authority of the medical community across the public health debates of the age. But why?

Some background — my father was an obstetrician in a medium-sized town in the Ohio river valley. Portsmouth, OH, was an interesting place, psychosocially, to be raised. It was a collapsing steel town, straight out of a Bruce Springsteen song, with ties to other resource extraction efforts. Empire Detroit Steel was one of the first big integrated steel mills to be shut down, in 1976. And since I got to watch it happen (I graduated from high school in 1979) from a ringside seat, I got to watch the literal formulation of a new, darker age in America’s heartland. Which still reverberates — especially in the medical community — to this day.

My father was an obstetrician/gynecologist in the community for almost all of his career. And as a doctor, I enjoyed the benefits of health care in what is literally a bygone age. When any of us kids were sick, outside a cold, my father would take us to the hospital when he did rounds. Along the way, he would encounter other doctors doing the same thing. He’d have them check me, and give their diagnosis. Then he’d take that aggregate opinion, and treat us as he saw fit. I knew most of the doctors in the community because of that.

But his socialization was not uncommon. Back then, doctors actually circulated in the community, with the various social organizations and fraternal groups. Knights of Columbus, the Shriners and such. Doctors were not an isolated class — they didn’t run for political office, but outside of that, they were everywhere. Doctors definitely ran the hospitals in town, one of which was owned by the Catholic Church. And their wives showed up in PTAs. They were scarce — there’s only so much time any practicing physician has. But you KNEW your doctor.

My father thoroughly enjoyed all of this. By the time his career ended, he had delivered something north of 4000 babies in Portsmouth. He was constantly running into patients at the grocery store and around town, and loved to hear the stories about everyone’s progeny. He was honored, called ‘Doc’.

And he was far from perfect. As he aged, his alcoholism got the better of him, and that’s a story I’ve told elsewhere. But even in the community, when he got busted by the physicians at the hospital for being a drunk, he still commanded respect. After he dried out, he attended his Alcoholics Anonymous meetings regularly, where he was known as ‘Manny’ (his first name was Manoochehr). In one meeting, a member had a literal heart attack. My father dropped to the floor, and started administering CPR, while someone else called an ambulance. He saved that person’s life that day. And immediately afterwards, everyone in the group gathered to shake his hand, saying “Thanks, Doc!” They all knew. Anonymity simply did not exist in that town.

It’s against that backdrop of relational development that we now have modern medicine. No one knows their doctors outside the hastily scheduled, over-managed but underperforming care that we have now. Hospitals are really not run by doctors any more — they’re run by administrators. Physicians are hired for specific roles and specialties. According to some quick ChatGPT noodling, over 80% of all doctors are now guns for hire with the hospitals they work at. Private practice is scarce or nonexistent. And those are subject to the vicissitudes of administrators working to maximize profits and minimize costs, as well as the concerns of private equity investors. In the for-profit sector, private equity owns somewhere between 22-30% of all hospitals. That means money is the only interest, outside of regulatory pressure.

The memetic shift in such a system is profound. My father, even with his alcohol problems, was known as an extremely competent doctor and surgeon. Through his circulation around town, before the town started depopulating from the steel mill collapse, he maintained relationships with all his former patients. This combination of externally defined relationships (he was an OB/GYN physician) and his friendship gave him powerful ties inside the community. But I also think it defined most of small town practice at the time. He saw his women patients for literally everything. There were no complex systems of referral or care, where insurance got to decide what happened. And as such, he had a strong relational base for all his interactions. He really KNEW people. And people KNEW him. And especially with an OB/GYN practice, there was a historical tradition of lifetime care. A woman would have a baby with him, and later on might get her tubes tied, which then led to a hysterectomy in later life. She maintained a changing, but lifelong relationship with her physician.

And so was the mental model of physician choice, and the importance of a primary care physician was established. As well as the concept of medical authority — the mental model of it sprung from a lifetime of care that a patient might receive from one person, who they developed a profound trust relationship with. This mix of formal and independent assessment implies solid scaffolding. You might pick a physician for a given need or specialty — that’s the title-based, externally defined relationship thing. But you wouldn’t persist with that person if you thought they were incompetent, or didn’t heal you. That’s the trust-based, independently generated relationship part. And that developed a much more complex psychosocial profile inside the community. These relationships were literally wiring the way the community thought about things.

What happened along the way that destroyed this, and turned this model into a psychopathic weapon used against the American public? The first thing that likely triggered this was fundamental labor mobility. Numbers are hard to come by, but only approximately 20% of all people persisted in their hometown from school years to death. There has been some reverse migration (another 20%) but the notion of a primary care physician giving you cradle-to-grave care simply doesn’t exist.

And the minute that happens you now liberate a powerful mental model from its independently generated roots. Now the BELIEF-BASED part becomes the only part of the relationship — what is the physician’s title — as opposed to the DATA-DRIVEN part — the independent relationship you generate with the physician based on whether they heal you or not.

Portsmouth, because of economic collapse, suffered the brain drain across the board that happens in that circumstance. It was so bad, Portsmouth turned into the epicenter of the opioid epidemic, which could be directly attributed to collapse of the medical community. When your smart, complexity-driven thinkers move away, the memetic deficit inside your community to handle complex problems also hits the skids. And who replaced them? In Portsmouth, one of the people was a woman I grew up with — the daughter of a doctor. She drove enormous amounts of opioid use across the region.

It’s not just the immediate effect of losing a competent medical community. That belief-based sense of competency is even further put through the wringer, through the machinations of the managed health care system. When you start adding the effects of economic dislocation, as happened throughout the Midwest from the ’70s-’90s, you have a medical community completely unmoored from personal friendships. Doctors are guns for hire, often not even living in the community where they practice. Instead, they take gigs based on intervals of time in residence in a community — 2 weeks on, 4 weeks off — and live somewhere else. In my most recent health crisis, involving a mesenteric thrombosis, all the physicians that took care of me, AND did my eventual surgery, lived outside of Pullman. One even commuted from Maine. In my case, I was lucky. One of the physicians that managed my care was a former Dean of a medical school, and my surgeon (also from 85 miles away) was top-notch. But there was no way for me to evaluate nor have any meaningful selection authority in my care. No agency.

Once a given memetic structure gets severed from his scaffolding, bad things are destined to happen. People are told “listen to your doctor!” or some such nonsense. But nowadays, people overwhelmingly have no data-driven relationship with that individual. So what happens is that meme is untethered, to be captured by the psychopaths running Big Pharma, to be used to sell drugs. In place of that relationship, we are served up an endless round of ads, telling us to ask for these from that doctor with our non-existent relationship. Only the most diligent of us, doing research, would even find the names of these drugs if we didn’t have the ads. So we are bombarded with odd names, with Woke representations of what the potential patients might look like. These representations are designed to be psychopathically manipulative — for example, most AIDS patients are overwhelmingly homosexual, African-American and male. But the ads themselves display a whole palette of sexes and skin types. The result is paranoia, with the appropriate backside covering when the medical community is actually approached. You didn’t trust them, and for good reason — but the mental model that is played is that if you DON’T trust them, something is wrong with YOU.

This then plays out in all sorts of perverse ways. Consider the vaccination wars. You either BELIEVE in vaccines, or you don’t. And your doctor damn well better believe in vaccines as well, or he’s a quack/crank/whatever. But vaccination as an issue has changed dramatically in the past 20 years. The number of tried-and-true vaccines I gave my kids (they’re now 25 and 27) has at least doubled. And the pressure to increase early vaccines has grown exponentially. Consider the recent fight over the Hepatitis B vaccine for infants. There’s no risk for a child being born with Hep B if the mother doesn’t have it. But it’s one more needle lined up for that infant arm, at the earliest possible moment of life. Does not wanting your infant to get a Hep B vaccine make you an anti-vaxxer? Hardly. But the psychopathic voice behind Pharma-aligned interests, as well as psychopathic voices wanting to establish control over what government is allowed to force on you is never-ending and relentless.

And then there is the never ending pressure from elites for Elite Risk Minimization. Vaccines are supposed to protect you from getting a given disease. What that means is that if YOU get a given vaccine, you’re supposed to be safe from contracting a given disease. But in the context of Elite Risk Minimization, that’s not good enough for them. Everyone else has to get vaccinated, so that there is no chance of even potential exposure. Regardless of the given statistics. What this leads to is a classic psychopathic Double Bind — you must get vaccinated even if others around you are vaccinated and shouldn’t be able to get the given disease. This obvious logical conflict then promotes more craziness in a society already under attack by psychopaths attempting to spread fear on other fronts.

The subtext for all of this is the deep fear of all humans of social ostracism. Not only do you not get to exercise your agency on what gets injected into your body. If you don’t, you suffer social catastrophe, especially in liberal communities. Jimmy Kimmel, during the COVID episode, was very clear about how the elites were going to function. If you were vaccinated for COVID, you could receive medical care for OTHER conditions. If not, tough luck. Worse, you lose your job and livelihood.

And then propagated by psychopathic forces was even more diabolical messaging. One was the gasping COVID patient with Neo-Nazi tattoos, who had refused the shot (which turned out to be a colossal bust) and was now gasping at the black nurse attempting to save his racist life.

As with all things, people figure out the bullshit. But it takes time. And then what happens is fascinating. After living through a couple rounds of this crisis, which REPLACES the formerly healthy, data-driven relational construction that people used to have with their original primary care physician, the people become memetically inoculated from the messaging. The problem is that this, downstream, doesn’t help the society when a real threat comes up. Fool me once, fool me twice, as the old adage goes.

Here’s the point of all this. Modern society, through multiple modes (Pharma, private equity, etc.) psychopathically destroyed the appropriately scaffolded, rational relationship people have with medicine. And attempted to replace it with a monetized model whose beneficiaries were not the people receiving care, but those making money off that care — which weren’t even the physicians. And then that institutional psychopathy reached out to other areas, like the COVID vaccine, and naturally, memetically took up the cause of the elites, with Elite Risk Minimization.

Some notable people are fighting back, like my friend Dr. Jay Bhattacharya, who now heads both the NIH and the CDC (at least temporarily.). But there are enormous institutional forces more than happy to pull out the mental models of the past, to ensure their own short-term gains. As with all psychopaths, they have no ‘bottom’ regarding accusations against actors attempting to stem the tide — look at the endless, relentless attacks against Robert F. Kennedy, Jr. And NOTE — all the attacks will be on the top, superficial level. No nuance given — that’s the knowledge structures piece.

The potential for reform is, quite honestly, bleak. As doctors overall have, more and more, been disenfranchised from administering these systems, there is only a modest amount they CAN do. They do have patients to care for, after all. But I believe it is only people inside the system that have enough detailed scaffolding to make a difference. Hopefully this piece serves as a crudely written road map of how we got there. And where we have to get back out of. Memetic evolution is always the answer. But it’s a very rough road.

And we’re not going to get there without some realization about the relational decline that got us here in the first place.

P.S. For a primer on the difference between rational, independently generated relationships, vs. externally defined, belief-based relationships, do read this piece. Trust vs. Loyalty, folks. Both have their place, so don’t go in with a pre-bias.