IM Doc on the Accelerating Decline in American Medicine

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Yves here. A story about a precipitous decline in “shelf test” scores at UCLA, considered to have a fine medical school, was so alarming to IM Doc that he first sent a lengthy e-mail, then drafted a post. The underlying account was from Washington Free Beacon, an unabashedly right wing venue, and was re-reported by the Daily Mail and others.

The story showed images of test results, so the underlying charges are hard to dispute. The Beacon headline weighed heavy on the idea that race-based preferences had resulted in a lowering of admission standards (and in fairness to the story, the collapse in test results does seem to have occurred under the current dean, who changed many policies), but the article also describe changes in teaching, such as reducing its pre-clinical curriculum from two years to one.

First from IM Doc’s e-mail:

I would encourage every one of you in the USA to avoid any and all students that graduated after circa 2010.

Yes, it is that bad. It is pervasive and constant and I see this every day.

The attached picture is a screenshot from an expose today of the fact that 50% of the students at UCLA, previously one of the nations finest, failed FAILED their shelf exams. The shelf exam is the test taken to determine competency at the end of each clinical rotation in the 3rd year, IM, surgery, peds, etc. The test is seriously on a curve, and quite a few questions can be missed and still pass. A failure on this exam is a sign of very very limited knowledge. In my day, it was 1 or 2 students in danger of failing. As you can see in most of these rotations it is a HUGE number that is failing at UCLA. This level of failure would have been apocalyptic in my day. The article this is from is making the assertion that this is from bad choices in admissions with minority considerations trumping all. That may be. I think the rot is much more than just that.

He then described in gory detail a fresh experience with an Ivy League Caucasian internal medicine student, on a rotation under IM Doc. The task was a presentation involving a patient that this student had seen for 30 minutes who had been stabilized after renal failure and was recovering. The student did not once mention the renal failure and potential ongoing issues in the presentation, instead focusing on (I don’t even think much) elevated blood pressure and attributing that to repressed homosexuality. Questioning revealed the student was unable to evaluate a kidney failure patient, read tests, or even know what simple lab tests mean.

IM Doc then made inquiries:

I immediately called two former students now faculty members at the school. Both told me the same story YOU HAVE NO IDEA. I talked to the program director and was informed this student had already failed 2 other rotations, but would still pass and graduate. They did not really fail students any more – that is such an oppressive totem from the past.

It is bad enough that many young doctors are graduating despite having poor skills. But there is deterioration on the other end of the pipeline as more and more physicians and nurses leave the profession. For the doctors, there has been a background degradation of their work conditions, with having to spend time fighting with insurers and dealing with medically counterproductive electronic health records made even worse by the corporatization of medicine and Covid fallout. For nurses, many quit over Covid vaccine mandates.

By IM Doc, a professor of internal medicine now practicing in flyover

This has been quite a week of revelations.

First we had the UCLA “half the students are flunking” report.

Now we have the following from Kaiser [note full name of recipient is posted on Instagram]:

I am just amazed. As I have said from the beginning, with regard to medical ethics, the COVID vaccine mandate was the single most unethical policy decision I have ever seen come over the transom in my lifetime. By the time it was promulgated on the nation, it was already obvious that there were big problems with efficacy and the safety issues were already well known. It was just an incredible time. But the problem is, the big corporations like Kaiser and many others over the country have literally self-immolated. Although not much in the news, those of us in the business absolutely know that huge numbers of the staff, especially the ancillary staff, viewed this as the final straw and left in droves. The practice of medicine has not been the same since. But the number of physicians and nurses that left, although much smaller, began a critical implosion that is continuing forward to this day. I cannot even begin to tell how many colleagues my age or older have just thrown in the towel. Seeing your profession’s leaders behave in such a confused and careless way is a dagger to the heart to those of us who take such things as ethics and compassion seriously.

So now, the big backtrack has begun. It is completely predictable and totally embarrassing.

From the beginning, I had been seeing all kinds of young women who immediately began to have issues with periods right after the injections. This is gravely concerning especially to those still wanting kids. And so the word went out. And more than any other thing, this was the driver for so many of the resignations as time went forward. First, the scofflaws were accused of heresy and literally killing people by their vaccine hesitation. Then as things became more obvious regarding the efficacy and the safety – they were accused of not being team players. And now – Open arms come back please – we need you. It was all a big hoo-hah, can’t you see.

And now this week – we have those leaders rushing to the TV shows to declare their current thinking. We have Dr. Birx “thinking” that the number of injured will be in the thousands, not the millions. Remember – this is the same woman who also “thought” that the vaccines were sterilizing and “hoped” they would work. We have seen Dr. Redfield, former CDC head, state that it is clear now that only high risk patients should be getting the vaccine because they very definitely have side effects that hurt people.

I think we all should remember that physicians were being censored, de-boarded, de-licensed, and ostracized for saying exactly the same thing a few years ago. They were stating with emphatic clarity what was happening to their patients in real time and were punished in all kinds of ways.

The axe cannot come quick enough for these people.

But the just unfathomable has also occurred this week. Dr Morens, the right hand man of Dr. Fauci was in Congress. Troves of his emails have been released. Literally bragging and laughing about evading FOIA. Lying, deceiving, and protecting the omerta. It was quite a show. My favorite part though was his statement “I am not really sure what the ethics department does.”

Well I can tell you Dr. Morens. The ethical framework that has built up in our profession over time is sacred. It is for the protection of not only patients but the physicians. Those physicians who play fast with ethics not only endanger their patients, they also put their own career and lives in peril. I am afraid that you are about to learn that lesson for all to see. And of course the Head of the Ethics Department at the NIH was none other than Dr. Fauci’s wife – because of course it was. What an absolute joke.

All the while these people were behaving like this, doctors who were acting in good faith all over this country were facing star chambers and worse in their medical boards and licensing agencies. Again, the axe cannot come soon enough.

The profession of medicine has been dealt a mortal blow by these clowns. I am not sure what the future holds, but I do know this – Accountability must occur before any chance of regaining the trust of the vast majority of Americans. And time is wasting.

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  1. Ignacio

    Human beings halt being rational when pandemics arise and when “protecting their values” amongst other instances.

    1. ChrisFromGA

      I still blame this mentality that puts the economy above every thing including life itself.

      We saw the same crap with the global financial crisis.

      The day that the trials were announced as “ready to go” the Dow ramped something like 1000 points.

  2. timbers

    Some how, this pervasive immunity from accountability for govmit folks can be linked back to Nancy Pelosi taking prosecution of GWB over Iraq off the table and Obama’s follow up performance “Look forward not at the review mirror.” And of course even further back because Nance/O was just a particularly glaring speed bump along the way.

    1. CA

      [ Somehow, this pervasive immunity from accountability for govmint folks can be linked back to… ]

      Forgive me, but I can find no evidence of the following assertions made concerning Iraq and Nancy Pelosi or Barack Obama:

      October 25, 2012

      Remarks at a Campaign Rally in Cleveland, Ohio

      We always come out on top because we pull together, because we look out for one another, because we leave nobody behind, because we don’t forget where we come from, because if we’re successful, then we keep the door open for folks who are coming up from behind, because we don’t look backwards, we look forward. We look at that distant horizon. We look at that new frontier. We are not afraid of the future…

      1. The Rev Kev

        With Barack Obama, I think that timbers is referring to the time when it came out that the CIA was actually torturing people which is not only illegal under international law but also American law. But Obama just covered it up and told people to look forward and not back. Doing this also made him guilty of a coverup of torture which is also a crime but he schucked and jived his way out of it. And because of this, torturess Avril Haines is now Director of National Intelligence instead of sitting in a cell in Leavenworth.

        1. Acacia

          Good summary of a very nasty piece of work.

          CA, if you want the gruesome details, try a search for “Obama ‘we need to look forward as opposed to looking backwards’ ” and you’ll find a whole pile of articles from around 2009-ish.

          1. Michael Fiorillo

            It also bears mentioning that he did this while purposefully allowing the best moment to re-orient the economy in more than half a century to slip away.

            I haven’t been able to listen to him for years; now I can’t even bear to look at him.

          2. Lefty Godot

            Every criminal would love it if we only looked forward instead of backwards. Since no one is prosecuted for future crimes. Yet (AI might change that, oh joy!).

        2. CA

          “With Barack Obama, I think that timbers is referring to the time when it came out that the CIA was actually torturing people which is not only illegal under international law but also American law…”

          I much appreciate the explanations, which I would have missed since Obama repeatedly spoke of looking forward while I now realize using the formula to shut away evaluation of past unfortunate policy.

          1. JTMcPhee

            Is it just me, or do the grammar, style and syntax of this CA snippet sound like ChatGTP text?

            Maybe us humans are just being trained by the increasing exposure to the regurgitated perversion of our own data sets, so we end up sounding like like AI chat bots?

            All about the apotheosis of FUD, used viciously to confuse and divide and obscure the rape and looting. So we are led willingly, by the short hairs of our remaining humanity, which itself is in worse shape than the Ukrainian army, to the bonfire of trust and civility

        3. spud

          bill clinton and al gore set the precedent.

          presidents set precedent.

          Creating Precedents Through Words and Deeds
          Summer 2017

          UNTRODDEN GROUND: HOW PRESIDENTS INTERPRET THE CONSTITUTION. By Harold H. Bruff.[1] Chicago: University of Chicago Press. 2015. Pp. 557. $55.00 (cloth), $35.00 (paper).

          “Bruff summarizes well the influences that mold presidential interpretation of the Constitution: “the president’s character, experience, and values; the incentives that the office and current politics create; the practical problems that must be solved; and an awareness of the actions of their own predecessors” (p. 457). From President George Washington’s exercise of the treaty power to President Andrew Jackson’s supervision over the executive branch, and from President Abraham Lincoln’s view of his emergency powers to President Harry Truman’s understanding of the Commander-in-Chief Clause, the book examines circumstances that forced presidents to take action or make statements reflecting interpretation of the Constitution. These include decisions implicating constitutional interpretation, such as the use of military force, as well as interpretations of the text as justifications to refuse to enforce laws or turn over information to Congress. Presidents affect our under”

          so to go after bush/cheney, obama, and biden, you would have to challenge what clinton and gore did in the courts, or through legislation. good luck with that.

      2. ChrisFromGA

        Pelosi was the speaker of the House I believe for at least 4 years of Obama’s presidency and held the power to investigate Bush for war crimes through committees. She had a duty to exercise her power of oversight and completely failed to do so.

        This isn’t a partisan thing. Mike Johnson similarly has a duty to investigate Biden’s contributions to Israeli genocide but obviously he won’t because he’s on team Genocide as well.

        1. digi_owl

          Basically USA is up to its old racketeering antics that Butler decried.

          It ran unchecked through the 90s until the late 2000s when Russia countered their play in Georgia. At the same time Chinese companies became increasingly active internationally and refused to heel like Japan and South Korea had.

        2. CA

          “Pelosi was the speaker of the House…”

          Again, I am grateful for the explanations and understand the problem presented now. Of course, neocons quickly came to be perfectly comfortable with the Obama administration, especially with Hillary Clinton as Secretary of State.

          July 5, 2014

          The Next Act of the Neocons
          Are Neocons Getting Ready to Ally With Hillary Clinton?

          1. ex-PFC Chuck

            It was more a matter of Obama et al becoming comfortable with the neocons than vice versa.

            1. Larry Motuz

              I think so also. The so-called Clinton moderates influenced him far more than he did them.

          2. spud

            bill clinton was the original neo-con.

            it cannot be said enough, everything bad facing america and the world came from bill clintons disastrous policies

            We are still dealing with the results of Clinton’s ill-informed decision making

            Bill Clinton was initially responsible for the militarization. He abolished the Arms Control and Disarmament Agency, and began the expansion of the N. A. T. O.

            bill clintons capitulations weakened or abandoned agreements dealing with the International Criminal Court; a ban on landmines; the Comprehensive Test Ban Treaty; and the Chemical Warfare Convention.


            January 18, 2022
            Bill Clinton’s Role in the Crisis Over Ukraine
            by Melvin Goodman

            Photograph Source: Matt Johnson – CC BY 2.0

            pick a problem, any problem facing america, and you can trace it back to the one man wrecking ball, BILL CLINTON

            Guy Mettan, in his book Creating Russophobia: From the Great Religious Schism to Anti-Putin Hysteria(Atlanta: Clarity Press, 2017), points out that the threat of Russian expansion has been invoked by Western leaders since the era of Charlemagne to justify their own expansionist policies.

            The United States during Clinton’s presidency wanted to capitalize on the collapse of the Soviet Union to expand its power and influence in the Eurasian heartland, which geopolitical strategists like Zbigniew Brzezinski viewed as key to global domination.[5]

            NATO expansion under Clinton coincided with support for “color revolutions” targeting pro-Russian and socialist leaders such as Alexander Lukashenko of Belarus,[6] and aggressive penetration of Central Asia in an attempt to pry its oil wealth away from Russia.

            In 1997, the U.S. Department of State told Congress that the Caspian Basin held as much as 200 billion barrels of oil—about ten times the amount found in the North Sea, and one-third of the Persian Gulf’s total reserves.[7]

            In the next three years, the Clinton administration provided $175 million in arms and military training and more than $1 billion in aid to countries in the region. Strategic planners sought to incorporate it into a “vast U.S. dependency,” which NATO would help secure.[8

            wars, Iraq, Yugoslavia, bombed Sudan, bombed Afghanistan.

      3. lyman alpha blob

        Pelosi said over and over again in the run up to the 2006 midterms that elections have consequences, and insinuated that impeachment was a strong possibility were the public to put Democrats in the majority. They did, and she immediately took impeachment off the table after taking the speakership.

        Obama, when presented with ample evidence of torture, famously said we needed to look forward and not dwell on the past, or something to that effect, letting the war criminals off the hook once again. He also admitted that the US “tortured “some folks” and did nothing about it. Perhaps he was too busy with his own extrajudicial assassinations.

        1. Duke of Prunes

          This seems to be the one of the few times in my memory that the Dems actually worried about setting a precedent that could later be applied to them. If I go ahead and prosecute Bush, I might be prosecuted for my war crimes when I’m finished. Can’t have that.

    2. spud

      pelosi knew it was never going to be on the table in the first place. because bill clinton and al gore made it U.S. law.

      to go after bush/cheney would mean reversing what clinton/gore did. bush would simply say it was legal under U.S. law.

      the precedent was set.

      ““Extraordinary rendition” is when shady government operatives stuff a bag over your head and fly you off to some foreign country where they can legally torture you. It sounds like something Alex Jones might dream up in a paranoid frenzy, but it’s a well-documented phenomenon under both Bush, Jr. and Obama—and Bill Clinton was the guy who started it all.

      Clinton and Gore signed off on the first rendition back in the ’90s, despite being aware that it breached international law. Until recently, rendered people frequently wound up in the prison cells of places like Mubarak’s Egypt or Gaddafi’s Libya, where they were tortured with electric shocks, rape, beatings, and even crucifixion. It can sometimes go hideously wrong: In 2003, the CIA snatched a terrorist off the streets and beat, tortured, and sodomized him, only to discover they’d accidentally grabbed the wrong man. The victim just happened to share a name with a wanted criminal. His suffering came care of the Clinton/Gore dream team.”

      there can be no reform, no justice, economic nor social, till americans finally bite the bullet, and look at every bill that clinton signed, everyone of his presidential orders. every single one of them must be gone through line by line.

      clinton was the one that the fascist elites desired since the end of WWII, he was the man. he instituted much of their agenda.

      1. cousinAdam

        My late mom who was a pretty sharp cookie (and an admitted Anglophile) once pointed out that Bill Clinton was no bumpkin from Arkansas – he was in fact a Rhodes Scholar. She explained how that was a pretty big deal – education at the top colleges in Britain with attendant perks. Some years later I came to realize that included indoctrination into British circles of power and politics – Skull and Bones-like affiliations and obligations were likely – so it begs the question, whose interests did he serve? (Besides his own, natch.) It was sobering to learn that the private contractors flying arms down during the Ollie North/Contra operation were allowed to return to the US without having to clear Customs- they were loaded down with cocaine to “defray costs and risk”. Where did they land? An airbase in Arkansas. Who was governor? W. J. Clinton. Figgers. The resulting drop in the street price started a distribution war with Jamaican and Colombian cartels which led to the invention of ‘crack’ cocaine to boost consumption which helped sell a more draconian War on Drugs. Welcome to the Incarceration Nation! Cui bono? Let us not forget the dismantling of Glass-Steagall during his time in office – remember “ It’s the Economy, Stupid “? He wasn’t the stupid one, after all. And to think I once thought he was cool because he could play the sax……..

        1. spud

          yep, you about covered it. there can be no reforms till we examine and eliminate what bill clinton did to america and the world.

    3. Dermot O Connor

      I have a pretty hard to deal with (sometimes) family member, who was called out by his wife for some stuff he’d done. His defence:


      Should have got a job in the Swamp, he’d have gone far.

  3. RPLérias

    I really take issue with the anti-Covid vaccine stance by my colleague IM Doc. I don’t mean the mandates, I mean the fact that vaccines saved and are saving millions of lives. Mortality for COVID plummets after vaccination. Countries with lower vaccination rates had far higher mortality from COVID. Yes, there are co-founders, yes vaccine injury is real, yes much is unknown. But what is known about vaccine injury pales compared to its benefits. Unfortunately some people died. Far more were saved.
    I am 5 times vaccinated. No choice available here in Portugal, so Pfizer it was. Millions of people around the world had and still don’t have access to vaccines. You look at the horrendous excess mortality in places like South Africa in the first couple of years of the pandemic and you get an inkling of what vaccines avoided in vaccinated countries.
    Many lies have been told about the vaccines, that it was sterilising, that it avoids disease/transmission, that it was completely safe. We know this isn’t true. But that doesn’t mean the vaccine isn’t saving lives, because it is.
    Also, not all vaccines are born equal. Vaccine injury isn’t the same across the different vaccines.
    I don’t particularly like commenting here, but as a fellow MD I felt some balance was needed.

    1. IM Doc

      It is exactly as is demonstrated above in the actual text of the article – those of us who question are immediately “anti-vaxx”. Very very rich and very very tiring given the fact that I estimate I have probably written the orders for 30000 or more vaccinations in my life. The problem is that in my own realm, the deaths from the vaccine (sudden cardiac death in youth, PEs, strokes, severe recurrence of shingles, and strange vasculitis problems) are very likely higher than the deaths from COVID. I have contact with so many who are now beginning to realize the same. If there was any kind of feeling that these issues were being dealt with frankly and above board by the authorities, we would feel much more comfortable. Their refusal to even broker conversation, much less deal with it unfortunately speaks volumes and brings back all kinds of unfortunate memories from the Institutional Review Board and Pharma games of the past.

      I do question any primary care or front line physician at this time who does not acknowledge the damage these have done to many patients. And the “millions of lives saved” belies a deep and abiding inability to accurately assess medical epidemiology and statistics. And to understand the nature of the data that has been used to make those assertions. I have yet to see any study of any kind demonstrating anything like this that is not based on modeling. Modeling is a very helpful thing at times but it can also be very dangerous. It is 100% dependent on the accuracy of the data being input. And the algorithmic assertions being made in the process. There is simply no other way. Having been on an Institutional Review Board for decades, I assure you, ANY and ALL assertions made from modeling were instantly trashed. It is simply not safe for people’s lives to rely on this. And as far as the data – I have repeatedly discussed the unreliability of the EMR systems. We simply are the blind leading the blind.

      I will give just one recent example in my own practice. Yves knows and all of my colleagues know the huge amount of time I have spent in my life compiling a database of every patient problem and condition I have seen over now 30 years. Every single one. My epidemiology colleagues know this. They also know of several other physicians who have done the same. So, often, I am asked by them to do simple data searches of issues of interest to them. The VAST majority of the time, these queries have nothing to do with COVID. They use my database as an initial touchstone to see if there COULD be a “there” there.

      A few weeks ago, I was asked about the incidence of cervical cancer and positive PAP smears in my practice – dating back 30 years. From the very beginning, all the way to 2020, there was an average of 2.6 cases a year – many years having 1, a few having 5. Out of all those years of practice, there were only 2 deaths from cervical cancer.

      In 2021, there were 7 cases of cervical cancer

      In 2022, there were 9

      In 2023, there were 8

      In 2024, there were 5 so far.

      These numbers are so subtle of a change that I did not even realize it was a problem. And that is just the issue when we are dealing with large scale population issues with very low level morbidity. Vioxx is a classic example. But also for the previous years before 2020 – as I stated there were only 2 deaths from cervical cancer. In 2021-2024 – unfortunately there have been 2 deaths from cervical cancer. Is COVID itself doing something in this regard? Is there something else going on? I will not go into the details of the COVID vaccination status of these women since 2021, but suffice to say it is not encouraging. And that is the crux of the issue. This proves nothing by itself. It does, however, give people who are working on these issues an idea that there is indeed a “there“ there. Added to the fact that similar findings in this regard have been found by other colleagues with similar databases.

      Please note, the above is NOT modeling. It is cold hard facts. Now that they have seen there may be something to this – they can go to the expense of going through all kinds of patient records with a fine tooth comb.

      Now you must think about cumulative damage – just like so many other Pharma disasters in the past. You have to add in sudden cardiac death, stroke, PE, vasculitis and so many others.

      Unless and until there is complete and total transparency from our officials and agencies, there will be no answers. As I have said so many times before – every single raw scrap of data must be released in its entirety. So far, there has been a very severe reluctance to do anything like this. And that speaks volumes. Not just to me – but probably the 3/4 patients in my practice in a big blue area – who will never trust the CDC or Health Dept again until vast changes are made.

      1. Yves Smith Post author

        Due to focusing on the most immediate issues triggered by the comment above, IM Doc skips over two key issues about the risk/reward profile of getting a Covid vaccine, that the data is disastrously corrupted.

        First, in the US, many many vaccine injuries have not been included in the VAERS database. IM Doc has described long-form multiple cases of injuries in his practice he attempted to record that were rejected. One I recall he alluded to above, a severe case of shingles that kicked off a cascade of other issues. It was rejected by an administrator with no medical background because he identified it as a particular shingles sub-type. The administrator said effectively that “We don’t recognize that as a side effect” even though shingles is a very common side effect of many vaccines.

        Similarly, IM Doc has also recounted other cases where patients went to tertiary hospitals, where the specialists at that hospital confirmed that the case in question was indeed Covid-vaccine induced but the case was not reported to VARES. I have a Covid vaccine side effect which continues. My doctors in very Covid vaccine gung ho NYC put in my test records that it was due to my Covid vaccine,. I am having regularly to get tests to rule out cancer. My case similarly was not reported to VAERS.

        Second, on the Covid case side, IM Doc has been reporting privately for the past year of so that he has had virtually no Covid cases among the never vaccinated. Yet the EMRs show many of his vaccinated Covid cases, many of them multi-vaxxed, as unvaxxed. He has repeatedly tried correcting their records, both in the database and with public health authorities, and his efforts have failed. So claims in the US about the vaccine status of current Covid cases need to be treated as a fabrication. No one has a clue. That is how bad the data is.

        1. LY

          Feels like everyone was doing things by the seat of their pants. Issues like long term safety of vaccines and general workplace safety were cans kicked down the road.

          I do have a case with VAERS over COVID vaccination, probably because I reported it directly online. I was reluctant to get the vaccine, considering the length of time for safety trials. I had been following the Lyme disease vaccine saga…

          My friend, a critical care pulmonologist in a hospital near NYC, advocated for the vaccines, convinced by the patients he was seeing throughout the initial years. He saw many patients, and earlier than most since his hospital was near the first big confirmed NYC superspreader outbreak.

          Then again, he did caveat that he was seeing the sickest of the sick, so I would not say his patients were representative of the general population, but he did state that many of them were younger than being portrayed in the media.

          1. Yves Smith Post author

            The problem is the layperson-reported VAERS cases are often ignored or discounted. The tacit assumption is if it was a real case, it would have been reported by an MD. I am told it is pretty easy to tell patient v. practitioner reported cases due to technical detail and manner of presentation.

      2. Anonymous Physician

        Lol, so it turns out that reality has a right wing bias. Oh well.

        So many people are so ideologically captured that they can’t admit that the Covid response was a disaster. The tell was the lying and suppression of dissent. I naively believed the Lancet when they published an expert opinion that Covid couldn’t be a lab leak. When it came out that, ackshually there was evidence to support it being a lab leak and the people who wrote and signed the editorial were connected to Ecohealth, then I knew something was up. That tiny corner of synthetic virology is like a small town, everyone knows everyone, and has a pretty good idea of who they’re shtuping. There’s literally no chance that the editors of the Lancet and the reviewers didn’t know that the writers of the editorial weren’t disinterested observers. But they said nothing.

        After that, I started to take the crazy talk on right wing web sites as possibly true. Still, I just saw drips and drabs of data, never in the mainstream, only in the right wing press, things like elevated cardiac inflammation markers in small RCTs. Persistent scarring on MRI after ‘rare-mild-temporary myocarditis’ But the professional drumbeat was that these people were cranks or ideologues. And the consequences of resisting were high, so I stupidly went along with it. I boosted myself and my family. I had a completely unexplained TIA and my [child] has POTS. The fact is, because they never did big prospective studies, I’ll never be really sure whether it was the vax or a silent covid. But the population data supports it being vax related. In the end, I blame myself for my child’s illness. In retrospect, it seems pretty obvious that inserting code to force a supratherapeutic titer of antibodies would have unforseen immunological consequences. But my family got off easy. I’m taking care of a 30ish health care worker who had a basilar stroke. [Their] life will never be the same. Now the talk on the right is of VAIDs, turbo-cancers and infertility, probably related to class switch recombination favoring IgG4, T cell exhaustion and other unresearched things.

        I now joke that it’s a vaccine so good that they’ll take away my medical license if I say anything bad about it. The threats worked. The most my colleagues say publicly is that they’re done with boosters. But if you get a primary care doc in a quiet calm place, establish that you won’t rat them out then they’ll start talking about their vaccine injured patients. Everyone knows.

        Maybe there will be Nuremberg 2.0 trials, I would love to see Fauci et al in jail, even if it were just for depraved indifference, but I doubt it. Maybe the truth will come out. But it wouldn’t surprise me if it were buried for 20 years. Everyone, including the media, big med, individual doctors, pharma and the politicians were all complicit. And if it was malice rather than stupidity, as the suspicious pattern of mutations suggests, then in 70 years we’ll still be waiting.

        I could go on and on but I’m tired.

        1. Yves Smith Post author

          For the record, IM Doc comes from a diehard Democrat family of the working class sort and was very loyal to the party. I hope he does not mind my speaking for him but he is appalled by what his former peeps have done.

      3. Rick

        It would be great to see more discussion of the different kinds of vaccine as well as more transparency on adverse events. I was suspicious of the mRNA from the beginning and have avoided them when possible. I’ve had both the J&J/Janssen and most recently the Novavax vaccines, neither of which are mRNA. I will not have another mRNA jab at this point.

        Seems to me we have a big problem dealing with a technology like vaccination which can have great benefits, but also have subtle or not so subtle problems. We crave the black and white and are quick to take a side and defend it blindly.

        1. Yves Smith Post author

          I would not assume J&J was safer. I got my side effect from one J&J shot and I personally know someone who had a different side effect which required a year of care overseen by a tertiary hospital. Consider those #s versus the much smaller number of J&J shots administered.

      4. RPLérias

        Dear Colleague,
        I never called you or implied I considered you “anti-vaxx”, you are using a false straw man argument.
        There is plenty of observational data out there comparing COVID vaccinated versus unvaccinated outcomes and it all shows the same thing: unvaccinated die from COVID several times more than the unvaccinated. This is just one example of such observational data: . I find your claim that it is all modelling results bizarre.
        As for your own experience, you seem to think you are able to identify who had and hadn’t COVID, again something bizarre to say when we have 50% or more at this stage of unsymptomatic infections.
        Blaming vaccines instead of infections for the bad outcomes we are seeing (I see them too, but I blame the virus itself) is difficult to understand. We know the virus causes immune damage, we are seeing an explosion of cancers due to this. You claim that the vaccines cause more severe immune damage than the virus itself. Now, that is a claim I am yet to see data on.
        Best regards

        1. Yves Smith Post author

          While you are affecting a polite manner, this reply is substantively dishonest. You clearly depicted IM Doc as anti the Covid vaccines. This is the dictionary definition of anti-vaxx:

          person who opposes the use of some or all vaccines, regulations mandating vaccination, or usually both

          So your claim falls squarely within the definition.

          Second, IM Doc showed his patient cervical cancer data. He first raised the point that it might be due to Covid. You straw manned his acknowledgement that it is not possible to pick apart Covid v. vaccine effects.

          Third, you ignore that he AND MANY OTHER US PRIMARY CARE PHYSICIANS have seen more Covid vaccine deaths and injuries than they have seen Covid deaths. One reason this is not well recognized beyond those who are seeing it in their practices is systematic misidentification of vaxxed patients, including multi-vaxxed patients, as unvaxxed in EMR databases and the gross undercount of vaccine injuries in the VAERS database.

          Fourth, you ignore the significance of nurses, who would have seen horrific Covid deaths of patients basically drowning in their own fluids, in large numbers resigning or being fired rather than getting the Covid vaccine. They were under no illusion as to the reality of what getting a serious case of Covid could produce. Yet many refused the vaccine due to the frequency with which the Covid shots were producing reproductive side effects in women, irregular periods (and some women are as regular as clockwork) and even the complete cessation of menstruation in young women. Young women who still want to have children were not willing to incur the risk of loss of fertility.

          Post-menopausal women have also experienced side effects. I started menstruating at age 64, had a D&C to try to stop that, and am STILL bleeding. I have now to go through the additional expense of frequent cancer tests (sonograms and endometrial sampling) to rule out cancer, and my tests continue to be negative. That is a cost and stress I do not need that is the direct result of the vaccine. Yet these reproductive side effects in women CONTINUE to be ignored.

        2. IM Doc

          I am not exactly sure what this document actually is. It is certainly not a scientific paper with adequate explanations of how they arrive at the assertions.

          The first problem is as you can see – no raw numbers. This is clearly a study that used huge data sweeps from the databases as they outlined in the methods. The problem here is there is no discussion of a human being even looking at this data. They even acknowledge this problem by stating later in the methods their methods of counteracting these issues. But please note, their method just is more key words – it is not actual human beings looking at the data and confirming with the subjects that it is correct. Before the advent of the EMR, epidemiologists would do statistical analysis of population sizes and prevalence of disease in their study, and determine how many random subjects would need to be involved to make things statistically correct and then dispatch the abstractors onto the task at hand. Since the EMR, and all the trillions invested, you just push a few buttons – and it tells you everything you need to know. That is all nice unless the data is corrupted to begin with.

          I have personal experience with patients from Washington State being admitted with COVID in my hospital. It happened in early 2022 during the time this study was active. There were an elderly married couple visiting. They were both COVID positive and both had to be admitted. Both had their COVID vaccine cards – and both had been vaxxed 3 times. However, our EMR which is supposedly directly connected to these state databases – and the national databases reported that they had received zero vaccinations. Despite all efforts to enter the data and the lot numbers on their card – the EMR refused to acknowledge their status – so this went down as 2 unvaccinated admissions – even though they were vaxxed and boosted.

          So, my experience with this state’s database is 0/2. I used to hear reports like this from colleagues everywhere with screenshots and all kinds of anger. Not so much anymore – the admissions are so rare – and so far with me for the past 12 months, all admissions have been vaccinated – and they are not being counted anyway so we just act accordingly.

          As they say in the computer realm – Garbage in Garbage out.

  4. zagonostra

    The profession of medicine has been dealt a mortal blow by these clowns. I am not sure what the future holds, but I do know this – Accountability must occur before any chance of regaining the trust of the vast majority of Americans. And time is wasting.

    The same can be said to apply to politics, higher education, the press, religious institutions, labor unions, the “five pillars” that Chris Hedges wrote about in the Death of the Liberal Class

    1. Neutrino

      Teachers in our circle are counting the days until retirement. They are fed up with the administrators dictating results without accountability, and of the resulting damage to the students. They spend less time actually teaching now than they did 10 or 20 years ago, and more reporting and trying to explain why those admin directives run counter to generations of proof. The test scores only reinforce the eyewitness evidence. Once upon a time, Johnny couldn’t read. Now he, or pick a pronoun, can’t think. Heartbreaking for all in the classroom.

      1. flora

        See the No Child Left Behind Act of 2001, which financially penalizes k-12 schools whose students’ overall test scores are lower than required. Then began the teach to the test, elimination of recess and music, of putting everything on boosting those test scores. How can students learn to think when so much time is spent drilling for tests? (This question sounds like a non sequitur, I know, but it actually follows.) Asking why about something is replaced with rote memorization and drills. Very demoralizing for both kids and teachers. But the schools’ federal funding is at stake! It might be reduced if kids don’t do as well on the tests as the govt guidelines say they should do. One size fits all. / end rant

  5. Mark Gisleson

    IM Doc’s comments have given me the courage to stay the hell away from hospitals until this investor-management crisis passes. I remember reading about the financialization of medicine back in the ’90s but never thought for a moment our healthcare system would degenerate so rapidly.

    I also think about how freaking hard my med school applicant clients worked just to be considered for acceptance into a medical school, then weep to think that DEI now counts for more than grades (if grades, in fact, still count for something).

    Naked Capitalism has been my go-to source for medical information for years now. That’s not a good thing but luckily for me, NC’s track record is 100x that of the CDC.

    1. Cristobal

      Re: med students that can´t pass the tests
      Blaming admissions policies is a cheap trick to attack the laudable desire to graduate more doctors from poor or minority backgrounds. At the end of the educational process, the student has either learned or has not. Admission should be open to more people with perhaps even marginal credentials. Let them give it a try. The winnowing out should take place once the education begins. At my university, a state school with very low admission requirements (a long time ago) 50% of the freshman class was invited to go home or find another school after the first year. The problem is not one of admission policy, it is one of teaching and evaluation. As has been noted before, too many of our universities are no longer educational institutions, they are in fact businesses.

      1. Yves Smith Post author

        Did you miss that the schools won’t fail anyone? You are arguing for something that will not happen.

        This has become pervasive in the US well before grad school. A friend teaches high school chemistry in CA in a magnet school in a poor area. I heard her teaching virtually during Covid. I politely said something like they way they teach chemistry now was not like what I got when I was young.

        She knew exactly what I was driving at. She said she had kids in her class that could not read. In CA, kids can’t be held back a year unless parents agreed and they pretty much never did. So un and undereducated kids were being sent along, grade to grade, through graduation.

        And KLG said about the UCLA story by e-mail:

        All I have to say is that our “rube red state” medical students fail shelf tests at the low single-digit percent level. They tend to do very well in the hospital in their third year. We accept students that would never be considered by UCLA or an Ivy League medical school.

        1. bayoustjohndavid

          I didn’t see your response when I made my response to Cristobal, so my response was kinda redundant (and potentially objectionable). I left this page before going to work this morning, and the comments hadn’t refreshed.

        2. Cristobal

          Yves, ¨Did you miss that the schools will not fail anyone?¨

          Exactly. That is my point. Too many of our schools and universities are now essentially businesses and they are loath to run off their customers. I think that the educational ¨business model¨ is the root of the problem.

          1. Grumpy Engineer

            Oh yes, the “business model” is definitely a strong contributor. Back when I was in college, if a student was booted because of poor academic performance, they were generally out a few thousand dollars of tuition money. People shrugged their shoulders and moved on. But after a few decades of tuition hikes that have significantly exceed inflation, it’s possible for a student who flunks the “shelf test” and gets booted to already owe $80k in student loans.

            That’s a genuinely harsh thing to do to a student, so faculty are naturally reluctant to do it, even if it’s the right thing to do. And university administrators may be concerned about potential lawsuits and the lost revenue if the student is not allowed to finish the program. So the easiest thing to do is simply not flunk students.

            And for some academic fields, nobody would care. But medical schools that do so are actively degrading the medical treatment that people will receive. And they’re wasting the time of veteran doctors (like IM Doc) who are trying to get new doctors up to speed. This is NOT okay.

            I’ve observed degradation in the quality of recent engineering graduates also, but that causes less harm. We can identify bad engineers fairly readily during interviews, and at least in my field (power generation equipment), new engineers are never in a position where they have final authority over product design. All new designs go through design reviews, safety reviews, in-house tests, and formal witnessed tests by regulatory bodies and/or certification agencies. And our customers have a LOT of clue. There are multiple layers of protection.

            But if a bad doctor is given patients to treat, who will overrule their bad treatment decisions?

            1. Cristobal

              Well said. It costs too much. Maybe it’s due to bells and whistles, too much administration, great way for banks to make money, or whatevercc . Some countries heavily subsidies medical education.

      2. Mark Gisleson

        I can’t think of any way in which an impoverished background would lead an intern on rotation to ignore the chart and wonder about repressed homosexuality.

        I often think the USA/UK has become the new Soviet Union. If so, we’re lagging behind on healthcare.

      3. bayoustjohndavid

        “Admission should be open to more people with perhaps even marginal credentials…At my university, a state school with very low admission requirements (a long time ago) 50% of the freshman class was invited to go home or find another school after the first year.”
        It’s no longer a very long time ago. If you tried doing that in medical schools today and flunked out a higher percentage of minority students than white students it would be “proof” of racism. It wouldn’t matter if a higher percentage of the marginal admissions were minority students. And once standards get lowered for any of the reasons that get mentioned,* you’re not far from ending up with students like IM Docs.

        *”The DEI and fear of being called racist reason is one that everyone’s aware of (whether they agree or not. Are most people aware of the decline in standards caused by the transformation of students into customers (brought about the ridiculous cost of college)? I know it’s discussed a lot here, but is it discussed widely?

  6. Lupana

    I would encourage every one of you in the USA to avoid any and all students that graduated after circa 2010.

    I don’t generally like to get involved in online conversations but I find this a bit of a bizarre over-reaction. My daughter graduated med school last year. She passed all her tests with honors and, as a resident, works extremely long days (often 6 days a week of 13 + hour days) for very little pay part of which goes to paying off massive debt. She takes her job very seriously and worries constantly about the repercussions of any errors she might make. She doesn’t talk about her day to day much with me but I know of one incident recently where she walked back after her shift had ended to check on a patient who was very nervous about being in the hospital. She thought something was wrong and noticed the signs of a stroke. Her ability to see this and her quick action saved the patient from long lasting negative effects. Anyway, just wanted to present an alternate view. And BTW, she is Hispanic so the DEI thing needs to be taken with a large grain of salt too. People are individuals and should be judged as such.

    1. IM Doc

      I do not consider it a bizarre over-reaction at all, but then again I am in the middle of it.

      As I told Yves this week, I am not so sure that admissions are the problem although lax standards are never good when we are talking about medicine and people’s lives. What I am certain of, however, is what is being taught and the curricula in current medical schools is leading to a generation of students who have no ability for independent thinking. What is more, they are spending huge amounts of time in their first few years on initiatives like DEI at the expense of actual medicine. It is obvious when an instructor like me for three decades interacts with the current students. The more elite their medical school, the more likely this is.

      So, time and time again – for the past 3 or so years – and I mean the vast majority of the time – I am confronted on rounds with students who just evaluated a patient and 1) They have zero ability to present the patient in any kind of rational way ( something that used to be a cardinal activity of the first 2 years of medical school ), 2) They melt like butter when quizzed about even the most basic pathophysiology regarding the patient in front of them and 3) they are constantly interjecting and projecting their own binary, race, gender, etc intersections on patient where no such things exist. It is very sad for me to see this – but the fact that it is happening is indisputable.

      There are also a few other things that go on all the time that are deeply disturbing. There appears to be no independent thought – they just play with UpToDate on their iPhones during rounds. When you insist the iPhones are put down, things spiral quickly. Also, there is a pervasive idea in residencies that seeing 8-10 patients a day is max – that is all you can do. When confronted with the real world where you simply cannot make a living doing that – the freak out ensues.

      We have all seen the results of this in the past few years. Young doctors on TV disparaging the unvaxxed and taunting them. Doing TikTok dances instead of taking care of patients, etc. Having the entire Ivy League graduating medical classes this year producing dancing TikTok videos seeing who could out-cringe the other. An entire med Twitter army of the young doctors who patrolled comments in social media and perfected mainly ad hominem attacks on anyone who went against the official narrative. I have noted with interest that all of that has really gone by the wayside. The young true believers in my orbit are all now very quiet, shell-shocked and at times distraught at how wrong everything has gone.

      But all of this is far more damaging to the practice of medicine in other ways. We in our area have had basically 2-3 open positions for PCP for the past 5 years. We have recruited one after the other of young docs right out of residency. And one after the other, they have failed. All predictable. They know all about intersectionality but actual bedside manner is the undiscovered country to them. The patients hate it. They have been trained to sit at the computer in the room and completely ignore the patient. They run on algorithms – whatever the computer tells them to do – they do. No thought required. They have zero effective ability to present patients to specialists leading to many harrowing disasters. They absolutely detonate if required to see more than 8 or so people daily. They demand the big salaries but have big problems doing the work to generate them.

      As such, we are very careful about who we even bring for an interview any more. Applications from those from certain states and schools go right into the trash. Our most recent hire lasted a total of 3 months.

      Again, I am not sure this has anything to do with admissions. Of this however I am certain – it has everything to do with how they are being trained. It is a very sad state of affairs.

      And yes – I am certain there are many kids who are recent grads who are earnest and hard workers. Unfortunately, the general public has no way of telling what they are getting into.

      1. Lupana

        I’m sure you’re seeing what you’re seeing and your perspective is bound to be both different and deeper than mine. My problem was with the blanket nature of the comment. I am curious and will save what you’ve written here to show my daughter when I see her next. I really don’t know what she’ll say.

      2. flora

        Thanks for this post and this comment.

        Your statement: “The young true believers in my orbit are all now very quiet, shell-shocked and at times distraught at how wrong everything has gone.”

        With any luck, this could be the start of their real education if they realize there is more to learn than they’ve been taught in school or can find on the computer.

        1. flora

          Sorry to come back so much later to the topic. However, I think this my latest comment might have some relevance here.

          Beginning about 10 years ago I noticed a marked difference in my young undergrad student job applicants. I hired some of these young applicants, of course, to help in the IT work in my department. What I noticed most was that the new hires seemed reluctant to accept or interface with older and seasoned IT pros. It took some time to work with them into understanding that the old pros had a simple and valuable experience and knowledge the online world lacked. It took some time to carefully and quietly to guide them through the mental assessments of learning how to approach a problem.
          How to approach a problem.
          How to approach a problem.

          My 2 cents.

      3. Juneau

        IM Doc-Thank you for writing this article.

        Regarding your statement: “An entire med Twitter army of the young doctors who patrolled comments in social media and perfected mainly ad hominem attacks on anyone who went against the official narrative.” These insecure doctors also don’t hesitate to report other physicians to the medical boards for questionable reasons, I have seen this in provider forums where a junior doctor doesn’t understand a medication regimen on a patient they inherit, and without even calling the former doctor for clarification, they will make a board complaint (on NP’s as well). I find this very concerning as they don’t take time to explore the history with the previous provider before making reckless changes in treatment regimens (that they haven’t bothered to understand) that can harm the patients and willy-nilly destroy careers.

    2. ambrit

      The problem with your last sentence is that, with DEI as basic policy, students and potential students are not being treated as individuals. They are now being judged as members of preferred and not preferred classes. It is the same old story as the “Good Old Boy Network,” but with different ‘preferred’ beneficiaries.

      1. Lupana

        My understanding of how it works though is that DEI which I take to be the same as affirmative action is that it is just one of many criteria upon which an applicant is judged. I don’t think there’s a huge advantage to being from a minority group. Every person applying is going to have advantages and disadvantages. When we went to my daughter’s graduation, what we noticed was a large number of doctor’s children graduating. I’m not sure how DEI works in admissions but if it’s like AA the way I view it is it’s opening a door for people from communities who don’t have a network of connections upon which to draw. I assume once someone is in that door they are judged equally to everyone else.

        1. Yves Smith Post author


          Even in the stone ages of my youth (1979) more women were admitted to MBA programs than was warranted on their application merits (GMATs, grades, prior work experience). And they hit the screen (didn’t make it through the first semester) in proportionately greater #s than men.

          I am told other top MBA programs has similar outcomes.

          So even before DEI pressures were as high as now, standards were bent a LOT to get out groups admitted.

          1. Lupana

            I’m not disagreeing entirely. Giving someone an opportunity is not the same as giving them a total pass. Once someone is in a program like medicine, I would assume the standards for graduation are applied equally or certainly should be. Anything less than that isn’t fair to future patients.

            1. Carla

              In for-profit medicine (which includes all so-called non-profits now), what is fair to future (or present) patients is of no concern.

              1. Lupana

                I would agree but that leaves out the human dimension. The organization may have no conscience but hopefully the individuals within the organization do.

                1. skippy

                  You keep coming back to the word ***individual*** like it has any meaning in this post by IM Doc, Lupana.

                  This post deals with a complete overhaul of not only Tertiary education, but he whole of the Medical industry[tm] itself via ideological perspectives under neoliberalism aka everything is a Market. Same thing is happening right now in the U.K. with PA’s IMO.

                  I saw the same thing happen in my work as both an MBA minted in the early 80s, civic/industrial/RE since the 90s in the U.S. and now here in Australia, and to top it all off my ex-wifes career as both a clinical paramedic and University teacher till a few years ago.

                  When she would grade papers is was high comedy except for the part about how this would translated down the road for both the students being churned out, profit for the Universities sucking up state funds [government student loans], students burden, market[tm] flooded with low quality widgets and cogs, everything theoretically sorted out on the job regardless of how it effects coworkers and those they service and at the end of the day its all about the individuals potential thingy … wow …

                  Decades of ratchet like effect have white anted everything, individuals have no agency in a market place[tm] setting, incentives rule, deviating from this will impair your earnings today and in the future, only option an individual has is too leave as noted in IM Docs post.

                  This is why Unions were attacked back in the day, so MBA’s and ideologically driven policy makers could shape industries and society that suited shareholders desires first and foremost …

                  1. Lupana

                    My objection was to the line where IM says to avoid any doctors who graduated post 2010. I think as a blanket statement, it’s questionable because although the system may be less than desirable – and it is – there are good individuals within the system and you can’t necessarily decide that all the bad ones are post 2010 grads and all the good ones pre 2010. Except, of course, the older ones have more experience but they had to get that experience over time. As I said to IM, I’m going to show this to may daughter when I see her and see what she thinks since she’s in the midst of it.

                    1. Fastball

                      Forgive me for impertinence but I am not concerned about your concern with “blanket statements” AS A PATIENT.

                      Patients have a right to be assured that ALL doctors who treat patients are competent to treat patients. This is not a case where “fairness to doctors” should matter.

                    2. Mark Gisleson

                      I think your daughter has concerns but you have fears. It’s called being a mom. Helping with the essay writing part of getting into med school, I sometimes dealt with moms. You’re all quite ferocious.

                      Your daughter has entered into a broken system. Unlike almost all other professions, your daughter will save lives and have the gratitude of her patients. And relative to the rest of us not in finance, she’ll be well paid.

                      Very few of us can have that kind of job satisfaction. She is making a difference, as is IM Doc. If IM Doc had his way, her career would be enormously satisfying. Since he won’t get his way, your daughter will increasingly face the wrath of patients angered by our broken system.

                      None of this is on your daughter. Talk to her about her working conditions, the inadequacy of staffing, the patients with preventable conditions, etc. She needs your support just as much as she needs experienced doctors filing complaints and trying to fix our broken system.

  7. Screwball

    Years ago in a conversation with my doctor, he said “you know what they call the person who finished last in their class in med school?” No, what? “A doctor”

    I never thought of that, and after that I never forget it

    1. KLG

      Actually, the last-in-the-class medical school graduate will not become eligible for a license to practice medicine until s/he completes a residency, which lasts from three (e.g., Family Medicine/Internal Medicine) to eight years (Neurological Surgery) and then passes the licensing examination and subsequent recertification exams. Otherwise the person with the suffix MD attached is the exact analog of a law school graduate who does not pass the Bar Exam. Neither is a doctor or a lawyer. Medical Education has become a problem. As my counterpart at a very good state-supported medical school on the west coast put it, “We have been accepting students who have proved nothing except they are adept at taking standardized tests for so long we have forgotten what it takes to practice medicine.” These same graduates have allowed medicine to be corrupted at its core, when they probably comprised the one profession that could have told their Neoliberal masters to go pound sand. Instead, they took the money happily and physicians my age and somewhat younger have run off to Sea Island and Pebble Beach and the like to live their version of the good life. If they had not complied with their masters, they would still be rich, just maybe with one less golf club membership. I’ll retire to my corner now.

      Addendum: IM Doc is correct. The problem is NOT in Admissions. Rather, the problem is what comes after. My colleagues and I are working on this. Our results will shake the foundations if we can get them published.

      1. Bigger world

        “Otherwise [i.e., without certifications and licensing] the person with the suffix MD attached is the exact analog of a law school graduate who does not pass the Bar Exam. Neither is a doctor or a lawyer.”

        Sorry, but to some extent you’re playing at semantics here. An MD is incontrovertibly a Doctor; it says so, right there on the paper. Being a small-d ‘doctor’ who is permitted by the state to actually practice medicine is something quite different. And since you bring lawyers into the discussion, I’ll mention something in that realm that is too often seen. A politician (or whoever) X will be described in a news story as a ‘former lawyer’. I’ll always try to ask the reporter, ‘Oh, has X been disbarred?!?’ If not, then she or he is in fact still a lawyer, whether practicing law or not, unto death.

        Your comment also ignores the fact that in the UK-and-Commonwealth tradition, as well as in other systems in Europe and worldwide, medical education is organised rather differently from the American four-year undergrad + four-year med school approach. In such places, students begin their studies/training right out of what Americans would think of as ‘high school’ and after a five-year programme graduate with a degree called Bachelor of Medicine. Yet they are ‘doctors’! Of course, just as in the US they have further hurdles (akin to internship and residency) before they can practice independently. But I have met more than a few Americans who cannot get their head around the fact that these fully-fledged doctors are not MDs!

        1. KLG

          Ah, semantics, another last refuge. Yes, a graduate of an MD Program does have “Doctor” in the diploma, as does mine, which goes back to Medieval Europe, when surgeons came from the ranks of barbers because they knew how to use a razor (one could note that physicians and surgeons were separate professions until fairly recently, a distinction that was made by Sir William Osler of McGill, Oxford, and Johns Hopkins as he revolutionized the practice of medical education and medicine 100+ years ago). My point is that the “MD” suffix does not entitle the holder to practice medicine as a physician in the United States, unless and until s/he completes an extensive residency in a recognized specialty and passes the board exam. The general practitioner (GP) who delivered me and was my family’s doctor for all things, including non-specialized surgery, graduated from medical school in the early 1950s and did a 6-month internship to become licensed to practice independently as a physician. But the internship was required. This was long before “Family Medicine” was a recognized primary care specialty. Anyway, that “MD/doctor” who is not licensed as a practicing physician will be called “Doctor” if s/he so desires, perhaps while working for Big Medicine/Big Insurance to deny coverage with the cover of that MD on the diploma on wall. Or something.

          And, yes, a graduate of medical school in a Commonwealth country is to my knowledge usually granted the title MBBS, Bachelor of Medicine-Bachelor of Surgery after seven years and without college/university as a prerequisite AFAIK. But s/he still must complete a postgraduate training course on the way to becoming a “Consultant.” They do it differently there. I do not know all the details or the terminology, but my comment is about the practice of medicine in the United States. I do have licensed physician colleagues with an MBBS who are granted the courtesy of using MD in the United States so they don’t have to explain.

          Finally, the recent law school graduate will have “Juris Doctor” on his diploma (previously LL.B, Bachelor of Laws), but until and unless s/he passes the bar exam in at least one state that does not automatically waive graduates into the Bar, s/he cannot practice law in the United States. More than a few law school professors never pass the bar exam. Very few professors (MD variety) in medical school are not board-certified in their specialty. On a side note, I have a practicing lawyer friend who wanted to be called “Doctor” because of the word on his diploma. That was a new one.

        2. Yves Smith Post author

          To add to KLG’s point, although he hardly needs help:

          Your comments about UK medicine are an irrelevant attempt at one-upsmanship or a reading comprehension failure. This post is explicitly about American medicine.

        3. Yves Smith Post author

          I failed to add: call yourself a doctor in a medical setting when you are not a licensed MD in that state and you are subject to prosecution, so KLG is 100% correct. I know a doctor of chiropractic (had a degree and once a license) who moved to a different state. Did not get licensed in his new state. Offered alternative treatments. not chiropractic. He did not have “Doctor” on any promotional materials but some of his patients called him Doctor.

          He was successfully prosecuted and sentenced to four and a half years in state prison in Texas. And this is not a rumor, I know the guy personally and his brother (who is a licensed MD).

  8. Jesper

    Great post.
    In relation to this post I believe someone has expressed the opinion that medicine is a combination of art and science. I have that belief, I do believe that sometime in the future then medicine might be 100% science but we are not there yet.
    Computers are a great help for doing science, not yet great for art. Computers appear to be used in assisting doctors in diagnosis and I have the impression that the trend in medicine (as in some other fields) is from doctors diagnosing with the help/assistance from computers towards doctors assisting computers in diagnosing. If such a trend exists then it might be possible that some students believe that they do not need to study and learn since computers will diagnose for them. The role of the doctor reduced to signing off on a computer diagnosis for liability reasons.
    One of the problems with that is that when garbage is fed into a computer then garbage is coming out from the computer (Garbage In Garbage Out, GIGO). Doctors who are collecting insufficient or even incorrect information are unlikely to get good diagnosis from a computer. There is a skill in knowing what information is needed and there is a skill in obtaining that information.
    Another problem is that students no longer see the need to learn and the one and only reason to attend school is to obtain the degree. There has been similar discussions about other subjects, why learn if the knowledge isn’t needed?

    I believe that once upon a time the reason for having admission standards was to establish a minimum level of knowledge for students entering the field. Without admission standards then it might be difficult to find the appropriate level to teach. So while I agree that the most important is what people know upon graduation I do believe that lowering admission standards reduces the time to learn more advanced things. It benefits both students and teachers to have clear expectations of what is needed to know before starting higher education.

    When it comes to discussions about vaccines and vaccine-mandates then I wish that additional nuance could be part of the official terminology. The definition of vaccine has evolved and widened over the years. In my opinion it has evolved and widened so much that it might be time to discuss if vaccines could be subdivided into vaccine type A (provides strong enough protection to be said to give immunity) and vaccine type B (provides strong protection but not so strong as immunity).
    The case for vaccine-mandate for vaccine type A is in my opinion stronger than the case for a vaccine type B.

    1. Yves Smith Post author

      I disagree. Computers will never substitute for doctors. There is too much information that comes from manual tests, like feeling the intestines. The most accurate test for breast cancer is manual, by someone who has felt a lot of boobs. But our love of science (and not having any/many breast clinics where there are people who feel boobs all day) means that it not an option in many cases. Similarly (and the government of Ontario spent a small fortune on this study in response to suits by police who were moved to lesser paid jobs for being too fat), the most accurate body fat measurement is a 14 site measurement using calipers…performed by someone who has done over 4000 measurements. Electrical impedance is unreliable because it is affected by salt consumption. The supposed gold standard of water displacement is also unreliable because the orignal studies were done on emaciated cadavers. The formulas derived from that regularly produce negative body fat levels for athletic black men.

      1. Gregory Etchason

        Yves you’re a little out of your depth, Breast physical exam has a sensitivity of almost zero That is negative in the absence of disease. By the time you can palpate a breast cancer it’s at least a year old and in the lymph nodes.

        1. Yves Smith Post author

          That is not what studies of breast exams by highly experienced examiners have found. You seem to be conflating that with the recommended monthly self-exams.

          Mammograms are a mediocre test. They are very good at identifying slow-moving growths that the overwhelming majority of women will die with rather than of, and poor at identifying dangerous fast-moving growths. And that’s before the known unknown of the consequences of regular X-rays going into soft tissue. There are studies that have challenged the widespread claim that mammograms save lives:

          Older studies found clinical manual exams to be as effective as mammograms. This is despite the fact that the exams are often done by doctors who do not perform them all that frequently. Due to the extensive use of mammograms in high income countries, there are no good recent studies on them v. clinical manual exams. The ones in poor countries are of mixed quality, with the meta-study noting the doctors and techs were often not trained!!!

          By contrast. Sydney had a breast clinic where staffers felt boobs all day. You simply cannot find that sort of person readily much of anywhere.

          Thermography can be effective at catching fast-moving growths early but is disfavored for reasons I cannot fathom. See a discussion here:

          1. Gregory Etchason

            Unfortunately you didn’t address the lack of sensitivity of physical breast exam.
            A “negative ” breast exam is meaningless. I never mentioned the use or overuse of mammography. The need for radical breast surgery has been nearly eliminated by mammography. A lack of controlled trials of physical exam vs mammography does not address the lack of sensitivity of physical exam in a disease where survival is time dependent.

            1. Yves Smith Post author

              This is a complete and utter fabrication. The reason the radical mastectomy is rarely performed now is SURGICAL and has nothing to do with screening. It has been replaced by the modified radical mastectomy, which unlike the radical mastectomy, preserves most or all of the chest muscle.

              Radical mastectomy used to be very common but is now rare. Surgeons have found that the modified version can be just as effective and produces fewer side effects.


              Modified radical mastectomies in fact are common, include DOUBLE MASTECTOMIES. 12% of women with invasive cancer opt for them.

              33% of women with stage 1 or 2 cancer opt for mastectomies:

              And you are straw manning me. The issue is that despite the increase in the use of mammograms, there is no evidence that it actually saves lives. See the independently funded Breast Cancer Organization (which advocates particularly for minority and low income patients). From Early Detection Does Not Save Lives:

              The rationale behind screening the general population is that by identifying and treating cancer early, even before it can be felt, treatments will be more effective and easier to bear. For many people this idea makes intuitive sense: surely the earlier something is caught, the better.

              Yet the latest study in The BMJ adds to the evidence from a number of studies finding little benefit to routinely screening healthy middle-aged women at average risk of breast cancer. Furthermore, these same studies have found there are significant harms to aggressively screening the general population for cancer.

              The recent Canadian study, involving 90,000 women followed over 25 years in a randomized trial, found that efforts to find breast cancers before they could be felt as a lump in the breast, using screening mammography, did not lead to lower death rates for average-risk women in their 40s and 50s. At the same time, around one in five of the cancers that were found through screening would not have required treatment were it not for the mammogram: resulting in overdiagnosis and overtreatment as these women underwent surgery, radiation, and chemotherapy to treat non-life threatening cancers…

              Some cancers are so aggressive that current treatments are ineffective, no matter how early the cancer is detected. Mammograms can’t tell us which breast cancers need treating nor can they overcome the shortcomings of our current treatments. At the same time, modern advances in systemic therapies mean that finding cancers early has become less important than when local control through surgery and radiation were the primary tools.

              This conclusion demands a radical re-thinking of the tenets of the breast cancer awareness movement. Mammograms don’t solve the fact that around 30 percent of women who are diagnosed with breast cancer will develop metastatic disease, often after the mythical five year mark, and die from breast cancer. Mammograms don’t solve the fact that there is a steep rise in late-stage breast cancers among young women, age 25-40 — for whom no medical group is suggesting routine screening mammography. Mammograms don’t solve questions about who is at average, and who is at increased, risk. And mammograms don’t solve the fact that Black women are 40 percent more likely to die of their breast cancers than White women.

              The fundamental philosophy behind “early detection” is flawed. Let’s look again at what the Canadian study reveals: in addition to challenging the basic tenet of mammography screening (that it saves lives), the study is also instructive about the importance of universal access to high quality healthcare. Women in the study who did not get mammograms fared as well as women who participated in screening, because these Canadian women knew to get lumps checked and had access to the medical care necessary for both diagnosis and treatment.


              This is a longer-form version of EXACTLY what I said. Mammograms are a poor test, pretty good at finding slow moving growths that do not need to be treated, not very good at detecting fast-moving, dangerous cancers. Manual testing in fact DOES do a good job of finding dangerous cancers soon enough, and as I indicated (and you tried asserting your way past), exams by very experienced practitioners (people who feel a lot of boobs) do an even better job.

              All you did was pretend to better knowledge, backed only by ‘tude, offering not a single link and Making Shit Up on top of that.

              I trust you will find your happiness on the Internet, elsewhere.

  9. Lefty Godot

    having to spend time[…]dealing with medically counterproductive electronic health records

    “But, but, but we paid millions of dollars for that third party medical record system! It must be good! Not just good but Best In Class! The salesman said so!”

  10. Eclair

    Well, where to start. An overview of my experiences, run-in’s, disappointments, wild successes, with medical professionals over the course of 80+ years, perhaps?

    My dad’s brother was a physician, general practitioner, who made house calls, and who served in France during WW2. My mom was an RN. So, I had ‘live-in’ health care for the first 20 years of my life. I have the scar from my small-pox vaccine, barely visible now, was first in line for the polio vaccine, was chest-x-rayed and tuberculin-tested to make sure I didn’t have TB. Suffered through whooping cough, measles, rubella, and chicken pox, pre-vaccines.

    Physicians were men, white men. Nurses were women, white women. The ‘natural order’ of things. My two children were delivered by white male OB/Gyns. One simply accepted that a strange guy would stick his gloved hand up your lady-parts. I did have a bizarre encounter with a woman physician at my ‘elite’ woman’s college, during the first week of my freshman year, but that is another story. Decades later my daughter laughed and asked me how I didn’t know that it was common knowledge my college was the ‘one for lesbians.’

    Back to the narrative. When med schools started graduating female physicians, I was relieved. Although, as I discovered, there are incompetent females as well as clueless males. But, so much easier to discuss ‘stuff’ with a woman, who had experience living in a female body. I would imagine that a Black or Indigenous or Hispanic person in America would also find it easier to discuss the stresses of living in a less-than-accepting-society (as physical health is so tied-in to one’s social and mental experiences) with a physician who is ‘one of them.’

    Fortunately, I have had no serious illnesses in my life. Thanks to my social and economic status, my early life, and sturdy genes inherited from my peasant ancestors. But, I was saved from an incompetent female doctor’s prescription of unneeded thyroid medication by an elderly, white male endocrinologist. And, given marvelous new lens to correct my cataracts (not all my inherited genes were good ones!) by an edgy young white male ophthalmologist. Lens are still working almost 20 years later! Although, he relied on the surgical techniques and medical engineering of lasers and collapsable, parasol-like lens that could be inserted into eyeballs. And, lovely ‘joy-juice’ that allowed me to stay awake during the procedure and allow sharp instruments to be inserted in my eye.

    I would chose, for general practitioner/internist, a physician who I can relate to easily. Someone I can talk to. Who gives me advice, but, like my current GP, who I really like, says, ‘you are obviously doing something right, keep on doing it, maybe with some minor tweaks,’ But, if I need a heart valve replacement, I want someone who lives and breathes hearts, whatever their gender or color or religion.

    So, what has worked in health care for me? Being relatively fortunate in the gene pool lottery. Timing: The 50’s and 60’s in the US were an anomaly in human existence. Economic status: Sufficient money, jobs with decent to excellent health care plans included. Excellent education that gave me access to wide ranging sources and options on how to live a healthy, both physically and mentally, life.

    And, of equal importance, knowledge of and access to, ‘alternative’ health care. Yoga, chiropractic, physical therapy, massage therapy. Two chiropractors have been responsible for correcting pain and musculoskeletal imbalances in my body, when ‘western’ physicians have given me pain pills, some of which were potentially addictive. Massage therapists have worked out stresses and kinks in my body, thereby relieving my mind. I have practiced yoga for almost 40 years and now do a short set of stretches daily. Oh …. and CBD oil and warm rice bags for aching joints.

    Finally, staying away from ultra-processed foods. But, that’s a whole other rant.

    Addendum: The CoVid shot thing. It has utterly destroyed my confidence in the CDC, as well as in the ability of the US government leadership to provide for excellent health and life span outcomes for citizens (and non-citizens.) CA links to our appalling life expectancy and infant mortality stats in a previous comment.

    Early in 2020, I had my annual visit with the University of Washington Med center’s ‘nevus guy,’ to check on the freckle on my retina. (We were all masked and hand-sanitized to a fare-thee-well.) The miracle shots had been made available to medical personnel, but were not yet available to the general public. I asked, rather jealously, if he had had his ‘shot’ and he replied yes, and he was happy that he would not not be able to spread CoVid to his patients. So, that was the story and he was sticking with it. Or, maybe, like the rest of us, he had been deceived.

    1. juno mas

      Like everyone, you want a compassionate yet highly competent person to administer your healthcare. Only the already competent can do that testing/selection.

  11. Carolinian

    I think all or most of us here appreciate IM Doc and his ethical attitude. But hasn’t the profession always been plagued by charlatans? Just asking.

    I recently re-read Sinclair Lewis’ Main Street and while the book is partially a Bovary-esque satire of small town provincialism it also talks about the town doctor performing surgeries on kitchen tables and other services so remote from our current hospital centric medicine. Perhaps here as in all else the country has become too much about money and all the rationalizations for that obsession. America has affluenza.

  12. JonnyJames

    Alarming, scary, depressing, but consistent and no surprise.

    I think one of Edward G.. Robinson’s characters in an old film said something like this:
    “Don’t’ like it? too bad!, there’s nothing you can do about it, see?. You better get used to it, ’cause it’s gonna get worse”

    That sums up what the slowly collapsing US society has to offer. Education, health-care etc. are a means of extortion and creating debt peons, not providing public utility or basic human necessity.

    The lack of critical, independent thinking is not just in medical schools, it is in most departments of most US colleges and universities. We have seen how even so-called public universities have become expensive, administration-heavy, authoritarian, degree-mills; and anti-democratic institutions who treat faculty and students like dirt. Recent student protests are just one indicator of this. There is no real academic freedom, one wrong post, and your career is toast.

  13. Rollo Tomassi

    How does this align with scores on Steps 2 and 3 testing? Those are the tests required for licensure. Those are certainly better indicators of how schools are doing and I assume those scores for each school are available.

  14. K.M.

    Half the students are flunking because of student debts.

    Bankers have done a lot of bad things to the US and the world but nothing can match the harm they are doing to America through student debts.

    They are destroying America. This article is just one example. What surpises me the most is how easily they are doing so.

    1. redleg

      If the school washes out underachieving or incompetent students, how is the school going to collect the tuition and fees from that student?

      Sarcasm aside, how much of the “give no F grades” is financial, especially for elite (expansive) schools?

    2. john r fiore

      Agree completely…forcing students to pay off massive debt when they have no money…and it cant even be discharged in bankruptcy if u continue to have no money…simply shocking, stupid, mean…and uniquely american….

  15. Coyote Man

    Long time reader, first time commenter with an anecdote related to Yves and IM Doc’s great post about recently graduated doctors, their lack of bedside manners, and their reliance on their phones for help.

    Three years ago, my young son broke his leg on a trampoline at daycare. At the Kaiser hospital, his mother and I met with a young (late 20s – early 30s) orthopedic doctor, who examined the leg and ordered some xrays. He assured us that my son would be fine: after all, kids are resilient, their bones are still growing, they heal much faster than adults, etc. With that, the young doctor cheerfully left the room to review the xray results, however when he returned a few minutes later he looked pale and shocked.

    “There is a 90% chance that your son’s leg will be permanently and noticeably disfigured,” he told us in a quiet, dour voice. “I’m sorry there’s not much we can do but hope for the best.” The news floored us, I felt faint and nauseous trying to comprehend what it meant for my son’s future. I pressed him for more information about the deformity and its causes. He responded by whipping out his phone, and showing us pictures and statistics about the deformity. From the address bar, I could see he was on a site called Orthobullets.

    When we got home, I looked up Orthobullets. It offers curriculum and course management, as well as a knowledge database for orthopedics. It was founded by “Dr. Derek Moore, a practicing orthopedic spine surgeon. He realized after returning to his residency following a period as a consultant at The Boston Consulting Group, that there were opportunities for improvement in the orthopaedic surgery training process.” I found the page for the injury my son had (link for those interested). Sure enough, under the Complications heading it suggested 50-90% of cases end in deformity.

    I figured the statistic about a 90% chance of deformity figure had to come from some medical study, so I searched PubMed to find it. Turns out, the figure comes from a single paper from a Greek hospital in the 1980s. I searched for more recent studies related to the fracture and deformity. For all studies published in the last 30 years, none ound the deformity occurred at a rate higher than the low single digits. Additionally, several of these studies with hundreds of participants didn’t encounter a single case of deformity.

    At the follow up appointment, I (politely and respectfully) brought up my research to the doctor. He was averse and somewhat hostile to my questions, until he abruptly left the room and had a nurse practitioner finish our appointment! I was shocked that a mild questioning of his prognosis would be enough to send him out of the room. Fortunately, the nurse practitioner told us she had seen dozens of these trampoline fractures in toddlers in her 20 years working at the hospital. All of them resolved without complication. Thankfully, my son’s leg has healed and he has shown no signs of complications or deformities.

    (1) A Boston Consulting Group alum decides that “Orthopaedic education can be improved and made more efficient.”
    (2) He hires developers to make a course management and knowledge app called Orthobullets for those med students.
    (3) The developers (possibly assisted by AI) scrape the internet for all information related to various orthopedic conditions.
    (4) Some outdated and incorrect figures are indiscriminately included in the app.
    (5) The young orthopedic students are trained on Orthobullets in med school and continue using it through their residency. Since it is the foundation of their education, they hold it in high regard and refer to in constantly.
    (6) When the information on the app is at odds with what’s happening in the office/hospital, they breakdown and, quoting IM Doc, “melt like butter.”

    1. Jamie

      Thanks for the fascinating comment. Lucky son, with you for the father. Great eagle eye, snagging

      Orthobullets also includes cook-book-style instructions for 100’s of surgeries!

      I’m looking at the Recipe for the Anterior Cervical Diskectomy . (My father had this surgery – made pain worse. Suffered till the day he died.)

      Step by step. Includes EVERY detail. Pre-op, Operative Technique and Post-op care. Right down to the stitches.

      I now wonder if new Surgeons rely on an Assistant to read each procedure from a tablet. . .

  16. playon

    Thanks so much for this post IM Doc. We moved to a new area last July and the doctor I was assigned at the clinic was fresh out of medical school as of 2023. He’s a nice guy but very inexperienced, after reading this I changed physicians to a dc who has been practicing for many years.

  17. Tom Stone

    Here in Sonoma County doing something as simple as renewing a prescription for blood pressure Meds or scheduling an appointment with a specialist has become an ordeal.
    Those who have remained in the Healthcare business are exhausted mentally and spiritually and many if not most of them are also dealing with the effects of multiple Covid infections.

  18. Duke of Prunes

    I had an issue with a detached toenail, and my toe becoming infected. I sought treatment at the immediate care center and a young doctor fixed me up and the toe has since recovered.

    The interesting part is that on my discharge papers – where all the medical notes from the visit are produced from the medical records systems, he wrote in pen (so not in the official records) that I should apply colloidal silver to my wound. I have had plenty of cuts, infections, incisions in my lifetime, but I had only heard of colloidal silver when Oprah had a guest that had turned blue from consuming too much.

    I searched for colloidal silver and google being the crap that it is, recommended all kinds of wound ointment, but none containing colloidal silver as well as articles highlighting the dangers of consuming colloidal silver. Deeper, more careful searching found lots of whoo-whoo about the supposed health benefits of consuming colloidal silver (especially on sites selling silver potions), and a few academic studies which seem to support the benefits of silver for wound care. At least one study talked about how silver was the go to topical antibiotic before antibiotics were discovered. Never did find a locally available silver containing wound ointment as the antibiotics had kicked in by the next day.

    I’m thinking about seeking out this doctor to become his regular patient (my old PCP retired during covid and I haven’t found a new one). I have to like a doctor who will recommend “forbidden” medicine and is smart enough to do it on the sly so as to not get in trouble with his superiors.

    1. Lena

      I remember seeing colloidal silver products in a Vermont Country Store catalog a few years ago. There was a cream and a soap, among other things. They probably still sell them.

      1. Arizona Slim

        They do indeed. Just go to their website and do a search.

        And permit me to thank IM Doc for helping me to decide not to get The Vaccine [TM]. Three years on, my appreciation for him only increases.

          1. Randall Flagg

            Ditto here as well and boy did I take some heat from my employer (no mandates but strongly encouraged), but quickly learned to hold my tougne on any thoughts when the conversation came up in general. I think kicking a baby would have generated less conflict than asking questions to the contrary of the widely held views of the miracle “vaccine” that was being pushed/mandated.
            Not pertinent to this thread but it was here in reader comments that I was encouraged to read the book : Calling Bullshit by Carl Bergstrom and Jevin West. It certainly opened my eyes to understanding so much that one always got a nagging feeling that something isn’t “right” that’s presented to us daily.

  19. kareninca

    I wonder if a lot of it is brain damage due to multiple covid infections. Almost none of these young people have been trying to avoid infection. How many times have they had covid, on average?

  20. Paul Jurczak

    the Head of the Ethics Department at the NIH was none other than Dr. Fauci’s wife

    That explains Morens’ answer: “I don’t even know what the Ethics office does.”

  21. Anon

    A lot of insightful comments, but the relaxing of standards is not an entirely new experience. In fact, here’s an article that I got from NC about a guy’s experience with the American medical system from back in 2020:

    What Ails America

    (Unfortunately, a paywall has been put up, but it is a must-read.)

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