From Authoritarianism to Advocacy: Lifestyle-Driven, Socially-Transmitted Conditions Require a Transformation in Medical Training and Practice

Abstract

The epidemic of socially-rooted, lifestyle-driven non-communicable diseases (NCDs; also referred to as socially-transmitted conditions) has now overtaken infectious diseases as the leading cause of human mortality. Despite this reality, physician education, training and practice within industrialized nations is heavily slanted toward the biopharmaceutical (and away from the psychosocial) aspects of prevention and treatment. As we underscore, the current state of physician training and practical application of guidelines pertaining to lifestyle is paltry and untenable. However, the solution is not a few more hours of nutritional biochemistry to check off the curricula box. Physician readiness for the current NCD crisis will require a philosophical shift in medicine-at-large, including candidate pooling. Recent elections in the United States and Europe have cast a spotlight on the public health consequences of political authoritarianism. However, we highlight that authoritarianism-and its related facets of social dominance orientation and Machiavellianism-are not exclusive to political candidates. Here, we open a dialogue on authoritarianism in westernized medicine as a starting point in order to encourage the development of critical research and to explore its potential as a barrier to patient care. We suggest that authoritarianism and its prejudices act as a border wall to the World Health Organization's broad vision of global health, cultural competency and patient autonomy. Moreover, the evidence reviewed here would suggest that in the context of the NCDs crisis, westernized medicine is long overdue a Flexner Report for the 21st Century.

Traditional Indigenous medicine in North America: A scoping review

“…The story told by David Baines about the oncologist calling the patient’s traditional healer a “witch doctor” was a clear example of a lack of respect for utilizing a shared decision-making methodology for best outcomes in a clinical setting [ 73 ]. Implicit as well as overt bias against medical pluralism in diverse settings needs to be acknowledged and addressed in often authoritarian institutional settings [ 100 , 101 ] for best patient outcomes.…”

Narrative Medicine Meets Planetary Health: Mindsets Matter in the Anthropocene

“…Perhaps out of necessity (in order to gain access to leading biomedical journals), it tells a comfortable tale of physicians being powerful beings-in the words of the author, "anointed as agents of social control who deploy special powers to rescue, heal, and take command". The JAMA paper elides even superficial discussions of social dominance orientation, authoritarianism, elitism, power, and neoliberalism within Western medicine [114][115][116], or the ways in which it has contributed to disparities [117]. It leaves out the storied reasons-some elegantly outlined by Dr Colon-that narrative medicine became a necessity in the first place.…”

The Canmore Declaration: Statement of Principles for Planetary Health

“…[10] Dunn underscored that authoritarianism is a primary blockade to global wellness; he encouraged greater inclusion of political science in wellness discourse, as well as the study of leadership styles, and broader awareness of the propagandistic misuse of scientific findings (Box 3). While the threat of political authoritarianism to public health is well known [22,23], authoritarianism and social dominance orientation are not exclusive to politics; they can be found in many contemporary social structures, including those associated with westernized medicine [24] and science (which can subsequently determine topics 'worthy' of study and selectively influence 'health' policy) [25]. Contemporary research supports Dunn's contention that individual (and in-group) authoritarianism stands in the way of the collective action that otherwise promotes high-level wellness in the form of social rights-based movements (civil, gender, environmental, etc.)…”