[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]


                        OH DOCTOR, WHERE ART THOU?
                         PANDEMIC EROSION OF THE
                        DOCTOR-PATIENT RELATIONSHIP

=======================================================================

                                HEARING

                               BEFORE THE

                    SELECT SUBCOMMITTEE ON THE CORONAVIRUS 
                                  PANDEMIC

                                 OF THE

                      COMMITTEE ON OVERSIGHT AND 
                              ACCOUNTABILITY

                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                           SEPTEMBER 14, 2023

                               __________

                           Serial No. 118-63

                               __________

  Printed for the use of the Committee on Oversight and Accountability
  
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT] 


                       Available on: govinfo.gov,
                         oversight.house.gov or
                             docs.house.gov
                             
                                __________

                                
                    U.S. GOVERNMENT PUBLISHING OFFICE                    
53-381 PDF                  WASHINGTON : 2023                    
          
-----------------------------------------------------------------------------------     
              
              COMMITTEE ON OVERSIGHT AND ACCOUNTABILITY

                    JAMES COMER, Kentucky, Chairman

Jim Jordan, Ohio                     Jamie Raskin, Maryland, Ranking 
Mike Turner, Ohio                        Minority Member
Paul Gosar, Arizona                  Eleanor Holmes Norton, District of 
Virginia Foxx, North Carolina            Columbia
Glenn Grothman, Wisconsin            Stephen F. Lynch, Massachusetts
Gary Palmer, Alabama                 Gerald E. Connolly, Virginia
Clay Higgins, Louisiana              Raja Krishnamoorthi, Illinois
Pete Sessions, Texas                 Ro Khanna, California
Andy Biggs, Arizona                  Kweisi Mfume, Maryland
Nancy Mace, South Carolina           Alexandria Ocasio-Cortez, New York
Jake LaTurner, Kansas                Katie Porter, California
Pat Fallon, Texas                    Cori Bush, Missouri
Byron Donalds, Florida               Jimmy Gomez, California
Kelly Armstrong, North Dakota        Shontel Brown, Ohio
Scott Perry, Pennsylvania            Melanie Stansbury, New Mexico
William Timmons, South Carolina      Robert Garcia, California
Tim Burchett, Tennessee              Maxwell Frost, Florida
Marjorie Taylor Greene, Georgia      Summer Lee, Pennsylvania
Lisa McClain, Michigan               Greg Casar, Texas
Lauren Boebert, Colorado             Jasmine Crockett, Texas
Russell Fry, South Carolina          Dan Goldman, New York
Anna Paulina Luna, Florida           Jared Moskowitz, Florida
Chuck Edwards, North Carolina        Vacancy
Nick Langworthy, New York
Eric Burlison, Missouri

                       Mark Marin, Staff Director
             Mitchell Benzine, Subcommittee Staff Director
                        Marie Policastro, Clerk

                      Contact Number: 202-225-5074

                Miles Lichtman, Minority Staff Director

            Select Subcommittee On The Coronavirus Pandemic

                     Brad Wenstrup, Ohio, Chairman
Nicole Malliotakis, New York         Raul Ruiz, California, Ranking 
Mariannette Miller-Meeks, Iowa           Minority Member
Debbie Lesko, Arizona                Debbie Dingell, Michigan
Michael Cloud, Texas                 Kweisi Mfume, Maryland
John Joyce, Pennsylvania             Deborah Ross, North Carolina
Marjorie Taylor Greene, Georgia      Robert Garcia, California
Ronny Jackson, Texas                 Ami Bera, California
Rich Mccormick, Georgia              Jill Tokuda, Hawaii
                         
                         
                         C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page

Hearing held on September 14, 2023...............................     1

                               Witnesses

                              ----------                              

Jeffrey Singer, M.D., Surgeon, Private Practice, Senior Fellow, 
  Cato Institute, Department of Health Policy Studies
Oral Statement...................................................    10
Azadeh Khatibi, M.D, M.S., M.P.H., Physician, Medical Ethics and 
  Freedom Advocate
Oral Statement...................................................    12
Jerry Williams, M.D., Founder, Urgent Care 24/7
Oral Statement...................................................    14
Andi Shane, M.D., M.P.H., M.S.C., Chief, Division of Infectious 
  Diseases, Department of Pediatrics, Emory University School of 
  Medicine
Oral Statement...................................................    15

Written opening statements and the written statements of the 
  witnesses are available on the U.S. House of Representatives 
  Document Repository at: docs.house.gov.

                           Index of Documents

                              ----------                              

  * Statement for the Record, North Carolina Physicians for 
  Freedom, submitted by Rep. Wenstrup.
  * Comments for the Record, from North Carolina Physicians for 
  Freedom.

Documents are available at: docs.house.gov.

 
                       OH DOCTOR, WHERE ART THOU?
                        PANDEMIC EROSION OF THE
                      DOCTOR-PATIENT RELATIONSHIP

                              ----------                              


                      Thursday, September 14, 2023

                        House of Representatives

               Committee on Oversight and Accountability

            Select Subcommittee on the Coronavirus Pandemic

                                                   Washington, D.C.

    The Subcommittee met, pursuant to notice, at 10:05 a.m., in 
room 2247, Rayburn House Office Building, Hon. Brad R. Wenstrup 
(chairman of the subcommittee) presiding.
    Present: Representatives Wenstrup, Miller-Meeks, Lesko, 
Cloud, Joyce, Greene, Jackson, McCormick, Ruiz, Dingell, Ross, 
Bera, and Tokuda.
    Dr. Wenstrup. Good morning. The Select Subcommittee on the 
Coronavirus Pandemic will come to order.
    I want to welcome everyone. Without objection, the chair 
may declare a recess at any time.
    I now recognize myself for the purpose of making an opening 
statement.
    Good morning and thank you all for coming here today to 
discuss the importance of the doctor-patient relationship and 
truly caring for patients.
    Every patient is unique, and one-size-fits-all solutions do 
not work well in medicine. From early on in the pandemic, I 
recommended to the Administration that Americans need to hear 
from the doctors that are actually treating COVID-19 patients 
and that sidelining doctors during the COVID-19 pandemic was a 
massive mistake.
    We've lived through many things, even before the pandemic. 
The requirements on our EHR, the reporting requirements they're 
obligated to give that--all these things to take us away from 
patients. Prior authorization and dictating what patients' 
medicines are from someone who has never seen the patient. All 
these interruptions. Your doctor, who knows you should have 
been the primary partner on health and medical decisions.
    Constant testing, for example, before entering a building 
but no testing required to enter our country over our southern 
border confused many Americans as to what was going on in the 
arena of public health. Instead, politicians with no medical 
background imposed mandates to be followed or to be fired.
    I'll tell a quick personal story. First of all, I believe 
the vaccine saved hundreds of thousands of lives. I truly do. 
And I was very much for the emergency use, especially for those 
that were most vulnerable. And that should have been our 
priority, especially when limited.
    I got the Pfizer vaccine. Months later, I got COVID, and 
the only reason I knew I had COVID is because I couldn't smell 
garlic salt when I was cooking. And I snorted the stuff, and I 
got nothing. I remember having chills about a week and a half 
before. I got better.
    I was told that I needed the booster to travel to Germany. 
So, I asked downstairs at the Physician's Office if I could get 
antibody levels and T-cell levels before doing the booster. 
They said: We can't do T-cells, but we can do antibodies.
    A strong level, as I got my results, showed that 40 was 
very strong. My level was 821.
    Should there not have been a discussion with the doctor as 
to whether or not you needed a booster? Whether or not it was 
going to make a difference? Whether there's a possibility of a 
hyperimmune response? There was no such thing.
    We've seen school boards not accepting notes from a 
physician about their students and maybe just getting one dose 
of Pfizer, so they don't get myocarditis. Rejected. That 
happened in my own district.
    To be clear, this important decision, whether to get 
vaccinated and boosted, is the exact choice that should be 
between each American and their physician. Why should 
individuals be strong-armed into getting a vaccine that they 
may have little or no marginal benefit or potentially create 
risk for themselves? Especially without a discussion.
    Ms. Dingell, on this committee, has told us many times--
because she had a reaction to vaccines when she was young--that 
she was very concerned. She was afraid. Understandably. But she 
tells the story that she talked to her doctor, and they made 
the decision to go ahead. Well, so many Americans were not 
given that option. They were told: You get this, or you're 
fired from your job.
    The sacred relationship between a doctor and a patient is 
directly connected with personal health outcomes. Every patient 
is different. Numerous studies have found that a physician's 
knowledge of a patient's ailments and emotional state is 
positively associated with the resolution of those ailments.
    The doctor-patient relationship, as well as the autonomy of 
physicians, has been eroded in recent decades. Government 
interference in medicine has continually crept in and taken 
advantage of in times of crisis. Bureaucratic red tape and 
administrative burden forces physicians to spend less time 
treating patients.
    For example, Dr. Ruiz and I have had a bill for several 
years to streamline--when insurance companies are saying, ``You 
must fail first, or this is the drug you have to take,'' so 
that there's no delay in patient care, and we can resolve that.
    Consolidation in the healthcare market has also brought 
physicians further under an umbrella of central control. More 
and more physicians are employees rather than employers. The 
pandemic rapidly accelerated these trends. As we continue to 
innovate and prioritize efficiency in our healthcare system, we 
must also preserve the sanctity of the doctor-patient 
relationship.
    With ``do no harm'' in mind, we must ensure that physicians 
have the autonomy to treat patients without undue interference. 
This is one of the great tragedies of our response to the 
COVID-19 pandemic. We allowed the government to censor and 
bully doctors, to try to get them to comply with the agreed-
upon narratives pushed by unelected bureaucrats and politicians 
who never treated a single COVID patient, let alone studied 
medicine.
    Doctors came under immense pressure to promote COVID-19 
vaccines to everyone, regardless of whether they felt it was 
warranted or medically appropriate. I remember a video I saw 
with Dr. Fauci, and I think it was around 2004. And, in the 
interview, he was asked: So, if you've had the flu, do you 
still need the vaccine?
    He said: No, no, no. No, you don't need it because you have 
more immunity if you've already had the flu than you'll get 
from the vaccine.
    So, people are confused with the message.
    Doctors who have prescribed off-label medications for years 
were suddenly vilified for doing the same during COVID-19. 
Today, you'll hear from one such doctor, Dr. Jerry Williams, 
who treated thousands of patients at his urgent care clinics, 
who felt the positive effects of his cures and treatments and 
also felt the negative effects of medical censorship.
    A Federal Court of Appeals recently determined that the 
Biden Administration violated the First Amendment by colluding 
with social media companies to stifle dissent about COVID-19 
online. It's just what the court said.
    The Federal Court also recently revived the lawsuit against 
the FDA for interfering in the practice of medicine by 
embarking on a politically motivated campaign against the FDA-
approved drug ivermectin. Most medicines for animals are also 
human medicines, but the doses are different. And it's not fair 
to say they're the same.
    This anti-science, anti-doctor, and government-mandated 
approach during the pandemic failed miserably, and it makes us 
less prepared to address a future pandemic. And I've done 
panels where people were hesitant, and they said: We just want 
to be educated, not indoctrinated.
    We need to set this straight if we're to be successful in 
public health.
    The Majority was in contact with a possible witness for 
today's hearing who is deeply passionate about these issues. 
That physician wanted to testify, but was too afraid that their 
career would be destroyed for speaking out any more than they 
already had. This is a problem. It's appalling that we have 
built a world which forces experts to choose between the 
government's treatment plan and the truth, or even be allowed 
to express their own opinion.
    Rather than listen to doctors, the government censored 
them. The very government officials that took an oath to uphold 
the Constitution that protects free speech. Rather than 
encourage Americans to seek out the advice of a doctor, they 
kept doctors' offices closed and deemed your treatment as 
unnecessary, even if there were no cases anywhere near where 
you were working.
    People were fearful. I understand that. But, as we look 
back, this is a mistake we should not make again. They imposed 
vaccine mandates and vilified any dissenters. We can't let 
these failures be repeated. We must learn from the past to 
succeed in the future. For many, this reality has been obvious 
for some time, but it appears that others still have not 
learned anything over the past several years.
    Just this week, the CDC decided to recommend an updated 
COVID-19 booster for all Americans over the age of 6 months. I 
suspect that some of this conversation today will be focused on 
this decision.
    My hope is that today's discussion will emphasize the 
importance of the doctor-patient relationship and why we must 
resist attempts by government or industry to take more 
decision-making power away from individuals, both doctors and 
patients, and put into the hands of bureaucrats.
    I look forward to an on-topic, respectful discussion today 
about a very important issue. Thank you.
    I would now like to recognize Ranking Member Dr. Ruiz for 
the purpose of making an opening statement.
    Dr. Ruiz. Thank you, Mr. Chairman.
    The relationship between a patient and their doctor is 
sacred. It is a cornerstone of healthcare delivery that is 
rooted in trust, empathy, and the oath to do no harm. As a 
physician, it is something that I deeply valued when I treated 
and cared for my patients in the emergency department, giving 
critical care at critical moments.
    And, for our Nation's physicians who served on the front 
lines of the COVID-19 pandemic, as I did in previous pandemics 
in the emergency department, I know it is something that they 
deeply value, too.
    And let me be clear: The physician-patient relationship is 
not one that occurs in spite of our government's public health 
institutions. Rather, it is a relationship that is complemented 
and fortified by the tireless work of public health officials 
and experts, particularly during times of crisis.
    And now that we have emerged from the darkest days of this 
pandemic, we, as lawmakers, have a responsibility to continue 
equipping our Nation's doctors with the tools necessary to 
provide the highest quality care to patients, both now and in 
the event of future crises.
    In order to do that, we must continue empowering 
collaboration between our physician and public health 
communities in our ongoing response to threats like COVID-19. 
We've seen what this collaboration can look like during the 
course of the pandemic.
    For example, once COVID-19 vaccines became available, the 
Biden Administration and the physician community worked 
together to rapidly deploy them and increase their uptake, 
including through commonsense policies like vaccine 
requirements for high-risk individuals working in high-risk 
situations.
    These public health measures, which were enacted in support 
and in consultation with physicians, allowed us to safely and 
responsibly reunite loved ones, reopen schools, businesses, and 
workplaces, save lives, reduce harm, and prevent additional 
hospitalizations.
    In fact, dozens of distinguished medical groups and leaders 
have gone on the record in support of these pandemic-era 
policies, including the physicians in the American Medical 
Association, the physicians in the American Academy of 
Pediatrics, the physicians in the American Academy of Family 
Physicians, the physicians in the Infectious Disease Societies 
of America, and more.
    So, thanks to the Biden Administration's leadership in 
successfully rolling out the country's largest vaccination 
program in history, we have been able to emerge from the depths 
of the pandemic, and now the work to keep COVID-19 at bay 
remains.
    We must continue working to preserve and expand access to 
treatments that ensure Americans can recover from COVID-19 with 
ease. This includes antiviral therapies, for which the 
Administration has successfully deployed thousands of test-to-
treat sites and preserved widespread access even after the 
conclusion of the public health emergency.
    Additionally, we must continue partnering with physicians 
to remove barriers that they and their patients may experience 
to treatments and medications that we know work and save lives.
    Throughout the pandemic, the Administration's weekly 
convening of clinicians across the country has equipped our 
Nation's providers with the resources and the latest 
information that they need to provide their patients with the 
best possible treatments and therapeutics.
    And now, as we enter the fall and winter months, where 
cases of COVID-19 and the flu are known to rise, our 
government's public health officials must keep this line of 
communication open with patients and physicians to promote the 
highest quality of care.
    We can achieve this goal by partnering with community-based 
organizations, especially those in under-served communities, to 
increase public health outreach and improve health outcomes 
from COVID-19. And, most importantly, we must work to ensure 
that everyone, even in the most rural and remote parts of the 
country, can get the care they need when they need it.
    Over the last 3 years, we have made great strides in 
achieving this goal. Because there is no patient-doctor 
relationship if patients don't have doctors.
    In fact, last year, congressional Democrats secured key 
provisions in the Consolidated Appropriations Act of 2023 to 
advance equitable healthcare access. This included maintaining 
tele-health flexibilities put in place during the public health 
emergency to ensure that all Medicare beneficiaries, no matter 
where they live, are able to access vital tele-health services, 
especially in areas where there are no physicians, and so this 
increases the opportunity to even have a doctor-patient 
relationship.
    And let's not forget the historic reforms under the 
Inflation Reduction Act that put more affordable care within 
reach for millions of Americans, capping out-of-pocket drug 
costs for Medicare recipients, and saving 14.5 million 
Americans hundreds of dollars a month on healthcare premiums.
    So, as we begin today's hearing, it is my hope that we can 
pursue a productive conversation about how we can work 
together, lawmakers and clinicians, to improve access to care, 
enhance trust between physicians and patients, and forge a 
stronger collaboration between physicians and public health 
officials that will fortify our Nation from future threats.
    As Ranking Member of this Select Subcommittee, my goal has 
always been and continues to be to identify forward-looking 
policies that protect the public's health and leave us better 
prepared for the next pandemic.
    So, after a long and productive district work period that I 
know everybody on this committee had, I hope that today's 
hearing puts us on the path toward that goal.
    I yield back.
    Dr. Wenstrup. I would now like to recognize Dr. McCormick 
for the purpose of making an opening statement.
    Dr. McCormick. Thank you, Chairman Wenstrup and Ranking 
Member Ruiz, for the special opportunity to address this 
committee as to my concerns, as we are doctors. We served 
during this entire pandemic. This is a special occasion for me.
    I just rewrote my entire opening statement in the last 5 
minutes, just listening to the words. The words sound great. 
The tools. We gave you guys the tools. There was great 
collaboration. They allowed us to. We removed barriers. We got 
more affordable healthcare. Those are all words we've heard 
recently by the government.
    The problem is, when the tools are biased by the 
government, when collaboration means the government gets its 
way or bribes scientists or gives them grants or bonuses to 
change their opinion--when they say, ``allows us to,'' that 
means once the government gives you permission to. When they 
say, ``removes barriers,'' unless the government disagrees. 
When they say ``affordable healthcare''--I don't know of 
anybody who, in America, thinks we have affordable healthcare. 
So, let's start there.
    Beginning in March 2020, the government took over the 
conversation of healthcare. For the first time ever, at least 
in my lifetime, we had a novel virus that was killing people. 
And for the first time ever, the collaboration between doctors 
and patients was interfered with, and also doctors and doctors, 
and also doctors and scientists, because the government got to 
have the ultimate say so. There's the biggest problem.
    In 2020, as a person who was involved in treating patients 
before we even knew what it was called, before we even knew 
what was going on, when we see fevers as exposed repeatedly, I 
was censored when I had a scientific/medical opinion. That 
turned out to be right, by the way, but that's inconsequential.
    The fact is the government got to tell me what was right 
and wrong. Government officials who hadn't seen a patient in 
decades or at all. People who didn't have an MD, who had never 
seen a person in the ER, who had never treated a virus in their 
life, got to censor me. And some people even threatened to take 
away my license because I disagreed with them. Because I'm an 
expert, too, I felt this is the biggest problem in the whole 
approach.
    It's not collaboration when the government gets the say-so 
and when they are the expert. And this goes back to our basic 
political philosophy. Is government the equivalent of God? Are 
they the moral authority? Are they equivalent of physicians and 
medical authority? Are they the equivalent of business-owners 
and get to tell you when your business is open or closed, who 
you hire and fire, whether you should get vaccinated, whether 
you can travel? This is the fundamental difference that we are 
arguing today.
    As a healthcare provider, and as an American citizen who 
has rights that are inalienable--not given to me by the 
government but given to me by God, in my opinion--the American 
people deserve to make medical decisions through the caring and 
informed conversations with their physician rather than through 
politically motivated mandates. The American people deserve a 
choice. The freedom of choice is as fundamental to this country 
as anything that ever existed.
    The COVID pandemic wreaked havoc on us. We all agree on 
that. We know it was a horrible thing. But we can't even agree 
on the science of what started this pandemic without making it 
political.
    Now, just to be clear, I'm not against someone wearing a 
mask. I'm not against someone getting a vaccination. I was 
actually one of the first people in the United States to get a 
vaccination, as an ER doc on the front lines seeing thousands 
of COVID patients. The science seemed clear to me at the time 
that it would have a real benefit against a novel virus from 
becoming ill and not being able to serve my patients. I got the 
vaccine willingly.
    And I'm a military guy. Over 21 years in the military. I've 
gotten plenty of vaccinations in my time. It doesn't scare me. 
But, as soon as the government said, ``You will.'' You're going 
to have resistance.
    And, ironically, it's not just the White conservatives. 
It's the Black liberals. Because people don't trust the 
government. And, as soon as you say, ``I really want you to get 
this,'' and they say, ``No thank you,'' and you say, ``No, I 
want you to get this.''
    ``No, thank you.''
    ``No, you're going to get this.''
    You know what the response is going to be from those 
people. You galvanize people. You don't attract them to 
something.
    And that's the political nature that we made this disease. 
And it actually defeated the purpose of a good conversation 
between a physician and their patient and what would be maybe a 
real benefit to a vaccination.
    Now, that has modified. Over time, the science has changed, 
so to speak. Well, the science hasn't changed, but the opinion 
has. The way that we use NSAIDs or steroids or different 
medications has changed. Now, the science changed, and we were 
able to do that. But ultimately, we have to let the scientists 
and the medical professionals, and the patients have those 
conversations if we're going to keep this from being a 
political conversation rather than a medical conversation. And 
that's what I'm sticking up for.
    Thank you very much. And, with that, I yield.
    Dr. Wenstrup. Thank you.
    I would now like to recognize Representative Ross for the 
purpose of making an opening statement.
    Ms. Ross. Thank you very much, Chairman Wenstrup and 
Ranking Member Ruiz.
    And thank you to the witnesses, all of you, for being with 
us today.
    I'd just like to take this opportunity to call attention to 
the hypocrisy of the Republicans in designating today's hearing 
topic, particularly in light of the current state of 
reproductive rights and reproductive healthcare in our country.
    My colleagues on the other side insist that public health 
guidelines based on strong medical consensus and evidence from 
the scientific community violated the relationship between 
patients and doctors. I take this relationship very seriously. 
My father is a doctor. He raised many of the concerns about 
having insurance companies interfere with his doctor-patient 
relationships. This is not an unfamiliar topic to me.
    But having this discussion while simultaneously advancing 
an extreme agenda to undercut reproductive healthcare and 
insist that elected officials know better than doctors and 
patients is really rich.
    It appears that some of my colleagues support government 
encroachment on America's privacy and health as long as it 
aligns with their goals of dismantling access to reproductive 
care. States across this country have enacted draconian 
legislation, targeting and criminalizing doctors and 
reproductive health providers, encouraging vigilantism, 
deputizing citizens to go after individuals seeking abortion, 
and forcing rape victims as young as 13 to carry pregnancies to 
term. Somehow, in their eyes, this doesn't qualify as 
government overreach or interference in the doctor-patient 
relationship.
    Over 1,500 healthcare providers in my home state of North 
Carolina penned an open letter in opposition to our Republican 
legislature's 12-week abortion ban, writing that it puts the 
government in charge of deciding which healthcare options are 
available to patients and sets a dangerous precedent that 
violates the sacred patient-clinician relationship.
    On top of that, the North Carolina Medical Society, the 
North Carolina Obstetrical and Gynecological Society, and the 
North Carolina Academy of Family Physicians all publicly oppose 
the law. And, yet, despite the outcry from physicians, despite 
the danger to public health, despite public opposition, a bunch 
of extreme politicians said, ``I know better.''
    And now, extreme Republicans eye a national abortion ban, 
as they attach anti-choice riders to appropriations legislation 
and fight to end the access to safe medication abortion 
nationwide. The ability for all women to make their own 
decisions about their healthcare is at risk. As a matter of 
fact, it's gone in many states.
    I want to remind folks that in the Roe v. Wade decision, 
the primary opinion came from Justice Harry Blackmun, who 
himself represented doctors at the Mayo Clinic. He understood 
the importance of the doctor-patient relationship and not 
criminalizing healthcare.
    In closing, I want to remind the committee of what Justice 
Ruth Bader Ginsburg wrote in her 2007 dissent in Gonzales v. 
Carhart, ``Legal challenges to undue restrictions on abortion 
procedures do not seek to vindicate some generalized notion of 
privacy. Rather, they center on a woman's autonomy to determine 
her life's course and thus enjoy equal citizenship stature.''
    She argued this point at her Senate confirmation hearing as 
well, explaining that the decision whether or not to bear a 
child is central to a woman's life, her well-being, and her 
dignity. It is a decision she must make for herself. And when 
the government controls the decision for her, she's being 
treated as less than a fully adult human responsible for her 
own choices.
    If my colleagues on the other side of the aisle genuinely 
believe that vaccine requirements constitute government 
overreach, then they must acknowledge that abortion bans, and 
contraception restrictions enacted across this country are 
evidence of an even greater overreach and violate the 
relationship that we have with our doctors.
    Thank you, Mr. Chairman, and I yield back.
    Dr. Wenstrup. Thank you.
    And I want to welcome all of our attendees today.
    And I do want to point out that free speech is obviously 
still allowed in our committees, but I would also like to 
remind everyone that this on-topic discussion we hope to have 
today is about the pandemic erosion of the doctor-patient 
relationship. And, out of respect for our panelists here today, 
that's what they prepared for. That's what they are here to 
discuss.
    So, I hope, for the remainder of this time, that we can go 
ahead and hear from our panelists and ask them questions and 
try and find ways that we can do better, especially in the area 
of public health, as it relates to the doctor-patient 
relationship going forward.
    So, our witnesses today are Dr. Jeffrey Singer. Jeffrey 
Singer is a senior fellow at the Cato Institute and works in 
the Department of Health Policy Studies. He is president 
emeritus and founder of Valley Surgical Clinics Ltd. and has 
been in private practice as a general surgeon for more than 35 
years.
    Dr. Azadeh Khatibi--Khatibi. Sorry.
    Dr. Khatibi is a fellowship-trained physician and surgeon. 
She is a physician scientist, medical freedom and ethics 
advocate, as well as a mindfulness mentor.
    Dr. Jerry Williams. Dr. Williams is a product of the 
university system of Georgia for both college and medical 
school. He is a University of North Carolina fellowship-trained 
child and adult neurologist, as well as the owner and founder 
of Urgent Care 24/7, a chain of urgent care centers, and he has 
practiced medicine for 32 years.
    Dr. Andrea Shane. Andi L. Shane is the division chief of 
infectious diseases at Children's Healthcare of Atlanta and 
Emory University. Dr. Shane earned a medical degree from 
Louisiana State University School of Medicine in New Orleans, 
followed by residency training with an additional year as the 
chief resident at Albert Einstein College of Medicine in the 
Bronx, New York.
    Thank you for being here today. Pursuant to Committee on 
Oversight and Accountability rule 9G, the witnesses will please 
stand and raise their right hands.
    Do you some solemnly swear or affirm that the testimony 
that you are about to give is the truth, the whole truth, and 
nothing but the truth, so help you God?
    Thank you. Let the record show that the witnesses answered 
in the affirmative.
    The Select Subcommittee certainly appreciates you being 
here today, and we look forward to your testimony.
    Let me remind the witnesses that we have read your written 
statements, and they will appear in full in the hearing record. 
Please limit your oral statements to 5 minutes.
    As a reminder, please press the button on the microphone in 
front of you so it is on, and the members can hear you. When 
you begin to speak, the light in front of you will turn green. 
After 4 minutes, the light will turn yellow. When the red light 
comes on, your 5 minutes has expired, and we would ask that you 
please wrap up.
    I now recognize Dr. Singer to give an opening statement.

                   STATEMENT OF JEFFREY SINGER, M.D.

                        SURGEON PRIVATE PRACTICE

                             SENIOR FELLOW

                             CATO INSTITUTE

                  DEPARTMENT OF HEALTH POLICY STUDIES

    Dr. Singer. Thank you, Chairman Wenstrup, Ranking Member 
Ruiz, and members of the subcommittee. I have submitted a 
longer written testimony, which I'll summarize here.
    In my 40 years of private practice, I have firsthand 
experience of government agencies progressively intruding into 
physicians' clinical decision-making and often casting a 
chilling effect on what clinicians feel comfortable 
communicating to their patients.
    Beyond the assault on their autonomy, clinicians face 
ethical dilemmas when concerns about job security or even if 
they can continue practicing their profession if they fail to 
adhere to orthodoxy distort their best judgment regarding what 
they perceive to be in their patients' best interest.
    In my Cato Institute study ``A Hippocratic Oath For a Free 
Society,'' I argue that physicians must always prioritize the 
autonomy and rights of individual patients. I call for doctors 
to take an oath declaring, quote: I will respect the crucial 
scientific advances in medicine but will always question the 
assumptions my profession has inherited and will judge them in 
the light of the latest evidence. I will respect my patient's 
autonomy, thoroughly explain all the diagnostic possibilities 
and therapeutic options as I understand them, offer my best 
opinion and advice from among these options, and accept their 
decisions.
    Government, public health, and other regulatory agencies 
have made it increasingly difficult to honor that oath. This 
became much more apparent during the recent coronavirus 
pandemic. As I stated in my essay ``Against Scientific 
Gatekeeping,'' ``A problem arises when some of those experts 
exert outsized influence over the opinions of other experts and 
thereby establish an orthodoxy enforced by a priesthood. If 
anyone expert or otherwise questions the orthodoxy, they commit 
heresy. The result is group-think, which undermines the 
scientific process.''
    During the coronavirus pandemic, most medical scientists, 
for instance, uncritically accepted the epidemiological 
pronouncements of government-affiliated physicians who were not 
epidemiologists. At the same time, they dismissed actual 
epidemiologists as ``fringe'' when those specialists dared to 
question the conventional wisdom.
    In my essay, I postulate that the deference to government-
endorsed positions is probably related to funding. President 
Eisenhower observed in his farewell address, ``While the free 
university is historically the fountainhead of free ideas and 
scientific discovery, a government contract becomes virtually a 
substitute for intellectual curiosity.''
    He also wrote that, ``We should be alert to the danger that 
public policy could itself become captive of a scientific 
technological elite.''
    Most physicians today are employed by hospitals or by large 
multi-state corporate clinics. Many of these organizations 
derive significant income from government funding and 
government-ran programs and are thus reluctant to stray from 
the recommendations of government health agencies. They insist 
that their physicians adhere to these recommendations, even if 
they might personally disagree with the scientific rationale of 
those recommendations. Employers discourage them from 
communicating their reservations and concerns to their 
patients.
    The intrusion into the practice of medicine by non-
clinician public health officials and by lawmakers and 
bureaucrats who are untrained in medicine--yet have the hubris 
to tell physicians how and what they may use to treat their 
patients--threatens the integrity of the medical profession and 
indirectly imperils patients.
    While the intrusion into the practice of medicine 
accelerated during the pandemic, it is not new. Government 
agencies, including law enforcement agencies, have been 
directly or indirectly telling doctors how to practice medicine 
for over 100 years to support drug prohibition.
    Relatedly, starting in 2016, state lawmakers started 
dictating in statute the medical management of pain. That 
practice continues to this day even after the Centers for 
Disease Control and Prevention admonished lawmakers for 
misinterpreting and misapplying the CDC's pain management 
guidelines and revised them in late 2022--and revised them in 
late 2022. This has led to patients being under-treated for 
pain and doctors being afraid to treat them.
    Will lawmakers or government agencies next dictate what 
drugs doctors use to treat high cholesterol or hypertension or 
diabetes?
    The decades-long trend of government meddling in medicine 
has and will continue to erode physician autonomy and the 
patient-doctor relationship. But more importantly, physicians 
are ethically bound to respect their patient's autonomy as 
sovereign adults. Impeding them from informing their patients 
of the new diagnostic and therapeutic options and imparting 
their best and honest opinions to them assaults patient 
autonomy.
    Thank you for allowing me to participate in this important 
hearing, and I look forward to answering your questions.
    Dr. Wenstrup. Dr. Singer, I want to give you credit because 
I know your written statement has a lot more to say, and I 
appreciate that you were able to hone that down for us today. 
But thank you for both your written statement and that.
    I now recognize Dr. Khatibi to give an opening statement.

            STATEMENT OF AZADEH KHATIBI, M.D., M.S., M.P.H.

                               PHYSICIAN

                  MEDICAL ETHICS AND FREEDOM ADVOCATE

    Dr. Khatibi. Good morning, dear members of the 
Subcommittee, and thank you for the gracious invitation to 
speak before you today.
    My name is Dr. Azadeh Khatibi. I'm a board-certified 
physician in California.
    As an Iranian-American immigrant, I'm very grateful to have 
spent most of my life free from living under an authoritarian 
regime. But, during the COVID pandemic, I recognized disturbing 
elements of authoritarianism. Government collusion and 
pressuring for censorship, chilling of American speech, 
abridgment of rights without good reason in justifying it, and 
promotion of a toxic culture of misinformation policing and 
othering of anyone who challenges the CDC's views.
    The work of a physician is a sacred one. And, prior to 
COVID, our healthcare work force was already suffering from the 
severe problems of burnout and loss of autonomy. But the 
pandemic exponentially fractured the patient-doctor 
relationship and physician autonomy, particularly in states, 
institutions, and organizations which have used the momentum 
generated by the Federal Government to, themselves, also 
overreach.
    Medical ethics has four pillars to which doctors must 
adhere for their patients: Beneficence, nonmaleficence, patient 
autonomy, and justice. Furthermore, doctors are expected to act 
as fiduciaries for patients to act in the patient's best 
interest.
    In California, I have seen the attempt to remove 
physicians' basic rights, so I, along with some colleagues, 
have sued the Governor and the Medical Board of California.
    In 2022, they passed a law that declared it unprofessional 
conduct for a physician and surgeon to disseminate 
misinformation or disinformation related to COVID-19. And it 
defined misinformation as false information contradicted by 
contemporary scientific consensus contrary to standard of care.
    It was clear to me, even though it wasn't clear to the 
California Medical Association, that this violated doctors' 
right to free speech by chilling their speech and also the 
patients' First Amendment right to hear their doctors' speech. 
It was also clear that making doctors conform to scientific 
consensus would stunt the development of medicine by dampening 
scientific questioning and academic debate. Lives and liberty 
were at stake.
    The word ``consensus'' in the law, which has popped up 
nationally on the stage after COVID, is problematic. In medical 
terms, consensus refers to the general opinion of doctors or 
groups of doctors, either in formal opinion or formal 
publication.
    And, even when you craft formal consensus opinion, there's 
discussion. There's debate. There's disagreement by experts. It 
is natural and normal for doctors to disagree on what is best 
for individual patients or groups of patients. It is natural 
and normal.
    Throughout history, doctors have had liberty to contradict 
consensus opinion. Consensus is always catching up to the 
latest emerging evidence or thought frameworks, and thus, it is 
always behind the cutting edge.
    Multiple times as a physician and also personally for 
myself and for my family, I have gone against consensus 
opinion, formal and informal, and I believe that's one of the 
reasons I am alive today.
    What's truly frightening about this law is that it was 
written to target doctors' public speech originally. Make no 
mistake about it. If they could have gotten away with 
prohibiting doctors' public speech, they would have.
    In court, we argued that the law violates the First and 
14th Amendments of the Constitution, and we were granted a 
preliminary injunction against the law. But damage to the 
doctor-patient relationship has already been done. Doctors are 
afraid to speak out. They tell me their stories.
    One doctor tells patients: I'd tell you what I think, but I 
can't because it's illegal.
    Another says: I don't speak up about dosing concerns about 
the vaccine that I have.
    One responds to vaccine safety requirements by giving 
patients a list of vaccine side effects and otherwise stays 
silent.
    Another tells patients: I can't say what I want to say 
because I might lose my license.
    One doctor advised a group of us docs in a social setting: 
Don't ever write a vaccine exemption because you're going to be 
investigated, and you might lose your license.
    Another was wrongfully terminated from his job when he 
started becoming more politically active. Another told me she 
feels like she's practicing under Communism. Doctors say that 
the situation has gotten, ``crazy, ridiculous, bizarre.'' By 
the way, the majority of these examples are physicians I knew 
from before the pandemic, not after.
    I'm currently involved in two lawsuits for physicians' 
rights, and I'm doing my part, and I look to you to do your 
part to lay the policy framework for wisely being responsive 
instead reactive, having an ethical government that shuns 
censorship and chilling tactics, and encourages a culture of 
supporting open scientific debate by trained people, no matter 
if they come from inside the government or outside, and even if 
they disagree with the government's assessment.
    Last, I'm mentioning this because I think it's so 
important. I urge you to investigate the effects of COVID on 
the consistently sickest people in our population. They're 
about 15 to 20 percent of people, but they have about 50 
percent of the diagnoses, healthcare expenditures, and office 
visits in the United States.
    And decades of research at this point has shown that these 
highly sensitive individuals are more malleable to 
intervention. So, they actually--by the time the next pandemic 
comes, we could make them more physically and mentally 
healthier than the rest of the population with incredible 
healthcare costs and utilization savings benefits for the 
United States. So, I'm happy to talk about that as well.
    Thank you so much for your time today.
    Dr. Wenstrup. Thank you, Doctor.
    I now recognize Dr. Williams to give an opening statement.

                   STATEMENT OF JERRY WILLIAMS, M.D.

                                FOUNDER

                            URGENT CARE 24/7

    Dr. Williams. Chairman Dr. Wenstrup, Ranking Member Dr. 
Ruiz, and Members of the Subcommittee, I am pleased and honored 
to testify on this Subcommittee's important work.
    I am here to address the challenges that I faced as a 
practicing physician in the trenches during the COVID pandemic, 
having developed my own treatment protocol and treated over 
5,500 patients, resulting in only five hospitalizations and 
zero deaths. Yes, zero.
    To come before you and do such a thing as this in this 
current environment is not for faint of heart. I heard what the 
Chairman said about the physician who didn't come, and I 
understand that pressure and that concern.
    This is for the man in the arena. As John Wayne said, 
``Courage is being afraid but saddling up anyway.'' Still, I 
almost didn't come.
    But then I heard the words of one of my heroes, fellow 
Savanian Supreme Court Justice Clarence Thomas, who said, ``I 
would rather die than withdraw.''
    The industrial-medical complex and bureaucracy demanded 
that I stand down. Check at the door my common sense. Two 
internships, one in internal medicine and pediatrics, and a 
residency and fellowship in child and adult neurology, but I 
refused. Sadly, the overwhelming majority of my colleagues did 
comply.
    I didn't stand down then, and I won't stand down now. I'm 
here to speak for the 1.2 million U.S. citizens who died with 
COVID and the over 5.8 million others worldwide that did the 
same. I speak for the countless patients who now suffer from 
long COVID and post-vaccine injury. And, no, I am not anti-
vaccine.
    I speak for those that died from complications of the COVID 
vaccine. I speak for the family members who were refused access 
to their loved ones while their loved ones died in a hospital 
and nursing home alone. It is our duty to be the voice of 
others, to speak for others that cannot. It is also my First 
Amendment right, and I will be their voice.
    In early 2020, as the pandemic was beginning, I took an 
inventory of the arrows in my quiver to fight the COVID-19 
virus. I had one. A zinc tablet from my local pharmacy. That 
was it.
    Realizing how unprepared I was, I immediately went to work 
and began researching everything I could find on coronaviruses, 
and I found the 2005 peer-reviewed article from the Journal of 
Virology on chloroquine and its effectiveness against SARS-CoV 
infection and spread. Considering I had nothing else, it was a 
start. An inexpensive, safe, well-used old drug with worldwide 
availability.
    Simultaneously, I was working to protect my employees 
because it quickly became abundantly clear that we didn't have 
enough PPE. No one did. And you couldn't buy it at any price.
    So, I found a paper from 2010 that addressed the H1N1 
influenza pandemic of 2009, and it showed a reduction of flu 
transmission to healthcare workers by using outdoor exam rooms. 
So, we had the first outdoor exam rooms that I knew of 
anywhere.
    And I was immediately attacked on social media, and I was 
immediately attacked by a local hospital for violating OSHA and 
HIPAA by having outdoor exam rooms, which, by the way, became 
the standard nationally and internationally.
    On March the 9th, 2020, in the journal ``Clinical 
Infectious Diseases,'' an in-vitro study showed 
hydroxychloroquine--chloroquine's first cousin, so to speak--to 
be more effective than chloroquine in the inhibition of SARS-
CoV-2.
    I had more experience with hydroxychloroquine and was very 
comfortable with that medication and its safety profile, and so 
I immediately started preparing our first version of our 
treatment protocol. We never attempted to do a publishable 
study. Our goal was to kill this virus and save the next 
patient coming through the door. We never took a one-size 
approach fits all. We treated each patient with as much of our 
protocol as was appropriate and safe and our anecdotal evidence 
accrued.
    In summary, I simply adhered to my Hippocratic oath and a 
basic tenet of medicine, specifically infectious disease 
medicine--which the medical-industrial complex and bureaucracy 
asked us to all forget--treat early to prevent the afflicting 
agents, whether bacterial, viral, fungal, or protozoal from 
getting a toehold.
    I rolled up my sleeves and applied what I had learned, was 
transparent and honest with my patients, observed carefully, 
followed up and documented compulsively, adjusted when 
necessary, learned to unlearn, and refused that which was 
antithetical to medical science.
    Thank you for the opportunity to participate in this bully 
pulpit.
    Dr. Wenstrup. Thank you, Dr. Williams.
    I now recognize Dr. Shane to give an opening statement.

              STATEMENT OF ANDI SHANE M.D., M.P.H., M.S.C.

                                 CHIEF

                    DIVISION OF INFECTIOUS DISEASES

                        DEPARTMENT OF PEDIATRICS

                  EMORY UNIVERSITY SCHOOL OF MEDICINE

    Dr. Shane. Chairman Wenstrup, Ranking Member Ruiz, Members 
of the Subcommittee, thank you for inviting me to testify.
    As a pediatric infectious disease physician, I have cared 
for newborns, children, and adolescents with COVID-19 and led 
efforts at my institutions to ensure that care was optimally 
provided throughout the pandemic.
    The clinician-patient relationship is a foundation of our 
healthcare system. To earn and maintain our patients' trust and 
exercise beneficial medical judgment, we must stay abreast of 
the best available data. Our public health agencies are 
partners in this effort.
    During the COVID-19 pandemic, physicians worked rapidly to 
update practices according to new information. These changes 
often appeared confusing and required explanations about the 
why behind them. These discussions involved a true investment 
in the clinician-patient relationship.
    As a pediatrician, I have the privilege of taking care of 
children who are my patients and their parents who are 
indirectly my patients. When I think about the clinician-
patient relationship before, during, and after the pandemic, I 
see evolution, partially driven by the pandemic, and partially 
driven by the information explosion that has changed the 
delivery of healthcare.
    Supporting population-based health measures enhances the 
provision of optimal care for individual patients. In addition, 
community-based measures that prevent infection, 
hospitalization, and death benefit both the individual who 
remains healthy as a result and the community in which they 
reside. Preventing hospital overcrowding and healthcare worker 
burnout better positions us to provide high-quality care to 
individual patients.
    When COVID-19 vaccines first became available, there were 
compelling reasons to boost vaccination rates quickly based on 
the information that was available at that time. As a result, 
many healthcare professional societies supported policies 
requiring vaccination, particularly for healthcare workers.
    But vaccine requirements are not new. Schools require--have 
enrollment vaccine requirements, and we require seasonal 
influenza vaccine requirements for healthcare. Those have been 
in place for many years.
    Clinicians have been leaders in efforts to vaccinate the 
population. Infectious disease physicians have been deeply 
engaged in educating other clinicians about COVID-19 vaccines. 
We've partnered with public health agencies, community-based 
organizations, and the media to educate the public because we 
saw before us the lifesaving impact of COVID-19 vaccination.
    COVID-19 therapeutics are critical in saving lives and 
preventing hospitalizations. Data has helped us inform the 
prioritization of limited COVID-19 therapies, how to optimize 
them, and how to manage potential adverse effects. The 
collaboration of public health and clinicians is critical to 
collect, analyze, update, and make publicly available data on 
COVID-19 therapeutics.
    Now, the Federal Government healthcare systems, public 
health officials, and clinicians must work together to expand 
equitable access to both vaccines and antiviral therapies by 
increasing the use of telehealth, mobile clinics, and community 
health centers.
    When examining the clinician-patient relationship, I cannot 
help but be concerned about access. People residing in 80 
percent of U.S. counties do not have direct access to an 
infectious disease physician. Over half of our adult and 
pediatric infectious disease training program physicians went 
unfilled last year. Low compensation relative to other 
specialties is just one barrier.
    Despite these challenges, we are committed to applying 
lessons learned to improve our preparedness and responses to 
future public health emergencies by improving surveillance, 
data infrastructure, laboratory capacity, communication, and 
research to ensure that we preserve the clinician-patient 
relationship that is so instrumental in our Nation's health.
    It will take all of us coming together. I am grateful for 
this opportunity to testify. Thank you.
    Dr. Wenstrup. I want to thank you all very much.
    I now recognize myself for questions.
    Dr. Singer, I understand you published a study earlier this 
year regarding the Hippocratic oath and how it should be 
adapted. In this study, you note that medical schools are 
straying further from the traditions of their oaths. You 
specifically note that none of these oaths prioritize or 
consistently apply a commitment to individual patient autonomy.
    In your opinion, why is it important for medical school 
graduates to swear an oath that reveres patients' rights and 
autonomy?
    Dr. Singer. Thank you, Mr. Chairman.
    In my study about the Hippocratic oath, I actually--even 
going back to the original one from Hippocrates of Kos, there 
tends to be--there's not enough emphasis on the fact that the 
patient is a sovereign adult with rights that we need to 
respect, and that we, as physicians, are basically consultants 
giving our best opinion to these patients. We're not their 
bosses. We don't make decisions for them. We just tell them, 
based on our best knowledge, what we think is the best course 
for them to follow.
    In recent years, the Hippocratic oaths that are 
administered at various medical schools have strayed further 
and further from an oath that originally didn't give enough 
respect to patient autonomy, and now has gone far astray. Some 
of the oaths don't even discuss much about patient care.
    So, what I argue is that we need to get back to focusing on 
what we, as physicians graduating from medical school, need to 
commit ourselves to, which is to respect the rights of our 
patients. To look at our patients in much of a way as clients, 
and we're their consultants. And we're ethically obligated to 
tell them everything we know, not to withhold information from 
them that they are entitled to know if we know this 
information, and at the end of the day, respect whatever the 
decision they make because they're the boss. We're the 
consultants.
    Dr. Wenstrup. Thank you.
    I want to talk a minute about off-label treatments. It's 
long been understood that the FDA is not in the business of 
regulating the practice of medicine. This includes a 
physician's right to prescribe FDA-approved medications off-
label, meaning that the approved drug is used outside the 
specific scope of the approval.
    Off-label medications are critical to providing necessary 
care for millions of Americans, often patients who have few or 
no approved medications for their condition. Studies have 
estimated that up to 20 to 30 percent of all prescriptions are 
for off-label uses.
    I'm a podiatrist. I often prescribe nitroglycerin. Why? For 
patients with Raynaud's. So, when they're going to be exposed 
to cold, they can put a nitroglycerin patch over their 
posterior tibial artery, and their foot will be perfused with 
oxygen and blood during that time, and therefore averting 
amputations. And it worked every time.
    A Federal appeals court recently revived the lawsuit 
against the FDA which alleges the agency surpassed its 
authority and waded into the regulation of medicine. One such 
example is the FDA's now infamous tweet from August 2021. You 
can see the poster: ``You are not a horse. You are not a cow. 
Seriously, y'all. Stop it.''
    That's from the FDA.
    Let me tell you, I worked in the drugstore in high school, 
and I can remember a time where a medicine that, you know, we 
commonly dispensed--I looked at the label, and I saw the name 
of the patient was Spot. It was for a dog. I understood what 
that was about. It was a human medication that is also used for 
an animal.
    This tweet is condescending in every single way. And it's 
palpable. And it's incorrect. And it's misleading. And this is 
coming from the FDA. Not to mention, the FDA appears to 
conflate the off-label usage of FDA-approved human-grade 
ivermectin with its veterinary counterpart.
    Dr. Williams, as a child and adult neurologist, you have 
been using off-label medications for years prior to COVID-19. 
Is that right?
    Dr. Williams. Yes, sir.
    Dr. Wenstrup. Including drugs like ivermectin and 
hydroxychloroquine?
    Dr. Williams. Yes, sir.
    Dr. Wenstrup. And did you ever have a problem obtaining 
them for your patients prior to COVID?
    Dr. Williams. Many times.
    Dr. Wenstrup. Do you believe that actions taken by the FDA 
or other Federal officials may have caused this?
    Dr. Williams. Yes. Without question.
    Dr. Wenstrup. Dr. Singer, why is it important to preserve a 
doctor's right to prescribe medications off-label?
    Dr. Singer. Well, first of all, much of clinical knowledge 
comes from prescribing drugs off-label. We read in the medical 
literature much of the time comparative effectiveness studies 
showing how different drugs that were developed for one 
particular disease appear to have a use in another disease.
    Especially when there's a scientific rationale for it, we 
doctors sometimes use it on our patients in certain clinical 
situations, and then we share our experiences. Sometimes as 
time goes on, we learn that--it turns out that it wasn't what 
we thought it was cracked up to be, and we pass the word along 
and abandon it. But other times, we find that, indeed, this is 
an excellent treatment, and eventually the FDA comes around and 
revises its recommendations for use.
    But this is the way we gain scientific knowledge in the 
clinical field. You really can't gain knowledge unless you try 
different things and report on it to your colleagues.
    Dr. Wenstrup. Yes. And not to pick on you, Dr. Singer, but 
I look at minoxidil, which was approved for treating high blood 
pressure. But a side effect was hirsutism and hair growth, so 
dermatologists started mixing it off-label with lotion for hair 
growth. And now we see where that's now used commonly.
    You know, I want to talk about missed appointments a little 
bit. Because of disruptions in care during the pandemic, the 
number of patients who were screened for cancer fell 
significantly. Correspondingly, the numbers of diagnoses also 
fell off. Early stage cancer diagnoses fell by almost 20 
percent in 2020.
    A recent study in The Lancet Oncology found that this has 
now led to an increase in diagnoses of deadly late-stage 
cancers across almost all types of cancer.
    Dr. Singer, are you seeing some more trends in your field?
    Dr. Singer. Chairman Wenstrup, yes. In fact, we even saw 
this during the darkest days of the pandemic.
    I'm a general surgeon. So, among the spectrum of diseases 
that I'll deal with is, for example, appendicitis or 
diverticulitis. We'll see patients show up in the emergency 
department with very advanced cases. You know, several-day-old, 
ruptured appendicitis or ruptured diverticulitis or 
peritonitis. The kind of thing you rarely see in our, you know, 
developed society these days.
    And, since then, too, we've seen an unusually large number 
of people present into our office with surgical problems that 
are in a much more advanced state than we're accustomed to 
seeing them as.
    Dr. Wenstrup. I appreciate that.
    You know, in the early days, everyone was scared. So, you 
know, you understand how we just need to shut everything down.
    But what I have concerns about is where we're looking at 
local levels. I mean, I even had a sheriff call me because 
someone who was scheduled for their painful hernia, their case 
was canceled at a time when, in that county, there were no 
cases of COVID. And he ended up taking his life because he was 
in so much pain. So, you know, lessons learned, I think we 
ought to take into consideration what's going on at a local 
level.
    And I do want to take just the opportunity to discuss off-
label again a little bit and give Dr. Khatibi and Dr. Shane 
both a chance to give your thoughts on the use of medications 
off-label in general.
    Dr. Khatibi. Certainly, in my practice of ophthalmology, we 
use off-label drugs all the time. If we didn't, we would 
actually have a lot less of an arsenal of drugs to use against 
diseases. So, it's an integral part of medical care, and the 
government shouldn't be dictating to you the off-label uses 
that actually aren't potentially dangerous to patients and make 
sense, and especially in a late-stage case or something where 
there's just no other options. It's a good thing to have to be 
able to utilize.
    Dr. Wenstrup. We passed a bill here several years ago 
relating to the right to try.
    So, Dr. Shane?
    Dr. Shane. Thank you, Chairman Wenstrup.
    In pediatrics, I have actually had several opportunities to 
use medications off label. Unfortunately, because many 
medications are not tried in children as part of clinical 
trials, we're often forced to do that. And so, one of the 
really potential ways that we can optimize that is by including 
children in clinical trials so we can gather data, and 
medications do not have to be used off label.
    Thank you.
    Dr. Wenstrup. Thank you. Thank you all for your input here.
    I now recognize Dr. Ruiz for questions.
    Dr. Ruiz. Thank you.
    Over the course of the pandemic, public health officials 
worked with limited and constantly evolving and changing 
information to keep Americans safe and implemented policies to 
help our Nation overcome the virus. You know, we talk about 
off-label uses of medication. As a physician, it's something we 
do, but we also do it with caution, and we do it in respect of 
science in search of the evidence to help us determine whether 
it's a sham or whether it's a real medication that has proof.
    And the whole scientific process is to move us from 
anecdotes to the statistical realm so that we can prove and 
replicate that our results are not due by chance but that, 
within a 95 percent confidence, that they are true, that they 
will happen, that this actually works. So, it's not anecdotal 
or if it just happens with this one time, it works or not, or 
maybe a group of 10 patients or 50 patients and we swear by it, 
but so that we can get to that truth.
    And I do believe that all of you had mentioned something 
very important that was common is I wish there were more 
studies, or we need more studies. Or even in these off-label 
uses, the studies refute its use, and it really didn't work, so 
we stopped using them.
    So, at the beginning of this pandemic, there was some 
anecdotes, some suggestions with bench research, perhaps, on 
some of these medications, but then we, with caution, said be 
careful; let's do more research. And then as the research 
developed, then there would be some recommendations, and the 
medical societies, the boards, the people that certify our 
board certifications in all of our respected fields, 
physicians, our colleagues, those that aren't, you know, 
running for office or anything, put certain parameters based on 
that research to give us some kind of gold standard of practice 
so that we can abide by.
    And those, your colleagues, my colleagues, his colleagues, 
all of you our colleagues who are the professors in 
universities and the researchers gave us these recommendations 
and said, look, if you want to be board certified and hold up 
to our standards, we believe that the scientific literature 
will recommend this and not recommend that, and this is what we 
believe at this time.
    At this time is always key and it's always important 
because we must be humble to the fact that science evolves and 
things change, and we're using that now to even understand long 
COVID, to determine what are the commonalties and how to treat 
it, because of symptoms, they are realizing because the science 
is real, and there is such a thing as a long COVID syndrome.
    And so, we are evolving in that aspect, and we are evolving 
in understanding the science to develop more therapeutics in 
addition to the vaccines so that when people do have a 
breakthrough symptomatology, that, even after a vaccine, that 
they have the treatments to be able to limit the intensity and 
the duration of illness.
    It's just science. It's what we are trained to do. It's 
what we want to look at to see if there is evidence about that. 
All of us participated in journal clubs during residency, and 
we learned how to analyze that science. So, this is--you know, 
this is what has evolved.
    It's not a, you know, government conspiracy to come and 
suppress the physicians or the physician's ability to think 
independently or to interfere into the patient-doctor 
relationship. This is a practice amongst our colleagues of 
saying, well, let's look at the data. Let's look to see what is 
out there and, as it evolves, let's give these the 
recommendations.
    And a clear example of that and in search of this science, 
our goal was to get a vaccine. We're all waiting for a vaccine 
to help us reduce the transmission, for many prevent getting 
sick, and for the rest to reduce hospitalizations and intensity 
and duration so that we can put kids back in schools and people 
back in jobs and come back to a new normal.
    And so, the notion that or the general notion that the 
Federal Government sought to subvert physicians and erode the 
doctor-patient relationship during the pandemic, even with the 
vaccine requirement, is just not true. And it's not helpful 
when we know that the vaccine is are best arsenal to help 
eliminate the spread of a dangerous virus and to protect the 
public's health.
    So as a physician, you know, I'd like to start by--with the 
COVID-19 vaccine requirements questions.
    And so, Dr. Shane, why were requirements a clinically 
appropriate tool to boost vaccine rates, especially among high-
risk individuals in high-risk settings, which is not a new 
notion? We've done it before in many different settings. And 
how have they been used in context outside of the COVID-19 
pandemic to reduce the threat of other dangerous diseases in 
the United States?
    Dr. Shane. So, thank you very much for that question.
    So, during the COVID-19 pandemic, as we know, as you 
mentioned, we were all waiting for a vaccine, and the reason 
why the mandates were so essential at that particular time was 
that we needed a rapid way of ensuring that people got 
vaccinated. And certainly, there was a lot of communication 
about the benefits, and with everything, there is always a 
risk, so communication about the risk as well.
    But the mandates or the requirements were really an optimal 
way to ensure that the vaccine reached the most number of 
people, and, in addition, that requirement also allowed for 
improving access, which was a clear and important issue as 
well.
    Dr. Ruiz. Thank you.
    So, thanks to the policies that President Biden put in 
place, including these common-sense vaccination requirements, 
more than 230 million Americans got vaccinated, 3.2 million 
deaths were prevented. 3.2 million deaths were prevented, and 
18.5 million hospitalizations were averted.
    And when pandemic era vaccine requirements were challenged 
in the courts, America's leading medical societies, our 
colleges, the physicians that certified your practice and your 
training and residencies and to ensure that all of our 
practices are up to our current standards, including the 
physicians in the American Medical Associations, the physicians 
in the American College of Physicians, the physicians in the 
American Academy of Family Physicians, the physicians in the 
American Academy of Pediatrics, and several others all 
expressed strong support.
    The physicians expressed strong support for these policies 
as a critical tool to help America overcome the pandemic.
    So Dr. Shane, as a physician, do you agree with the 
allegations that doctors were sidelined, and that the 
physician-patient relationship was disregarded in the 
discussions surrounding COVID-19 vaccine requirements?
    Dr. Shane. So, thank you.
    I do not. You know, desperate times calls for desperate 
measures, and the vaccine requirements were the optimal way to 
enhance that.
    Despite the requirement, there were lots of opportunities 
for physicians to communicate with their patients and families 
to ensure that there is a good understanding of, as I mentioned 
in my statement, the why behind the rationale, and that is what 
is so important, is making sure that people understand the why 
and rationale.
    Dr. Ruiz. And there are some patients that we would 
recommend not to get the vaccine. There were some 
contraindications based on the studies and the histories that 
should not get the vaccines.
    Do you agree with the characterizations of COVID-19 vaccine 
requirements as a one-size-fits-all protocols that undermine 
the quality of care Americans receive from their physicians?
    Dr. Shane. No, I do not. And especially since I take care 
of children of many different sizes, I certainly couldn't have 
a one-size-fits-all approach and had to tailor all of my 
recommendations based on the patient and their condition.
    Dr. Ruiz. You know, I would also like to address the 
suggestion that population-based health approaches undermine 
the quality of care that a physician can provide to their 
individual patients.
    Dr. Shane, in your written testimony, you state that, 
quote, supporting population-based health measures does not run 
counter to providing optimal care for our individual patients. 
You note that community-based measures prevent infection, 
hospitalizations, and death; thereby, benefiting individuals 
who stay healthy as a result.
    So how did population-based COVID-19 public health 
measures, such as masking and other mitigation measures, 
safeguard individuals' health during the pandemic?
    Dr. Shane. So, thank you for the question.
    Those mitigation measures both had an impact on the 
individual and, in addition, to the community. So, when 
individuals are healthy, that means--individuals comprise 
communities and communities are healthy.
    And the vaccinations were one. Masking, separation when 
needed, having people stay home when ill, those were all things 
that we had to do to flatten the curve and to make sure that we 
could bring ourselves back to a society that was enabled to 
have the normal interactions.
    Dr. Ruiz. Thank you.
    You know, I have both a doctorate in medicine and a 
master's in public health, and the practices, although overall 
achieved the same objective, a healthy individual, a healthy 
population, there are some practices for population health and 
the understanding of that field that's different than what we 
learn in medical school. And so, I think that that's why there 
is oftentimes a lot of confusion trying to extrapolate 
individual care to population care and vice versa.
    And so there is a profession and a goal to keep a 
population safe as it relates to the individual care, and they 
are not incongruent, but they are different.
    So, one final question for you. How does the work of our 
public health institutions complement, as opposed to undermine, 
a physician's role in providing the best care for their 
patients?
    Dr. Shane. So, thank you for the question.
    That's actually very critical, and the clinician has a 
perspective, the individual perspective, and then the public 
health institutions have a different perspective, and so 
bringing those two together is the best way to ensure that we 
have policies and recommendations that take into account both 
the individual and the community.
    Thank you.
    Dr. Ruiz. Thank you.
    And I yield back.
    Dr. Wenstrup. I now recognize Dr. Miller-Meeks for 5 
minutes of questions.
    Dr. Miller-Meeks. Thank you, Mr. Chairman. I would like to 
thank the SSCP for having this hearing, and I would also like 
to thank all of the witnesses for testifying before this Select 
Subcommittee today.
    First let me just say for those who don't know me, I'm a 
physician, was a nurse prior to being a physician, was also the 
director of the Iowa Department of Public Health, and a 24-year 
military veteran. So, I have a lot of experience in all facets 
of medicine.
    The COVID-19 pandemic dramatically altered many aspects of 
healthcare. As we know, hospitals and clinics were closed even 
though in the healthcare setting we know how to manage 
infectious diseases. But most notably I think what we saw was a 
further erosion of the doctor-patient relationship.
    So as a physician and a nurse with decades of experience 
delivering care to patients of all ages and in various 
healthcare settings, I recognize the value and the reality that 
patient medical needs can rarely, if ever, be broad brushed. 
Individual needs vary drastically. These can be due to 
allergies, comorbidities, intolerances, various other medical 
factors or social factors that require a robust doctor-patient 
relationship, and this is something that all doctors, including 
my friends and physician colleagues on the other side of the 
aisle publicly recognize.
    And let's also admit, as Dr. Wenstrup did at the start of 
this hearing, that there have been decades of erosion of the 
doctor-patient relationship from pre-authorization, step 
therapy, fail first therapies, even when things have already 
been tried, even how EHRs and standardized practices gear 
toward billing rather than toward actual patient assessment and 
care.
    The use of off-label medicines. Never before have we had 
Governors threaten the medical licenses of individuals if, 
through their interactions and their medical knowledge were to 
prescribe a patient a certain type of medication, or boards of 
pharmacies to be told that those certificates would be removed.
    I was and am still appalled by the multitude of COVID-19 
vaccine mandates imposed by Federal, state, and local 
governments throughout the pandemic for exactly this reason, 
and I would disagree with our witness who said that there were 
lots of opportunities. There were not lots of opportunities.
    If you were in the healthcare setting, despite over a year 
of having provided care to patients with PPE, you were mandated 
to get a vaccine or lose your job. I know of people who lost 
their job. If you were in the military, you were required to 
get a vaccine even if you were 18 or 20 years old, even if you 
had--your risk for getting myocarditis or pericarditis, may 
have, in fact, been greater than your risk of being 
hospitalized or dying of COVID-19.
    We did not recognize infection-acquired immunity, which we 
have in every other type of infectious disease but not in this 
one. Somehow it just evaporated when it came to COVID-19.
    And in our school systems, you couldn't go to school as a 
child if you weren't vaccinated, so excuse me if I do not 
believe that the doctor-patient relationship and the doctors' 
conversations with individuals may have said you're at low risk 
getting vaccinated or you've had COVID-19.
    I had the same experience as Dr. Wenstrup. I was 
vaccinated. I gave vaccines in the 24 counties in my district, 
recommended for people to be vaccinated and have conversations 
with their provider, but nonetheless, when I was testing my 
antibody levels and keeping track of them because of some 
research that said you may decrease antibody levels with 
boosters, my antibody levels were high but even last December 
was still recommended to get the vaccine, to get a booster.
    So, I'm not going to continue to pontificate, although we 
could go on for quite a while.
    Dr. Williams, in your written testimony, you detail how you 
developed your own treatment protocol for COVID patients during 
the pandemic. And let's remember that COVID patients were told 
if they tested positive, come back when you're really sick, and 
you might die first before you come back in. So, there were no 
treatment protocols offered to these individuals.
    So, your protocols resulted in five hospitalizations, zero 
deaths, despite seeing over 5,500 patients. Can you detail why 
this approach was effective and whether your practice would 
have benefited from increased government presence?
    Dr. Williams. Thank you, ma'am, for the question.
    I took what I was trained to do, and I applied it because 
we didn't have any options at that point at the beginning of 
the pandemic. And I dove into the research, and I found what I 
could find, but we all agree it was an incomplete data base. 
And there is the old saying, I cannot argue with anecdotal 
evidence. But that was all we had. That was all we had.
    But then we do what we do. We practice medicine and we 
observe, and we adjust, and we learn and, most importantly, 
sometimes we unlearn.
    And I was pro-vaccine. I was as anxious, and I was one of 
the first people to get the vaccine in my county at the behest 
of our county health official who called me directly because my 
name wasn't on the list. And I said, no, in the Marine Corps, 
the drill sergeant goes last. He eats last. His troops eat 
first. I'll go last. He said, I need you to re-think that for 
me. I need you to go first because there is some trepidation.
    And I gladly went first. I'm twice vaccinated and once 
boosted, but when they started refusing to acknowledge natural 
immunity post infection, it was a red flag for me. And I've 
always maintained, and I've made this very public that it's an 
individual decision between the patient and their medical care 
provider.
    My protocols took a broad stroke approach at this virus. 
It's almost like peeling an onion. There's multiple layers. So, 
we were trying to attack the virus to kill the virus using 
virucidal whatever we had that we felt like was safe, first do 
no harm.
    But I was also looking at, with this silent kind of storm, 
what was killing these patients in the hospital. So, the 
inflammatory response to this virus is something that we needed 
to talk about more, we needed to address. So, we used, 
amazingly, some very simple over-the-counter medications that 
stabilized the mast cell and the neutrophil. These are cells in 
our body that control the inflammatory response.
    And we're talking about things like Claritin, loratadine, 
famotidine, Pepcid AC. These kinds of drugs and the supplement 
melatonin is a strong mast cell stabilizer. So, we were working 
hard to stabilize these patients' mass cells.
    My goal, owning an urgent care company, was I had to 
address these patients that showed up at my door frightened, 
and some of them were very, very sick and did not want to go to 
the hospital. And my goal was to save each patient that came 
through the door and to address this virus from every direction 
that I could.
    Dr. Miller-Meeks. Thank you, Dr. Williams. I hope others 
will allow you to expand on your testimony.
    I yield back.
    Dr. Wenstrup. I now recognize Ms. Ross from North Carolina 
for 5 minutes.
    Ms. Ross. Thank you, Mr. Chairman.
    Right now in America we're witnessing an unprecedented 
interference in the ability of physicians to provide the best 
possible care for their patients. In states across the country, 
politicians are practicing medicine without a license, getting 
in the middle of decisions that should be made by a woman and 
her doctor.
    We've heard Republicans on this panel say that Americans 
need to be educated by doctors, not indoctrinated by 
politicians. I could not agree more.
    From North Carolina to Arizona, extreme Republican 
legislatures at the state level have pursued draconian policies 
to control women's reproductive freedom in spite of 
approximately eight in ten American adults who believe the 
decision to have an abortion should be left to a woman and her 
doctor.
    And, yes, in spite of this, we also have medical consensus 
from doctors all around the country. They have told us so. The 
American College of Obstetricians and Gynecologists led 24 
medical organizations, including the American Academy of 
Pediatrics, the American Academy of Family Physicians, the 
American College of Physicians, the American Medical Women's 
Association, in filing an amicus brief in Dobbs versus Jackson 
in opposition to Mississippi's abortion ban after 15 weeks of 
pregnancy, writing that the ban impermissibly intrudes in the 
patient-physician relationship by limiting physicians' ability 
to provide the healthcare that the patient, in consultation 
with her physician, decides is best for her health.
    And that Mississippi's policy places clinicians in the 
untenable position of choosing between providing care 
consistent with their best medical judgment, scientific 
evidence, and the clinician's ethical obligations or risk 
losing their medical license.
    Dr. Shane, as a physician, do you agree that abortion bans 
intrude on a physician's autonomy to provide the best care for 
their patients in accordance with their medical judgment?
    Dr. Shane. Thank you for the question.
    Yes, I do.
    Ms. Ross. Thank you so much.
    This isn't the only example of physicians speaking out 
against extreme abortion bans enacted in states across America. 
In Ohio, the American College of Obstetricians and 
Gynecologists, the American Medical Association, the Society 
For Maternal Fetal Medicine filed an amicus brief in opposition 
to the State's 6-week abortion ban, writing that the law would 
force clinicians to delay provided needed medical care until a 
patient is in a critical situation.
    And by the way, on the opposing side were 18 Republican 
attorneys general, some might say a group of politicians, who 
filed a brief in support of the abortion ban. The list goes on 
and on.
    Now, let's compare how doctors responded to public health 
measures implemented during the COVID-19 pandemic.
    In November 2021, the American Medical Association, led by 
60 organizations and more than 30 preeminent doctors, 
scientists, and public health leaders had a statement of 
support for OSHA's vaccine policies. In BST Holdings v. OSHA, 
the AMA filed an amicus brief in support of the agency's 
vaccine and testing policies emphasizing that COVID-19 poses a 
grave danger to public health and that halting the policies 
would irreparably harm the public interest.
    In MB, parent of minor SB v. Knox County Board of 
Education, Democracy Forward filed an amicus brief on behalf of 
the Tennessee chapter of the American Academy of Pediatrics in 
support of schools making policies pointing to the significant 
protection that masking provides to teachers, students, and the 
community. The list goes on.
    Dr. Shane, based on everything that I've just shared, do 
you agree that the vast majority of the physician community 
supported public health measures implemented to reduce the 
spread of COVID-19 and overcome the pandemic?
    Dr. Shane. Thank you for the question.
    Yes. During the time of the COVID pandemic, physicians did 
overwhelmingly support the mitigation measures that was so life 
preserving and enabled people to continue to do some of the 
essential work like attending schools, going to businesses, and 
doing all of those other things very, very safely.
    Ms. Ross. Thank you very much.
    And Mr. Chairman, I yield back.
    Dr. Wenstrup. I now recognize Ms. Lesko from Arizona for 5 
minutes of questions.
    Mrs. Lesko. Thank you, Mr. Chair.
    First, I want to thank you for having this topic of 
discussion. I think it's an important topic.
    And I also want to thank all four of you for coming to 
testify today in front of us. And I have to admit that I know 
Dr. Singer for, I don't know, like 20 years I think, 20 years. 
He's from Arizona, and I represent the Phoenix area and some 
suburbs of Phoenix in Arizona.
    I would love to debate some of the extreme pro-abortion 
views that are going on in our country right now that support 
abortion up to the very last minute, but this is not the 
meeting to do that at. So next time I will debate that if we 
have a hearing on that.
    Dr. Singer, on April 2, 2020, Arizona Governor, Doug Ducey, 
issued an executive order barring pharmacists from dispensing 
hydroxychloroquine or ivermectin unless they had a prescription 
from a doctor saying the patient had COVID-19.
    In Arizona, patients were not allowed to use these drugs 
for preventative measures even if a doctor prescribed it. The 
Governor limited the prescription to 14 days. This was the case 
not just in Arizona but across the country. Now, I'm not sure 
in the case of Arizona if--I think he did it, quite frankly, 
because he thought there would be a shortage of ivermectin and 
hydroxychloroquine.
    Also, in 2021, William and Karla Salier had gotten 
prescriptions from a doctor in Missouri for ivermectin and 
hydroxychloroquine to treat their infection with COVID-19. 
William Salier had become seriously ill from the virus. 
Pharmacists at Walmart and Hy-Vee refused to fill those 
prescriptions. Karla Salier says the Walmart pharmacist rudely 
lectured her about the dangers of treating COVID-19 with 
ivermectin, and the Hy-Vee pharmacist said it was against 
corporate policy to prescribe the drugs for COVID-19.
    Dr. Singer, do you think it was right for governments and 
pharmacies to overrule doctors?
    Dr. Singer. Thank you, Representative Lesko.
    As I said in my opening Statement, this was a major problem 
and nowadays most pharmacies employ pharmacists, and most 
medical doctors are employed either by hospitals or corporate 
clinics who, even if they're not explicitly told by government 
agencies what the policy should be, they certainly feel the 
pressure, and they don't want to go against government 
agencies.
    Right now, the evidence suggests that hydroxychloroquine 
and ivermectin are not helpful in the treatment of COVID-19, 
but in the early days of this pandemic, when thousands were 
dying on a daily basis, and we didn't know--the information was 
just coming in--we're still getting information. We're still 
learning more now than we thought we knew--there was anecdotal 
and observational evidence that these drugs may be effective to 
prevent or treat COVID-19.
    It was, I would argue, the ethical thing for a physician 
speaking to their patient to say, I'm aware from anecdotal 
evidence that this may be helpful. We're talking about drugs 
that have a very good safety profile. They've been around for 
years, used for other things, and don't have a very high 
complication rate.
    And I think it would have been unethical for the physician 
not to mention to the patient that this may be helpful, 
providing you understand that I can't guarantee it because all 
the information isn't in, and providing that you're willing to 
accept whatever risk this drug has, and then let the patient 
decide.
    So, this became politicized, and this is kind of 
unprecedented because as it was mentioned earlier during the 
testimony, 20 percent or more of all drugs prescribed in this 
country are off-label prescriptions, and we don't see this kind 
of interference. And we physicians, as we learn, as time goes 
by, if we learn that the off-label use of that drug turns out 
not to be effective, then we stop doing it.
    But if we suppress basically clinical investigation and 
just sharing of clinical knowledge, then you suppress the 
advancement of medical science.
    Mrs. Lesko. Well, I agree, and so thank you very much.
    Dr. Williams, do you have anything more to say on the 
subject? Because I know Dr. Miller-Meeks ran out of time.
    Dr. Williams. Well, my colleague--thank you--she made a 
good point. As a pediatric subspecialist, as a child 
neurologist, I've had to use drug off label for my pediatric 
patients, for example, my entire career. I mean, we did it 
every single day of fellowship, for example. So, I was used to 
having that conversation with my patient about off-label use 
risk/benefit, and we make a decision--the patient makes a 
decision in consultation with their medical care provider, 
whether it's a physician, nurse practitioner, PA, et cetera. So 
that's part of that sacred relationship that we're here talking 
about today.
    And also, I would ask everyone to keep in mind that early 
on, hydroxychloroquine had an EUA briefly for use.
    Ms. Lesko. All right. Well, thank you all again.
    And I ran out of time, so I yield back.
    Dr. Wenstrup. I now recognize Mr. Garcia from California 
for 5 minutes of questions.
    Mr. Garcia. Thank you, Mr. Chairman.
    I just do want to start just by pushing back against some 
of the Republican claims and some from my colleagues that these 
abortion bans that are completely extreme and out of step are 
outside the scope of this hearing. Now, to use their own words, 
this hearing is about a `` one-size-fits-all protocols promoted 
by politicians that eliminate the decision-making power of 
patients and physicians.''
    Now, we know that abortion bans have deprived women in 22 
States of access to abortion and criminalized doctors seeking 
to provide the highest quality care to their patients. They 
have assaulted the reproductive freedom and bodily autonomy for 
more than 25 million people.
    House Republicans advanced these bans before the pandemic, 
during the pandemic, and are continuing to do so this day. So, 
with all due respect, I disagree, and I think it's critical 
that we ensure this hearing addresses the doctor-patient 
relationship, especially when it comes to abortion bans.
    Now, today we're also, unfortunately, enabling extremists 
who claim that masks are child abuse and that vaccines don't 
work. It's appalling, it's embarrassing, and it's endangering 
American lives.
    Now, the House Republicans have built an entire platform 
around controlling women's bodies, banning health care for 
LGBTQ+ people, and putting corporate profits over the health of 
everyday Americans. As a committee, we should be coming 
together to protect public health and fighting to make medical 
care more accessible for all Americans, but instead, House 
Republicans are working to undermine the doctor-patient 
relationship and push essential health care out of reach for 
women, LGBTQ+ people, low-income Americans, and seniors.
    Now, the truth is most doctors and medical professionals 
continue to support common sense guidelines about pandemic 
response just like they overwhelmingly support access to 
abortion, gender forming care, and HIV prevention. But right 
now, Republican leaders are working overtime to restrict every 
single one of these things even over the explicit protest of 
doctors, patients, and medical experts.
    Now, over 20 Republican-led State legislatures have 
criminalized health care for LGBTQ+ people, forcing families to 
travel hundreds of miles and even flee their communities to 
access lifesaving medically recommended care. It's also 
estimated that nearly 400,000 transgender adults live in States 
that are considering legislation to ban health care that they 
actually depend on. This is almost half a million Americans.
    And this doesn't stop at trans people or the broader LGBTQ+ 
community and their families. Far right leaders are so 
desperate to continue their attacks on LGBTQ+ Americans that 
they're targeting critical medication that prevents the 
transmission of HIV.
    In March, an extreme Republican appointed judge in Texas 
struck down the Affordable Care Act's free preventative 
services requirement all because of a culture of vendetta 
against the very existence of gay people. And I know this 
because I, myself, am part of the community.
    Now, Mr. Chairman, medical providers are pulling out of 
already underserved communities and Republican led States 
explicitly because these policies infringe on their ability to 
care for patients. Doctors are being threatened with legal 
action for simply providing safe, effective, and medically 
necessary health care all because extremists points of view 
have decided their top priority should be interfering with 
people's most personal medical decisions and the doctor-patient 
relationship.
    Dr. Shane, I want to ask you, given your perspective as an 
expert in infectious diseases, I want to ask you about the 
importance of accurate science-based public health information. 
First of all, how important is it for government institutions 
to provide patients and physicians with clear and consistent 
public health information, especially during an ongoing 
pandemic?
    Dr. Shane. Thank you for the question, Representative 
Garcia.
    It is absolutely critically important that information is 
available, that it is accessible, that it is interpreted and 
communicated to families and to patients.
    Mr. Garcia. And is it fair to say the overwhelming majority 
of physicians, including infectious disease doctors that you're 
representing today, supported efforts to get Americans 
vaccinated?
    Dr. Shane. Absolutely, yes, we do.
    Mr. Garcia. And I want to add also I was mayor of my city 
for 8 years. We have our own health department. We don't use 
the county system. We run one of the largest health departments 
in the State of California, and we pushed to get everyone 
vaccinated, and that was on the advice of the overwhelming 
majority of doctors.
    So, I want to thank you, Dr. Shane, for being part of the 
medical community that actually worked to save lives, not to 
try to cause disinformation that actually got people killed 
during the pandemic.
    I want to also ask are individuals, including political 
leaders, who spread misinformation about vaccines endangering 
public health and costing American lives?
    Dr. Shane. Thank you for the question.
    Yes. Unfortunately, when misinformation is spread, that has 
tremendous adverse effects that impact not only the individual 
but the entire community.
    Mr. Garcia. Thank you.
    And I want to again add that it's really unfortunate that 
we continue to push vaccine hesitancy not just in this 
committee but across the country.
    And with that, Mr. Chairman, I yield back.
    Dr. Wenstrup. I now recognize Mr. Cloud from Texas for 5 
minutes of questions.
    Mr. Cloud. Thank you.
    And I want to thank you all for being here. Often, it's 
said that we're the home of the free because of the brave, and 
certainly our minds go to our soldiers and veterans when we 
hear that, and rightfully so. But as I've traveled in my 
district and the country, I often remind people that we only 
save our Nation when everybody in every walk of life stands up 
and is courageous.
    And so, I want to thank you for being here in spite of some 
of the concerns that have been mentioned that's going on with 
doctors being ostracized and losing licenses and all those 
different kind of things.
    I'm concerned about a trend that we've seen recently in 
health care where we go from America being the envy of the 
world when it comes to health care system, bringing innovations 
to the world, doing all these different kind of things. And 
sure, it's not a perfect system, but we certainly led the world 
in it to where we've seen recently a kind of massive 
consolidation of power.
    And then that has also been a part of this separation 
between the doctor and patient, Obamacare being a big part of 
this to where we see more people on health insurance rolls and 
less people actually getting health care. So, it was great for 
the profits of the health insurance companies; not so great for 
the patient.
    And then COVID pandemic and our response to it exacerbating 
that in a sense, and you've touched on a number of those things 
in the past, but truly the pandemic made this situation worse. 
We saw people silenced. We saw people dissented.
    I know of public health officials that were out there 
spouting the CDC official line but then had a closet full of 
hydroxychloroquine or ivermectin for their own patients. I know 
of pharmacists that it's been mentioned that wouldn't fill 
doctor prescriptions. I was in, you know, much of my district's 
role, and there were hospitals that stopped doing surgeries 
even though there was not one single case of COVID in their 
district.
    Even here in the House, the House physician sent out a memo 
giving fines for people not wearing masks, but it was just for 
the House. So, you could literally be in the Rotunda and 
subject to a fine for not wearing a mask of one half of the 
Rotunda, take two steps over in the same room and be totally 
clear even though--and how should I put this--the demographic 
profile of the Senate was more vulnerable to COVID.
    So, this whole thing has really been bizarre, and it's 
caused a massive distrust from the American people when it 
comes to what they should expect out of it, and a lot of this 
consolidation of power has turned to these nice terms like 
consensus, which is actually a good thing, population-based or 
community-based health care, as opposed to focusing on the 
individual in front of the doctor.
    And you all have given great testimony.
    Dr. Khatibi, I wanted to talk to you because I was 
interested in how you talked about consensus and also 
especially you being an immigrant from an authoritarian regime. 
I find it interesting that when I travel, many immigrants 
actually understand and are more concerned even than people who 
have been kind of in the boiling pot of what's happening in 
America, kind of a frog in a boiling pot. They see what's 
happening when it comes to some of these concerns.
    And I was wondering if you could speak to some of that and 
your concerns about that and, you know, especially maybe why 
this is happening. What do you think is behind all of this?
    Dr. Khatibi. Well, let me start off with the why. I think 
that as a consciousness in the United States, we're still very 
much in a reactive way of behaving, and we certainly saw that 
during COVID. People, instead of being wisely, mindfully 
responsive, they're just reactive. They ``other''. They don't 
listen. We've seen that here.
    And what happens is then people stop thinking, and they 
start trying to kind of focus on ego-based protective 
mechanisms that then actually prevent you from thinking 
cognitively.
    And the people who had experience living in authoritarian 
regimes have seen it, so they have more access to that 
cognitive experience because they've lived it, and so they can 
connect the dots more easily than someone who is just living in 
fight or flight and being reactive.
    So, they recognize these patterns of chilling of speech, 
everybody kind of in a group think, the government pressuring 
for censorship or suspecting it and noticing that there is 
pressure from the government. They notice these things better, 
easier.
    And so, I have certainly seen that in my immigrant 
community, that people are more weary of the American 
government now, and I think people are waking up a little bit 
and seeing what happened during COVID. People who disagreed 
with me a few years ago are agreeing now.
    What was the first part of your question?
    Mr. Cloud. I don't recall.
    Dr. Singer, you talked a lot about the cash incentive 
involved in it, and it seems like there is kind of almost a 
carrot and stick to this in the sense that the Federal dollars 
flowing into the system in ways have kind of messed up the 
incentive structure of honest feedback.
    And it seems also in a sense there is also the legal 
recourse in that a lot of people, like the CDC, will come out 
and just say, oh, it's a recommendation. But you know, 
unspoken, if you don't follow it, that you open yourself up to 
lawsuit abuse; meanwhile, you know, you have these massive 
companies that are kind of protected from liability, 
specifically in the case of vaccines.
    I was wondering if you could speak a little more to your 
concerns in that regard.
    Dr. Singer. Representative Cloud, that's a very good point. 
In fact, it's not limited just to the coronavirus pandemic. In 
general, when government agencies recommend things, it 
oftentimes becomes a de facto mandate because of the government 
agency being a source of funding or maybe having, you know, 
regulatory oversight that could be detrimental to the entities 
that is making recommendations to it.
    So, I jokingly say that, you know, when the CDC recommends 
something, it's oftentimes like when Tony Soprano recommends 
something.
    So, your point is well-taken, and I think it's just a 
natural phenomenon the way it is when the government gets 
involved in these things. I think it's unavoidable, but that 
contributes to a creation of distrust between the patient and 
the doctor because especially with the experience that we've 
had where there was constant changing of different 
recommendations, which is understandable because the 
information was changing. So, these recommendations had to be 
revised.
    Patients started wondering are you, doctor, recommending 
this to me because you really believe this is what you think I 
should do, or are you recommending this to me because you're 
afraid you'll get in trouble if you don't recommend this to me? 
And that's not a healthy relationship between a patient and a 
doctor.
    Mr. Cloud. Thank you.
    Chairman, I'll yield back.
    Dr. Wenstrup. I now recognize Ms. Tokuda from Hawaii for 5 
minutes of questions.
    Ms. Tokuda. Thank you, Mr. Chair.
    The entire premise of this hearing is the erosion of the 
doctor-patient relationship as a result of politicians telling 
doctors how they should treat their patients. So, let's talk 
about that.
    It is truly hypocritical that my Republican colleagues are 
convening a hearing on government overreach into the doctor-
patient relationship when their party is literally writing the 
playbook across our country on how to do exactly that all while 
endangering the lives of 25 million women by denying them 
access to abortions and forcing doctors to break their 
Hippocratic oath to do no harm when government denies them the 
ability to provide their patients with the care and treatment 
they need.
    Since the right-wing majority of the Supreme Court 
overturned Roe, extreme Republican lawmakers have been tripping 
over themselves to pass dangerous bans and restrictions, 
defying the will of the majority of Americans.
    According to the American College of Obstetricians and 
Gynecologists, and its over 57,000 members, abortion is an 
essential component of women's health care. Abortion is health 
care.
    Ms. Green. Murdering babies.
    Ms. Tokuda. When we criminalize--excuse me, Mr. Chair. I 
would like some--the ability to answer my question.
    When we criminalize health care, undermine a patient's 
ability--thank you very much.
    Dr. Wenstrup. Please, we'll have order, and I will expect 
that Ms. Tokuda has her right to make her comments.
    Ms. Tokuda. And I appreciate----
    Dr. Wenstrup. Everyone will get their time.
    Ms. Tokuda. Thank you. I hope so.
    When we criminalize health care, undermine a patient's 
ability to access health care, tell doctors how they should and 
should not treat their patients, we have failed.
    Dr. Shane, yes or no. Do abortion bans undermine any role 
of the doctor-patient relationship?
    Dr. Shane. Yes.
    Ms. Tokuda. Since Dobbs took effect, we have heard horrific 
stories of patients, and during life-threatening situations and 
unthinkable, emotional trauma before doctors felt they could 
legally provide care.
    The far rights warn abortion is a direct attack on one in 
every four women in the United States that have received 
abortion care and an assault and infringement on every single 
person's ability to obtain the health care they need in 
consultation with their health care providers. These draconian 
bans have devastating consequences on all of our communities.
    Longitudinal studies have shown us that denying access to 
abortion care increased household poverty, subjected 
individuals to long-term financial distress, bankruptcies, and 
even evictions. Women denied this most basic health care were 
often more likely to stay in violent relationships, were often 
left raising their children alone, and, in the most tragic 
cases, suffered serious health problems and life-threatening 
complications.
    Dr. Shane, simple yes or no. Does banning basic health 
care, such as abortion care, harm patients?
    Dr. Shane. Yes.
    Ms. Tokuda. When abortion is banned, it severely limits a 
provider's ability to provide their patients with timely, high-
quality access to care. It directly undermines and erodes the 
relationship between patients and medical professionals and, 
even worse, puts patients' lives at risk.
    Dr. Shane, do these consequences pose an even greater 
threat to the doctor-patient relationship than a pandemic or 
public health policies like COVID-19 vaccine requirements?
    Dr. Shane. Yes, they absolutely do.
    Ms. Tokuda. As we see a rise even right now in COVID cases 
throughout our country and even in the halls of Congress, I 
urge my colleagues on the other side of the aisle to think long 
and hard about this subcommittee's priorities. We spent the 
last 2 hours discussing baseless hypocritical allegations of 
interference in the doctor-patient relationship during the 
pandemic, all the while, we have Republicans systemically 
damaging the doctor-patient relationship by criminalizing basic 
reproductive health care and inflicting harm on millions of 
women across our country.
    I yield back.
    Dr. Wenstrup. I now recognize Dr. Joyce from Pennsylvania 
for 5 minutes of questions.
    Dr. Joyce. Thank you, Chairman Wenstrup and Ranking Member 
Ruiz for holding today's hearing. And to the witnesses for 
being with us today, we appreciate both your time and your 
testimony.
    As a physician, I understand the importance of the doctor-
patient relationship, and I have dedicated my career to serving 
my patients. More important, I understand the irreparable harm 
that comes from a one-size-fits-all approach to medicine. This 
approach was exacerbated by the coronavirus pandemic, and 
served the trust between the medical community and physicians 
and their patients was fractured.
    Throughout the pandemic, public health officials 
consistently inserted themselves between the doctor-patient 
relationship in the exam room, in public service announcements, 
and further eroding what is a critical and a sacrosanct 
relationship.
    Physicians' feet were often dangled above the fire if they 
didn't comply with the questionable COVID-era policies, with 
vaccine mandates, and often physicians were censored or 
blacklisted, and researchers in the same vein were censored or 
blacklisted for dissenting opinions regarding COVID vaccines, 
COVID data, and specific to this conversation, to patient care.
    Dr. Singer, you have written about the ethical questions of 
COVID-19 vaccine mandates, and you have often said, and I'm 
quoting at this point, as a medical doctor, I enthusiastically 
endorse COVID-19 vaccine, and you personally had been 
vaccinated and will encourage others to be vaccinated. But you 
continued brilliantly by saying, but I will use persuasion, not 
coercion. Your words.
    Dr. Singer, do you believe that vaccine mandates without 
exemption are incompatible with the Hippocratic oath or the 
tenets of the basic doctor-patient relationship?
    Dr. Singer. Representative Joyce, Dr. Joyce, yes, I do. I 
think it's actually you have no right to force someone to be 
vaccinated. Obviously, I believe that the vaccines saved 
hundreds of thousands of lives, and I got vaccinated. I got the 
first two shots, and I got the booster shortly thereafter, and 
I'm glad I did. But my role is to recommend to people, not to 
force people, not to compel people.
    In addition, there are some people who have very good 
reasons to not be vaccinated. They may have allergies. They may 
have already had COVID, and they have natural immunity, and 
they are concerned about getting a reaction to a vaccine that 
is of a new technology and hadn't been subjected to clinical 
trials because there was an emergency use authorization. These 
are not unreasonable concerns. I need to respect those 
concerns.
    I do need to qualify that that doesn't mean that private 
organizations don't have the right to have requirements. For 
example, if passenger cruise ships said that we will only take 
you on our tour if you're vaccinated, they are a private 
business, a private entity, and they have every right to set 
the terms by which they're going to allow people to come on 
their ship. It also might make business sense for them.
    Dr. Joyce. Let's continue this discussion, and I appreciate 
your candor.
    As you know, the CDC just recommended the booster to all 
Americans over the age of 6 months. Can you expound on this 
recommendation, as well as your view regarding the booster?
    Dr. Singer. Well, based upon my understanding of this, I 
think the United States is actually an outlier here. In the UK 
and most European countries, they're not recommending the 
booster to anyone under the age of 65 unless they're in a high-
risk group. And then even over 65, they're recommending that 
you consult your physician and talk it over with your 
physician.
    I'm with Dr. Paul Offit in this one, the director of the 
Children's Hospital in Philadelphia. When you have over 90 
percent, maybe close to 100 percent of young children, and 
you're talking about like 6-month olds who have already been 
exposed to the virus and have natural immunity, and they are 
among the lowest risk group from getting severely ill from 
COVID, then I don't see a justification for subjecting young, 
healthy people to yet another vaccine that does have, we're 
seeing particularly in young people, some complications, such 
as myocarditis.
    Unless again--you have to individualize. You could have a 
young child that is immunocompromised, has Leukemia or 
something like that. That's a different story. But in general, 
as a general rule, I don't advocate it.
    Dr. Joyce. Finally, very simply, do you feel that vaccine 
mandates facilitate fracturing the patient-doctor relationship?
    Dr. Singer. I think mandating does because, first of all, 
it's a natural tendency for people to recoil when they're 
mandated even if what's being mandated is actually a good idea. 
People don't like being told they have to do things.
    And so, when you have somebody who it's important that they 
have a very trusting relationship, the doctor and the patient, 
and the patient understands that they're being compelled to do 
something, I think it just undermines the relationship of trust 
between the doctor and the patient.
    Dr. Joyce. Thank you for your candor.
    Mr. Chairman, I yield.
    Dr. Wenstrup. I now recognize Ms. Greene for 5 minutes of 
questions.
    Ms. Greene. Thank you, Mr. Chairman.
    I find it pretty appalling that the Democrats on our 
committee are using this hearing to talk about the murder of 
unborn children, babies, people who have rights in our country 
due to the Constitution.
    Abortion is not health care. It's not. It's murder. Health 
care saves lives, and that's what many doctors tried to do 
during the COVID tyrannical shutdowns, the censorship of 
doctors, and outrageous government practices that destroyed 
businesses, destroyed freedoms, took away freedom of religion, 
free speech, and killed people and continue to kill people.
    And one of the reasons we're talking about doctor-patient 
relationships today, one of the biggest reasons that we have 
seen an erosion in the doctor-patient relationship is because 
of this, because of all the deaths reported to the VAERS system 
that have been ignored and not investigated.
    And these are the numbers. These are the reports of deaths 
that started in 2021 with the COVID vaccines, and these are 
reports of others, but you can see the spike. And this is why 
people are having a hard time trusting their doctors.
    I'm not vaccinated. I refused to take it.
    Dr. Williams, what has been your position on vaccination? 
And has your position changed? And if so, why?
    Dr. Williams. I commented earlier, Congresswoman, that I 
was one of the first people to get vaccinated in my company 
because I was asked to do so, and I was happy to do so. I did 
it unhesitatingly, but when natural immunity was being 
discounted and ignored, my position personally changed.
    Now, my practice of medicine has been, from day one, that 
it's an individual's decision that they need to make informed 
with their health care provider, and I maintain that right now.
    The recommendation of the most recent booster, though, has 
me astounded. It hasn't been studied in children at all, this 
newest booster, and to recommend everyone 6 months of age or 
older to do that, I just don't understand it. But I still 
maintain that it needs to be an individual's decision, the 
parent in the case of a child, or the individual patient and 
their provider.
    Ms. Greene. And have you been censored for sharing your 
experience treating your patients, what you felt was the right 
thing to do during COVID?
    Dr. Williams. Many times. I was lifetime banned from 
Twitter for just simply responding that if someone needed to 
speak to someone from the press, that I would be happy to 
answer some questions. I woke up the next morning and had a 
lifetime ban from Twitter. Three months after Elon Musk bought 
the company, I got reinstated, and they asked me to rejoin the 
platform and apologized.
    But I also was banned from YouTube for reviewing an NIH 
published paper on quercetin, which is a supplement, and all I 
did was review the paper, and I was banned from YouTube and 
then threatened with a lifetime ban on YouTube.
    Ms. Greene. The FDA in 2021 tweeted, you are not a horse, 
you are not a cow. Seriously, y'all, stop it. They were 
referring to the drug ivermectin.
    Dr. Williams, has ivermectin ever been used by human 
beings?
    Dr. Williams. Yes, ma'am.
    Ms. Greene. Does it have a history of use on human beings?
    Dr. Williams. Yes, ma'am.
    Ms. Greene. So why did the FDA send a tweet implying that 
ivermectin was just a medicine for horses and cows?
    Dr. Williams. I don't know. I know that the fifth circuit 
court a week ago last Friday took issue with that, and I think 
that's going to go back to the lower court and be addressed, 
but I don't know why they would have said that.
    Ms. Greene. Is ivermectin safe?
    Dr. Williams. Yes, ma'am. In my experience, very safe.
    Ms. Greene. What about hydroxychloroquine?
    Dr. Williams. It is safe. Hydroxychloroquine is--you can 
use hydroxychloroquine in all three trimesters of pregnancy. I 
mean, the most difficult patient to treat with medications is 
the first trimester pregnant female. So, it's a very safe drug.
    But, you know, like all drugs. We use all drugs carefully. 
I don't prescribe Tylenol without thinking about its 
consequences.
    Ms. Greene. Of course not. You wouldn't do that.
    But they kicked you off of Twitter just for talking about 
COVID.
    It's been reported that 41 percent of Americans forwent 
receiving medical care they needed during the pandemic. What 
effect did this have on people missing a diagnosis of a serious 
illness, Dr. Williams?
    Dr. Williams. You know, it's been my concern. The two 
things that I've thought about is how many routine 
colonoscopies and how many routine mammograms didn't get done, 
and I don't think--obviously, at this point we don't know the 
full measure of the damage that was caused by that. It's going 
to be great, though.
    Ms. Greene. It will continue to be great.
    What effect did vaccine mandates have on people who may not 
have known they had an illness that would have made taking the 
vaccine more dangerous?
    Dr. Williams. You know, I think that that situation is 
where the person who is getting a vaccine needs to consult with 
their health care provider, and it needs to be done in an 
environment where there is a place to do so. You can't have a 
personal, confidential conversation with a pharmacist at a 
counter with dozens of people around, with no privacy.
    And so those patients needed to go see their health care 
provider prior to getting a vaccination. And sadly, some people 
have access to care issues, and I acknowledge that, but I think 
those patients that you're addressing here, they shouldn't have 
gone to get a vaccine in a retail environment, or they needed 
to go to their provider and have a discussion.
    Ms. Greene. Yes, unfortunately, they weren't given a 
choice. Many of them were mandated to do so or they'd lose 
their jobs.
    I've run out of time. Thank you, Mr. Chairman. I yield 
back.
    Dr. Wenstrup. Normally, at this time we have an opportunity 
for the Ranking Member to make a closing statement and then the 
Chair to make a closing statement. He won't be here, so I will 
go ahead and make a closing statement.
    And I just want to start with one thing. Dr. Shane, I 
appreciate what you said about access to care. My district has 
traditionally been urban and rural, and the access to care 
problems are tremendous. And I will say that at the end of 
2020, we did get into law in a bipartisan fashion, 1,000 new 
residency programs with 25 percent earmarked for rural, which 
hopefully will help address exactly what you're talking about.
    Today was about the doctor-patient relationship, and I just 
want to say I said early on, and I said it to the previous 
administration, and I tried to say it to this administration, 
America needs to be hearing from the doctors who are treating 
COVID patients, not the politician, not the person in the lab.
    There is a difference between those that write the white 
papers and those that put on the white coat and are seeing 
patients. Those experiences are real. Those are real people, 
and it's not just on paper, and it makes a huge difference in 
the delivery of care and public health in the United States of 
America.
    I wonder today where our Surgeon General is in the 
conversation. I remember, when I was young, C. Everett Koop. 
Everyone knew who C. Everett Koop was, and we heard from C. 
Everett Koop. And when he spoke, he talked about why, and he 
had some bedside manner, which doesn't exist.
    You talk about vaccine hesitancy. It doesn't help when a 
political candidate says, well, if it comes up under Trump, I 
ain't taking it, right. And at the same time, see comments, and 
these are quotes from the President, if you're vaccinated, 
you're not going to the hospital. You're not going to be in the 
ICU unit. You're not going to die.
    What I said from the very beginning, following the trials 
very closely, one, I applaud the trials because normally you 
get between 8 and 10,000 patients in a trial. This had 30 to 
40,000 brave Americans that got in these trials, and what we 
learned was not always what was related to the American people. 
What we learned was that there are certain people that are very 
vulnerable to dying from COVID and that many of those very 
vulnerable people did not get as sick, were not hospitalized, 
and may not have died.
    That wasn't everybody but that was the tendency. That's the 
discussion you have with your patient.
    You know, and then we see, you know, the shocking headline 
that there's a variant. That's not new. There's always 
variants. Why weren't we saying from the very beginning, by the 
way, there will probably be variants to this because there 
usually are.
    We missed the boat. I mean, I hear today talk about the 
physicians. The physicians recommended this. Physicians 
recommended. Which physicians? And only certain physicians with 
one mindset, unfortunately, while so many other physicians were 
silenced.
    And I heard today some say that, well, you didn't have to 
get it. We had to mandate it. We had to mandate it, but you 
didn't have to get it. Well, that's not true unless you wanted 
to lose your job. Then you didn't have to get it, and that's 
the facts.
    I mean, there is a surgeon that I worked with at Walter 
Reed. She was being treated for breast cancer, and she was not 
against the vaccine, but her oncologist said, I don't think you 
should get that right now.
    Dr. Wenstrup. I don't think you should get that right now 
because it may interfere with what we're trying to do.
    And the military would not accept that. And she was 
punished for that. She'll never get promoted. She had to get an 
attorney to fight this, to even stay in the Navy.
    You tell me this is right? You tell me there's no 
interference between the doctor-patient relationship, and some 
people had a choice? You have to go through a heck of a battle 
to get your choice, I guess, on whether you get the vaccine or 
not.
    Every doctor here today spoke about the advantage of being 
able to use things off-label. In one case today, I think it was 
insinuated that that was negligent and not thought out. I don't 
know one doctor that's going to use something off-label that 
hasn't done their research to be able to defend why they're 
using something off-label. And I think every one of you would 
agree with that. Yet it was implied that people were being 
dangerous. They weren't. They absolutely weren't. What was 
dangerous is shutting them down.
    I had doctors call me. Friends of mine. We had started 
practice around the same time. They called me saying: I just 
got a call from the pharmacy board telling me I'm going to lose 
my license if I do this. And I haven't harmed anybody. I've 
only helped people. But I got a couple kids I got to get 
through college.
    I said: Do you want to come and testify that?
    No. No, because I know what will happen to me.
    These are facts that America needs to know about that has 
been taking place in our government.
    And, Dr. Khatibi, I applaud you for being able to talk 
about what it's like in an authoritarian regime and quickly 
recognizing what's going on. And it's our job to make sure that 
this doesn't happen again and quits happening now. That we 
actually do things.
    Look, I know Dr. Ruiz always says, ``I was in public 
health.'' I was in public health. I was on our board of health. 
But I was also practicing. And the people that worked on our 
health board, the physicians that actually were still seeing 
patients, had much greater insight to what was actually going 
on than those that weren't. They may have the degree, but they 
haven't been seeing patients anymore. It was very advantageous 
to have that.
    You know, I apologize to all of you for some of the things 
that happened here today because you came here to talk about 
how you believe it's best that we can save human lives and what 
our public-private partnership should look like. And I'm sorry 
it got off topic so much.
    Dr. Dingell--excuse me, Representative Dingell--I 
referenced you in my opening statement. You had the option to 
talk to your doctor because you were scared. Many people did 
not get that.
    It's about benefits and risk. Those are the conversations 
that we have to have. That wasn't taking place. That wasn't 
taking place.
    And I just think the bedside manner has been horrific. And 
I think we can do a whole lot better. And it's up to us to 
create a path so that we must do that and must do it that way 
on behalf of patients.
    Dr. Williams, you referenced why you are here. It was on 
behalf of your patients. And I would contend that the doctors 
that have decided to come to Congress are here on behalf of 
their patients as well.
    A little out of order, but I would like to give Mrs. 
Dingell the opportunity for a closing statement.
    Mrs. Dingell. So, I just want to say that, as we do close, 
that I do think that the doctor-patient relationship is very 
important. And I think that, quite frankly, as we talk about 
COVID-19 in so many ways, it shined a light on problems that we 
have in the supply chain and our emergency preparedness. We had 
a problem before the COVID, and we have a problem after COVID--
which is really not over, just for the record.
    But that people--not everybody is as lucky as we are to 
have access to a doctor. There are too many people that don't 
have access to a doctor or have a family practice doctor.
    Yesterday, I was in a meeting with a number of different 
areas of medicine, and it's stunning when you learn the number 
of--there are 5,000 infectious disease doctors in the country, 
period. And fewer people are going into it. And, when you talk 
to the neurosurgeons and that--when you go to each of the 
specialties, it's terrifying. So, we got to, like, work on 
making people want to go into healthcare. And how do we work 
together to give everybody--to have the access that we do?
    And, you know, unfortunately, the reason that I had access 
to an infectious disease doctor--I talked to doctors here, but 
the infectious disease was because I got osteomyelitis during 
the pandemic and waited too long. And the doctor told me when I 
was in the operating room, people die when you get to the point 
that you get to. So, I don't want that to happen to people 
either.
    So, we want them to be able to get--to have a doctor. To be 
able to go to the doctor. And I think it's a crisis that we 
have in this country that there are too many people that don't 
have access to healthcare, period.
    So, you know, I could always ask you to join my fight for 
Medicare For All, but we won't do that right now.
    I do want to push back against some of the 
misrepresentation that was made today that the courts have 
decided that the FDA inappropriately overreached into a 
physician's ability to describe ivermectin to treat COVID-19 
patients.
    While the Fifth Circuit Court has recently ruled to allow a 
lawsuit involving the FDA's public communications of ivermectin 
to proceed, this does not mean that the Federal Government 
subverted physician autonomy. It also does not change Federal 
health agencies' current science-based guidance that ivermectin 
is not an effective treatment for COVID-19.
    Beginning in August 2021, the FDA has publicly discouraged 
the use of this to treat COVID-19 on social media and its 
website by promoting public awareness that it's not authorized 
or approved as a COVID-19 treatment--a COVID-19 treatment. The 
currently available data shows that it is--does not show it is 
effective at preventing or treating COVID-19, and that taking 
large doses of it is dangerous.
    But your health provider or care provider can knowingly 
write a prescription. In these public materials, FDA also 
states, quote: If your healthcare provider writes you an 
ivermectin prescription, fill it through a legitimate source, 
such as a pharmacy, and take it exactly as prescribed.
    In court, the Federal Government has represented that the 
FDA explicitly recognizes that doctors do have the authority to 
prescribe ivermectin to treat COVID, and the FDA is clearly 
acknowledging that doctors have the authority to prescribe it 
to treat COVID-19.
    This is because the FDA determines which drugs are allowed 
to be marketed as a treatment for a specific indication but 
doesn't regulate how physicians prescribe approved drugs, which 
we talked a lot about today, and, you know, there are a lot of 
alternative labels. And every time somebody talked about it, I 
keep thinking about diabetes medicine that's being used right 
now for weight loss. And I won't comment on that either, but 
that's a very obvious use that everybody in the country knows 
about right now.
    I just think it's--I want to work with you to make sure 
that we do--every person has access. I think these were 
complicated times when this all started. We didn't know the 
answers.
    I'm not old, but I'm seasoned, and I remember the sugar 
cube and the panic in this country about polio. I mean, I was 
the generation after. Let's just remember when the sugar cube 
did come. But, you know, you had to get it to go to school. You 
had to have that.
    And what we have to do--and you know I've said this to you 
before. We've got to work together. I want to work to make sure 
that every patient has the opportunity to have a relationship 
with a doctor that can know and treat the total patient. And I 
don't want to undermine people's confidence in public health. 
And there are a lot of public health scares right now.
    And I'll never take a flu shot, but that doesn't mean that 
a whole lot of other people shouldn't have a flu shot. And 
we've got to help talk to people about why maybe they shouldn't 
take something, but why it benefits most of the population.
    So, I hope--as I've said to you before, I want to work with 
you together on that, Mr. Chairman, and I think it's important. 
So, thank you, as we close this hearing.
    Dr. Wenstrup. I thank you. And I'll offer an invitation to 
you to support me in our path to being the healthiest Nation on 
the planet. That's what we should be after. Too often, we just 
talk about what insurance plan you have. How about we work on 
being the healthiest Nation on the planet?
    But I want to thank all of our witnesses here today. This, 
to me, is--I'm passionate about this. As a physician, 
obviously, it's important that this committee--this 
subcommittee held today's hearing to better understand the 
sacred doctor-patient relationship and the effects of the 
interaction of the government getting involved with that 
relationship. And I think that we can have a better path 
forward in the future if we really listen to what has taken 
place and do better going into the future.
    As doctors, we know the importance of holding a patient's 
hand and patting them on the back to let them know that we're 
there and that we care for them. And, when you're told you have 
to go get a shot in your arm, regardless of what it is, and no 
conversation with the physician that you know and trust, and 
you get it at the pharmacy or you get it from the National 
Guard or whatever the case may be, let there be at least the 
opportunity for a discussion with your physician.
    We can't let ideology replace medical science. To me, it's 
a new twist on government overreach. It's no secret. Democrats 
are for larger government. Republicans are for smaller 
government. OK. But how far are we going to take this? And we 
want to know it's in the best interest of the patients overall, 
and that's where we're going.
    We saw natural immunity ignored. We really quit talking 
about convalescent plasma, which early on, I saw patients in my 
hometown--I saw people lining up to give their blood that had 
COVID and donate their antibodies, basically, and other people 
get better. We didn't really talk about all of the above. And 
that, to me, is the problem. And that's what interfered between 
doctors and their patients.
    Anyway, I thank you all for being here today. It's 
important. This conversation is far from over, but I'm glad we 
had the opportunity to discuss it today.
    And, with that, I close. And my final statement is, with 
that, and without objection, all members will have 5 
legislative days within which to submit materials and to submit 
additional written questions for the witnesses, which will be 
forwarded to the witnesses for their response.
    If there's no further business, without objection, the 
Select Subcommittee stands adjourned.
    [Whereupon, at 12:22 p.m., the committee was adjourned.]

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