[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
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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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