HJNO Mar/Apr 2025

30 MAR / APR 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   What Cassidy didn’t apparently expect when he withdrew his finger from the dike as one of the last Republicans standing against what most call anti-vax but the proponents call pro-freedom, was the aftermath of the politicization of COVID and the extent of govern- ment reach during a pandemic, particularly the events back home. Within hours of RFK Jr.’s confirmation, U.S. Healthcare Journals received a rare press release from the Loui- siana Department of Health (LDH), cosigned by Louisiana’s first surgeon general, Ralph Abraham, MD, and his deputy, Wyche T. Coleman III, MD. The message signaled a signifi- cant policy shift: LDH would cease promoting mass vaccinations through media campaigns or community health fairs, though vaccines will still be available at parish health units. A MESSAGE FROM LOUISIANA SURGEON GENERAL RALPH L. ABRAHAM, MD Restoring Trust in Public Health Starts with Restoring Trust in Medicine For much of the last century, public health has taken it upon itself to fill the gaps in our bro- ken healthcare system — providing guidance, information, and health recommendations. But when we get it wrong and overreach, the harm is often irreparable. Trust is built over years and lost in seconds, and we’re still rebuilding from the COVID missteps. To name a few: inaccurate and inconsistent guidance on masking, poor decisions to close schools, unjustifiable mandates on civil liberties, and false claims regarding natural immunity. But the greatest missteps were on vaccines and some continue to this day. Within months of their approval, COVID vaccines were shown to have no third-party benefit in terms of reduced transmission, yet they were still mandated — through both policy and social pressure. That was an offense against personal autonomy that will take years to overcome. Even now, the CDC recommends that 6-month-olds receive COVID vaccinations — woefully out of touch with real- ity and with most parents, who have less faith than ever in the merit of the CDC’s recommen- dations. A study in Health Affairs found that after the pandemic, only 37% of the public trusted infor- mation from the CDC a “great deal,” and only 25% trusted state and local health departments. Doctors fare better, but the trend is consistently alarming. A recent survey from JAMA showed that confidence in doctors decreased from 71% in 2020 to 40% in 2024. The antidote to this freefall in public trust is simply to start telling the truth. Until confidence is restored, the majority aren’t going to take advice from public health, no matter how well-founded it may be. For the past couple of decades, public health agencies at the state and federal level have viewed it as a primary role to push pharmaceuti- cal products, particularly vaccines. Some have even referred to this practice as the “corner- stone” of public health. There are some appro- priate examples of government recommenda- tions, such as encouraging routine screenings like colonoscopies or Pap smears and facilitat- ing access, especially for the poor. But promo- tion of specific pharmaceutical products rises to a different level, especially when the manufac- turer is exempt from liability for harms caused by the drug, as is the case for many vaccines. It is understood that the products pushed will benefit some and cause harm to others, but public health pushes them anyway with a one- size-fits-all, collectivist mentality whose main objective is maximal compliance. Under this ideology, the sacrifice of a few is ac- ceptable and necessary for the “greater good.” As Americans, we should recognize that our rights come to us as individuals. We should re- ject this utilitarian approach and restore medical decision-making to its proper place: between doctors and patients. Perhaps there are some treatments that every human being should take, but they are few and far between, and things that are good generally don’t have to be pushed by the government. Medical decision- making is a zero-sum game: when outside forc- es get involved, patient autonomy is sacrificed. We should empower people to make better decisions for themselves, keeping in mind that maximizing benefits for individuals will lead to maximal benefit for the population as a whole. To rebuild trust, we need to focus on the is- sues that truly matter to people. Unfortunately, many public health departments are still stuck in pandemic-response mode. Not known for agility, they continue pushing the same guid- ance and recommendations from half a decade ago. Every business owner knows that to pro- mote one thing, you must choose not to pro- mote something else. We saw many examples of this over the past four years, in which people missed routine screenings and cancers went un- diagnosed. Treatment for substance abuse was put on the back burner as deaths from opioid overdoses skyrocketed. Mental health disorders were left unattended, spilling over into crises of homelessness and crime. In Louisiana, maternal and infant mortality remain near the worst in the nation. All the while, chronic disease rates continue creeping up to crisis levels. These are the post-pandemic priorities of the Louisiana Department of Health. As a nation, we must recognize that there is no miracle pill for the major population health problems we face. The solution to increased spending and declining outcomes in our coun- try is unlikely to come in the form of a pill or a shot. Much of the solution will likely come down to the usual hard work of improving diet, increasing exercise, and making better lifestyle choices. Government should admit the limitations of its role in people’s lives and pull back its tentacles from the practice of medicine. The path to re- gaining public trust lies in acknowledging past missteps, refocusing on unbiased data collec- tion, and providing transparent, balanced infor- mation for people to make their own health de- cisions. By demonstrating genuine integrity and respect for personal autonomy, public health agencies can begin to mend the rifts they’ve created. Ultimately, restoring this trust requires returning medical decisions to the doctor-pa- tient relationship, where informed, personalized care is guided by compassion and expertise rather than blanket government mandates. Sincerely, Ralph L. Abraham, MD Louisiana Surgeon General Wyche T. Coleman, III, MD Deputy Surgeon Genera l Source: https://ldh.la.gov/news/7478