I have been posting Labor Day greetings on this blog dating back to 2012. Throughout those years, there hasn’t been much to celebrate, but this year feels distinctly different. The news is mixed: we may be standing on the brink of another public health catastrophe, yet the dividing line between practicing physicians and the executives who manage the business of medicine has never been clearer.
When I first began writing about this, I focused on the gradual deterioration of our clinical environment—a shift that began when governments everywhere handed the reins of medicine over to corporate interests. That decline has progressed at a steady, predictable pace. But a new variable entered the equation recently: the narrative that physicians will soon be displaced by AI. I am not particularly concerned about AI actually replacing doctors; what concerns me is how this narrative will be marketed and deployed by politicians and healthcare executives.
In any poorly managed enterprise, the primary goal of leadership is to establish control over knowledge workers. Managers view this control as essential because, deep down, they realize the system cannot function without us. Business schools train managers to see themselves as the ultimate arbiters of operational reality, fostering a self-congratulatory culture around the term entrepreneur. The word is often treated as a synonym for genius, even though success in that sphere usually owes far more to luck, leverage, and capital than to intellect or creativity.
Rather than rehashing the most glaring industry flaws this year, I want to focus on the subtle rhetoric being used to delegitimize the medical profession. Much of it operates as "meta-rhetoric"—arguments that obscure underlying facts, repeated endlessly across social media and mainstream outlets to create the illusion of substance where none exists.
Consider a primary example: vaccination. Vaccines represent one of the most effective public health interventions in human history, having saved millions of lives while significantly expanding both lifespan and healthspan. Yet, the current administration—along with its allies—actively propagates vaccine misinformation. Their tactics range from outright falsehoods to framing immunization as merely a "personal choice," all while attempting to manipulate research and standard vaccination schedules.
This is a direct assault on evidence-based medicine. Beyond preventable mortality, diseases like measles demand significant hospital resources. Our healthcare infrastructure is already fragile, and proposed trillion-dollar cuts to Medicaid threaten to defund rural and safety-net facilities. If another winter respiratory season brings a surge in hospitalizations, a diminished bed capacity could trigger shortages rivaling the worst phases of COVID-19. Meanwhile, revisionist narratives continue to downplay the severity of the COVID pandemic, driven by those who never worked the frontline.
The core reality regarding immunizations and COVID is straightforward: these matters are settled by evidence. Endless debates over vaccine efficacy, pandemic handling, or viral origins ignore established facts. Active political interference in clinical care wastes critical time and degrades the practice environment, forcing physicians to alter proven protocols to accommodate political narratives.
Even more critical is the question of capacity. Psychiatrists are already accustomed to seeing patients board in emergency departments for days due to a lack of inpatient psychiatric beds. What happens when that same bottleneck hits pediatric or adult medical wards during a combined surge of measles, COVID, and seasonal flu? I experienced this thin margin firsthand with my wife's care—the line between adequate access and system failure is razor-thin. Government and corporate interests have spent four decades rationing access, and the system is reaching a breaking point.
To illustrate how these arguments are recycled, the table below outlines how past COVID rhetoric is currently being repurposed during active measles outbreaks:
| COVID-19 Narrative Strategy | Repurposed Measles Narrative | Impact on Medical Practice |
| Downplaying Severity ("It's just a mild flu") | Framing measles as a routine, harmless childhood rite of passage | Ignores high hospitalization rates, encephalitis risks, and immune amnesia |
| False Equivalency & 'Choice' ("Personal freedom over mandates") | Frame routine pediatric vaccination schedules as unnecessary state intrusion | Undermines herd immunity, exposing vulnerable and immunocompromised populations |
| Institutional Distrust ("Public health agencies are corrupt/political") | Discrediting established CDC/ACIP guidance in favor of unverified/disproven alternative theories | Forces clinicians to spend limited appointment time debunking viral misinformation |
| Rationing Normalization ("Hospitals always operate near capacity") | Treating pediatric bed shortages as an acceptable baseline operational reality | Normalizes emergency room boarding and delayed acute interventions |
The proliferation of these narratives is not accidental; it reflects a coordinated effort to reshape public perception. Yet, this crisis of governance also presents an unprecedented opportunity for medical advocacy.
We are already seeing evidence of collective resistance. In response to federal vaccine misinformation, 28 states have announced they will no longer rely solely on CDC guidance for immunization schedules. Furthermore, 15 states have issued statewide clinical guidance directly referencing recommendations from professional medical societies (such as the AAP, ACOG, and AAFP) rather than ACIP, following the dismissal of ACIP panel members.
This shift demonstrates what organized physician advocacy can achieve, but maintaining this momentum will require greater institutional courage. Having served as an officer in a professional society, I understand the inclination toward "big tent" neutrality to maintain broad membership and protect non-profit status. However, non-profit status does not preclude professional societies from issuing firm, factual critiques when public health policy diverges from medical evidence.
In psychiatry, key issues like autism research, evidence-based antidepressant prescribing, and equitable depression care require clear advocacy. Beyond psychiatry, systemic challenges—such as gun violence, maternal mortality, and substance use disorders—remain unaddressed. Nationally, Medicaid reductions threaten safety-net hospitals, while internationally, cuts to PEPFAR and USAID jeopardize global care for HIV, tuberculosis, and malaria.
If any moment can unite physicians against administrative and corporate overreach, it is this one. It offers a clear opportunity to establish a firm boundary between rational, evidence-based medicine and arbitrary rationing.
George Dawson, MD, DFAPA
Supplementary 1:
To clarify my AI concerns - it will be quite easy for managed care corporations and pharmaceutical benefit managers to replace the current reviewers who generally deny care of specific medications with an AI agent. That should concern you greatly if you are a physician or part of any medical team that needs to address denials of care. The scope and intensity of denials will easily escalate and be more difficult to negotiate. As far as I can tell - nobody is talking about this. I see it as an obvious problem in the not too distant future. The AI buildup by all of the tech CEOs constantly talking about it is done to legitimize business applications like this one. It is also done to suggest that an AI agent is an omniscient, value neutral entity when it has already been established that it has no moral or ethical underpinnings and can easily decide in favor of any business over an individual needing care.
Supplementary 2: Guide to the acronyms:
AAP = American Academy of Pediatrics
AAFP = American Academy of Family Practice
ACOG = American College of Obstetricians and Gynecologists
ACIP = Advisory Committee on Immunization Practices
USAID = US Agency for International Development
PEPFAR = U.S. President's Emergency Plan for AIDS Relief
References:
1: Kukoyi OM, Wang
VS, Yao K, et al. US State Actions Related to COVID-19 Vaccination
Infrastructure and Access Amid Federal Shifts. JAMA. 2026;335(19):1719–1721.
doi:10.1001/jama.2026.5148
2: Rubin R. Hundreds
of Medical Groups Challenge Childhood Immunization Schedule Changes—Here’s What
to Know. JAMA. 2026;335(6):475–477. doi:10.1001/jama.2026.0095
3: Gostin LO, Lurie
P. Assault on the Centers for Disease Control and Prevention—Budget Cuts,
Political Control, and the Erosion of Trust. JAMA Health Forum.
2025;6(10):e255467. doi:10.1001/jamahealthforum.2025.5467
Graphics Credit:
I took that photo driving home from work a few years ago.