You may realize that your physician’s political beliefs could affect where they shop, what restaurants they prefer, what neighborhood they live in, and maybe even what music they like, but do you think it could go any further? Could politics intrude into their professional life? Affect their medical judgments? Their decisions about the best course of treatment? The way that they evaluate medical research?
Let me return back to these troubling questions in a bit.
We certainly know that political ideology impact the way that politicians and citizens view disease.
Consider COVID.
From the onset, President Trump minimized the threat of the virus. In February 2020, he referred to it as a hoax and exaggerated the extent to which the U.S. had diminished its proliferation. Prominent conservatives generally expressed more skepticism and indifference toward the impact of the pandemic than have liberals. Fox News host Sean Hannity referred to COVID-19 as a “fraud” and the network’s Trish Regan accused Democrats of using the virus to “destroy and demonize the president”. Tucker Carlsen claimed the death toll had been exaggerated and that the public was being lied to about the vaccine, which he argued was being used for “social control.” Additionally, as noted, Republican governors were generally slow to stymie viral transmission, with the last eight states to issue stay-at-home orders all having Republican leaders. Senator Rand Paul asked people to think about whether the pandemic could be a “big hoax.”
An embarrassment of data, conducted by social scientists and by public opinion pollsters showed that these attitudes from the top filtered down to the general public. At each stage of the pandemic, we found ourselves divided between red and blue, with red America consistently resistant to embrace the danger inherent in the virus. Conservatives were less likely to believe COVID was a threat, less likely to believe in and practice social distancing measures, less likely to accept mask wearing, and less likely to become vaccinated.
My own work with Thomas Wilson, Davis Whaley, Daniel Rosenfeld[1] showed that these effects could at least partially be explained by conservative distrust of the mainstream media and beliefs that they were exaggerating the severity of the virus. Once politicized, our partisan lens affected the way we viewed information about COVID. In place of the mainstream media, conservatives embraced alternative sources of information steeped with conspiracy theories about seemingly every aspect of the virus, from its origins to best treatment. In a classic case of motivated reasoning, partisans rejected conclusions that went against their tribal identity and sought out information with friendlier implications to their prior beliefs.
But how is any of this relevant for medical doctors, trained to put aside their personal bias and to deliver the best possible care to their patients? Perhaps more than you’d think.
Let’s consider the curious case of hydroxychloroquine. Hydroxychloroquine is an anti-malaria drug that has been proven to be ineffective in treating COVID. The FDA has reported that the drug also produces serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure. Despite its ineffectiveness, hydroxychloroquine has been pushed by those on the right. In about a dozen states, Republican lawmakers proposed, and in some cases passed, legislation to limit medical licensing boards’ ability to take action against providers who prescribed hydroxychloroquine[2].
According to new research published in the Proceedings of the National Academy of Sciences[3], from April 2020 to April 2022, conservative medical doctors were more likely to prescribe hydroxychloroquine than their liberal counterparts. This clearly demonstrates that physicians were not objective practitioners influenced by the evidence but rather moved by their political beliefs and the influence of conservative media the way laypeople are.
There was even some evidence that doctors were biased by their ideology in how they interpreted the results of medical studies. When a non-identified drug was presented as inferior in fictitious study results, liberal and conservative physicians agreed in rejecting it. But when the same studies identified the condemned drug as ivermectin, an anti-parasite drug used commonly on animals, there were some discrepancies between liberal and conservative doctors in eschewing the drug. Conservative doctors seemed less able to accurately process information about the discredited – yet promoted by the right – drug.
Together, the two pieces of evidence suggest that the tendency to digest evidence and interpret it favorably to support our prior beliefs – motivated reasoning – isn’t only true for the general public. It also applies to highly evaluated professionals who are sworn to protect patient well-being within the parameters of science. Even with life and death hanging in the balance, motivated reasoning seeps in.
Besides looking at physicians’ credentials, do we need to start asking them information about their political beliefs?
[1] Politicizing the COVID-19 Pandemic – Ideological Differences in Adherence to Social Distancing (1).pdf
[2] Concern as Republicans push to make dubious Covid cure prescriptions easier | Republicans | The Guardian
[3] The political polarization of COVID-19 treatments among physicians and laypeople in the United States (pnas.org) Levin, J. M., Bukowski, L. A., Minson, J. A., & Kahn, J. M. (2023). The political polarization of COVID-19 treatments among physicians and laypeople in the United States. Proceedings of the National Academy of Sciences, 120(7), e2216179120.