"People Apart Moving Together" John Hooper,on public display Saint John NB.
This blog article is now published in (click below to access hot link)
The influence of politics on scientific endeavors, including funding, prioritization and public messaging, is not new (McLaughlin, 2021).
For example, COVID-19 has resulted in polarization and politization of pandemic related issues, especially related to scientifically promoted mitigation measures (Hart, 2020).
Canada is not immune to such given recent “Freedom Convoy” protests and occupations which speak to a growing divide between scientific and political dialogue and what defines “truth.”
Another trend that the COVID-19 pandemic has uncovered is increasing “political capture” of clinicians and scientists, especially public health physicians. We rely on these individuals to communicate to the public, at times on daily basis, pandemic information, and evolving emergency measures.
“Political capture”, also called “state capture”, is “the domination of policy making by private, often corporate, power.” (Britannica accessed May 18, 2022).
This is similar to the concept of “regulatory capture” which is defined as “…an economic theory that says regulatory agencies may come to be dominated by the industries or interests they are charged with regulating. The result is that an agency, charged with acting in the public interest, instead acts in ways that benefit incumbent firms in the industry it is supposed to be regulating.” (Investopedia accessed May 18, 2022)
I offer an alternate definition of political capture as “the domination of scientists, clinicians and other content specialist by their political masters.”
Prior to the pandemic many would have been hard pressed to name or identify their Chief Medical Officer of Health (CMOH). Now, due to constant media attention, most Canadians instantly recognize their CMOH and could identify the CMOHs of other provinces or territories.
CMOHs, including the Federal Chief Public Health Officer (Dr. Theresa Tam), serve as senior civil servants and generally at “the pleasure of the Minister”. The advice they give government is protected under the umbrella of “cabinet secrecy”. Cabinet secrecy allows governments to receive candid advice in confidence from various sources to assist them in making policy decisions. The downside is that the CMOH cannot publicly disclose what advice they gave the government without the Minister’s permission.
In part, this is because public health is just one source of information that governments consider when making health policy decisions. Governments shape policy decisions using many lenses such as economics, legal, ethics, public opinion etc. (Demeter, 2016). Final policy decisions are a mélange of multiple considerations which are rarely fully communicated to the public.
The risk is that governments will oversimplify their final decision as “we are following the advice of our medical experts” when, in fact, things are much more complicated.
This is not unexpected as politicians understand that physicians and scientists are considered more trustworthy sources of information versus politicians (Proof Strategies access May 18, 2022).
The public may overestimate the power of their Public Health leaders as was suggested by a Toronto Sun front page headline - “Doctatorship” (March 18, 2021). The associated editorial by Brian Lilley stated:
…Thanks to politicians wanting to ensure that every decision they make has cover, they, and we in the media, have elevated the position of public health doctors to that of omnipotent god instead of what they really are, medical advisors.
In a democracy such as ours, there is no way that unelected doctors should wield so much power and authority, enough to force us to close schools, businesses, change our entire way of life. Yet, that is where we are in Ontario thanks to a system deeply in need of reform
…“I’m going to be very frank. There’s no politician in this country that is going to disagree with their chief medical officer. They just aren’t going to do it. They might as well throw a rope around their neck and jump off a bridge. They’re done,” Ford said.
If this is the case in Ontario it is a dangerous situation as politicians should be ultimately responsible, and accountable, for their decisions and not hide behind their medical advisors.
The relationship between the CMOH and government is quite different in Alberta where the Alberta’s CMOH, Dr Deena Hinshaw, appeared to be in the dark when Premier Kenney announced ending public health orders on June 15, 2020. Hinshaw is quoted saying:
When CBC News asked Dr. Deena Hinshaw about what this would mean for Albertans, she said, "I haven't had the opportunity to have that conversation so I think that might be a question best addressed to the premier in terms of that particular information." (Michell Bellefontaine, CBC, May 28, 2020)
It has been uncommon, during the COVID pandemic, to have a Public Health officials so clearly direct press to the government for answers. This should happen more often.
Another way of serving a government agenda of “kicking the can down the road” is to appoint prominent medical advisors and leaders as heads of various “task forces.” This provides a buffer for politicians to defer comment, or engagement, as the “task force is working hard on the issue, and we await their recommendations.”
An example is the Manitoba Diagnostic and Surgical Recovery Task Force which was struck in May, 2022 and tasked to …find new solutions to address the backlog in care that resulted from the COVID-19 pandemic.
It is interesting to note that the same government created the MB Wait Times Reduction Task Force in 2016 which produced an over 300 page report with recommendations in 2017. Obviously, implementation, or non-implementation, of their recommendations did not prepare MB for the stress COVID-19 put on health care system, being the only province to transport over 50 ICU patients out of province.
In addition, the public can become confused and lose trust when task force leads disagree publicly with other health care leaders on health policy issues. This is happening in MB where the President of Doctors MB, Dr, Kristjan Thompson, and Dr. Peter MacDonald, Chair of MB’s Diagnostic and Surgical Recovery Task Force, are at odds about what metrics to use to measure the magnitude of the province’s diagnostic and elective procedure backlog. As reported by CBC:
MacDonald said the task force doesn't entirely agree with the numbers compiled by Doctors Manitoba. The task force is working with the doctors group to try to verify those numbers, he said.
"We both acknowledge that there's pitfalls in the methodology on both sides," he said, noting wait times may be a more important metric to patients than a broad number representing the backlog.
"When you look at the backlog numbers, they're very daunting. And then when you talk to the front lines, you get a different story in some areas," MacDonald said.
Asked what current wait times are, MacDonald said "there's a huge spectrum of procedures" and varying urgency levels. The task force "has a good idea" on average wait times for most procedures but it would take some time to gather that. (Darren Bernhardt, CBC March 30, 2022)
Clinicians and scientists, when advising government and especially when functioning as senior civil servants, need to walk a tightrope to avoid political capture (and keeping true to their moral compass) and being the scapegoat for the consequences of government decisions.