Medicine and politics are obligatory companions, as inseparable as tea and biscuits. Although academic reactionaries and purists may argue that medicine should not be tainted by political agendas, rarely has this been, or is it, reality. (1)
     Medicine--as practiced in times and regions as diverse as pre- Christian Hippocrates, Freud’s Vienna or Massachusetts’s Back Bay--invokes relationships, all of them illustrating a political connectedness to governing authorities.
     When I hear fellow Pennsylvania physicians speak of politics in medicine, the substance often reflects those controversies that attract media scrutiny and hefty emotional responses: Fee-for-service vs. managed care reimbursements, Darwinian evolution vs. creationism, stem cell research vs. right-to-life arguments, clean needles for IV drug users vs. moral objections, and/or financial support for AIDS prevention and treatment vs. financial resources allocated elsewhere. However riveting are those arguments, it is the day-to-day interrelationship of politics and medicine---those that border on the mundane—that cement the relationship. The existence of that bond makes the case, at least for me, that our relationships to, and with, governing bodies are fundamental to medicine and therefore critical to medical reporting. (2)
     In psychiatric medicine, the evolution of this interrelationship, particularly as it pertains to 19th and 20th century U.S. federal and state policies, is highlighted by involuntary commitment, deinstitutionalization, Federal, State and private sector funding sources, psychiatric epidemiology and pharmacoepidemiology(3).
     As is true of both psychiatric and non-psychiatric medicine, our profession in Pennsylvania is licensed by authorization of the Department of State. The Secretary of State is an official appointment of the elected Governor. The regulatory oversight and management of conduct for practitioners of the healing arts (including medicine, dentistry, veterinary, podiatry, nursing, etc) is defined by Pennsylvania Code (applicable laws of Pennsylvania) as well as federal and local/community standards. Similar laws and standards define the compensation for our services from federal programs (Medicare), federally-subsidized state programs (Medicaid) and from private insurers who are under State and Federal licensing and regulation.
     Medical practitioners prescribe within the directives and guidelines of the Federal Drug Enforcement Agency (DEA) and, where applicable, individual state agencies that monitor controlled substances. (Not all US states have separate registries for controlled substances; Pennsylvania is one that does not.)
Like its counterparts in the UK(MHRA, NPSA; others), our pharmaceutical and therapeutic prescribing habits have Federal watchdogs, including the U.S. Food and Drug Administration, multiple collateral advisory committees and Federally-funded programs that assist the process of research and information dissemination (National Institute of Health/National Institute of Mental Health/Substance Abuse and Mental Health Services Administration: NIH/NIMH/SAMHSA; others.)
     The American Psychiatric Association (APA) and its collaborative organizations devote a prodigious effort to legislative and political agenda. The current APA website’s Homepage highlights three “front and center” advocacy items: Endorsement of recent Congressional passage of an $83 million dollar ‘Suicide Prevention Bill’, and two subsequent links to the APA Advocacy Action Center and APAPAC, both sites that promote lobbying efforts on behalf of APA’s constituency. (4)
     Oversight regulation, advocacy and legislative agendas, investigatory and legal mandates underscore medicine’s inseparable coexistence with politics. With issues of medical record confidentiality, academic research freedoms, parity, tort reform, the involuntary commitment of individuals, the duty to warn, the continued evolution of Lyndon Johnson’s Community Mental Health Act of 1965 or George W. Bush’s New Freedom Commission’s recommendation to screen American’s youth for psychiatric disease, psychiatry is as much about legal and political agendas as it is about mental illness and mental health.
     Whether the issues pertain to psychiatry or non-psychiatric medicine, it is crucial for journals to discuss political trends and counter-trends in medicine---just as it is expected that they deliberate the epidemiology and pathophysiology of heart disease, cancer or schizophrenia. Medical journals and physicians would be well served, I believe, by confronting-- not denying--the issues and the political forces that shape them.

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