Do ethics fall to the wayside when doctors become pundits?

I watched Dr. Mehmet Oz talk one-on-one with Donald Trump while I was in the midst of studying for my first objective structured clinical examination as a first-year medical student. This test measures competence at interviewing and examining patients. Using that examination’s grading scale, I believe that Oz would have almost certainly passed his medical interview with the Republican presidential candidate.

Here’s why: Starting with a “review of systems,” Oz comprehensively explored Trump’s family medical history. He gathered information about Trump’s current prescriptions and previous hospitalizations, all the while keeping the conversation friendly, open, and even apolitical as his guest tried repeatedly but without success to veer off topic and attack Hillary Clinton.

Oz pressed Trump on diet and exercise habits, warning him his high body mass index is approaching the clinical definition of obesity. Perhaps most important, Oz avoided dominating the conversation, allowing Trump to air his sentiments about his personal health in a way that physicians rarely let their patients do these days.

Yet as Oz read aloud Trump’s blood test results printed on a letter from Lenox Hill Hospital, and even encouraged his live audience to applaud his guest’s testosterone levels, I felt that something sinister was happening, something beyond the usual hyperbole of showbiz. I wondered how a medical interview about Trump’s health would inform voters. What insight does an LDL cholesterol level or a report of normal thyroid function provide about a potential Trump presidency? It was as if Oz expected me, the voter, to make my decision this fall based on the physical fitness of the candidate, rather than his or her policies, experience, or temperament.

Oz’s recent foray into political journalism is yet another example of the emerging physician-pundit. In some cases, their contributions come in the form of relatively objective explanatory articles unpacking the significance of Hillary Clinton’s recent pneumonia diagnosis or interpreting Trump’s widely publicized “medical reports.” But others editorialize science and manipulate political debate under the objective veneer of medicine.

In this election cycle, we have watched Dr. Drew Pinsky express “grave concern” about Clinton’s health and Dr. Jane Orient fan conspiracy flames by suggesting that Clinton is actively battling Parkinson’s disease or brain injury without ever having examined her as a patient. The Oz-Trump “medical interview,” fraught with its own ethical complexities, rests somewhere along this spectrum of punditry.

Perhaps Oz was simply helping voters better understand the personal health of a man who may become the oldest elected president in modern history. But while doing so, he quantified Trump’s signature campaign issue of “stamina” for the presidency into blood glucose levels and protein-specific antigen scores, and employed his authority as a physician, rather than as a private citizen, to implicitly endorse the candidate sitting next to him.

This election isn’t the first time that health professionals have found themselves in the hot seat, balancing professional opinion against personal politics. During the 1964 presidential contest between Barry Goldwater and Lyndon B. Johnson, the now-defunct Fact magazine polled thousands of psychiatrists for a story that profiled Goldwater. A majority of them believed he was psychologically unfit to become president. Like the physician-pundits of today, many of the psychiatrists laced their armchair diagnoses with medical jargon and offered only speculative psychiatric opinions lacking a demonstrated clinical basis.

After Goldwater brought a libel suit against the magazine and won $75,000 in punitive damages, the American Psychiatric Association added a section to its code of ethics. Commonly referred to as the Goldwater rule, it prohibits psychiatrists from diagnosing public figures “unless he or she has conducted an examination and has been granted proper authorization for such a statement.” Most psychiatrists continue to abide by the Goldwater rule today, with an understanding that their unfounded clinical judgment may sway voters and impact elections.

For all physicians to follow the Goldwater rule and recuse themselves from any involvement in an election, especially one so pivotal to our country’s future, may reflect an unnecessary extreme. With their unique experiences and specialized skill sets, it is arguable that physicians have an obligation to both provoke and inform conversation on issues that matter most in our society.

However, as more doctors in the coming days pit themselves against each other in the editorial pages of newspapers, the expert panels of cable television, and in other media, it is clear that doing nothing to regulate this behavior treads a dangerous path. Although the American Medical Association has passed directives aiming to address this issue in the future, it has yet to establish clear ethical boundaries on this issue to protect medicine from being weaponized by both the political left and right.

In an evermore hostile political environment, those boundaries, and the debate within the medical community to forge them, could not come soon enough. Without them, physician-pundits like Oz, slinging opinions across the media, just may end up deciding this election come November.

Vishal Khetpal is a first-year medical student at the Alpert Medical School of Brown University and a student member of the American Medical Association.