The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”

You can search Spotify for “Gerry at The Health Equation”

Or use the link below

https://podcasters.spotify.com/pod/show/gerrygaj

Below is the specific link

Gerry Gajadharsingh writes:

“Many people seem to be increasingly adopting a binary stance to many important issues such as, Brexit/Remain, love Trump/hate Trump, pro vaccine/anti-VAX.

Life, however, is filled with nuance, and I suspect life would be easier if we adopted less binary and confrontational positions.

Below I have published an excellent article recently released by the Louisiana Surgeon General in the USA. His focus is on the miss-steps from the management during and after the COVID-19 pandemic, much of his opinion could also be applied to the UK.

Trust is at the heart of all relationships, government/people, parent/child, school/pupil, business/employee and of course the clinician/patient relationship. As the author correctly states, “Trust is built over years but lost in seconds.”

The author gives examples such as inaccurate and inconsistent guidance on wearing masks, poor decisions to close schools, unjustifiable mandates on civil liberties, and false claims regarding natural immunity (eminent scientists who dared to discuss herd immunity were often vilified by the media). COVID vaccines were shown to have no third-party benefit in terms of reduced transmission, yet they were still mandated — through both policy and social pressure.

All drugs and vaccines can have positive effects on some people and negative effects on others, but public health policy pushes them anyway with a one-size-fits-all, collectivist mentality whose main objective is maximal compliance.

Under this ideology, the sacrifice of a few is acceptable (adverse effects and occasionally deaths) and necessary for the “greater good.”

I have noticed increasing number of patients presenting with unusual and complex clinical scenarios over the past few years (as have some of my medical consultant colleagues). As with many complex clinical problems there are usually multiple factors interacting with each other to generate the patient’s symptom picture. I spend a lot of time talking to the patient to understand their history, and particularly the chronology of how their symptoms started. It is not unusual for there to be in an association post vaccination for some of these patients or indeed related to medications or poly pharmacy (taking multiple medications, which seems to be quite common in the elderly population).

Our immune systems are complex and highly balanced systems, the aim of vaccination is to interrupt these systems and build immunity to a specific pathogen (the intent is laudable but there may be unintended consequences). Now this can be a good thing in terms of helping our bodies fight specific infections. What is unknown is what are the medium and long-term consequences for our health (especially with COVID-19 vaccinations because they are so new).

Many medical conditions are classified as autoimmune; the body is attacking itself, and generally the response from medicine is that we don’t know why.

In our elderly population, they are still being contacted by their NHS practices to come in for another COVID-19 vaccine, some patients have had six or seven COVID-19 vaccines. And yet when we test patients to ascertain their levels of COVID-19 antibodies (which are produced after previous COVID-19 infection and or vaccination), almost all of them continue to have >2500 Abs (the maximum the Lab can measure) sometimes several years after their last vaccination, those patients can then take the decision not to have another COVID-19 vaccine. This begs the question, why continue to have repeated COVID-19 vaccines, with the risk that it may be contributing to disruption within our immune systems and therefore contributing to other health problems.

The answer is generally one of cost, it’s much cheaper to provide a vaccine than it is to test patient antibodies, and because of the philosophy “the sacrifice of a few is acceptable and necessary for the “greater good.”

What about the flu vaccine?

Gov.UK stats show that 42.8% (503,499 out of 1,176,102) of all frontline health care workers (HCWs) in NHS trusts with direct patient care received the influenza vaccine in England: a decrease of 7.1 percentage points compared with that seen in the 2022 to 2023 season (49.9%). Why do most frontline healthcare workers decline to have a flu vaccine?

I’ll leave you to draw your own conclusions.

As we all know, correlation is not causation, but as the author says, the antidote to this freefall in public trust is simply to start telling the truth. Until confidence is restored, the majority aren’t going to take advice from public health, no matter how well-founded it may be.

A recent survey from JAMA showed that confidence in doctors decreased from 71% in 2020 to 40% in 2024. So that means 60% of patients consulting doctors in the US don’t trust them! How on earth can you develop a therapeutic relationship with that level of trust and if a patient is not completely open with a clinician, how can the clinician know their patient?

I saw a female patient today and one of the things we were discussing was HRT. She and her friends all seem to be taking the same protocol of HRT and when they ask their prescribers whether they should they have some blood tests to see whether they need to continue HRT or indeed whether their dosage needs adjusting, the answer seems to be “it’s not necessary”. This is partly because the British Menopause Society (BMS) guidelines suggest that it’s okay to prescribe HRT based on patient symptoms (taking into account medical history such as breast cancer and other risk factors) rather than the evidence via blood tests, albeit it is sometimes challenging given hormonal fluctuations during a female’s monthly cycle.

The author suggests that “As a nation, we must recognize that there is no miracle pill for the major population health problems we face. The solution to increased spending and declining outcomes in our country is unlikely to come in the form of a pill or a shot. Much of the solution will likely come down to the usual hard work of improving diet, increasing exercise, and making better lifestyle choices.”.

I completely agree with the sentiment; however, words are just words. The devil is in the detail. I would say that for many of my patients, when I question them on diet, they generally think they have a good diet, I would beg to differ. 70% of them have abnormal breathing behaviour, which contributes significantly to autonomic nervous system dysfunction, something I have blogged about many times before. Autonomic nervous system dysfunction contributes significantly to many of the health problems that I tend to see. This is completely different to flagging up the usual lifestyle culprits of obesity, smoking, drinking alcohol and using recreational drugs.

Some areas of medicine seem to be embracing the concept of individualised patient care, for example chemotherapy and cancer care.

The problem is that really understanding your patient is time-consuming, and if you’re going to run tests, these can sometimes be perceived to be expensive (especially in the UK as we have the almost “monopoly” of the NHS which of course provides tests and treatment for “free”, unless of course you understand it’s the good old taxpayer that’s actually paying for all of this. And then if you’re going to provide individualised patient care after making a more accurate diagnosis, it’s incumbent on the clinician to explain their thoughts, their diagnosis, a treatment plan that is mutually agreeable with the patient and the expectation that the patient (what they do, how they live, their understanding of good nutrition, their understanding of their capacity to cope with stress and their understanding of supportive exercise) is part of the healing process.

Ultimately, restoring this trust requires returning medical decisions to the doctor(clinician)-patient relationship, where informed, personalized care is guided by compassion and expertise rather than blanket government mandates.

Louisiana Department of Health

For much of the last century, public health has taken it upon itself to fill the gaps in our broken healthcare system — providing guidance, information, and health recommendations. But when we get it wrong and overreach, the harm is often irreparable. Trust is built over years and lost in seconds, and we’re still rebuilding from the COVID missteps.

To name a few: inaccurate and inconsistent guidance on masking, poor decisions to close schools, unjustifiable mandates on civil liberties, and false claims regarding natural immunity. But the greatest missteps were on vaccines and some continue to this day. Within months of their approval, COVID vaccines were shown to have no third-party benefit in terms of reduced transmission, yet they were still mandated — through both policy and social pressure. That was an offense against personal autonomy that will take years to overcome. Even now, the CDC recommends that 6-month-olds receive COVID vaccinations — woefully out of touch with reality and with most parents, who have less faith than ever in the merit of the CDC’s recommendations.

A study in Health Affairs found that after the pandemic, only 37% of the public trusted information from the CDC a “great deal,” and only 25% trusted state and local health departments. Doctors fare better, but the trend is consistently alarming. A recent survey from JAMA showed that confidence in doctors decreased from 71% in 2020 to 40% in 2024. The antidote to this freefall in public trust is simply to start telling the truth. Until confidence is restored, the majority aren’t going to take advice from public health, no matter how well-founded it may be.

For the past couple of decades, public health agencies at the state and federal level have viewed it as a primary role to push pharmaceutical products, particularly vaccines. Some have even referred to this practice as the “cornerstone” of public health. There are some appropriate examples of government recommendations, such as encouraging routine screenings like colonoscopies or Pap smears and facilitating access, especially for the poor. But promotion of specific pharmaceutical products rises to a different level, especially when the manufacturer is exempt from liability for harms caused by the drug, as is the case for many vaccines. It is understood that the products pushed will benefit some and cause harm to others, but public health pushes them anyway with a one-size-fits-all, collectivist mentality whose main objective is maximal compliance.

Under this ideology, the sacrifice of a few is acceptable and necessary for the “greater good.”

As Americans, we should recognize that our rights come to us as individuals. We should reject this utilitarian approach and restore medical decision-making to its proper place: between doctors and patients. Perhaps there are some treatments that every human being should take, but they are few and far between, and things that are good generally don’t have to be pushed by the government. Medical decision-making is a zero-sum game: when outside forces get involved, patient autonomy is sacrificed. We should empower people to make better decisions for themselves, keeping in mind that maximizing benefits for individuals will lead to maximal benefit for the population.

To rebuild trust, we need to focus on the issues that truly matter to people. Unfortunately, many public health departments are still stuck in pandemic-response mode. Not known for agility, they continue pushing the same guidance and recommendations from half a decade ago. Every business owner knows that to promote one thing, you must choose not to promote something else. We saw many examples of this over the past four years, in which people missed routine screenings and cancers went undiagnosed. Treatment for substance abuse was put on the back burner as deaths from opioid overdoses skyrocketed. Mental health disorders were left unattended, spilling over into crises of homelessness and crime. In Louisiana, maternal and infant mortality remain near the worst in the nation. All the while, chronic disease rates continue creeping up to crisis levels. These are the post-pandemic priorities of the Louisiana Department of Health.

As a nation, we must recognize that there is no miracle pill for the major population health problems we face. The solution to increased spending and declining outcomes in our country is unlikely to come in the form of a pill or a shot. Much of the solution will likely come down to the usual hard work of improving diet, increasing exercise, and making better lifestyle choices.

Government should admit the limitations of its role in people’s lives and pull back its tentacles from the practice of medicine. The path to regaining public trust lies in acknowledging past missteps, refocusing on unbiased data collection, and providing transparent, balanced information for people to make their own health decisions. By demonstrating genuine integrity and respect for personal autonomy, public health agencies can begin to mend the rifts they’ve created. Ultimately, restoring this trust requires returning medical decisions to the doctor-patient relationship, where informed, personalized care is guided by compassion and expertise rather than blanket government mandates.

Sincerely,

Ralph L. Abraham, MD

Louisiana Surgeon General

Wyche T. Coleman, III, MD

Deputy Surgeon General