It took a viral pandemic to break down the barriers to effective telemedicine, especially across state lines. Now, it seems those barriers are being rebuilt.

Telemedicine, the practice of physicians consulting with patients on the telephone, or more often online with video, became commonplace during the Covid pandemic. Patients, as well as physicians, were reluctant to see people who might be infected with the virus. Therefore, it made perfect sense for patients to stay connected with their doctors through telemedicine since in-office visits were inadvisable. To facilitate these telemedicine evaluations, interstate restrictions were also removed. This enabled physicians to help more and more people during the pandemic, even across state lines.

But now that the pandemic crisis is over, though Covid is still around, some states are reimplementing restrictions on interstate telemedicine. This not only seems petty and unnecessary, but is interfering with access to medicine for some patients, especially those who established interstate doctor-patient relationships during the pandemic.

Shannon MacDonald, a radiation oncologist at Mass General Brigham Hospital in Boston and an associate professor at Harvard Medical School, writes about the impact of these restrictions in an article published in The Wall Street Journal. Dr. MacDonald tells us of a nine-year-old boy from New Jersey she began treating in 2009 with a brain tumor, medulloblastoma. Though the boy and his family traveled between states for appointments, he remained her patient at all times. Telemedicine made it possible for her to answer his parents’ questions, discuss his imaging, and propose new therapies when others failed. He was able to receive state-of-the-art treatment and continuity of care across state lines with the aid of telemedicine.

Though the boy has since died, telemedicine was an integral part of his treatment. You would think that the Covid pandemic would have awakened state governments to the benefits of telemedicine such that the emergency orders permitting interstate treatments would have been permanently waived. But, alas, such is not the case. Some states, like New Jersey (where this boy lived) have rescinded the approval of this practice now that the pandemic crisis is over.

Dr. MacDonald explains: “Instead of enlightening local governments about the benefits of telemedicine, the pandemic highlighted what physicians are forbidden to do. While I never hesitated to pick up the phone to call the boy’s parents and give them advice, I wouldn’t legally be able to do that now because New Jersey has decided that a simple phone call constitutes the practice of medicine. Giving medical advice to an out-of-state patient over the phone can put me at risk of losing my license, and, in states such as California and New Jersey, of criminal charges as well.”

At the outset of the pandemic, some state medical boards feared that telehealth would enable out-of-state doctors to poach patients from local physicians, especially in rural communities. State health authorities also didn’t want the hassle of pursuing malpractice claims across state lines. These concerns were unfounded. Fees and carve-outs—for example, restricting interstate telemedicine to specialty care or requiring referrals—could address these issues without undue limits on access, as could a requirement that physicians adhere to the laws of the state in which the patient is located.

The benefits of telemedicine outweigh any hypothetical concerns. Rural areas lack specialists, but rural residents need specialized healthcare as much as anyone. Distant specialists, accessible to rural residents by phone, shouldn’t be thought of as competitors to rural physicians but as resources capable of extending patients’ lives.

Personally, I have never understood why physicians are not granted the privilege to practice medicine in all 50 states when they pass the National Board of Medical Examiners test, which is required by every state for licensure in the U.S. I’m sure the reason has more to do with collecting state licensure fees than with any concerns about qualifications to practice medicine. I’m sure most doctors would be happy to pay a little more for national licensure, which could be shared with other states. In turn, these states would save money because they wouldn’t have to license these physicians themselves. This is an issue that has more to do with state control and fees than it does with qualifications.

Dr. MacDonald has tried to overcome this hurdle to interstate telemedicine. She explains:

“Without interstate telehealth, I’d have to become licensed in all the states where my patients live if I wanted to continue treating their rare childhood cancers or bone tumors. Because I believe strongly in the benefits of telehealth, I have obtained licenses in six states through the Interstate Medical Licensure Compact. Doing this took months, cost thousands of dollars, and still leaves me unable to care virtually for patients in 43 states. The process is so cumbersome that less than 1% of physicians use it.”

“Military doctors have long been able to practice medicine across state lines. In 2018 it became legal for sports-team doctors to practice medicine during out-of-state away games. If we can make a law that allows treatment across state lines for a National Football League player, can’t we consider it for a child with a brain tumor?”

This is clearly a problem begging for a solution that is in the hands of politicians, not doctors. The time has come for the politicians to make it easier to practice the best possible medicine. Some day those politicians may need access to interstate physicians themselves.

Woke medical education isn’t going away. If you’re a regular reader of this blog, you know I first began writing about woke medical education in 2022, hoping it was a passing trend that would eventually go away. But today there is evidence it is getting worse.

In my last post on this subject, called Woke Medical Education Update, I wrote about Dr. Stanley Goldfarb, former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine. Dr. Perelman was the first to call attention to this situation as early as 2019 in an Op-Ed published in The Wall Street Journal called “Take Two Aspirin and Call Me by My Pronouns.” He wrote, “Concerns about social justice have taken over undergraduate education.” He warned about the “focus on climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness.”

Grace-Marie Turner, writing for The Galen Institute, says many students say they are admitted to medical schools only if they give the “right” answers to a litany of woke questions. Students are being indoctrinated to see skin color as the most important thing about a patient.

Dr. Marilyn Singleton wrote in a recent Washington Post Op-ed that she “graduated with a medical degree in 1973, a black woman in a class of mostly white men. Since I became a physician, I have seen exactly one instance of racism in health care – and it was from a patient, not a fellow physician. As for my colleagues, I have been consistently impressed with the conscientious, individualized care they have provided to patients of every race and culture. When we all took our oath to ‘first, do no harm,’ we meant it, and we live it.”

The latest evidence of this awful trend is a new editorial from The Wall Street Journal called The New Segregation on Campus. The editors tell us “If you’ve heard that the diversity, equity and inclusion agenda is going away, don’t believe it. An emerging practice at elite medical schools segregates students by race to teach them about alleged structural racism in healthcare.”

They go on to explain: “The University of California Los Angeles School of Medicine requires that first year students take a class called “Structural Racism and Health Equity” as part of the standard curriculum. In one exercise for the course, students divide by racial group and retreat to different areas to discuss antiracist prompts. This is known as racial caucusing, a teaching device that UCLA describes as an “anti-racist pedagogical tool” to “provide a reflective space for us to explore how our positionality—particularly our racial identities as perceived within clinical spaces—influence our interaction with patients, colleagues and other staff.”

Fortunately, there is an organization fighting back. Do No Harm is a group that describes its mission as “eliminating racial discrimination in healthcare.” They say this UCLA practice is illegal – that it violates the 1964 Civil Rights Act. In a letter to the San Francisco Office for Civil Rights, Do No Harm wrote this week that the school’s racial caucusing groups “illegally segregate and separate its first-year medical students based on their race, color and/or national origin” in violation of Title VI.

Medical students in the class are asked to choose which of three racial categories they will identify with. They can select among “white student caucus group,” “Non-Black People of Color (NBPOC) student caucus group” or “Black student caucus group.” In case students think they have a choice of which group to join, a letter from the school makes clear they should sort themselves by how they look to others.” Recognizing the imperfect and problematic nature of our socially constructed racial categories,” the school says, “we ask that you identify the group in which you feel you are most perceived as in clinical spaces.”

The day the civil-rights complaint was filed, UCLA abruptly informed students that the caucusing exercise was cancelled, which suggests that administrators know the practice is legally suspect. In accepting federal funds, schools must agree to abide by Title VI, which prohibits discrimination by race. It contains no exception for discriminating in pursuit of an antiracist agenda. As a public university, UCLA is also governed by the Equal Protection Clause of the 14th Amendment.

When I went to medical school, we had more than enough to learn in the relatively short period of four years to complete our medical degrees. We didn’t have time for learning nonsense like this. Neither do the students in medical school today.

Most people complain about the price of prescription drugs in our country. That’s why politicians, like former President Donald Trump, current President Joe Biden, and presidential candidate Governor Ron DeSantis all agree on the idea of importing less-expensive drugs from Canada. It seems to make perfectly good sense.

But a closer look can be revealing. The issue is more complicated that these politicians will tell you. By importing prescription drugs from countries with socialized healthcare systems, you are also importing their government price controls.

Last week the Food and Drug Administration approved Florida Governor DeSantis’s request to import drugs from Canada. The Wall Street Journal editors tell us DeSantis pitched the idea in 2019 to lower drug prices, and the Trump Administration teed it up for FDA approval with enabling regulations. “We will finally allow the safe and legal importation of drugs from Canada,” Mr. Trump said in 2020.

With this approval, Governor DeSantis is taking a victory lap. “Canada has the same drugs. They’re like 25 cents on the dollar, and part of that is because of the way their government suppresses the price,” he said in Iowa. “Bottom line is that if I can get 25 cents on the dollar, I can save $100 million, $200 million in Florida.”

Full disclosure, I have been a Governor DeSantis fan ever since the Covid pandemic, when he governed Florida better than any other state in the union. That’s why Florida is the number one state for Americans who choose to move from one state to another. But the governor doesn’t seem to appreciate the downside of his position on importing drugs.

The WSJ editors explain: “Drug importation has gained support among Republicans who say Americans are subsidizing drugs for the rest of the world. There’s some truth in this. Drug prices in Canada are more than 50% lower than in the U.S. That’s largely because Canada’s government can compel manufacturers of patented drugs to reduce their prices. But Americans also get access to more innovative drugs, and sooner. Drugs were approved 468 days earlier in the U.S. than in Canada for the 218 medicines authorized in both countries between 2013 and 2019, according to the Fraser Institute.”

In other words, there is a tradeoff, a price to be paid, for allowing price controls in the U.S. just like they have in socialized countries like Canada. The price is less availability of drugs, longer waiting times, and less new drug innovations. This can be extremely important in situations like the Covid pandemic when new, life-saving drugs are being developed and brought to the marketplace.

WSJ says Trump could have used trade negotiations to prevent Canada and other countries with drug price controls from extorting American drug makers and “free-riding” on Americans. Instead, his Administration issued regulation on how states could obtain FDA approval to import drugs from Canada. Biden then followed with an executive order directing FDA to work with states that have proposed importation programs. Florida is the first to gain approval, but Texas, Colorado, and New Mexico are hoping to join in soon. Florida says its plan could save $150 million annually.

But this depends on no changes in the current system. Drug makers say they’ll reduce sales to Canada if their products will be exported to the U.S. Furthermore, Canada has warned it would restrict drug exports to the U.S. to prevent shortages. In other words, the supply of drugs in the U.S. imported from Canada is likely to be limited.

All of this is an attempt to import foreign drug price controls that the U.S. Congress won’t accept. But trying to get around the system this way only undermines and erodes U.S. intellectual property protections of the pharmaceutical industry that are necessary to reward the great cost of innovation and investment in drug research.

The old saying, “There’s no such thing as a free lunch” still applies.