To the Editor:
As pediatricians and medical educators, we were taken aback by Huddle's1 recent perspective entitled “Medical professionalism and medical education should not involve commitments to political advocacy.” We strongly disagree.
Clinical advocacy in medicine is a direct response to the needs of patients. On a daily basis, the 21st-century doctor confronts illness caused by social determinants: poor nutrition (both under- and overnutrition), substandard housing, interpersonal violence, stress, commercial pressures, media influences, and poverty. To care for our individual patients, we need to be well versed in knowing how to be advocates for a wide range of resources that improve health and ensure life chances.
Group advocacy has been used successfully by doctors to bear witness to specific hazards affecting the health of populations and to create solutions. Doctors have been in the forefront of advocacy for safety caps on medication, car seats, bike helmets, HIV treatment, and on and on. Without the voices of physicians, these lifesaving interventions would not be available to patients. In fact, vigilance is needed to ensure continued funding and availability of even the most effective interventions, such as immunizations.
It is valuable for physicians to engage in legislative advocacy for improved services and access to care. A good example is early childhood intervention programs. They are evidence based and confer protection against threats to healthy development. At birth, at least 5% of children have discernible biological limitations; by school age, more than 25% are behind where they should be, in a socioeconomically graded manner. We physicians have joined our voices with those of parents and educators and have begun to garner federal support for programs like Early Head Start and Home Visiting.
Dr. Huddle warns against professional advocacy, and we agree that some professional advocacy can be overly self-serving. On the other hand, in pediatrics, the recent threat to our children's hospitals and their training programs (by the zeroing out of funding in the president's 2012 budget) places access to specialty care for our sickest patients at serious risk. As such, pediatricians recently mobilized to protect access to care; they were driven by medical necessity, not financial contracts. When someone or something gets in the way of our doing our job for our patients, professional advocacy is justified and necessary.
Physicians inherit the results of failed public policy.2 The time is now to bear witness to that reality.
Judith S. Palfrey, MD
Past president, American Academy of Pediatrics, and senior associate in medicine, Children's Hospital, Boston, Massachusetts.
Lisa J. Chamberlain, MD, MPH
Assistant professor of pediatrics, Stanford University School of Medicine, Stanford, California; firstname.lastname@example.org.