When a doctor stands on a public stage and proclaims that the COVID-19 vaccine has caused cancer it is, to say the least, problematic. It takes acres of words and mountains of outrage to row it back, no matter how delusional the claim. This falls into a phenomenon sometimes known as Brandolini’s law or the ‘bullshit asymmetry’ principle.1 It takes an order of magnitude more energy to refute misinformation. One response on social media caught my attention, and it was almost heartbreakingly naïve, asking about a doctor’s ‘oath’ and how this was surely breaking it.
The persistent belief in this ‘oath’ is at odds with the reality of regulatory frameworks. Sadly, one does not have to look far to find doctors who have more elastic morals and those with the power to reach wider audiences can wreak havoc. The sociologists Friedman and Reeves have done remarkable work on the elite of the UK and while there is no suggestion that doctors are de facto ‘elite’, their work offers some insight into the mindset of doctors.2 Like almost everyone else who enjoys any degree of success, doctors will tend to adhere to a meritocratic self-narrative. People believe, against the evidence one might note, that they have the status and salary because they deserve it.
One of the insanities of the UK healthcare system is the wildly varying pay for GPs that is often completely unhitched from the relative needs of populations. There is evidence that pay for GPs is generally poorer in more deprived parts of the country3 and pay erosion for GPs is a more general problem.4 Defending this system is verging on delusional. It is a significant weakness of the UK’s GP partnership model that it has not been able to maintain GP pay in our most needy communities. This worrying flaw aside, most would agree that doctors are offered considerable status in society and get some decent financial reward as part of that.
This matters as there is, arguably, a problem with doctors and ‘distance from necessity’. Friedman and Reeves outline this when they reference another sociologist, Pierre Bourdieu, and that ‘material affluence affords people a certain distance from economic necessity’. I would argue it also, in the case of doctors, affects how we approach our clinical work and inclusion health. There are many people out there battling to reduce health inequalities and to bring inclusive health to clinical care — but far fewer doctors than one might expect. Is this ‘distance from necessity’ part of the problem?
Paradoxically, Friedman and Reeves also found that people in the UK, when asked, tend to ‘down-class’ themselves — to a quite significant degree. People who are clearly in ‘solidly middle-class professional and managerial jobs’ regarded themselves as working class. No figures for doctors are teased out here but I would wager it would hold for the medical professional. Not all delusions are in plain sight, spouting wingnut nonsense on a stage, and some are quiet barriers to change.
Highlights
Research this month is tilted towards cancer and end-of-life care with articles on equitable inclusion on palliative care registers, access to medications out-of hours in palliative care, how to develop our approach to diagnosing oesophagogastric cancers, and a retrospective cohort study showing how we need to interpret full blood count results with ethnicity in mind. Mitchell et al’s editorial is essential reading given the urgent need to strengthen palliative care as legislation on assisted dying progresses. Clinical Practice covers the unusual condition of delusional infestation and a detailed Analysis in managing menopausal symptoms following breast cancer will guide care.
Notes
- © British Journal of General Practice 2025
