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Controversial ‘medical freedom’ movement under US spotlight

By Bette Browne - 13th Aug 2023

Washington DC United States government skyline silhouettes of the White House, the United States Capitol Building and the Supreme Court.

So-called ‘medical freedom’ is being championed by a governor bidding to be the next US President. Bette Browne reports 

The purported “medical freedom” movement in the US, which opposes many public health guidelines, was once seen as being on the fringes of politics. But now it is being promoted by a governor who could be the next US president.

Mr Ron DeSantis, Governor of Florida since 2019, recently declared his bid to become the Republican party’s candidate in the 2024 presidential elections. Currently, former President Donald Trump leads the way in the Republican presidential primary. Mr DeSantis’s supporters like to portray the governor as “Trump without the drama”.

Mr DeSantis is not immune to controversy himself, however. Critics have suggested it is something he courts to boost his profile, a charge he has rejected. However, he rose to prominence as a national Republican figure by denouncing Covid-19 lockdowns and face-masking as curtailing “freedom”.

In 2020, Florida was one of the first major states to lift its Covid-19 lockdowns, defying warnings about the consequences from federal health officials. A year later, Mr DeSantis continued to speak out against Covid-19 vaccine mandates, even as deaths soared in the state during the pandemic.

Mr DeSantis’s support for re-opening a state dependent on tourism was credited with putting him in a strong position during his re-election run in 2022. He also increased his national profile by portraying his stance as “standing up for freedom”.

It was Mr DeSantis who coined the term “faucism” when charging that President Joe Biden’s former Chief Medical Adviser on Covid-19, Dr Anthony Fauci, was depriving America of its “freedom”. Dr Fauci was a popular target for the “medical freedom” movement and became a political lightening rod for Republican anger for treading a cautious path during the pandemic. 

Mr DeSantis delivered his attack on “faucism” on 24 February 2022 at the Conservative Political Action Conference, the biggest annual gathering of conservatives in the US. “From the very beginning, we refused to let this state descend into some type of faucian dystopia where people’s freedoms are curtailed and their livelihoods are destroyed,” Mr DeSantis declared. “Florida has defeated faucism. Freedom has prevailed in the sunshine state.”

Despite some criticisms of Mr DeSantis’s position, he was re-elected governor in November 2022 with 59.4 per cent of the vote to opponent Mr Charlie Crist’s 40 per cent. It was the largest margin of victory in a Florida gubernatorial election since 1982. 

Mr DeSantis also pushed for restrictions on abortion before the US Supreme Court overturned the constitutional right to the procedure in 2022. This year, he signed into law a bill approved by the Republican-dominated Florida legislature to ban abortion after six weeks. 

He has stated that he wants to position Florida as “the national leader for medical freedom”. On 11 May, Mr DeSantis signed the “strongest legislation in the nation for medical freedom”. He said the legislation “prohibits global health institutions, like the World Health Organisation (WHO), from dictating policy in Florida”. He added: “Our early actions during the pandemic protected Floridians and their freedoms. We protected the rights of Floridians to make decisions for themselves and their children and rejected Covid theatre, narratives, and hysteria in favour of truth and data. These expanded protections will help ensure that medical authoritarianism does not take root in Florida.”

Many public health experts were alarmed at what they saw as the politicisation of Covid-19 vaccination. An analysis by the Commonwealth Fund and the Yale School of Public Health, which was published in December 2022, estimated that the vaccinations prevented more than 3.2 million deaths and 18.5 million hospitalisations in the US. 

Mr DeSantis was an early advocate of vaccination, but his tone subsequently became much less enthusiastic.

A detailed analysis recently published in The New York Times noted: “While Florida was an early leader in the share of over-65 residents who were vaccinated, it had fallen to the middle of the pack by the end of July 2021. When it came to younger residents, Florida lagged behind the national average in every age group. That left the state particularly vulnerable when the Delta variant hit that month.”

According to the analysis, Floridians died at a higher rate, adjusted for age, than residents of almost any other state during the Delta wave. “With less than 7 per cent of the nation’s population, Florida accounted for 14 per cent of deaths between the start of July and the end of October.” Of the 23,000 Floridians who died, 9,000 were younger than 65, the newspaper reported. The majority of people who died were either unvaccinated or had not yet completed the two-dose regimen.

Health insurance is another major issue, with Florida ranking 42nd in the percentage of insured adults. More than 12 per cent of residents have no health coverage. 

In Massachusetts the figure is 3.6 per cent, noted Ms Teresa Hanafin in the Boston Globe

Yet the economy of Florida, where individuals pay no income tax apart from sales taxes, is the fourth largest in the US, with a $1.4 trillion gross state product as of 2022.

Healthcare rankings 

In March, an in-depth analysis of Florida’s ranking on healthcare and other social needs was carried out for Time magazine by Mr William Kleinknecht, author of States of Neglect. In that book, published in February, he stated there had been “a lurch to the right in Republican-controlled state houses across the country that has had dire results for ordinary citizens, but has largely escaped the lens of the national media”. 

Florida and its governor do not fare well in the analysis. “Even a cursory dip into the statistics of social and economic well-being reveals that Florida falls short in almost any measure that matters to the lives of its citizens,” stated Mr Kleinknecht. “More than four years into the DeSantis governorship, Florida continues to languish towards the bottom of state rankings assessing the quality of healthcare, school funding, long-term elder care, and other areas key to a successful society.”

He contended: “DeSantis weaponises the cultural wars to distract attention from the core missions of his governorship, which is to starve programmes geared towards bettering the lives of ordinary citizens so he can maintain low taxes on the wealthy and corporations. Florida is the ideal haven for privileged Americans who don’t want to pay their fair share of taxes. It has no income tax for individuals, and its corporate tax rate of 5.5 per cent is among the lowest in the nation.” 

Mr Kleinknecht stated it is “no wonder” that Florida ranks below the northern Democratic states in life expectancy and rates of cancer death, diabetes, fatal overdoses, teen birth rates, and infant mortality.

The “culture wars” cited by Mr Kleinknecht include Mr DeSantis’s high-profile attack on Disney after it decided to suspend political donations in Florida when the state’s legislature passed a “don’t say gay” law in 2022. The law prohibits discussion of gender identity and sexual orientation in schools. In retaliation, Mr DeSantis sought to strip Disney of a special tax district designation. But this would have resulted in local taxpayers having to cover the Disney tax district’s debt of $1 billion, so the issue became enmeshed in legal and political battles. The legislature had to adjust course and Disney managed to essentially retain its special tax district status.

Against this backdrop, a number of public health experts are concerned about the potential impact of a Mr DeSantis presidency on agencies like the Food and Drug Administration (FDA), Health and Human Services, the Centres for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), among others.

“Can you imagine what happens to federal agencies, such as FDA, CDC, and NIH, if the Florida governor becomes president and he populates the leadership of those agencies with members of his so-called integrity committee? OMG, what a horror show,” tweeted Dr Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and Co-Director of the Texas Children’s Hospital Centre for Vaccine Development. 

His tweet was posted in December 2022 when Mr DeSantis was preparing to enter the presidential nomination race.

The governor’s policies on guns are also considered alarming from a public health perspective. According to data from the CDC, 48,830 people died from gun-related injuries in the US during 2021. That’s an average of 133 people a day. The numbers are rising, with at least 200 mass shootings across the US so far this year, according to the Gun Violence Archive. Polls have shown that most Americans want stricter gun control, although this has also become politicised, with Republicans much less inclined to want stricter laws. In April, Mr DeSantis signed a bill into law that allows adults in Florida to carry concealed guns without a permit or training.

Profile of ‘medical freedom’ movement 

The governor’s rise in popularity, especially within his party, has boosted the profile of the “medical freedom” movement. This movement generally opposes regulation of health practices and advocates for increased access to “non-traditional” healthcare. 

Mr DeSantis is seen as having emboldened other states to follow his lead and “medical freedom” bills have been introduced in a number of state legislatures. Between January 2021 and May 2022, legislators enacted 65 laws in 21 states that now limit the powers of public health authorities to respond during an emergency, according to research by Pennsylvania’s Temple University in July 2022.

The notion of “medical freedom” is not unique to the US, with alliances and groups having formed in other countries, although often operating on the fringes of societies.

“One hallmark of the health freedom movement as it has evolved has been a vibrant conspiracy theory: A belief that the entire medical ecosystem – doctors, the government, academic researchers, the WHO – is populated by pharmaceutical shills, colluding in a plot that keeps people sick to maintain profits,” according to Mr Matthew Hongoltz-Hetling, author of If It Sounds Like a Quack… A Journey to the Fringes of American Medicine.

Writing in The New Republic in February, he stated: “Over the past two decades, the motivating force of this conspiracy theory, together with the organising efforts of the medical freedom movement, has allowed alternative practitioners to triumph beyond their wildest imaginings. The right-wing medical freedom campaigners have carried their unscientific beliefs deep into universities, hospitals, legislatures, and the pocket of the American consumer. For the public, the dividends have been dramatic and tragic: Billions of wasted dollars, countless assaults on the concept of science, and untold deaths.”

The aforementioned Dr Hotez has also warned of the threat posed to the US public health system.

“Under a flag of health or medical freedom, an outright defiance of masks and social distancing came to symbolise allegiance to President Trump. This contributed to the rampant spread of severe (Covid) infections. Misguided ideologies from populist regimes in Brazil, Mexico, Nicaragua, Philippines, and Tanzania bear varying degrees of resemblance to health freedom and contribute to the global Covid-19 death toll,” wrote Dr Hotez in a paper published in the Journal of Clinical Investigation in 2021.

“Health freedom, also referred to as medical freedom, represents a longstanding and pervasive belief system in American life. Its tenets espouse an aversion to government interference in personal or family health choices, often coupled to the counter promotion of a spectacular or miracle cure. The high death toll (during the pandemic) was exacerbated by a medical freedom ideology linked to political extremism.”

Appeal

For all the criticism of Mr DeSantis for his embrace of “medical freedom”, he holds a strong appeal among many Republicans, due in part to his resume.  

Mr DeSantis is a graduate of Yale University and Harvard Law School, a military veteran, and a former member of the US House of Representatives. At age 44, he is considerably younger than either Mr Trump or President Biden.

Mr DeSantis has also helped rebuild the Republican party in Florida, which traditionally tended to swing between Republicans and Democrats, but now increasingly looks like a Republican stronghold.

Recent polls show the governor has lost some momentum in his bid to become the Republican standard-bearer in the presidential election. At the same time, he has a war chest of over €100 million, has never lost an election, and appears to be free of personal scandal.

Ongoing controversy surrounding Mr Trump may also boost the governor’s chances. In May, Mr Trump was found liable for sexual abuse in a civil case taken by writer Ms E Jean Carroll. This month, US prosecutors charged Mr Trump in connection with his attempts to overturn the results of the 2020 presidential election. It is the third indictment brought against Mr Trump in recent months.

Meanwhile, it is noteworthy that President Biden’s campaign launch video on 25 April was titled “freedom”. He referenced “freedom” or “freedoms” six times over the course of the clip. 

President Biden and his campaign have framed conservative “culture war” issues like book bans and laws targeting gender-affirming care as a matter of freedom, believing it will resonate with Americans. A Fox News poll in April found 77 per cent of parents were extremely or very concerned about book banning by local school boards, an increase of 11 percentage points since May 2022.

On 8 June, President Biden declared at a White House news conference: “It’s wrong that a person can be married in the morning in the United States and fired in the afternoon by their employer because they’re gay. It’s wrong that the violence and hate crimes targetting LGBTQ people is rising. It’s wrong that extreme officials are pushing hateful bills targeting transgender children, terrifying families, and criminalising doctors.”

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