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Janet A. Jokela, an infectious disease physician, discusses her article, “Doctors, grounded in our oath, must act now more than ever,” reflecting on the physician’s solemn commitment to patient care, integrity, and advocacy. With increasing challenges to public health institutions like the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO), physicians must decide how to uphold their oath amid political and systemic disruptions. The conversation explores the role of medical professionals in defending science, advocating for patients, and maintaining ethical standards in health care. Listeners will gain insights into actionable steps, from professional advocacy to public communication, that reinforce the vital responsibility physicians carry both inside and outside the clinical setting.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Janet A. Jokela. She is an infectious disease physician and treasurer of the American College of Physicians. Her latest article is “Doctors grounded in our oath must act now more than ever.” Janet, welcome back to the show.

Janet A. Jokela: Thanks so much, Kevin. Delighted to be here.

Kevin Pho: All right, so tell us what your latest article is about.

Janet A. Jokela: Yeah, you know, with everything going on in the world today and in our country and all these changes that are, you know, happening, the question is how do we as individual physicians respond and what do we do? You know, if we are concerned about these things which are happening, how do we decide what to do and what do we do? So I realized, you know, I thought it was important to pause, reflect, and kind of go back to the oath that we took when we graduated from medical school—like, what are the values and principles that we promised to uphold? And I think by following that and adhering to that oath, we are going to be in a good place. You know, knowing about these values and principles that we promised to uphold when we graduated from medical school can guide our decisions in terms of how we think about these issues and what is important and what may be less important in terms of our core oath, and it can help us decide what we should do and what to do.

Kevin Pho: Do you feel that there are events in the world that are making physicians, I am not going to say question their oath, but have to think back as to why they entered medicine in the first place?

Janet A. Jokela: Maybe, you know—not me, not me—but perhaps there are people who, you know, are out there questioning that, but that is sad. I think many—I work with medical students regularly, and I see them all the time. And I think many medical students, when they come into medical school and they go through and then they graduate, they are very highly motivated to help others, to take care of the sick, and really to help make the world a better place. And in many ways, that is what our oath tells us and, you know, guides us to do. I think the medical students are in that place. Now, as you know, we all know there is a huge number of challenges in practice and everywhere else that may sour people on, you know, some of the things that we all get tied up in delivering health care. But putting that aside, at its core, we are here to serve others, we are here to take care of patients, and how do we do that best?

Kevin Pho: So I want to read the first few lines of the oath that you put in your article. It says, “I solemnly pledge to dedicate my life to the service of humanity. The health and well-being of my patient will be my first consideration. I will respect the autonomy and dignity of my patient. I will maintain the utmost respect for human life. I will not permit considerations of age, gender, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient.” And, of course, the oath goes on. So we obviously live in a very polarized political environment. There are a lot of changes with our health care institutions as we speak, specifically with the World Health Organization and the National Institutes of Health and Health and Human Services. So tell us some of the tensions that you are seeing—the American College of Physicians is seeing—between the oath and some of the political changes going on with our health care institutions.

Janet A. Jokela: It is really challenging right now. It is really, really challenging. And I will tell you, the ACP has spoken out about this, and so have a number of other organizations. The ACP has partnered with entities like the pediatricians, the obstetrician-gynecologists, and others to put out a statement about the problematic issue of withdrawing from the WHO because it harms patients, right? And, you know, the same thing—the AAMC, the Association of American Medical Colleges—has spoken out very strongly about the threatened cuts at the National Institutes of Health. But ultimately, when you drill down on these issues, it is about harming patients, and that is the problem; that is the concern. Even thinking about USAID and the things that are going on globally and the work that the U.S. has been doing there—by abruptly stopping funding or, you know, whatever it is, all that is going on—patients at the end of the receiving line of that support have been affected. And even patients who have been enrolled in clinical trials affiliated with USAID—suddenly, with those abruptly being stopped, those are issues for patients as well. Medicine does not stop at our borders, you know, within the border of a state or the border of our country. This is really—it is a global thing, and that is what hurts. I mean, that is what hurts so much.

Kevin Pho: Now, for people who may not understand the impact on patients, let us give those scenarios that you talked about—withdrawing from the World Health Organization, the cuts at the National Institutes of Health, and withdrawing from World Aid. For those who may not understand, how does that directly impact our patients? Let us just talk, for instance, about withdrawing from the World Health Organization. Talk about the patient impact of that specifically.

Janet A. Jokela: Yeah, I tell you, you know, we are on the—I hope we are not—but I am concerned we are on the brink of a bird flu H5N1 potential pandemic, and it is really critical that we collaboratively work with our colleagues across the world on this to help stay on top of the data in terms of what is evolving with that and also where there may be outbreaks, where there are not, but then also figuring out how best to prepare for that and therapeutics and, you know, all of that. By withdrawing from the WHO, it weakens the WHO’s ability to combat that and to address those issues, and for us to even communicate with the WHO and to receive information and data back from the WHO. And that hurts everybody. It potentially hurts. It hurts people here in the U.S. It hurts people all over. But that aside, for us as clinicians to be able to answer questions and also to be able to provide the most up-to-date information and guidance for what to do around the potential for, say, bird flu—that is really important. It is a huge deal.

Kevin Pho: So let us talk about the next example in terms of the cuts for the National Institutes of Health. Again, for those who may not understand what the NIH does and the direct impact it has on patients, talk about some of the cuts that potentially can impact our patients going forward.

Janet A. Jokela: I tell you, I have many colleagues who are biomedical researchers and who work in this space, and some of the comments I have heard from them—I mean, it is fear. It is really fear. And it is like this will destroy the research infrastructure in this country, you know, and beyond. There are many international researchers who collaborate with researchers in our country who, you know, work on studies and things together. I tell you, I could not help but think about this again as someone who has experienced breast cancer and gone through chemotherapy and all that. You know, as I am thinking, as I am lying there getting infused with these chemo drugs, you cannot help but think, well, why these drugs? You know, why these two drugs? Why not those other drugs? And the only reason is because of research that has been done through the NIH to establish that these drugs are the safest drugs and they are the best drugs for the kind of tumor that I had. So as an example, that is just one small example, but it directly impacts potentially patient care and our future going forward. I mean, it is almost like—yeah, the concern is that research could just stop or really slow down at this point, and we could be treating the same tumor that I have had the same way 10 years from now because we do not have new information in terms of what to do differently. I hope that helps.

Kevin Pho: Now, you work at an academic medical center, of course, and you are talking to a lot of researchers who receive NIH grants. You mentioned fear. Go into more detail about what you are hearing. Do they feel powerless? Is there anything they can do? How are they responding to these cuts at the NIH?

Janet A. Jokela: Yeah, well, first of all, the potential cuts at the NIH—they have been paused right now due to a court order, and we will see how that all plays out. So I think there is fear, and people are just very unsettled, not knowing what is coming next, and these things are all happening so quickly. You know, this happens, and then that happens, and it is a lot to absorb and keep track of. So with that, I think people are trying to figure out how best to respond and what to do and where to turn. So I think people are getting their footing and their grounding and realizing this is really important, and this is foundational, and they are figuring out a way forward. But I think the first reaction is, oh my goodness, I cannot believe this, and why would we ever do something like this? You know, how is it going to affect me, of course, and then they are figuring out how best to respond and what to do. I really feel for the early career researchers and people who are in this space when things are so unsettled, but we will see.

Kevin Pho: And why specifically the early career researchers? What are some specific things that they need to look out for with all the changes going on?

Janet A. Jokela: I think they need to look out for the same things that all of us are looking out for. Again, to have committed one’s training and early adult years to all this work—they may be MD-PhD people, or straight PhD or straight MD people—but they have spent a tremendous amount of time gaining a very sophisticated and very strongly based scientific background. And now, you know, they are at the cusp of jumping into their career. With this sort of activity going on—which is very unsettling for them in terms of funding support and all this going forward—it is almost like, I think it could potentially have the feeling of the rug being pulled out from under them. Now, that said, we do not know how this is all going to settle out. My hope is for early career and everybody that things will be more settled and, you know, we will end up in an OK place. But I just feel for them. It is a very unsettling time.

Kevin Pho: And then let us talk, of course, about the third example: the essential shuttering of foreign USAID and all the ramifications of that. So in the lens of patient care and the impact on the patients that we care for, how does that affect them?

Janet A. Jokela: Yeah. Well, you think about colleagues we have who are working overseas and have been working overseas for a long time in this. So I am going to talk about HIV and HIV prevention specifically. We know these trials that are partially funded by USAID have provided antiretroviral therapies for individuals who are enrolled in these trials—preventive therapies in some cases. So those who have been participating are now left high and dry, and it is like there is nobody for them to go talk to about what is happening; they cannot get new medicines. We all know with HIV, when people stop taking their medicines for a week or short periods of time, their viral load will start to rebound, and we start to see more effects of uncontrolled HIV. It is more likely that the infection can be transmitted to others under those circumstances, and the whole thing becomes unraveled. So you think about the impact for those individual patients who have trusted us to participate in these trials and have done well—to suddenly again have that yanked away—it is just heartbreaking. It is just heartbreaking.

Kevin Pho: Now, how is the American College of Physicians responding to these flurries of actions? And like you said, it is coming so fast. So how are professional organizations like the ACP responding?

Janet A. Jokela: Yeah, yeah, yeah. No, that is a great question. First of all, I think everybody is thinking that, you know, this is a marathon, not a sprint. That said, with all these EOs coming out so suddenly and so frequently, it does feel like a sprint, but that aside, it is a marathon, not a sprint. I think for individuals, it is important to focus on specific issues that are important to them and then act accordingly. For the ACP, the ACP has just updated its website in terms of advocacy and specific actions that they have taken so far, and they have been putting out statements, writing letters, and also working to collaborate with other physician organizations to, again, figure out the best course. So I am very proud of the ACP and the things that they are working on, and I think their heart certainly is in the right place.

Kevin Pho: So let us get back to the individual physician and their oath. With this flurry of news, it seems like every day there is a seismic event that affects our profession and affects the patients that we care for. What can individual physicians do to reconnect with their oath, to remember why they went into medicine in the first place, to remember their proverbial North Star? Just give us some advice in these unsettling times.

Janet A. Jokela: Yeah, I think coming back to our North Star, our commitment to our patients, is critical. And it is important that we do that independent of executive orders and, you know, other things going on, but just to remain focused on that—that is why we are here, and that is why we do what we do day in and day out. I think certainly for busy clinicians, it is critical for them to continue to do their day job day in and day out. I mean, our patients need our care, and that is our commitment. That is where we focus our attention. That said, I think if these other issues are important to an individual clinician—and I think many of them are, once we begin to look at it and recognize the gravity of what the implications of some of these things are—there are a lot of different things that individuals can do. Probably the primary one is to call our congressional representatives, and if we cannot reach them, leave a message on voicemail, and just let them know what your concerns are about whatever the issues are. So I think that is the primary thing. And the others are things, and some of them I mentioned in the article: we can be an ally to our biomedical researcher colleagues and our public health colleagues—that is important. We can offer moral support to each other. We can do our best to stay abreast of the news, which I think is helpful; that has been one of my approaches. I feel better trying to know what all is going on. At the same time, I think there are times you have to take a break from the news; you just cannot keep up with all of this. But I think in many ways, working together with our colleagues is helpful. Some people have talents to do podcasts, for instance, and it is one way to get the news out about whatever may be going on. Others may be writing op-eds, and others may be, again, getting on the phone and calling their congressional representatives. So there are a lot of different ways that I think we can come together to address the concerns that any number of us may have.

Kevin Pho: We are talking to Janet Jokela. She is an infectious disease physician and treasurer of the American College of Physicians. Today’s KevinMD article is “Doctors grounded in our oath must act now more than ever.” Janet, as always, let us have some take-home messages that you want to leave with the KevinMD audience.

Janet A. Jokela: Sure. Thank you, Kevin. Again, we have all been given gifts and talents of various sorts, and it is up to us to put them to good use. And by adhering to our oath and the principles that we agreed to in our oath when we graduated from medical school, we will land in a good place, and we will do the next right thing, which is what is so important to do, especially in these uncertain times.

Kevin Pho: Thanks so much. Janet, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Janet A. Jokela: Thank you so much. Delighted to be here.