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Choose Your Medicine: Freedom of Therapeutic Choice in America

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Lewis Grossman’s book, Choose Your Medicine: Freedom of Therapeutic Choice in America covers the history of social movements and legal battles dedicated to ensuring that people can use their preferred therapies and practitioners without government interference.

Image courtesy of interviewee. February 2, 2024

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The speaker is a law professor with a focus on food and drug regulation, who is also a historian. They have been researching and teaching about the Abigail Alliance case, which addresses the question of whether terminally ill patients have the right to access unapproved drugs. This video video issue of medical freedom is deeply rooted in American history, as explored in the speaker's book which spans from the American Revolution to present-day.

The speaker highlights how concepts of medical freedom have evolved, beginning in the Jacksonian era of the 1830s when a movement led by botanical medicine practitioners dismantled the existing medical licensing system, thus prioritizing patient access to alternative treatments. Despite later resurgences of medical licensing, they maintained some protections for non-orthodox medicine.

The speaker discusses significant historical movements, including the 1970s cancer cure craze and the AIDS movement of the 1980s, which sought freedom in medical choices. They also examine the recent success of medical marijuana as part of a broader medical freedom movement.

Through various lenses, including bodily and economic freedoms, religious freedom, and freedom of inquiry, the speaker describes a longstanding American commitment to medical choice, which complicates contemporary healthcare reform efforts. They reveal how historical skepticism towards medical establishment and expertise persists, particularly evident during the COVID-19 pandemic where calls for access to unproven treatments mirrored earlier movements for medical freedom.

Finally, the speaker critiques the paradox of expecting comprehensive healthcare reform in the context of the persistent demand for therapeutic freedom, and highlights the unusual political coalitions that form around medical freedom rhetoric across the political spectrum. The book aims to show that the current climate of medical skepticism and demand for choice is not new but a return to American norms.

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Here are some key quotes from the video:

1. **Introduction of the Speaker's Background:**
- "I'm a professor of, uh, law, um, who focuses on food and drug regulation. Um, but I'm also a PhD historian, and this topic very much combines my two passions."

2. **Discussion of the Abigail Alliance Case:**
- "This topic... concerns whether or not a person dying of an apparently incurable, uh, terminal illness should have the right to access a drug, um, that is not yet approved by FDA."

3. **Historical Perspective:**
- "As a historian, I became very interested in the question of just how deeply rooted is the commitment to freedom of therapeutic choice in American history and tradition."

4. **Medical Licensing in Early American History:**
- "In early American history... a once robust medical licensing system... was basically, uh, wiped out eviscerated by a medical freedom movement."

5. **Impact of the Cancer Cure Movement:**
- "I review very various episodes, um, in the history of American drug regulation that show the power of the medical freedom movement in the United States, including the quite extraordinary, um, social movement in favor of a, uh, cancer cure."

6. **Themes of Modern Medical Freedom:**
- "During Covid... the anti- um, elitist anti-establishment rhetoric that was directed against... pharmaceutical companies... was in many ways, uh, very typical of American approaches to these issues."

7. **Freedom of Therapeutic Choice:**
- "America's commitment to freedom of therapeutic choice poses a tremendous obstacle to major health reform or any notion or prospect of nationalized medicine in the United States."

8. **Collaboration Across Political Spectrums:**
- "There’s not any kind of obvious correlation throughout American history between progressive and conservative versus, uh, medical freedom advocacy."

9. **Commentary on Covid's Effect on Medical Freedom:**
- "What you saw during Covid was a reversion to the norm. And you see all of the themes that I mentioned... they all popped up."

10. **Final Reflection on Medical Freedom and Health Reform:**
- "I hope that readers... recognize that the modern attitudes regarding anti-establishment skepticism about orthodox medicine and demands for freedom of choice... are in many ways a reversion to the norm."

These quotes encompass the core themes of the video, including the intersections of law, history, medical freedom, and societal attitudes towards drug regulation and therapeutic choice.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

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I'm a professor of, law,

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who focuses on food and drug regulation.

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Um, but I'm also a PhD historian,

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and this topic very much combines my two passions.

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And for years now, I've been teaching a case

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to my students in the food

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and drug class called Abigail Alliance,

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which concerns whether

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or not a person dying of an

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apparently incurable, terminal illness

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should have the right to access a drug, that is not

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yet approved by FDA.

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And this, has been a, big issue,

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in both the legal

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and the political sphere for years in the United States,

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and the test that was ultimately embraced by the courts,

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to address that right,

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asks whether the right is deeply rooted in American

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history and tradition.

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And as a historian, I became very interested into,

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in the question of just how deeply rooted is the

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commitment to freedom

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of therapeutic choice in American history and tradition.

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And that's what got me hooked on this subject.

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Well, this book, covers the entire sweep

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of American history from the

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American Revolution to the present.

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And, what struck me when I did my research is

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how deeply embedded,

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this concept is in the American psyche.

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And so to give you an early example,

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in early American history, during the, what is known

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as the Jacksonian era of the 1830s

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and 1840s,

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a once robust medical licensing system in America,

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which privileged orthodox medicine

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and made it difficult for people to access

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alternative medical approaches like homeopathy

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and botanical medicine, was basically,

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wiped out eviscerated by a medical freedom,

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freedom movement led by, the Ians

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who were a botanical medical school.

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Uh, and by school here, I mean medical method, not,

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not actual educational institution.

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In the early years of the Republic, medical licensing

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was very widespread.

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Something like 18 out

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of the 24 states had medical licensing regimes,

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and these medical licensing regimes were supported

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by orthodox doctors as a method for

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suppressing unorthodox methodologies.

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Uh, like,

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Homeopathy la a little bit later on,

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but also botanical methods

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and a medical, movement arose called

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Pianism, which was closely connected to Jacksonian democracy

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in the 1830s and 1840s.

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And in a under examined

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but quite extraordinary political movement, the Ians

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managed to basically erase medical licensing

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from American law.

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So by the start of the Civil War in 1860,

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there was not a single

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functioning medical licensing system in the

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United States of America.

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Um, I trace the licensing question,

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into the later 19th century

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and even into the 20th century.

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But what's notable is that even as medical licensing

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resurged in the late 19th century, it was

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both designed

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and enforced in ways that continued to protect the practice

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of non-Orthodox medicine.

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So that's one historical example.

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In the 20th century, the questions turned largely

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to drug regulation as well as the regulation

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of medical practice.

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And I review very various episodes,

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in the history of American drug regulation

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that show the power

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of the medical freedom movement in the United States,

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including the quite extraordinary,

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social movement in favor of a, cancer cure.

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Uh, in quotes, called Lail in the 1970s,

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which kind of swept the country

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and led to, huge fervor in favor

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of freedom to access unorthodox therapies.

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I have a chapter on the AIDS movement

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in the 1980s, which was a slightly different type

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of medical freedom movement

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because it was people trying to seek freedom to access drugs

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developed by the orthodox medical pharmaceutical system,

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but nonetheless carried forth.

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Many of the themes, that we've seen

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or that I I identified earlier in American history.

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As you mentioned, I have a chapter on medical marijuana,

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which is really one of the most

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strikingly successful medical freedom movements.

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In recent American history.

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Uh, marijuana has gone from

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a completely unacceptable, product,

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to a, a widely accepted medical product,

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in much of the country.

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In fact,

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it may be rescheduled soon in the United States under the

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Controlled Substances Act,

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because it is now increasingly recognized,

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have some medical uses, it has its own twists and turns

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because arguably the biggest challenge

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to medical marijuana isn't,

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the bans on medical marijuana,

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but rather the increasing, legalization

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of recreational marijuana, which is kind

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of swamping the medical marijuana market.

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In the book, I focus on the different strains

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of American libertarianism that feed into

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American medical freedom philosophy

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throughout American history.

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And the one that most people are familiar

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with is bodily freedom.

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And indeed, that's a very prevalent one throughout American

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history and the rhetoric of hands off my body.

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Uh, it's my body, my choice.

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That kind of rhetoric,

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is in many people's eyes, the dominant one today.

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Um, but there are other strains of medical freedom,

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ideology that go all the way back

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to the roots of the country.

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Uh, one of them is economic freedom.

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Uh, sometimes this is, presented,

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as a simple free market argument

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that people should be allowed to choose the practitioners

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and the, therapies that they want

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and let the market decide what works.

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But there's also a very, significant anti monopolistic,

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aspect to it.

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Uh, American Independence was partly founded,

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founded on anti monopolistic, ideology.

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The East India, company was one

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of demons in the American vision.

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And in fact, the Boston Tea Party was directed against,

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the East India company as well as against the, the,

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the British, government more broadly.

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Um, but that has continued on,

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throughout American history,

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and it has often taken the shape in the world.

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I'm talking about as, allegations

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that there is some kind of insidious conspiracy

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between organized medicine and

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or the pharmaceutical industry to,

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restrict medical medical choice in a way that enriches

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and empowers, elite forces.

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Another quite American strain here is the connection

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between American, between freedom of medical choice

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and religious freedom.

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Um, sometimes if it's not more explicitly religious

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freedom of conscience, the longstanding notion

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that it is violating American's spiritual,

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religious freedom of choice to,

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prohibit them from choosing the medical

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treatment that they want.

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And then finally, there's the general notion

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of freedom, of inquiry.

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The idea that the way that knowledge advances is by,

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unfettered trial

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and error experimentation, often

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by people who don't have

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the highfalutin education

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and degrees that, many researchers, have.

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And, this is in very obvious tension

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in modern times with the notion

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of the randomized controlled clinical trial,

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which is very far from unrestricted,

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experimentation, but actu

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but is rather very, very, regulated

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and restricted experimentation.

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If you look at what happened in America with respect

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to covid, that the anti,

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elitist anti-establishment rhetoric

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that was, directed against

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the American government, health bureaucracy

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and pharmaceutical companies

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and Anthony Fauci, was in many ways,

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very typical of American approaches to these issues.

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I argue in my book that there was a period in the middle

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of the 20th century that was utterly atypical,

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in the, level of trust that Americans had

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for their establishment institutions, including

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pharmaceutical companies and physicians

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and health regulators and so forth.

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And I think that in many ways, what you saw

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during Covid was a reversion to the norm.

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And you see all of the themes that I mentioned,

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bodily freedom, conspiratorial,

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anti conspiratorial, anti monopolistic,

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arguments, religious freedom, freedom of inquiry, they,

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they all popped up.

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One thing that I think is interesting about the covid

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epidemic is that part of it was focused on preventing

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compulsory medical measures such as

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masking and vaccines.

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Um, but another aspect of it was demanding access to,

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to unproved uses of

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approved medicines like hydroxychloroquine and ivermectin.

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And this is kind of like a very modern version

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of medical freedom,

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because it is basically demanding the right to,

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access to off-label uses of approved drugs.

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Um, but it still has the same kind

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of anti-establishment fervor,

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because the way it was shaped was that,

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while these are off patent cheap uses,

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cheap alternatives,

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and it's kind of a thumb in the eye to the pharmaceutical

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industry to say, we're not going to use your

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newfangled expensive vaccines.

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We're going to, seek other,

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remedies and cures.

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Um, even if they don't meet your scientific standards.

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I hope that readers, recognize that

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the, modern attitudes that they are,

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perceiving now regarding anti establishment,

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skepticism about orthodox medicine

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and demands for freedom of choice are not a

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temporary diversion from American normalcy,

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but rather are in many ways a reversion to the norm

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that those of us old enough to remember America's golden age

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of medicine in the forties and fifties

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and sixties,

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actually experienced an anomalous period in America.

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And that this is very much, the way

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that America has approached, today is very much the way

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that America has approached these issues

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for most of its history.

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Um, I also think that it identifies

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a very important aspect of American ideology

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that will always be an obstacle

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to thorough going health reform in America,

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because the combination of the demand for freedom

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of therapeutic choice with the expectation

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that, the government will pay for

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whatever therapy people want,

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is simply an irresolvable paradox.

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And in the book, I actually focus on that

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in a chapter called, freedom to be reimbursed

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or Freedom to be Covered.

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So the second message, with presentist implications

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that I think people can take from the book is

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that America's commitment to freedom of therapeutic choice

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poses a tremendous obstacle

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to major health reform or any notion

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or prospect of nationalized medicine in the United States.

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I have a chapter called Freedom to Be Covered,

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which is an examination of how freedom

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of therapeutic choice rhetoric pervades even situations

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where,

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the controversy is not over whether people can legally

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obtain a therapy, but rather whether the government

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or other insurance will pay for the therapy.

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And you have conservatives, along with,

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people from elsewhere on the spectrum getting enraged when,

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a quote unquote death panel

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or quote unquote rationale

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is preventing people from accessing,

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the drugs they want in an insured, insured context.

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And if you have even the conservative side

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of the political spectrum, who normally are

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for small government, saying that, well,

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if you are gonna have reimbursement,

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you gotta reimburse everything.

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That's a, that's basically an unsolvable

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problem in the United States.

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So one other phenomenon

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that I analyzed throughout the book is the notion

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of strange bedfellows.

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There's not any kind of

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obvious correlation throughout American history between

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progressive and conservative versus,

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medical freedom advocacy or resistance to it.

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In fact, I point out episode

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after episode where you have people from very different

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parts of the political spectrum joining together

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in their skepticism of expertise

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and the establishment and in favor of medical freedom.

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This is most obvious in the 1970s

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where you had this kind of coalition

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of countercultural hippies

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with right wing John Birch society types,

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on the same side when it comes to medical freedom.

17:27.075 --> 17:31.665
The, the striking thing to me about,

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the Trump era, medical freedom activism,

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is not so much the, resistance

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to, alleged medical compulsion

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and resistance to medical expertise

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and to drug companies by the right part

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of the American political spectrum.

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But the, the rather, striking embrace

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of medical compulsion

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and, embrace of science

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and embrace of the establishment by the progressive side

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of the American political spectrum, this is not a given.

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It's not necessarily permanent anti-vaccination is,

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at its roots, is not a conservative notion.

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It draws from skepticism about government

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and the establishment from both sides

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of the political spectrum.

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And I find, I found it very, very striking that,

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medical freedom rhetoric aligned with

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one part of the political spectrum.

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So strikingly so, so obviously in the covid epidemic,

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although of course not exclusively, there continue to be

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progressive skeptics about the medical establishment

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and about vaccines in particular.

00:00 - I'm a professor of, law, who focuses on food and drug regulation. but I'm also a PhD historian, and this topic very much combines my two passions. And for years now, I've been teaching a case to my students in the food

00:22 - and drug class called Abigail Alliance, which concerns whether or not a person dying of an apparently incurable, terminal illness should have the right to access a drug, that is not yet approved by FDA. And this, has been a, big issue, in both the legal and the political sphere for years in the United States, and the test that was ultimately embraced by the courts,

00:56 - to address that right, asks whether the right is deeply rooted in American history and tradition. And as a historian, I became very interested into, in the question of just how deeply rooted is the commitment to freedom of therapeutic choice in American history and tradition. And that's what got me hooked on this subject. Well, this book, covers the entire sweep of American history from the

01:28 - American Revolution to the present. And, what struck me when I did my research is how deeply embedded, this concept is in the American psyche. And so to give you an early example, in early American history, during the, what is known as the Jacksonian era of the 1830s and 1840s, a once robust medical licensing system in America, which privileged orthodox medicine

02:02 - and made it difficult for people to access alternative medical approaches like homeopathy and botanical medicine, was basically, wiped out eviscerated by a medical freedom, freedom movement led by, the Ians who were a botanical medical school. and by school here, I mean medical method, not, not actual educational institution. In the early years of the Republic, medical licensing was very widespread.

02:38 - Something like 18 out of the 24 states had medical licensing regimes, and these medical licensing regimes were supported by orthodox doctors as a method for suppressing unorthodox methodologies. like, Homeopathy la a little bit later on, but also botanical methods and a medical, movement arose called Pianism, which was closely connected to Jacksonian democracy

03:14 - in the 1830s and 1840s. And in a under examined but quite extraordinary political movement, the Ians managed to basically erase medical licensing from American law. So by the start of the Civil War in 1860, there was not a single functioning medical licensing system in the United States of America. I trace the licensing question,

03:47 - into the later 19th century and even into the 20th century. But what's notable is that even as medical licensing resurged in the late 19th century, it was both designed and enforced in ways that continued to protect the practice of non-Orthodox medicine. So that's one historical example. In the 20th century, the questions turned largely to drug regulation as well as the regulation

04:23 - of medical practice. And I review very various episodes, in the history of American drug regulation that show the power of the medical freedom movement in the United States, including the quite extraordinary, social movement in favor of a, cancer cure. in quotes, called Lail in the 1970s, which kind of swept the country and led to, huge fervor in favor

05:00 - of freedom to access unorthodox therapies. I have a chapter on the AIDS movement in the 1980s, which was a slightly different type of medical freedom movement because it was people trying to seek freedom to access drugs developed by the orthodox medical pharmaceutical system, but nonetheless carried forth. Many of the themes, that we've seen or that I I identified earlier in American history. As you mentioned, I have a chapter on medical marijuana,

05:39 - which is really one of the most strikingly successful medical freedom movements. In recent American history. marijuana has gone from a completely unacceptable, product, to a, a widely accepted medical product, in much of the country. In fact, it may be rescheduled soon in the United States under the Controlled Substances Act,

06:09 - because it is now increasingly recognized, have some medical uses, it has its own twists and turns because arguably the biggest challenge to medical marijuana isn't, the bans on medical marijuana, but rather the increasing, legalization of recreational marijuana, which is kind of swamping the medical marijuana market. In the book, I focus on the different strains of American libertarianism that feed into

06:42 - American medical freedom philosophy throughout American history. And the one that most people are familiar with is bodily freedom. And indeed, that's a very prevalent one throughout American history and the rhetoric of hands off my body. it's my body, my choice. That kind of rhetoric, is in many people's eyes, the dominant one today. but there are other strains of medical freedom,

07:16 - ideology that go all the way back to the roots of the country. one of them is economic freedom. sometimes this is, presented, as a simple free market argument that people should be allowed to choose the practitioners and the, therapies that they want and let the market decide what works. But there's also a very, significant anti monopolistic, aspect to it.

07:50 - American Independence was partly founded, founded on anti monopolistic, ideology. The East India, company was one of demons in the American vision. And in fact, the Boston Tea Party was directed against, the East India company as well as against the, the, the British, government more broadly. but that has continued on, throughout American history, and it has often taken the shape in the world.

08:23 - I'm talking about as, allegations that there is some kind of insidious conspiracy between organized medicine and or the pharmaceutical industry to, restrict medical medical choice in a way that enriches and empowers, elite forces. Another quite American strain here is the connection between American, between freedom of medical choice and religious freedom. sometimes if it's not more explicitly religious

09:01 - freedom of conscience, the longstanding notion that it is violating American's spiritual, religious freedom of choice to, prohibit them from choosing the medical treatment that they want. And then finally, there's the general notion of freedom, of inquiry. The idea that the way that knowledge advances is by, unfettered trial and error experimentation, often

09:36 - by people who don't have the highfalutin education and degrees that, many researchers, have. And, this is in very obvious tension in modern times with the notion of the randomized controlled clinical trial, which is very far from unrestricted, experimentation, but actu but is rather very, very, regulated and restricted experimentation.

10:11 - If you look at what happened in America with respect to covid, that the anti, elitist anti-establishment rhetoric that was, directed against the American government, health bureaucracy and pharmaceutical companies and Anthony Fauci, was in many ways, very typical of American approaches to these issues. I argue in my book that there was a period in the middle of the 20th century that was utterly atypical,

10:54 - in the, level of trust that Americans had for their establishment institutions, including pharmaceutical companies and physicians and health regulators and so forth. And I think that in many ways, what you saw during Covid was a reversion to the norm. And you see all of the themes that I mentioned, bodily freedom, conspiratorial, anti conspiratorial, anti monopolistic, arguments, religious freedom, freedom of inquiry, they,

11:31 - they all popped up. One thing that I think is interesting about the covid epidemic is that part of it was focused on preventing compulsory medical measures such as masking and vaccines. but another aspect of it was demanding access to, to unproved uses of approved medicines like hydroxychloroquine and ivermectin. And this is kind of like a very modern version of medical freedom,

12:05 - because it is basically demanding the right to, access to off-label uses of approved drugs. but it still has the same kind of anti-establishment fervor, because the way it was shaped was that, while these are off patent cheap uses, cheap alternatives, and it's kind of a thumb in the eye to the pharmaceutical industry to say, we're not going to use your newfangled expensive vaccines.

12:39 - We're going to, seek other, remedies and cures. even if they don't meet your scientific standards. I hope that readers, recognize that the, modern attitudes that they are, perceiving now regarding anti establishment, skepticism about orthodox medicine and demands for freedom of choice are not a temporary diversion from American normalcy, but rather are in many ways a reversion to the norm

13:26 - that those of us old enough to remember America's golden age of medicine in the forties and fifties and sixties, actually experienced an anomalous period in America. And that this is very much, the way that America has approached, today is very much the way that America has approached these issues for most of its history. I also think that it identifies a very important aspect of American ideology

13:58 - that will always be an obstacle to thorough going health reform in America, because the combination of the demand for freedom of therapeutic choice with the expectation that, the government will pay for whatever therapy people want, is simply an irresolvable paradox. And in the book, I actually focus on that in a chapter called, freedom to be reimbursed or Freedom to be Covered.

14:35 - So the second message, with presentist implications that I think people can take from the book is that America's commitment to freedom of therapeutic choice poses a tremendous obstacle to major health reform or any notion or prospect of nationalized medicine in the United States. I have a chapter called Freedom to Be Covered, which is an examination of how freedom of therapeutic choice rhetoric pervades even situations where,

15:21 - the controversy is not over whether people can legally obtain a therapy, but rather whether the government or other insurance will pay for the therapy. And you have conservatives, along with, people from elsewhere on the spectrum getting enraged when, a quote unquote death panel or quote unquote rationale is preventing people from accessing, the drugs they want in an insured, insured context. And if you have even the conservative side

16:06 - of the political spectrum, who normally are for small government, saying that, well, if you are gonna have reimbursement, you gotta reimburse everything. That's a, that's basically an unsolvable problem in the United States. So one other phenomenon that I analyzed throughout the book is the notion of strange bedfellows. There's not any kind of

16:33 - obvious correlation throughout American history between progressive and conservative versus, medical freedom advocacy or resistance to it. In fact, I point out episode after episode where you have people from very different parts of the political spectrum joining together in their skepticism of expertise and the establishment and in favor of medical freedom. This is most obvious in the 1970s where you had this kind of coalition

17:14 - of countercultural hippies with right wing John Birch society types, on the same side when it comes to medical freedom. The, the striking thing to me about, the Trump era, medical freedom activism, is not so much the, resistance to, alleged medical compulsion and resistance to medical expertise and to drug companies by the right part of the American political spectrum.

17:55 - But the, the rather, striking embrace of medical compulsion and, embrace of science and embrace of the establishment by the progressive side of the American political spectrum, this is not a given. It's not necessarily permanent anti-vaccination is, at its roots, is not a conservative notion. It draws from skepticism about government and the establishment from both sides of the political spectrum.

18:35 - And I find, I found it very, very striking that, medical freedom rhetoric aligned with one part of the political spectrum. So strikingly so, so obviously in the covid epidemic, although of course not exclusively, there continue to be progressive skeptics about the medical establishment and about vaccines in particular.

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