It's time for Trump administration doctors to speak up — whatever the consequences

It's time for Trump administration doctors to speak up — whatever the consequences
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President TrumpDonald John TrumpTrump suggests some states may 'pay nothing' as part of unemployment plan Trump denies White House asked about adding him to Mount Rushmore Trump, US face pivotal UN vote on Iran MORE may have given the four doctors nominally guiding the country’s response to the coronavirus no choice but to resign — if they are to fulfill the Hippocratic Oath

Until now, it has been understandable why Anthony FauciAnthony FauciPublic health expert: 50 percent effective coronavirus vaccine would be 'better than what we have now' Overnight Health Care: Trump to take executive action after coronavirus talks collapse | Vaccine official says he'd resign if pressured politically Fauci's DC neighbors put up 'thank you' signs in their yards MORE, director of the National Institute of Allergy and Infectious Diseases, and Deborah BirxDeborah BirxIt's our fault 'the monster' virus is everywhere Massachusetts governor pauses reopening, reimposes some coronavirus restrictions Birx warns of uptick in coronavirus cases in 9 cities MORE, the coronavirus response coordinator, have continued to serve; likewise for Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC), and Jerome AdamsJerome AdamsSunday shows preview: White House, congressional Democrats unable to breach stalemate over coronavirus relief It's time for Trump administration doctors to speak up — whatever the consequences Surgeon General: We need to lower transmission rate of coronavirus to reopen schools MORE, the surgeon general.

By remaining in their positions, these four experts could hope to exert some positive, expertise-based influence on the president’s understanding and decision-making in this crisis. Despite his decisions having so far proved disastrous, they – and we – could still believe that by being there, by being on the inside, they might still be able to work quietly to minimize the damage. 

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That hope, however, will be dashed if the White House blocks key parts of the critical bill Congress will soon consider that seeks funding for expanded testing and contact tracing, as well as for the CDC.

This is not a partisan issue. In March, a group of health policy experts at the conservative American Enterprise Institute spelled out in detail a national contact tracing and testing program. Yet the executive branch successfully fought against implementation of the program then and appears determined to thwart it again.

To be clear, these are basic and foundational measures without which many more tens of thousands of people may die. And that is the problem for any physician associating themselves with this White House. On the first day of their careers, all physicians pledge to do no harm. But the administration they are serving is causing needless harm. It doesn’t seem interested in implementing scientifically based policy changes to finally contain and manage this pandemic.

Most experts agree that managing the pandemic requires masking mandates, testing, contact tracing and isolation support. The federal government should be leading national coordination of these specific efforts across regions and states. This includes funding and public communication.  

To be sure, working from the inside can be honorable. We imagine that, early on, Drs. Fauci, Birx, Redfield and Adams probably tried to educate administration officials, offering their best advice and attempting to channel informed decisions, while serving as the public face of efforts to combat the pandemic. There is something to be said for their willingness to stand the heat in the middle of a botched initial response. 

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But this is a make-or-break time for the inside game. If the additional funding for testing and tracing does not pass, Fauci and his colleagues will need to examine their consciences and recognize that working from the inside for all these months simply has not worked.

It is time for our colleagues to privately demand and, failing that, to publicly advocate that the administration support legislation to fund and coordinate more coronavirus testing, contact tracing and isolation support and to withhold relief from states that do not mandate masking. 

Our medical colleagues must be willing to speak the truths that may put them at risk of being fired, and they must be willing to resign in protest if ignored. We do not advocate resignation lightly. Indeed, we respect Dr. Fauci’s resilience in the face of calls for his departure. But there’s a difference between leaving because of persecution and resigning over principle. Resigning en masse could jolt both Republic and Democratic politicians into action.  

As the mishandling of the pandemic worsens and the harm intensifies, physicians have an obligation to say “no more” — to adamantly call out what’s wrong and to have the moral clarity to demand what's right. 

To say nothing, to go along, enables more suffering and many unnecessary deaths. The tipping point has arrived. These physicians must risk their position to honor their Hippocratic Oath and no longer enable harm.

Norbert Goldfield, MD, is a practicing internist and founder of Ask Nurses and Doctors. Andrew Goldstein, MD, MPH is a primary care doctor and assistant professor at NYU School of Medicine. Robert Crittenden, MD, MPH is a family physician and former policy adviser to Gov. Booth Gardner, Gov. Jay InsleeJay Robert InsleeWhy a rising star is leaving Congress Inslee, GOP's Culp advance in Washington governor's race Governors call for Trump to extend funding for National Guard coronavirus response MORE and Sen. George Mitchell.