When you bake a cake, it’s good to follow the recipe. But as any good cook knows, there are times when it’s best to modify the recipe in certain situations. If you’re at high altitude you may have to adjust the temperature of the oven or how long you bake. If your family or friends eating the cake have medical conditions like diabetes, or high blood pressure, you may want to reduce the amount of sugar or salt you use. You can’t just blindly follow the recipe in all situations.

But doctors are now being trained to treat patients like following a recipe – one that doesn’t allow for any deviations. It’s called protocol-driven medicine, or evidence-based treatment.

David Mansdoerfer, professor of healthy policy at Pepperdine University, writes in The Epoch Times, “Medical education once trained doctors to think like detectives, piecing together clues from a patient’s story, symptoms, and unique circumstances. It taught them to sit with uncertainty, ask tough questions, and see the person behind the illness. Today, it’s at risk of churning out technicians who follow checklists instead of their instincts. The culprit? A growing obsession with standardized protocols that’s turning medicine into a paint-by-numbers exercise.”

He calls this the quiet corruption of medical education: the slow erosion of the physician as healer. Protocols—those step-by-step guidelines for everything from prescribing antibiotics to managing heart disease—were meant to make care safer and more consistent. They can help, especially in a crisis. But somewhere along the way, they went from being tools to being the boss. A push for standardization, kickstarted by efforts to improve healthcare quality in the late 1990s, has made protocols the backbone of medical practice. Hospitals, insurers, and government agencies now lean on them to measure performance, decide payments, and enforce rules.

Medical schools have followed suit. Instead of teaching students to wrestle with complex cases or challenge assumptions, many curricula now drill them on following algorithms. Students learn to tick boxes for conditions like diabetes or infections but aren’t always encouraged to ask, “Does this make sense for this patient?” The classroom, once a place for debate and discovery, feels more like a training ground for compliance.

Why is this happening?

You might wonder how things got this way. When I was a medical student, fifty years ago, we were taught to think. In fact, we were taught that our medical education was not a four-year experience but a life-long pursuit of medical knowledge; not the mindless use of pre-determined protocols to obviate our need for thinking!

As in most situations like this, the change is much more about money than the pursuit of medical excellence. The author tells us, “Healthcare systems and insurers love protocols because they’re predictable and easy to measure. Payment systems reward doctors for sticking to guidelines, even when bending the rules might better serve a patient. Medical schools, too, are caught in this web. Many rely on funding tied to “quality” metrics, which often mean protocol adherence. Professors, pressed to meet these expectations, teach students to play by the book rather than think outside it.”

Why should we be concerned?

First, it’s eroding the art of medicine. Doctors trained to follow protocols may hesitate to trust their gut when a patient doesn’t fit the mold. A rigid guideline might push antibiotics for an infection that needs a different approach or limit pain relief for someone in agony. Patients stop feeling like individuals and start feeling like data points.

Empathy takes a hit, too. Listening to a patient’s fears or hopes doesn’t fit neatly into a flowchart, so it gets sidelined. Yet we all know a doctor’s compassion can make as much difference as their prescription pad. When medicine becomes mechanical, that human connection fades, and patients notice.

Worst of all, this approach stifles the curiosity that drives medical progress. If doctors are trained to follow protocols without question, who will challenge outdated practices or dream up new treatments? A 2014 editorial in The British Medical Journal warned that rigid guidelines can hold back the kind of creative thinking medicine needs to evolve.

Recipes are useful as a starting point and protocols have their place as a foundation of our medical treatment. But skilled chefs and physicians alike must be able to adapt to the particular needs of their customers to produce the best meals and treatment they deserve. We must be able to think sometimes “outside the box” if we want our treatment to fit the particular needs of the individual we are treating – and to advance our knowledge of medicine beyond today’s understandings.

If you or your child have a rare disease, the chances of getting newly developed medicine to treat it just got better. This is one of the less-discussed benefits of the Big Beautiful Bill (BBB) just passed by Congress and signed into law by President Trump.

The BBB reverses the damage done by President Biden’s Inflation Reduction Act (IRA) that was woefully misnamed. The Editorial Board of The Wall Street Journal tells us the IRA was a woeful bill in countless ways, but the worst is its Medicare drug price controls. The early damage has been less investment in so-called orphan drugs for rare diseases. Because the pool of patients is small, manufacturers have to set higher prices to recoup their investment. This makes them an attractive target for Medicare bureaucrats.

The IRA price controls exempted orphan drugs, but only if they are approved for a single indication. They lose their exemption if they are used to treat more than one rare disease, though many diseases share an underlying pathology such as a gene mutation. Of the 280 orphan drugs approved between 2003 and 2022, 63 were approved later for another indication.

The law has discouraged companies from studying orphan drugs for multiple rare diseases. Some face a Hobson’s choice. If an experimental medicine works for two rare diseases, companies might have to jettison one use lest their drug become subject to price controls and return on its investment collapse.

Several orphan drug makers have canceled studies for follow-on indications since the IRA controls took effect. A recent analysis by the National Pharmaceutical Council found that the share of orphan drugs that received a second orphan drug designation fell by nearly half after the law passed—to 6.3% from 12.1% pre-IRA. This is a disincentive to finding new uses for existing drugs.

Republicans addressed this problem in the BBB by adding a provision to their tax bill that would ensure orphan drugs remain exempt from the price controls even if they are repurposed for other rare diseases. Many Democrats have signed onto similar legislation, though it’s telling that the left’s price-control crowd is now screaming about the provision’s $5 billion budget cost.

Progressives say expanding the orphan drug exemption will encourage Congress to make more tweaks that erode the price controls. Let us hope so. The orphan drug is a microcosm of the IRA’s disincentives to innovate. America has always been the leading country for new drug innovations and should remain so. Patients with rare diseases were an important voice in helping rouse political support for the orphan drug fix. Their success will improve and lengthen countless lives.

Most of the talk about the BBB will focus on the tax law changes and who benefits most. Democrats will try to convince you that only the rich will benefit although I doubt the rich care about no taxes on tips, no taxes on overtime, and reduced taxes on social security – all provisions of the new law which will benefit low income Americans. But you won’t hear about removing disincentives to new drug innovations – which will benefit everyone since disease is no respecter of incomes.

Politicians on both sides of the aisle have been known to distort the truth for political advantage. But Democrats have taken this art form to a new level in an effort to mislead the American people about President Trump’s recently passed Big Beautiful Bill (BBB).

The Wall Street Journal is calling out these Democrats in a recent editorial called No One is Gutting the Safety Net. The WSJ editors have often criticized President Trump, especially concerning his new use of tariffs, but they strongly defend his BBB when it comes to criticism of Medicaid.

They say, “Democrats and their media collaborators always distort GOP policy, but the coverage about the big budget bill has kicked free of the earth. Allow us to temper the histrionics about “gutting the social safety net” with a few facts about Medicaid, food stamps and Republican priorities.”

“By now you’ve seen the headline in every outlet: The Republican law will soon toss millions from Medicaid and cut the program to the bone. But annual spending on the health entitlement will grow over the next decade even with the bill’s roughly $1 trillion in estimated savings. Medicaid spending has risen by roughly 60% since 2019, and the bill’s intent is to try to bend Medicaid’s trajectory closer to the bad old days of 2020.”

“Democrats and some Republicans have offered cynical distortions that pregnant women in poverty and disabled children will suffer. But Republicans are trying to address the program’s enormous ObamaCare expansion to prime-age adults above the poverty line, and note the details of those who will allegedly lose coverage.”

They tell us that the Congressional Budget Office (CBO), in a letter last month about the House bill, said 4.8 million won’t comply with the bill’s part-time work requirement. That should be a warning about the country’s social condition. The work requirement doesn’t apply to anyone who is disabled, pregnant or caring for a child younger than age 14. Volunteering 20 hours a week or enrolled in school? You can get Medicaid.

The WSJ editors say, “Don’t buy the Democratic talking point that the working poor will be lost in red tape as they try to prove they’re on the job. States have handled work requirements in food stamps and cash assistance for decades. As the Foundation for Government Accountability notes, when Arkansas experimented with such requirements in Medicaid, “enrollees only had to report work once, and it was easy to do so.” The state cross-referenced wage and employment data and folks could also self-attest online or call a hot line. The Democratic position is that Medicaid should be a free universal benefit for men who refuse to work. The other main provision is tamping down state scams to hoover up more federal dollars. The main losers here are large hospital systems that have been doing well on the largesse.”

This comes as no surprise since Democrats, especially Progressives, have been pushing for total government control of healthcare, socialized medicine, for over a hundred years! They believe every American should have government provided, and government controlled, healthcare. What they won’t tell you is that this leads to limited access to care, rationing of care and denial of care to the elderly and others deemed unworthy of care based on their life expectancy and contribution to society. This is the reality of every socialized healthcare system that currently exists in the world.

The WSJ editors go on to say, “The GOP bill also includes sensible measures such as asking states to check their Medicaid expansion rolls every six months and more scrutiny on ObamaCare subsidies. That is necessary because the Biden Administration waved millions onto health entitlements. The Paragon Institute estimates that 6.4 million people are enrolled in fully subsidized ObamaCare plans but don’t meet the eligibility criteria. Apparently, this is what Democrats support.

The bill’s changes to food stamps are also modest and rooted in the tenet that work is central to upward mobility. As a refresher, the program currently requires able-bodied adults without dependents to work about 20 hours a week—or lose benefits after three months. That 90-day dispensation allows those who suffer a setback time to get back on their feet.”

But here is the not at all radical reform proposition: More of those who rely on benefits for longer need to be working. The GOP bill would expand the current work requirement to cover more able-bodied adults, including some parents with older children in school and those in their 50s and early 60s. The law also tries to tighten up waivers that states have abused to eliminate the work rules. The other major change is asking states with high improper payment rates to have skin in the game and pick up a share of benefit costs, which are currently billed 100% to the federal taxpayer.

These are common-sense ideas that have public support, though most voters aren’t hearing a defense from Republicans. Here is the abiding lesson for the GOP: Ducking the hardest reforms, public groveling, the bill’s eleventh-hour $50 billion blowout for rural hospitals—none of it will stop dishonest Democratic attacks. There is no substitute for defending your own ideas.

The editors have a warning for Republicans: “Democrats think they can ride the Medicaid scare into a midterm victory, but there’s still time for the GOP to lay out the facts. Roughly a quarter of Americans are on Medicaid, which is worse than private insurance. Food aid tops $100 billion a year and no longer shrinks as it once did when the economy is growing. America is a generous society that cares for the vulnerable. But it should also be a land of opportunity, not a European welfare state.”

The Republicans have the upper hand in this debate but only if they get the facts to the American people. They can’t depend on the mainstream media to do it for them.