Ideology and Values in Healthcare: A Commentary on Baker's (2025) Medical Lysenkoism

There are many reasons why an individual will engage a physician. The individual may want to learn about the cause of the symptoms they are experiencing and what to expect if there is no intervention, and/or obtain care that gives a reasonable chance to change the course of their health state. The physician is valuable in such cases, as they will often possess expertise that is not otherwise accessible to the individual. What makes that expertise valuable is that claims physicians make in service of their patients are not arbitrary—rather, they are grounded in a system of knowing that produces reliable and valid claims. In a recent paper published in the Journal, Baker [1] raises concerns about how ideology can undermine the physician's system of knowing, potentially compromising patient care. Tensions can arise where an ideology that is imposed on the medical community (either through regulation or social pressure) conflicts with what is accepted in the medical knowledge. How physicians navigate that tension can impact both their epistemic authority and the standard of care they provide to their patients. Ideology is frequently used pejoratively to describe beliefs that one opposes. However, ideology can also be understood as a system of beliefs that guides particular actions or applications. As we will highlight in this commentary, the generation and application of medical expertise operate within social institutions, and as such, the impact of ideology is unavoidable. As such, we must be cautious in drawing sharp distinctions between social values, our ontological beliefs about nature, and our epistemic commitments to understanding it—recognizing the central role that humans play in shaping these foundational assumptions. A key question to consider is when does ideology become problematic, and who has the authority to decide? Baker invokes the term “Medical Lysenkoism” to describe how ideological forces shape medical science, drawing a parallel to the famous case of Soviet biology in the 20th century. Trofim Lysenko was a mid-20th century Russian biologist and proponent of a theory of inheritance of acquired characteristics akin to Lamarckian inheritance, a theory itself discredited by Darwinian evolution and subsequent work in genetics [2]. Despite its lack of credibility in both the local and international biology community, Lysenko's views gained traction with the Russian government, primarily due to a perceived alignment of the theory with a Stalinist interpretation of Marxist ideology. In what would come to be known as the Lysenko Affair, the biology of Lysenko would be officially adopted by the State, leading to persecution of more than 3000 scientists who did not conform, which included dismissal from their jobs, imprisonment, and even execution [3]. Adoption of the theory was also devastating for agriculture in the country, leading to decreased crop yields and subsequent famine for many. Lysenkoism is invoked as a cautionary tale of where ideology can adversely affect scientific progress with implications for the greater public good. Just as the adoption of Lysenko's theories subordinated genetic science to a politically driven state ideology, Baker argues that current trends in medicine risk placing social and political agendas above epistemic standards, potentially compromising scientific integrity and patient care. The inherently social nature of health care complicates the boundaries between epistemic and non-epistemic values. While the Lysenko Affair exemplifies political interference in science driven by government ideology, Baker's concerns, on the other hand, center on the influence of ideology arising from what he identifies as social movements and their potential to change clinical thinking and decision making. Baker's perspective, grounded in the belief that the world is an ordered system discoverable through empirical inquiry, emphasizes the danger of integrating non-epistemic beliefs into medicine. Such beliefs can distort the pursuit of objective knowledge, threatening the elemental goal of medicine: a reliable understanding of the natural world to improve health outcomes. Yet, clinical care is fundamentally social: shaped not only by technical knowledge but also by the values, priorities, and resources of the communities it serves. What patients will demand (and why), what the public will fund, how public resources are allocated all impact the clinical encounter and shape what the clinician can offer and to whom and for what reasons. It is reasonable that two communities with differing values can vary in how they address such issues, potentially leading to very different practice styles among clinicians, models of care, and patient outcomes and experiences. Baker's analysis does not suggest we outright reject the role of non-epistemic beliefs in clinical practice. Rather, we need to be careful that what we accept or promote in clinical practice is sensitive to the needs of the patient, and that clinical practice does not simply become a tool for social or political agendas. Indeed, even the core scientific foundations of medical expertise, such as clinical trials and basic sciences on biological processes, are subject to the influence of social ideologies that shape both the direction of research and the practice of clinical care. For example, Canadian government grant proposals for clinical research currently require explicit statement by the investigators of how the research will incorporate diversity considerations in design and analysis or an explanation justifying any exclusions. Similarly, the National Institutes of Health (NIH) grants in the United States often stipulate the collection of racial data to ensure proportional representation and inclusivity, thus impacting how research is framed and conducted. Government granting agencies frequently call for directed research on high-profile health concerns like COVID-19 or prioritize improving care for vulnerable or marginalized populations, such as indigenous peoples and LGBTQ+ communities. These requirements could be interpreted as political interference or as incentives designed to advance a particular social agenda—one that placates constituents and incorporates policy priorities into scientific inquiry. However, this shift can also be understood as epistemic justice [4]: recognizing that health inequities may arise from overlooked biases and gaps in study design, these directives might be seen as a corrective effort to broaden the scope of what counts as scientifically rigorous and ethically sound. In this sense, efforts to include diverse populations and perspectives are not simply socio-political impositions but can be seen as integral to advancing a more comprehensive, reliable, and objective body of medical knowledge––one that more accurately reflects the reality of the world it aims to understand. Medical knowledge has always been shaped by changing philosophical and cultural frameworks, complicating the role of ideology in the standards by which we justify accepted truths. One important criterion for evaluating medical knowledge, raised by Baker, is “falsifiability”—the principle that scientific claims must be empirically refutable, ensuring that medical knowledge remains open to dissent and protected from the distorting influence of ideology [5]. Yet, the history of medicine is a history of changing ontological, epistemological, and ethical commitments about the nature of the world, our understanding of the human body, and the principles that define effective care. Many practices stemming from earlier belief systems would not stand up to empirical justification through rigorous study and the standard of “falsifiability,” and yet, they were not considered problematic when they were practiced. Humoral theory, advanced by Hippocrates and Galen and practiced in Europe for almost two millennia, was grounded in a belief system about the elements of nature (earth, wind, fire, air) and the elements of “man” (i.e., the four humors: blood, yellow bile, black bile, phlegm). The interaction of these humors led to disease, and their balance was necessary for good health. Ayurvedic and Traditional Chinese Medicine (TCM), originating in India and China respectively, have been practiced for 3000 years and are deeply rooted in belief systems centered on the balance of energy—whether through the Doshas in Ayurveda or Qi in TCM. While Baker holds the received view that science has since progressed toward an objective understanding of the natural world, with increasingly stringent standards for justifying our claims, a finer distinction must be made between “incomplete knowledge” and “ideological contamination.” The application of the above-mentioned belief systems in clinical practice differs from the Lysenkoism discussed prior in that they were not impositions by governments adhering to an ideology. Rather, these belief systems were reflections of the accepted ontology about nature and health established by epistemic communities of the time [6], where shared commitments guided medical practice and informed the way that medical knowledge was understood and applied. Although these systems would mostly be replaced—we say mostly because many practices have persisted, for example, the wisdom of our grandmothers had us dressing appropriately to avoid “catching a cold” in cold weather, eating soup when we are sick with a “cold,” and striving for “everything in moderation,” and some communities embrace pluralism by practicing these traditions alongside “modern medicine”—these systems also differ from Baker's concerns in that they were seen by both practitioners and the community as positively serving the interests of the patient. Furthermore, they did not create a conflict for the physician, where they would need to decide between what is implied from the medical knowledge and what is asked of them by adherents of the ideology. “Scientific medicine” was born out of a change in how we saw the world, with an emphasis on empirical observation over speculative or deductive reasoning, paving the way for more ostensibly rigorous methods of evaluating medical knowledge. This led to the rejection of many traditional practices and theories in medicine, including humoral theory, miasma theory, and views on contagion, and likely emerged in part as a response to the growing prevalence of dubious medical practices, such as homeopathy, that lacked empirical support and were thus of questionable value. Claude Bernard, a 19th century French physiologist, advanced the idea that medicine should strive to be grounded in clear understanding of empirically demonstrated mechanical processes. He asserted that “in a word, if based on statistics, medicine can never be anything but a conjectural science; only by basing itself on experimental determinism can it become a true science, that is, a sure science,” [7]. The advent of Evidence-Based Medicine (EBM) arose from similar recognition that many medical practices at the time lacked rigorous systematic corroboration, leaving their true effect uncertain [8]. Proponents of EBM “have identified randomization as a necessary condition to establish the relationship between cause and effect,” suggesting that the randomized controlled trial (which yields an estimate of average effect)—the favoured design in the EBM hierarchy of evidence—is the best way to determine the effect of interventions [9]. The difference between Bernard's mechanistic determinism and EBM's evidence hierarchy lies in the contrasting ways each assigns significance to statistical data, both underpinned by differing commitments about causation. Yet, both approaches reflect their respective attempts to ground medical practice in empirical reality. These differing views (i.e., mechanistic determinism vs. EBM) can be considered ideologies in the strictest sense in that they are systems of beliefs that provide a basis for practical application, such as clinical decision-making. The difference between these ideologies is not trivial—physicians that do not follow what is suggested by high quality clinical trials are at risk of having their decisions labelled “not evidence based” by adherents to a strong EBM program, even if they can claim a basis in reasoning from mechanisms (consistent with Bernard's view, and what could be implied from basic science). Such tensions exist in many clinics today and have led to concerns raised in the literature about “cookbook medicine” and reconsidering EBM [10], the role of context in decision making [11], and the patient centred care movement [12]. These evolving perspectives on medical practice represent a shift in how scientific methodology is understood and applied, with changes often originating from within the medical community itself. Despite these internal critiques, the overarching aim remains the same: to reflect the objective, knowable reality to be uncovered through careful observation and methodical inquiry. Ultimately, this dynamic reflects the tension between rigid adherence to a singular scientific methodology and the evolving recognition that medicine, like science itself, must adapt and refine its approaches to better reflect the complexities of the world it seeks to understand and intervene in. This world, however, and our understanding of it, is shaped by and for human beings, whose experiences and limitations must be recognized as contributing to the pursuit of medical knowledge and care. Baker raises several interesting examples of where the conflict between ideologies can put the physician in a difficult position in having to choose between what will satisfy an individual or community and what is consistent with the knowledge base and ethical responsibilities of their profession. Yet, focus on the tension between medical knowledge and ideological conflicts overlooks the extent to which social values, embedded in the same sources of medical knowledge, shape the physician's deontological duties and the physician-patient relationship. Physicians have a fiduciary responsibility to the individual patients they serve, as is reflected in their professional oath and in the ethics of practice. Ultimately, views on what constitutes ethical behaviour are ideologies, and regulations are shaped by ideology about what is right and fair. These ethical frameworks are not always moral absolutes, but are culturally and historically contingent, reflecting the values, beliefs, and power dynamics of the societies that produce them. For example, the principle of respecting autonomy in medical ethics, which emphasizes the patient's right to make informed decisions about their own care [13], is deeply rooted in liberal individualism. This principle may conflict with cultural or religious views that prioritize collective decision-making or deference to authority figures, such as family members or religious leaders. Moreover, the medical profession's ethical obligations are often codified in laws and regulations, which are themselves products of ideological influences, and can differ across countries and legal systems. Respecting autonomy is a legal obligation in many jurisdictions, which often require the physician obtain informed consent of the patient before administering care or acting on the patient's behalf [14]. Physicians also have a knowledge base that is recognized by the profession. For example, knowledge from a clinical practice that was by a medical a systematic by data published in a recognized or a in an medical would likely be considered medical knowledge. views or practices that are with such sources might be considered questionable by the medical community and would undermine the credibility of the individual and potentially the profession. What can be in that of a physician's credibility is that the system of that what is considered medical knowledge is informed by ideology. 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