When politics enters the doctor's office

In this episode of Democracy Works, host Chris Beam speaks with Juliana Pacheco, a political scientist and department head at the University of Iowa, about the growing intersection of politics and healthcare. Pacheco discusses her research on 'deaths of despair'—a rise in opioid overdoses, suicides, and gun violence among poor, rural white Americans—and how these crises correlate with lower voter turnout and civic disengagement, suggesting that despair undermines both individual agency and collective political power. She then shifts to her current work on political polarization in medical settings, exploring how partisan divides are infiltrating the doctor-patient relationship. Drawing on surveys and real-world examples, including politicized responses to mask mandates and the 'horse to warmer' treatment for COVID-19, Pacheco highlights how political identity now influences medical trust, treatment adherence, and even physician-patient matching. She warns of emerging 'medical polarization,' where patients may switch doctors based on political alignment, potentially worsening health disparities. Despite these challenges, Pacheco emphasizes that physicians still strive to uphold the 'sacred space' of clinical care—rooted in trust, empathy, and patient autonomy—even as they navigate political pressures, time constraints, and institutional contradictions. The episode concludes with a call for broader recognition of political determinants of health and a reminder that maintaining professional integrity in any field requires protecting the space where meaningful human connection can occur.