I have grown utterly exhausted by the hysteria surrounding the Fifth Circuit Court of Appeals. For the past week, the mainstream media and the medical establishment have been wringing their hands over the court's decision to block nationwide mail and telehealth access to mifepristone. We are told this is a catastrophe for reproductive health. We are told this upends a two-pill regimen the FDA safely approved in 2000. We are told, rather rudely, that appellate judges have absolutely no business practicing uncredentialed medicine from the bench.
To this, I say: since when did a lack of medical training disqualify an American from prescribing your medication?
The critics are completely missing the disruptive genius of the Fifth Circuit. By arbitrarily removing the first half of a two-pill pregnancy termination protocol, these brave jurists have forced abortion providers to rely solely on misoprostol. Do you realize what this means? The Fifth Circuit looked at a clunky, two-step medical procedure and boldly asked, what if we just legally mandate the second step? That is the kind of lean, move-fast-and-break-things efficiency our bloated healthcare system desperately needs. Did they consult a doctor before overhauling a twenty-four-year-old FDA protocol? No. But neither did Alexander Fleming when he discovered penicillin.
Just last Tuesday, I was dining with a prominent conservative appellate judge at a rather exclusive steakhouse in Washington. Between bites of a bone-in ribeye, he drew what he confidently assured me was a diagram of the female reproductive system on a cocktail napkin. Was it anatomically correct? My wife later informed me that the uterus is not connected directly to the spleen. But the sheer, unwavering conviction with which he crossed out the FDA’s safety guidelines was nothing short of breathtaking. That is the kind of bedside manner you simply cannot teach in medical school.
We firmly believe that three men in black robes skimming a Wikipedia article about pharmacological protocols is the absolute gold standard of patient care.
Consider the FDA. For over two decades, this unelected alphabet agency has hoarded the right to determine which drugs are safe and effective, relying on outdated metrics like double-blind clinical trials and peer-reviewed data. The Fifth Circuit has finally democratized this process. By issuing an injunction against a drug they personally find distasteful, these judges have proven that you do not need a biochemistry degree to regulate the pharmaceutical industry. You just need a gavel and a vague sense of moral superiority. I, for one, am thrilled at the prospect of the appellate courts taking over all FDA duties. I cannot wait to see what the Ninth Circuit decides to do about my cholesterol medication.
What the detractors fail to understand is the immense emotional toll this takes on the judiciary. Do you know how difficult it is to draft a sweeping, legally binding medical directive when you do not know the difference between a fallopian tube and a tort? These judges are putting their reputations on the line to play doctor with millions of strangers' internal organs, and all they get in return is whining from board-certified physicians who think years of clinical research trumps a really solid textualist reading of a nineteenth-century obscenity law.
Tragically, the Supreme Court has already issued a one-week stay on the Fifth Circuit’s order, proving once again that the highest court in the land is terrified of true medical innovation. They are pandering to the special interests, namely, doctors who want to use the medicine that works best. It is a cowardly retreat from the new frontier of judicial pharmacology.
It is time we bypassed the American Medical Association entirely. If I ever find myself in need of a complex medical procedure, I do not want some smug, highly trained specialist handling my chart. I want a Reagan appointee with lifetime tenure, a profound misunderstanding of basic biology, and the absolute unearned confidence to just start guessing my dosage.