Where Does Medicine’s Responsibility for Human Trafficking End?

In a recent New England Journal of Medicine Perspective, Nicholas Peoples, MD, of Massachusetts General Hospital in Boston, and colleagues argued that physicians have a role not only in recognizing and treating people affected by human trafficking, but also in addressing the conditions that allow trafficking to continue.

The argument has prompted debate over where medicine’s responsibilities should end and whether physician advocacy on politically charged issues risks undermining the profession’s credibility.

In the debut installment of “Off the ‘Page,” MedPage Today’s new video series exploring thought-provoking perspectives in medicine, Peoples discusses why he believes trafficking prevention belongs within the public health conversation.

The following is a transcript of this video:

Voiceover: When does a public health problem become medicine’s responsibility?

A recent Perspective in the New England Journal of Medicine argues that physicians have a role not just in recognizing and treating victims of human trafficking, but in addressing the conditions that allow it to continue. But that argument sparked some pushback from physicians online.

Is advocacy like this really part of a doctor’s job? And could weighing in on political issues actually undermine medicine’s credibility?

We asked co-author Nicholas Peoples, MD, where he thinks that line should be drawn.

Peoples: Responsibility starts the same way as it would treating diabetes, as it would treating HIV/AIDS, as it would treating substance use disorders, things like depression, suicidality. It starts with the patient. So it starts in the exam room, it starts in the clinic.

It starts with things like … recognizing trafficking, treating the physical and psychological health harms and consequences of trafficking, protecting patients, helping people access social work and case management, making a report when it feels safe and appropriate to do so and the level of suspicion is reasonably high. So it starts there. I think that is indisputably within our remit, but it doesn’t end there.

And this is the part that makes so many people uncomfortable. Nobody would question that there is some element of prevention that is needed, that these things are preventable and that physicians and public health experts have standing and have a role to play a part in those conversations of prevention.

So this is the point where some people would say, “This isn’t our lane anymore. Let’s turn it over to the experts on these things and we’re going to bow out and go back to the clinic.” And that’s where I would say no.

And not that we dominate it because we shouldn’t. And not that we’re the principal expert on it because we’re not. But we do have principal expertise on the health consequences and the public health crisis caused by human trafficking. And we’ve got to get that perspective and that voice into the conversation if we’re going to have a balanced and meaningful conversation where policymakers can then act effectively.

Voiceover: But some physicians raise a broader concern. Since COVID, medicine has faced its own credibility problems. Does weighing in on political issues risk making that worse?

Peoples: The bottom line is medicine and public health are political. You cannot separate medicine and public health from politics. Those two are inextricably linked. What medicine and public health don’t need to be is partisan. And I think this is the distinction that we need to do a better job recognizing and helping people to understand.

We are not experts on every political issue, nor should we try to be. It’s not our job to pass legislation. In the case of human trafficking, it’s not our job to investigate human trafficking networks. It’s not our job to hold them accountable and it’s not our job to decide what those consequences should be.

But what is squarely within our lane is to stand up and say as a matter of public health, transparency and accountability in these investigations would have a preventive effect on downstream future child sex trafficking, and it would mitigate and reduce the public health burdens of this public health crisis.

That is something we can say, that is something I think everybody could get behind regardless of their other political sensitivities.