July 10, 2026
Dear Interested Readers,
Physicians and The Declaration of Independence: Redux
When I signed off on my second attempt at last week’s letter discussing the participation of physicians who signed the Declaration of Independence, I thought it was a one-and-done process, but not so. I was delighted to receive, on Wednesday (my 81st birthday), almost like a birthday present, an excellent comment from an old colleague.
Gene,
Came across this Substack post (https://substack.com/home/post/p-205081761) that also talks about the four physician signers of the Declaration of Independence. Listen to the presentation by Nate DiMeo highlighted in the article. I think you’ll appreciate it.
Be well, Ed
The Substack article my old partner shared with me was written by Jeremy Faust, MD, MS, an emergency medicine physician whose writing focuses the public’s attention on issues of personal and public health. After Dr. Faust’s brief introduction, there is an entertaining and informative video of a recent presentation at the Aspen Institute about the four physicians who were signers. It turns out that we know the most about Bingamin Rush because he was a prolific writer. We know much less about Matthew Thornton because he did not write and is barely mentioned in others’ writings, although John Adams describes him as quite sociable and a good storyteller.
It should not have been a surprise to me that others shared my interest in learning more about the physician-signers of the Declaration of Independence that marked the birth of our nation. This fact was underlined for me when, on this Wednesday, not long after getting notification of Ed’s comment, my wife returned from checking our mailbox at the post office with the July 2 edition of the New England Journal, where the lead article was yet another discussion of physician signers of the Declaration of Independence.
Mail delivery to our small town in rural New Hampshire during the Trump era has been very sporadic and seems to be getting worse. Since the beginning of his second term, mail-order prescriptions from Boston have taken up to 10 days to reach us, and we are only a hundred miles away! So, it was not a big surprise that my NEJM arrived six days after its official publication date. I was quite surprised that the lead article was “History of Medicine: Declaration of Independence–Physicians and the U.S. Body Politic, 1776-2026.” The surprises continued as I read the article and discovered that the authors credited five signers with medical expertise, and that there had been two earlier NEJM articles that somehow I missed, connected to the 250th anniversary commemorating physicians who were major actors in the Revolution. Google’s Gemini summarizes those articles:
Physicians in the American Revolution” (April 2025): The inaugural article explores doctors’ critical roles beyond medicine. It highlights figures like Dr. Joseph Warren, a prominent physician, Founding Father, and militia general who died at the Battle of Bunker Hill. [1, 2]
“Smallpox at the Siege of Boston, November 1775–March 1776” (December 2025): This installment examines the devastating impact of smallpox on the Continental Army. It investigates the widespread fears of biological warfare and George Washington’s fateful decision to mandate the inoculation of his troops. [1, 2, 3]
The fifth medical professional identified in the NEJM article was Connecticut’s Oliver Wolcott. It seems the explanation for other reports not including Wolcott was that there is little or no evidence he ever practiced medicine beyond a brief apprenticeship. The authors of the NEJM article are Scott H. Podolsky, M.D., and David S. Jones, M.D., Ph.D., both Harvard faculty members, and Justin Barr, M.D., Ph.D., from the Ochsner College of Medicine. They write:
Connecticut’s Oliver Wolcott completed 2 years of a medical apprenticeship before pursuing roles as high sheriff, judge, legislator, militia leader, and eventually, like Bartlett and Hall, governor. He and Bartlett were 2 of just 16 men who signed both the Declaration of Independence and the Articles of Confederation.
With that mystery solved, I think it is clear that the article’s intent aligns with my original intent, which was to show that at least a few medical professionals at the time of the Revolution saw their role through both social and professional lenses. As I did, they write at greatest length about Benjamin Rush, since he was the most prominent and influential medical voice at the convention which produced the Declaration of Independence in the summer of 1776, but he also had the most impressive combination of political and medical contributions of any physician of the time. Of the other four, Wolcott included, three became governors of their states, Lyman in Georgia, Bartlett in New Hampshire, and Wolcott in Connecticut. The authors report that Thornton, the signer who is least well known, is said to have been a judge and, in 1776, to have chaired the committee that wrote New Hampshire’s constitution, the first state constitution to be ratified.
The article’s authors agree that the most notable among their five physician signers was Rush. They, like other historians, are impressed by his multiple contributions over many years. They write:
Of the Declaration’s physician-signers, Benjamin Rush was by far the most celebrated. He was also the only one with a formal medical degree (University of Edinburgh, 1768). Based in Philadelphia throughout his career, Rush became a founding father of America and American medicine, renowned for his advocacy of “heroic” medical practice involving the aggressive use of bleeding and purgatives. At the same time, he encouraged a gentler, more supportive approach to people with mental illness. Rush was also a prominent supporter of the abolition of slavery, though he would in the years after the signing of the Declaration of Independence purchase and eventually manumit an enslaved man.
Rush is also credited with addressing alcoholism as an affliction and not as evidence of a moral failure.
The authors of the NEJM spend some time comparing Rush’s contributions to the contributions af another colonial physician, Joseph Warren, who, had he not been killed in April of 1775 at what is known as the Battle of Bunker Hill, which was actually Breed’s Hill, may well have been a signer of the Declaration also. I reviewed some of this last week, but repetition never hurts. They write:
Like Boston physician Joseph Warren, Rush became an early campaigner for American independence. Roused by the 1765 Stamp Act and shaped by his medical education in Edinburgh in the late 1760s, Rush linked medical and social reform to a growing commitment to republicanism. When he returned to Philadelphia and established his medical practice, he became active in politics. In 1773, he cowrote a proclamation denouncing the British Tea Act — a document that helped motivate Boston’s like-minded Sons of Liberty to stage their Tea Party.
In 1775, Rush encouraged Thomas Paine to write Common Sense (also suggesting the title and offering other advice and edits). That influential tract swayed many colonists to support independence. A prominent physician and statesman in Philadelphia, Rush became a close friend and lifelong confidant of both John Adams and Thomas Jefferson. He had more complicated relationships with both Alexander Hamilton and George Washington (even though they dined and corresponded, Rush infamously criticized Washington during the war).
Unlike Warren, who died at Bunker Hill, Rush survived his military service as both a physician-surgeon and a military medical leader. Among other engagements, he crossed the Delaware with Washington’s troops in December 1776 and treated soldiers wounded in the Second Battle of Trenton and the subsequent Battle of Princeton. In 1777, he began serving his short turn as Surgeon General of the Middle Department of military hospitals (covering the region between the Hudson River and the Potomac River). His 1778 Directions for Preserving the Health of Soldiers began with what would become a classic observation: “Fatal experience has taught the people of America that a greater proportion of men have perished with sickness in our armies than have fallen by the sword.” Indeed, the vast majority of American deaths in the war resulted from disease.
After reviewing the critical roles of the physician signers and Warren in securing our independence, the authors move from then to now, as I tried to do last week, to discuss why physicians are less active in politics than they once were. The article is accompanied by an 11-minute interview with Dr. Barr of Ochner, who wears two hats that might surprise you. He is a transplant surgeon and a historian. In the interview, Dr. Barr reviews most of the information in the article on physician signers and comments on the broader role physicians might play in improving our country’s social and medical well-being today. The interview concludes with ideas that I would categorize as “what if…”. The article ends with a somewhat softer expression of the same recommendations. Judge for yourself:
The current American landscape contrasts starkly with that of 1776, when doctors led in society and politics, serving as accoucheurs to both their patients and their new country. Writing in 1787, Rush noted that the nation remained a work in progress: “The American war is over: but this is far from being the case with the American revolution. On the contrary, nothing but the first act of the great drama is closed. It remains yet to establish and perfect our new forms of government; and to prepare the principles, morals, and manners of our citizens, for these forms of government.”1 This call for engagement still resonates. As our nation continues to grapple with issues for which medical expertise is sorely needed, physicians may wish to reconsider their independence from national politics.
As I was thinking about all I have known about the Declaration of Independence since my student days, and what I have recently learned about the activist physicians who signed it, an unusual thought occurred to me, which I decided to explore with ChatGPT. If you are familiar with the content of our Declaration of Independence, you know that Thomas Jefferson wrote the inspiring introduction, and then he went on to document King George III’s abuses of the Colonies in a list of 27 grievances. Since Trump took office on January 20, 2025, we have had several well-attended “No Kings” events where those who felt that Trump was acting like an autocrat or self-annotated monarch have gathered in public places in cities large and small and even in little towns like mine to register their concerns about his abuses of power. I decided to bring my thoughts to ChatGPT. So, I asked:
In the Declaration of Independence, the signers listed 27 complaints against King George III. How many similar complaints could be formulated against Donald Trump, and how many of those complaints would relate to health care at home and abroad?
ChatGPT was quick to point out that I was asking it to compare two unrelated situations. I was a little disappointed as I began to read what initially seemed like a “rebuff” of my little game. Once again, I will bold what I want you to consider. The Bot answered:
This is an interesting historical and constitutional exercise, but it requires careful distinction between historical analogy and historical equivalence.
The Declaration of Independence lists 27 grievances against King George III. These were intended to justify dissolving the political relationship between the American colonies and the British Crown. Many grievances concerned the structure of government itself—for example, dissolving legislatures, obstructing justice, maintaining standing armies without consent, interfering with colonial self-government, and waging war against the colonies.
A similar document regarding a modern president would necessarily be different because:
- The U.S. President operates within a constitutional system with checks and balances.
- Presidential actions are subject to judicial review, congressional oversight, elections, and, in extreme cases, impeachment.
- Many policy disputes reflect differences in political philosophy rather than violations of constitutional principles.
As I read on, my initial disappointment was mollified a bit. The Bot carefully crafted an answer that it must have realized wasn’t exactly what I was trying to get, but close. It continued.
Could a comparable list be written?
Yes. Supporters and critics of virtually every modern president have assembled extensive lists of grievances. For President Trump’s second administration, critics have identified dozens of policies and actions they believe have harmed democratic institutions, public health, scientific research, environmental protection, immigration policy, and international alliances. Supporters, in contrast, argue that many of these actions restore constitutional limits, improve government efficiency, strengthen border security, and reduce unnecessary regulation. A modern “Declaration of Grievances” would therefore be an advocacy document rather than an objective historical fact.
How many complaints might be formulated?
There is no single correct number. A critic could easily produce 27 or more distinct complaints, mirroring the structure of Jefferson’s Declaration. A supporter could likewise produce a list of accomplishments or rebuttals.
How many might relate to healthcare?
Given your longstanding interest in healthcare policy, one could identify roughly 10–15 major healthcare-related areas that critics have focused on during the second Trump administration. Examples include:
- Reductions in biomedical research funding (e.g., NIH grants).
- Reorganization or downsizing of HHS agencies.
- Changes to CDC and public health priorities.
- Changes in vaccine policy and leadership.
- International health assistance and global health programs.
- Medicaid policy and financing.
- SNAP and nutrition assistance changes with health implications.
- Environmental health regulations.
- Maternal and reproductive health policy.
- Immigration policies affecting the healthcare workforce.
- Scientific advisory committee composition.
- Public health preparedness and infectious disease programs.
The Bot surprised me once again with a pretty convincing job of convincing me that we have a “relationship.”
You and I have discussed many of these topics over the past year in the context of rural healthcare, primary care, social determinants of health, and New Hampshire.
Health abroad
Critics have also raised concerns about international effects, including:
- reductions in global infectious disease programs,
- changes in U.S. participation in international health organizations,
- foreign assistance for HIV/AIDS, tuberculosis, malaria, and maternal-child health,
- pandemic preparedness partnerships.
Again, supporters often argue that these changes appropriately prioritize domestic needs or improve accountability.
A Jeffersonian framework
If one were deliberately modeling a document after Jefferson’s Declaration, it would be more faithful to organize grievances into broad categories rather than simply listing policies. For example:
- Alleged interference with independent institutions.
- Changes affecting the rule of law.
- Alterations to the civil service.
- Policies affecting scientific research.
- Changes in healthcare access.
- Public health policies.
- Immigration and workforce policies.
- Environmental and occupational health.
- International alliances and global health.
- Fiscal policies affecting states and local governments.
An important difference
One major distinction should be emphasized. Jefferson’s Declaration concluded that the colonies were justified in declaring independence because they had no meaningful constitutional mechanism to change their government.
The United States today has regular elections, an independent judiciary, federalism, congressional oversight, and constitutional processes for challenging executive actions. Consequently, criticisms of a president—even extensive ones—exist within an ongoing constitutional framework rather than serving as a justification for revolution.
I thought that was a good point for the Bot to make, but I thought it was being too literal. My question was meant to underscore that, just as in 1776, when prominent physicians felt the need to be actively involved in directing the colonies toward a more just future, we need physicians to be more involved in resolving the issues that affect the nation’s health today. The Bot sort of understood my intent as it continued. Nevertheless, I felt a little admonished for attempting to push my idea that, with reference to healthcare and the social determinants of health, Trump was acting like a monarch and that doctors should collectively say, “Enough!” The Bot then offered a slight change of direction and a little support to my position:
Given our many conversations, I think a particularly interesting project would be a scholarly comparison of Jefferson’s 27 grievances with modern concerns about democratic governance, public health, and healthcare policy. Rather than making a partisan argument, it could ask:
- Which of Jefferson’s principles remain relevant today?
- How would Jefferson, Madison, Hamilton, or Benjamin Rush evaluate modern debates over executive power, science, public health, and healthcare?
- Which contemporary issues concern constitutional structure, and which concern ordinary policy disagreements?
That approach would stay grounded in history while exploring questions that remain highly relevant today.
Even though the Bot did not give me exactly the answer I wanted, I did feel understood, and I am sticking to my original concept and to what I think the NEJM article advocated. I feel that the NEJM article, the interview with Dr. Barr, and even with a little stretch, ChatGPT support my feeling that physicians today have as much to offer in the discussions about our nation’s future as any other group, like the attorneys, business types, academics, labor leaders, and yes, billionaires from whom we hear regularly. Just as physicians were involved in the creation of our democracy as they attended to the challenges of medical practice, it would be a good thing if, once again, more physicians could widen their scope of vision to include actively working to protect what has been accomplished and to effectively advocate for a relaunch of efforts to develop new policies that might return us to a road that could bring us closer to the objectives of the Triple Aim. Said more directly, our country desperately needs its doctors and other healthcare professionals to be much more involved in the current pursuit of the heroic ideals for all Americans that Jefferson mentions in the second paragraph:
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
I Love Summer Evenings, Like The One in the Picture
One can’t be constantly aggrieved by the president’s daily actions that discount our hard-won progress over the past 250 years. One must take a break occasionally from fretting over the loss of healthcare access that so many neighbors will endure as a result of his bad policies and the cruelty of the One Big Beautiful Bill. One also needs a break from witnessing the ineptitude of the Democratic Party in its need to offer coordinated positive alternatives.
I use my daily walks and swims as an antidote to the frustrations that arise from reading the newspapers, political blogs, and podcasts each day. Another great source of relief is sitting on the dock with my wife at the end of the day and watching the coming of night. Wednesday evening wasn’t the greatest for an inspiring evening sky, but it was at least a 7 out of 10. We were joined on the dock by my second son. It was his last evening with us before returning to his work in behavioral health in South Carolina. Over the last two weeks, we enjoyed visits from 18 family members and friends. I am a lucky guy living in a land with many people who are not well served by their elected leaders. I am going to rest up for a few days and then re-engage with those doctors of 1776 as my inspiration. Join me in the effort. November will be here very quickly. Let’s not miss the opportunity to begin repairing all that has been lost or damaged over the last 18 months.
Be well,
Gene
