By now you have seen X-many lists of answers to all the questions people are asking. So I thought I’d work on a list of answers to questions people are not asking.
These are questions people may not want to ask because they fear the questions may not be politically correct, or they haven’t thought of them yet, or the questions are too horrible. I’m putting off the too horrible ones until tomorrow.
The first question — the most politicized and therefore difficult to address rationally — is whether we could be overreacting. Overreaction versus underreaction has become a political third rail.
But, yes, we could be overreacting in a number of ways. The main one is psychological. In fact, we have a history of overreacting to anything that public health authorities and the media tell us is an epidemic, let alone a pandemic.
An article published 10 years ago in the distinguished international medical journal Lancet called, “Moral Panic and Pandemics,” looks at that history. The author, Sander L. Gilman, says our reactions tend to be influenced by what he calls the “folk memory” of the 1918 Spanish flu pandemic, written about here a week ago by Lucas Manfield.
Gilman looks at both bird flu in 2005 and swine flu in 1976 in that light: “(President) George W. Bush announced, in 2005, having read John Barry’s history of the 1918 pandemic, that avian influenza was the equivalent of the 1918 influenza epidemic and posited it as the world’s greatest risk, replacing international terrorism for a time.
“The reality turned out quite differently in both cases. The swine flu vaccine in 1976 caused more harm in the normal morbidity associated with vaccination than did the disease itself. Avian influenza in the 21st century triggered international responses greatly out of scale to its actual danger. The epidemics never materialized.”
There’s another more grim way in which we could be overreacting, having to do with the dismal science of economics and how much a life is worth compared to what it costs to save it. But, you know what? Let’s save that one for now.
One of the realities we have to acknowledge is that we also have a record of underreaction. Yeah, sorry. We go both ways.
Gilman points out in the Lancet piece that the public in 1976 may have been thinking Spanish flu, helped along by some politicians and the media, but civil servants and scientists in the public health profession were haunted by something much closer in time.
In 1968 the nation was struck by a devastating flu epidemic and a public panic for which the entire field of public health and the government were badly ill-prepared — a classic case of underreaction with tragic consequences.
By the time swine flu showed up in ’76, Gilman says, the Centers for Disease Control were under new leadership, and their mantra was “Beat ’68.” So they did. By overreacting to the swine flu.
Overreact. Underreact. It’s a problem. That’s my answer. And you are welcome. I live to serve.
Another question: Can we count on the media to tell us the truth about what’s going on in a pandemic? Well, questions about my own profession always tend to put me in Clintonesque mode. I want to say that depends on what meaning of “count on” you're counting on. But generally I would say, ah, no, not totally. I’m not going to myself, anyway.
It’s dicey. Yes, in anything big and public with major political repercussions, you’re going to get a lot of spin and self-serving propaganda from some political leaders. It’s our job in the media to cut through that static and let you see the truth. But are we smart enough to see the truth ourselves? There’s the rub.
In a book called, Ethical and Legal Considerations in Mitigating Pandemic Disease published 13 years ago by the National Academies of Sciences, one of the authors looked at media coverage of the 1976 swine flu vaccine — the one that killed more people than the disease.
At the time, President Gerald Ford was up for reelection (he lost). This was all pre-internet and before we even had national newspapers. The big three major television networks were a news oligarchy with enormous national sway.
According to the book, NBC told its viewers that the vaccinations were a good thing and that Ford was listening to the experts. NBC news reports suggested Ford was ordering the vaccinations in a selfless act of leadership even though the decision might work against his chances for reelection.
CBS reporters said their sources at the Centers for Disease Control were telling them the vaccine was premature and the vaccination program a bad idea. CBS, the book says, suggested to viewers that Ford was backing the vaccinations because he thought it would help him get reelected.
Somewhere in there, a lot of people took a bad vaccine and died, and it happened in part because not enough people had been vaccinated in 1968, and they died.
Of course I wish I could tell you that we in the news business now all have way higher IQs than they did way back in ’76, plus most of us for sure now have Ph.D.s in molecular biology, but that would not be a bit true, would it? So, on the question of trusting the media, my answer is maybe yes, maybe no, up to you. And, again, I’m just glad to help.
A last question is sort of personal — one that occurred to me but might not to anyone else. It has to do with the threat of great shortages in the medical field, and it really wasn’t a question so much as an assumption.
The doctors, I assumed, are required to treat us. If push comes to shove, they’ll have to postpone their tummy tucks and sports medicine operations and get on down to the un-air-conditioned military tents to treat us. Right?
As it turns out, I think I was wrong. They may not be obligated, exactly. In a 2008 article called “Ethics, Pandemics, and the Duty to Treat” in The American Journal of Bioethics, six different authors take on this question from several points of view.
The Hippocratic oath, for example, the one in a frame on the wall of the doctor’s office with the fancy script and that scary picture of a snake crawling up a rod, says, “Into whatsoever houses I enter, I will enter to help the sick.”
Basically, the authors say the Hippocratic oath is an oath, not a legal contract. Closer to a binding contract is the code of the American Medical Association.
The AMA code said in 1847, “When pestilence prevails, it is (physicians’) duty to face the danger, and to continue their labors for the alleviation of suffering, even at the jeopardy of their own lives.”
In 1957, that language was amended to say: “A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability.”
In 2008 when the Journal of Bioethics article was published, the authors said only about 25% of practicing American physicians belonged to the AMA and could be presumed to subscribe to its code. A recent article in Business Insider reports about the same level of membership now.
The Bioethics article looks at other issues having to do with the huge increase in specialization in medical practice. The original assumption that all physicians should roll up their sleeves and pitch in, the authors say, was based on what they call a “firefighter” model of medicine: Every firefighter knows how to fight a fire. Every firefighter who sees a fire has an obligation to go help put it out.
But things have changed in medicine. Not every doctor is a firefighter. Doctors in highly specialized fields may be years away from their general internships. They may not remember how to put out a lot of types of fires, and there may be no blanket obligation for them to try.
I have talked about this informally and off the record with a few doctors whom I happen to know personally. They all said the same thing. They got into medicine to cure people. If they saw a way in which they could help with this epidemic, they said they would try.
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But I am struck by another part of this answer — well, the question anyway — that I couldn’t find help with in a scientific journal. It seems to me there’s such a thing as marshaling our resources.
On TV the other night, they showed a guy in South Korea who had taken time off from his job to serve as an unpaid helper at a drive-thru testing site. He was wearing a white hazmat suit, reaching into cars to take swabs of people’s mouths, which he said he was doing as a service to his community.
So I guess before we send all the physicians into the trenches to risk infection taking people’s temperatures, we could train a few off-duty weekly newspaper opinion-writers to do it. I think we should use up the people on the daily newspaper editorial boards first, but then I could think about it.
If there is a larger theme, I don’t think it’s some cold declaration that we are all out on our lonesomes deciding these things in isolation. If anything, we are all working together on the same questions. But we do have a right and an obligation to independently weigh all this stuff. I would say we should take it with a grain of salt, but I’ve actually gargled up all my salt already. I need to go out and hoard some more.