Sunday, May 02, 2021

Guest Post: Advocating Restoring the Leadership of Hospitals by Medical Professionals, Thus Reversing the Managers' Coup D'Etat

Health Care Renewal presents a guest post by Dr. Gene Dorio.  Dr Dorio  is a geriatric physician from the Santa Clarita Valley in California,  providing house calls to older adults.  He has been an advocate and whistleblower for his community leading several causes from attempting to preserve the hospital Transitional Care Unit for seniors in 2006, to today trying to allow admission of teens to the psychiatric unit.

He is President of the Los Angeles County Commission for Older Adults, an elected Assembly Member of the California Senior Legislature, serves on the Triple-A Council of California, and member of the Santa Clarita Valley Senior Center Advisory Board.

For 5 years, Dr. Dorio served on his hospital’s Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine. 

 Doctors are highly trained medical professionals trying to survive in a complex sociopolitical system.  We have been pawns utilized by hospitals and government for our knowledge and skills, yet more recently expected not to have a voice or opinion.

As a physician in private practice for 40 years, changes in the past 10 years have been difficult.  It was hard for me to hear non-medical business administrators force cut-rate medicine compromising evidence-based patient care.

I was elected to the hospital Medical Executive Committee (MEC) seven years ago with the hope from the inside I could improve threats against patient care.  This did not succeed and the fury coming from the hospital intensified as the self-governing MEC was swallowed up by the Board of Directors and Administration.

Doctor voices protecting patients diminished, and many whistleblowers were left to defend themselves from bullying and attacks.  

Lies and insults persisted, and the only power I had was knocking out keyboard articles to social media as a shield.  Throughout the country, there were scant physicians in the same situation, so we networked the best we could to survive.  “Never give up” was our mantra.

Periodically murmurs could be heard, but it was always muffled.

This year in California, a law was introduced in the State Senate to keep hospital administrators from “practicing medicine without a license.”   Most doctors don’t know about it, but of course the state hospital association is diligently fighting it.

It can be seen here.  

At the end of April, I was asked to testify at the State Senate Health Committee, and this is what I provided:

===

Good morning Mr. Chairman and members of the California Senate Health Committee.

My name is Gene Dorio, and I am a geriatric physician in Santa Clarita serving my community for 34 years.

Until two years ago, I was on staff at a local hospital which is a non-profit, but run like a for-profit hospital.  For 5 years, I served on the Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine.  

During my time there, I witnessed administrators use manipulative, clandestine tactics to capture each voting facet of the health facility, including the Board of Directors, contracted physician groups, and the Medical Staff so business people could make patient-care decisions.

At my hospital, business community members were appointed to the Board of Directors and provided lucrative contracts in exchange for their vote.  Bankers were given hospital accounts; a real estate agent was given property to rent; and a doctor was given space for a dialysis unit.

Exclusive Contracts were signed by physician groups for emergency room care, radiology, and operating room anesthesia.  The hospital could not technically practice medicine, but they coerced these groups with the threat of severing contracts if they did not adhere to their orders, or vote as told. Needless to say the administration got their votes, while the Medical Staff became only a shell of a self-governing body once devoted to improving patient care.

Eventually, the Medical Staff was taken over too, and our policies were changed to bring in more revenue—even when it was terrible for patients. My patients are geriatric, and at times clinging to life. Nonetheless, staff started to leave daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement “Not a Part of the Medical Record” which was removed later by the Medical Records Department erasing hospital culpability.

Hospital administrators also knowingly wrote orders without doctor consent for Palliative Consults, to place patients on hospice care which financially benefits the hospital by getting them out of the hospital for care.  

They also made decisions about medications patients could receive. They decided not to use insulin pens as they were too expensive, and instead jeopardized diabetic patient care using multi-source insulin vials which are less precise and easily contaminated.  The presiding CEO was released from their previous hospital after violating State Medi-Cal laws substituting inferior anesthesia in the labor and delivery department.

Hospitals also hold regular “throughput” meetings for physicians, where they publicly display the number of referrals, expensive tests, procedures, and overall revenue that each doctor is generating. They talk about productivity and efficiency—not the quality of patient care.

Because I tried to advocate for my patients, my hospital privileges were constantly in jeopardy. Typically, privileges are renewed every two years.  For me, it was every 4 months.

If hospital administrator actions were truly to improve healthcare for our patients, I would have no qualms.  But instead through abusive tactics and bullying, they interfere with physician decision-making, and ultimately increase administrator salaries, bankroll retirement portfolios, and yearly bonuses.

SB 642 is an important step to removing hospital administrators from practicing medicine without a license.  Their surreptitious plans taking over a non-profit hospital for their own personal benefit must be thwarted by this law.

Patients have entrusted physicians to be guardians of their health.  We are professionals that have taken a solemn oath to provide care in the best interest of the patient.  Therefore, SB 642 will serve Californians by putting medical decision-making back into the hands of patients and their doctors.

Thank you.

===

I have never testified before a legislative body, but this is where my keyboard has brought me.  There needs to be more voices fighting for patient care diminishing hospital administration power.  Doctors must be part of the balance providing better healthcare to citizens of our country, but we must hear you speak!  

Follow that mantra, “Never Give Up!”

Gene Uzawa Dorio, M.D.

[Editorial Note] For background on the managers' coup e'etat, managerialism and related issues, see this post.

Thursday, April 22, 2021

Disinformation: a Medical Meditation. Dander At Half Mast.


Are there no foes for me to face?

Must I not stem the flood?

Verse 3, Isaac Watts (1674-1748),
"Am I Not a Soldier of the Cross?"

Introduction

In what follows I expand on our ongoing series—most recently appearing here—on the crisis of fair and accurate information in science and medicine. I divide this meditation into four sections—"meditation" used to excuse a certain amount of meandering, hoping readers will bear with me. I enumerate these sections in order for those with less interest or time to pick and choose.

  • What's logical and what's illogical: the disciplinary messiness of disinformation, what else impacts the acceptance of disinformation?
  • What's the broad media problem, old and new?
  • Was there any responsibility on the part of elites, institutions and academics in bringing about the mistrust that now, ironically, lingers about them like a bad smell? And how did the elites treat their own innovators?
  • Within health care, what are the more narrow, "hidden" sources of disinformation and information asymmetry among actors, including patients?

For all of us, disinformation means information degradation around our health, both that of our populations (vaccination→autism) and that of individuals (nostrums→cure). Disinformation means intimidation of experts and the deprecation of expert knowledge. It means free communication in the arteries of our society suffers from a kind of thrombosis, as true believers latch onto all the niduses of nonsense that disinformationists increasingly spew, often with disastrous results.

A. Beyond Logic.

looking across so many different domains and disciplines, it's remarkable to see how much has been written about disinformation. It's all the more strange we've really only just scratched the surface, leaving us incredulous when Kennedys and Trumps alike smear it around. Enter the concept of disinformation as a search term in any engine. Or put it into an academic search engine. What comes back is a tsunami of attempts to wrestle with this phenomenon, crossing many disciplines.

So for this writer it's pretty daunting to stare at a blank page and consider what more to say. At the beginning of this year, HCR's series editor, Dr. Poses, wrote a lucid piece on logical sources of disinformation. But the very vastness of the expanse of work on the subject, epistemologically, methodologically, its sprawling and protean nature, its slipperiness, may actually give us a clue to why disinformation seems so hard to pin down. (At the risk of being slightly off-kilter I'll treat it here as interchangeable with misinformation.*)

Yet as we enter this post-covid age of proliferating echo-chambers, with all this blather that seems meaningless to some yet somehow persuasive to others, ponder it we must. Political science, philosophy, computer and data science, sociology, cognitive psychology, social psychology, communications, legal studies, clinical medicine and more all help us focus on what disinformation might be, and what we might do about it. 

For starters, the philosophical science of logic is a good place to begin. Pretty quickly, however, dip into sources on "logical fallacies of reasoning" in science and medicine, such as this one. An even cursory glance implicitly warns you: go further. Look beyond logic. "White skin causes inferior brain capacity" or "vaccine causes thrombosis" are classic examples of the post hoc propter hoc fallacy, the exposition of which goes all the way back to the Hippocratic Corpus in Greek antiquity. Logic! Illogic! Every freshman medical student comes across this in introductory medical decision making. But peruse the laundry-list of fallacies to which the human mind is inexorably drawn. Even in the "logic" laundry lists, you quickly see that many, if not most fallacies simply don't have a logical basis at all: they depend on a whole mug's gallery of social and psychological tendencies, misconceptions, and biases.

If lying is weaponized, then a major part of the problem must be how the human brain elaborates patterns of behavior to deal with real or perceived adversaries, to gain the upper hand in social conflict.  Far more than it is logical, such adversarialism is emotive and primitive-brain. Gaslighting for example has no real logical component. Indeed, its very illogic is part of its eerie power. So is the brain's poor track record when it comes to assessing risk. NY Times editor Jenée Desmond-Harris quotes these statements from her social media feeds:**

You say you won’t get the vaccine because you don’t know what’s in it but you'll eat a hot dog!

You think the government is using the vaccine to put a tracking device in your arm, but have you looked at your life and asked whether there’s anything worth tracking?

You’re afraid the vaccine might kill you, but guess what we know can kill you? Covid!

 What sets all of these apart is the illogic of risk assessment. We're hard-wired not to be logical. We're tuned in mainly to other things: fight versus flight; the over-privileging of gurus' opinions; big-name pretty-faces, sports stars and entertainment figures. We're also tuned in, as we've come to learn recently, to the pronouncements of blow-hard reality-show idols skilled at fanning the flames of illogic in our reptilian brains. These flames include fear of the Other, tribal shibboleths, the pursuit and possession of secret knowledge (e.g. QAnon); or pride in in-group belonging (Proud Boys, Boogaloo Bois, Three Percenters, many others).

There's another supra-logical bias that's less emotional but certainly not steeped in pure logic: historical. I speak to Black friends who explain vaccine hesitancy using the "remember Tuskegee" trope. Understandable, completely. But history doesn't repeat, it just rhymes, we've all heard it by now. And not just post-Tuskegee (or post-HeLa) suspicion of Big Science, but concern among many groups that the deck may be stacked in some way so let's just wait and see who springs for this newest-ride-in-the-park. Logical, but in a different way, really, coming from a different part of the brain: the social brain, exposing, let's say, its own different sort of logic. (On the Black experience see the excellent column, author What Doesn't Kill You Makes You Blacker.) For this author, Damon Young, the upshot is "weigh it all out, then decide." Of course.

If, say, you want to advocate for herd immunity, addressing historical bias requires some rudimentary knowledge of historical narratives and social circumstance. Then one might begin fully to understand their power as determinants of behavior. Historical, social and emotional foundations swirl powerfully around and beyond what's rational, and end up dictating behavior. They all impact the degree of presence or absence of that most basic commodity, trust. Trust is something that's in dangerously short supply in a fragmented society that never really was e pluribus unum. The importance of coherence, of a social compact, was something our teachers peddled in schools who had their own institutional interests in perpetuating certain myths.†


B. External Forces I. Media and Technology: the Disinformationist's Nidus of Nonsense 

1. Old Media.

I know it's nothing new for me to say this, but just because we have more forms of media proliferating, or more technologies to give us all the new flavors of megaphone, why would we expect the resulting information to be better? To quote Uncle Joe, come on, Jack! Not better information. Just a widening cornucopia. Just a louder, covid-spiked, Harley roar of intrusive noise.

Yet there are many who think they benefit. Actually, the media barons and tech bros clearly do benefit. Right in the wallet. It's absolutely beneficial for those acting as intermediaries for health (actually, all) information to put out there what's discomfiting, alarming, or otherwise stimulating in those places that dopamine seems to work its magic. What's perhaps less well recognized is just how calculating this is, even as some members of the "Great PR Families" (Sacklers, moreMurdochs, more) begin to show just an inkling of a superego long after the patresfamilias have done most of their damage.

Examples? Here are a couple. Start with those that preceded the current almost post-apocalyptic Fury Road of tech blogs and secret covens and digital echo chambers. One of the intriguing things about the early, print-only media moguls—or mogul wannabes—was how they seemed all to style themselves as Renaissance Men. The opiate kings, the Sacklers, spent lavishly on art and plastered their names everywhere—a common enough trait for the filthy-rich.‡

In any case, for those new to Health Care Renewal, the disastrous disinformation peddled by this media-savvy family revolved almost exclusively around a single trope that was pumped out through many subsidiary channels. Such channels includes speaking engagements by "pain specialists" at lavish detail-man sponsored dinners, touting the safety of these drugs that had made them multi-billionaires. Interestingly, the family got into trouble just a little too early—at least I think this is true, please write a comment below if you know otherwise—to benefit fully from the digital-channel revolution.

In 2014 a more recent example of the use of Old Media to flatter physicians into robot-prescribers was described in detail by physician-historians Scott Podolsky and Jeremy Greene, now respectively at Harvard and Johns Hopkins. The compare and contrast two media-savvy physicians from the 1950s, '60s, and '70s, the zenith of the print era in medicine and of post-war medical triumphalism. Two roughly contemporary physician leaders, internist William Bean (1909-1989), a midwestern leader who tended to published in posh AMA journals, and immigrant psychiatrist Félix Martí-Ibañez (1911-1972) who tended to self-publish in his own Sackler-style "throw-aways" such as MD and his popular book Centaur, both made careers of flattering their medical brethren.

Yet "high road" Bean became notorious for his vicious assault on "low road" Martí-Ibañez for the latter's exercise of "a decline in taste, the faults of bombast, and flatulent writing. … [The author’s scholarly colleagues] must have winced at the polycythemic and apoplectic style of this literary centaur." What was interesting, though, was the fact that both of these "medical humanists" were furiously sucking at the teat of Big Pharma. Big Pharma has always been, one infers, to medicine what the Koch Brothers are to the Republican Party. (Or, let's say, fat-cat donors to both political parties.) Drs. Podolsky and Green conclude that the real argument was over what we might call "intention to inform." That is, disinformation. They conclude that for some, e.g. Bean, it was a bridge too far—open, overt pandering—when Martí-Ibañez declared that the "'whole operation [of running Martí-Ibañez's media] is done so artistically by our spellbinders that the reader, without knowing exactly what has happened, falls gratefully under the magic spell and reads, enjoys and remembers everything stated in MD. As a consequence of this special mood in which he is placed by the magazine we can logically assume, and I am sure it could be proved, that the reader is more receptive to advertising messages because their power is considerably enhanced by the mere fact of their being within the covers of MD'  With this," the authors conclude, "the fault lines between the humanistic visions of Martí-Ibañez and Bean are clearly exposed."

To some extent, then, information, even in public health and the current pandemic, is now seen by many as simply an arm of marketing. As we've seen, such an approach has its powerful antecedents, going back to the post-war period and probably before. Since when did marketing people feel the need to be truthful? For them, the mission's never been about putting out some semblance of the audience's actual reality. Rather it's been about "controlling the narrative" in order to achieve market dominance in any given domain. The "crime" of Martí-Ibañez was that he pulled the curtain aside and admitted overtly what he was doing.

And, as a sort of coda to the old-media story, let's recall the immediate past flowing right now into 2021. The team put together by the White House the to combat our still-ominous viral epidemic ended up only "spinning" the epidemic to benefit the Orange Man in the Oval Office. Hence the truly chilling story—a non-digital story—of the White House's efforts to muzzle the CDC and bowdlerize its message. How did that work out for the people of the United States? More on that in a minute.

2. New Media. To Each Person Their Own Megaphone

New media clearly has the edge when it comes to creating megaphones and echo chambers. This digital world of tiny communities and hermetically-sealed "pages" can and does spawn much larger cohorts of belief. It's all fractionated and atomized. Each person to their own echo chamber. A new report—thanks here to Anne Peticolas for this reference—on The Disinformation Dozen shows how new media have all but cornered the market, literally, on antivaccinationism. The entire antivax movement is dominated by a dirty dozen writers' names, individuals who've almost cornered the market. Two-thirds to three-quarters of all content originates with these twelve nattering nabobs of negativism. That's enough for herd immunity! In the era of Old Media—so much for Internet democratic leveling—it's hard to imagine even a Random House, Simon & Schuster or National Bible cornering the market for cult belief.

In a subsequent writing I'll address some of possible ways to combat this meretricious lack of information balance. In the meantime, one way to confronting it with awareness, at least a start, is to make a point of lurking somewhere you don't like to be. For me, that's here. The digital on-ramp is so, so much more accessible than its print predecessors, especially for digital "content creators."

Actually, all these digital rabbit-holes provide an answer—the wrong one—to the question I posed above, "how did that White House manipulation of the Covid narrative work out?"  The question could've been taken as rhetorical.  For example, more specifically, "how did White House disinfo affect the CDC?" Yet here we have the author of the entirely suspect Health Impact News complaining that the "medical tyrants now [2020] had Big Tech behind them, and it was time to make their main move: Seek to vaccinate every person on the planet using the fear of a 'pandemic' to accomplish their plans." For them, such manipulation was clearly a good thing, and everybody got to define for themselves what was signal and what was noise. If vaccination were just noise, then countering the "medical tyrants" was surely God's Work.

There are so many more new media like this, splintering off, every-man-his-own-megaphone, each decrying the conspiracies of  mainstream media, each purveying their own truth. If every man his own-megaphone, ergo every man his own truth. At which point, there is no truth, just truthiness, right? Um, not right. These new media mavens are the folks for whom, unlike the old-media Sacklers and Murdochs in their day, the benefit is harder to divine. Maybe, given the frictionless access to all these new media—WhatsApp? Slack me! No, SMS! No, Instagram!—it's enough to be a mini-mogul with your shiny new mini-megaphone. If you don't get rich, at least you'll be be famous, adorned in previously unimaginable numbers of followers.

And there's always the hope of becoming a Sackler, or even a Zuckerberg.§

[Note: six days after this blog posting was uploaded, the redoubtable Peter Hotez came out with a similar plea for stronger counter-measures in a well reasoned Nature piece. Entitled "COVID vaccines: time to confront anti-vax aggression," he avers "Halting the spread of the coronavirus will require a high-level counteroffensive against new destructive forces." Amen.]

Mostly, though, the digital infomeneurs, or infomanures, are going to have to settle for some lesser bit of notoriety and their perceived access to the special joys of secret knowledge. Mostly, they're followers masquerading as leaders. Followership itself, where there's a putative "leader" such as "Q" of QAnon, is incredibly strong, as we learn repeatedly from the burgeoning literature on cults, from Jim Jones to Scientology to antivax. Indeed, if we plunge into any of these rabbit-holes, sometimes it's hard to tell the leaders from the followers.

Oh, and here's the Oz-like, surreal part of that last assertion: followers versus leaders. Look at QAnon. Who is its mysterious "Q"? A recent bit of sleuthing, if what it purports to reveal can be confirmed, is instructive. In a new television documentary for HBO, it seems the medium really can be the message. All that secret knowledge about the Man in the High Castle, 'Q,' may well emanate from the guy who built the megaphone, Ron Watkins. Watkins is the guy behind the curtain, administrator of 8kun, a favorite online base for conspiracism. Seems there's one born every minute in the Land of the Paranoid. Watkins is the latest in a long line of salesmen. For every Jonestown there is a Jones, or, in Oz, "not a bad man just a bad wizard." Or, let's say, a bad man and bad wizard.

Next, during the post-pandemic transition, moving from BC (before covid) to AD (after disinfo), everyone's head will swivel in a permanent driving info-torrent. Billowing spam, social media rooms'n'zooms, spoofed identities, random come-ons for new health insurance. (And let's not forget your expired automobile warranty.) There's a weird and enervating synergy between the disinformation bubbling up out of those flickering screens and the cramped ennui seeping out of public health restraint. Little wonder then that such synergy, in the spring of 2021, draws antisocial behavior—Fury Road! Mass Murder du Jour!— from people we squint to encounter, and shrink back, as we venture out into the daylight.

The article goes on, “'[w]e really shouldn’t be all marching in lockstep like lemmings to go and do what the government tells us to do,' said [Chris Christie], positioning himself as a political outsider. 'They’ve [the experts?] screwed up too many times for us to do that. But I really do believe the facts that I’ve learned, and the experiences I’ve had, should make at least everybody … think hard' about getting a vaccination." Note the faux outsiderism in which politicians takes great pains to distance himself from those uppity experts, and gives only a qualified recommendation lest he be identified to closely with those Others.

There's nothing terribly new about this disinfo-fueled attitude. An aw-shucks, populist-tinged suspicion of government and of elites actually works. It produces effects that benefit the issuer. It pretty much deep-sixed Barack Obama but may save Joe Biden. It's actually nothing new in the least, having long ago been described by Richard Hofstadter in his 1963 landmark Anti-Intellectualism in American Life. But it has taken on a new cast in the twenty-first century, receiving impetus both from new technologies (every man his own platform) and Ronald Reagan's now-canonical 1980 inaugural dictum, "government is not the solution to our problem, government is the problem."

Reaganism was a major source of energy for the wave on which Donald Trump is just the more recent surfer. Just a little over a decade earlier, the Kennedy-Johnson years had come blasting to a close with shots heard around the world, political and scientific. Of course this doctrine's culmination came in the more debased form we saw, and sadly continue to see, in Trumpism.

You can fill in the blanks from here on out. What ensued? Disinformation. And it just keeps on coming. But maybe, just maybe, we could be coming to the end of a forty-year cycle of science- and government-bashing.

But here I'm offering here a meditation not on historical cycles, but on disinformation. It's not just Trumpism's right wing shock jocks and wrestling enthusiasts who're to blame. So we must turn next to some exploration of how, across multiple disciplines over these same forty or so years, academic elites may have contributed, to a national mistrust of science and medicine.


C. External Forces II. Academia and the Chattering Classes

At some point between Hofstadter's 1963 publication and Reagan's 1980 inauguration, in almost every discipline of social sciences and humanities and on both sides of the Atlantic, the academy began a radical shift. Academic thinkers, especially those who were the Oedipal young pupils of the postwar generation such as Hofstadter, turned against his approach to a positive narrative of what many thought of  as a postwar liberal consensus. They reasoned, not without justification, that that consensus had perpetuated a new war in Asia along with economic disparity, racial injustice and colonial domination. Arguably one upside of this revolt against the post-World War II regime was the partial melioration of some of these ills. But there was an equally clear downside. It had to do with the value of science, medicine, "progress" and the pursuit of "truth."

Heretofore, in approaching the way the public might view science and the quest for truth, Americans relied on narratives of progress. This so-called triumphalist view stemmed from a positive philosophy that emphasized both the reality of a goal and men's ability to home in on that goal through a combination of empirical practice and theoretical refinement. A new wrinkle was added in 1962 when Thomas S. Kuhn, a physicist with an interest in the history of science, injected a sort of Darwinian, punctuated idea of what he called paradigm shifts. In such shifts, Kuhn portrayed positive science lurching in new directions through generational and disciplinary change, leading to new communities of practice. For philosophers of science, he folded into the mix some important notions of social participation and discontinuity.

What Kuhn may or may not have anticipated was the fact that another, more radical and more nihilistic epistemology was about to supersede his own notion of how and why scientists change their world views. In some ways it was almost an anti-epistemology, because it was consonant if not causative in relation to the outcome we've been talking about: "every man his own truth." In another irony, the shift in many disciplines' outlook on "truth" was itself a sort of paradigm shift, both disciplinary and generational, away from a western-centric emphasis on elites and Heroic Dead White Men, and toward a rather insular and jargon-laden sociological analysis.

In a number of ways this was, in fact, a salubrious shift. It had a de-centering and iconoclastic effect. But as some of its own practitioners (vide infra, discussion of Bruno Latour) would come to point out, it went too far. Apart from loosing the grip of expertise on policy making—populists' insistence that we don't have to listen to those pointy-headed guys—more focally it loosened and deprecated scientific and medical institutions' valuation of the social sciences and the humanities. Around the United States, one by one, medical school departments examining the history of medicine and health care either ceased to exist or morphed into "medical humanities." Too often this last could be roughly translated into "Ethics Lite."

Only now, with the pandemic, are we seeing new pleas for, you guessed it, the reincorporation of such a "long view" back into medical education. We can expect to see more pronouncements such as Molly Worthen's recent analysis proclaiming that "A Once-in-a-Century Crisis Can Help Educate Doctors," urging an improvement on what has by now shrunk to "off the beaten track [discussions and courses] engaging a small, self-selecting group of students." A revived version of this study of the long view would goes well beyond the old paradigms, neither overly triumphalist nor overly cynical. It would emphasize topics as patients' own narratives, science as it is really practiced (see below), and far more complex stories of earlier epidemics. (Yale's new Covid-19 study group garnered 65 students: not bad.)

Long before Covid-19, mid-20th century scientific triumphalism had come crashing down with the notion of American virtue. A multicentric approach labeled variously as post-modernism, structuralism, deconstruction, post-structuralism, or "the Strong Programme," this new narrative dethroned the idea of progress as a peculiarly slippery and pernicious western instrument of domination. Replacing the idea of progress was a focus on scientists' and physicians' actual, often baser motives in conducting science. The new narrative revolved around social control and career ambition. From the French school came particular critiques of psychiatry and prisons. From the Scottish school came critiques of science and scientific communities, such as that exposed in Barry Barnes's and Steven Shapin's 1977 manifesto on Britain's Mechanics Institute.

Our purpose in this paper is to show how the founders of British Mechanics' Institutes thought a scientific education would aid in the social control of those artisans who were their designated target. We intend to elicit from the public statements of the movement's leaders the basis and structure of their own belief that a regimen of scientific education for certain members of the working class would render them, and their class as a whole, more docile, less troublesome, and more accepting of the emerging structure of industrial society.

An analogous and contemporaneous argument was made for medical care by Leicester sociologist Nicholas Jewson in his 1976 article on "the disappearance of the sick man." In this still oft-cited article, Jewson posited the inevitability of a loss of human and social relations by 19th century patients as the result of incursions into medical—especially hospital—care by technology and bureaucracy. And at the same time, medical science was suspect as new GMBs—Great Man Biographies, except delete the 'G,' these were anti-GMBs—tried to show not the actors' genius but, rather, their feet of clay. The net result of dethroning life sciences, exact sciences, and medical care was, within academia, a decline in interest in the narrative of progress, suspicion around clinical research, and at least possibly a decline, though I don't think anyone's ever quantified it, in actual boots on the ground to study these topics.

Interestingly, whatever the influence or lack thereof between post-modernism in academia and general population (or politicians') attitudes toward science and truth—and vaccines—it seems pretty clear that current events in the 2020s are clearly starting to reverse both trends. And this reappraisal, accompanied by a striving toward a more nuanced and realistic view of science and medicine, actually started before Covid-19 and the idolatrization of the appropriately scrappy truth-teller Anthony Fauci. In 2009 the whole Jewson "sick-man" concept, after it was invaginated by a whole generation of college students, was reassessed in an important critique. Some years later but still before the pandemic, the toppling of Louis Pasteur's statue, discussed below, was also upended.

What's wrong with bringing scientists and physicians down a notch? We do it all the time in this blog! The answer is tricky. Maybe nothing's wrong with it. (Maybe it doesn't even make a difference, so have at it!)  But for a generation, the leveling of the idea of progress was prevalent and could well have had some negative effects. The truth is that neither narrative was adequate to the task. Not "N1," the narrative of man inexorably pursuing inexorable progress across the ages. And not "N2," the narrative of science as social control and truth as hopelessly elusive, . A new narrative was called for and is just starting, with some assist from a virus and the people who study it, to emerge.

One wishes that someone I once briefly but enjoyably worked for, Anthony Fauci, the sharp-elbowed former basketball guard and gruff opponent of Capitol Hill swells, were here in a video. He'd pipe up and say, in that gravelly Brooklyn-inflected voice: "sure, we screw up, and there's plenty of career science-and-medicine types—go look at the White House in 2019-2020—puffing up their careers at the expense of the rest of us. But we're trying to get closer and closer to the reality here. We need to cut down on all those people dying out there. With a little help, we can do that."

Oh, wait, Fauci is here (here), sort of, in a video!

To see how medicine really works, pace all the earlier philosophers and sociologists of science, let's look at how the changes I've been describing rather abstractly were actually embodied in two key figures. Neither is American so US readers may not be familiar. Both are illustrative of important changes that actually calm my dander and give me cause for some optimism.

The first, Bruno Latour (b. 1947) is a Paris-based author with global reach. His Wikipedia page calls him, as befits the polymathic member of a celebrated French viticultural family, a "philosopher, sociologist and anthropologist." My Neeva search results page arrays his photograph alongside those of the much-older figures Thomas Kuhn and Michel Foucault, both born 1922. N1 and N2, side by side. I doubt that Latour, unlike some of his UK compadres of the iconoclastic "strong programme" ilk, ever really needed to work. But in his early years, based eccentrically at the School of Mines in Paris, work he did, profligately, publishing yet another heretical work on Pasteur and then a slew of subsequent books and articles including the important and still-available 1986 Laboratory Life. (This last was co-authored by UK sociologist Steve Woolgar and in the current edition introduced by none other than Jonas Salk.) That later book's subtitle was telling, reflecting Latour's own early program: "the deconstruction of scientific facts."

In recent years, however, Latour, much of whose current output seems to be positioned in the province of literature for the management community, seems to recant. And this is the interesting part. In the 20th century I met Latour, an astute, personable, and sensitive individual. I was fascinated when, in 2004, in Critical Inquiry—a journal not well known to science-and-medicine types—he published a piece called "Why Has Critique Run out of Steam?" In it he first posed a question that, by the turn of the century, must have bubbled up in many academic minds,

My question is simple: Should we be at war, too, we, the scholars, the intellectuals? Is it really our duty to add fresh ruins to fields of ruins? Is it really the task of the humanities to add deconstruction to destruction? More iconoclasm to iconoclasm? What has become of the critical spirit? Has it run out of steam?"

Latour has become less interested in science-as-crap and more in the effect of computers—and the effect of academia on the body politic. So at the end he answers his own question, cryptically but still tellingly, in this way:

[We wish to be] generating more ideas than we have received, inheriting from a prestigious critical tradition but not letting it die away, or “dropping into quiescence” like a piano no longer struck. This would require that all entities, including computers, cease to be objects defined simply by their inputs and outputs and become again things, mediating, assembling, gathering many more folds than the “united four.” If this were possible then we could let the critics come ever closer to the matters of concern we cherish, and then at last we could tell them: “Yes, please, touch them, explain them, deploy them.” Then we would have gone for good beyond iconoclasm."

As the pandemic finally started to rage and much of the world was in lockdown a decade and a half later—early summer 2020—Latour was interviewed by The Guardian. He was asked to meditate on three of that newspaper's cardinal concerns that haunted the new century's tumultuous third decade. Climate, coronavirus, and post-truth: call them the three horsemen, or "the revenge of the real." Here, in extenso, are his final two responses to queries put by the newspaper's interviewer.

Your work has often challenged the objective, God’s-eye view of science. You argue convincingly that humanity cannot be so detached. But the political right have twisted this approach to undermine all expert knowledge on the climate and nature crises. Any regrets?
A critique of how science is produced is very different from the post-truth argument that there are alternative truths that you can choose from. Post-truth is a defensive posture. If you have to defend yourself against climate change, economic change, coronavirus change, then you grab at any alternative. If those alternatives are fed to you by thousands of fake news farms in Siberia, they are hard to resist, especially if they look vaguely empirical. If you have enough of them and they are contradictory enough, they allow you to stick to your old beliefs. But this should not be confused with rational scepticism.

Has the Covid-19 crisis affected our belief in science?
The virus has revealed the number of things you need to know to decide what is factual and what’s not. The public are learning a great deal about the difficulty of statistics, about experiment, about epidemiology. In everyday life, people are talking about degrees of confidence and margin of error. I think that’s good. If you want people to have some grasp of science, you must show how it is produced.

Couldn't have said it better myself. Latour was, and is, the consummate observer of science and medicine. His writing has gradually evolved to a point where he can no longer be called either a triumphalist or an iconoclast. He seems to be suggesting a new, middle way, in which science and truth are always provisional, but if pursued within existing guardrails ought to be trusted. In lay terms we could call it the law of 20-20-hindsight-but-it's-the-best-we-got. To test this hypothesis we can next exam the career of another European scientific leader, this time an practicing scientist rather than a philosopher. Like Latour she has strong ties to the US but emerges from the European tradition.

In the mid-1908s, far removed from the issues of how either societies or their elites look upon truth, a Hungarian biochemist named Katalin Karikó (b. 1955), two year old daughter in tow, accepted an invitation to join the staff of Philadelphia's Temple University. With this choice she strove to pursue her research on the transcription of messenger RNA. At that point mRNA, yoked to very new technologies, promised much. But it did not yield results fast enough for US medical schools. Ten years later she transferred (1989) to the University of Pennsylvania's neurosurgery department. By 1995 she'd been demoted and removed from that department's faculty track. Not enough of her grant proposals had achieved funding. (My report here is assembled from many fine accounts of her work, two mentioned below, most of them based on interviews. All are available upon a simple name search. The NY Times also reported part of this story after the present blog was written. Best among them are from The Guardian and, especiallyThe Harvard Crimson.)

Karikó's work continued at Penn only because of certain contingent factors: first and foremost, she believed in the power of mRNA as an eventual therapeutic and soon thereafter vaccinology tool; second, she was tenacious and willing to accept a lesser post in order to pursue the work even after it repeatedly failed to yield the paramount coin of the realm, NIH largesse; and, third, a conviction about the  mRNA technology shared with her clinical colleague Drew Weissman. And, yes, fourth—maybe most significantly—she wanted to hang on to the tuition reimbursement benefits that allowed her daughter Susan, a promising athlete and rower, to attend college at Penn. 

It took another ten years, down into the middle of the first decade of the present century, for Karikó's mRNA work to come to fruition. She landed on her feet through the creation of Germany's BioNTech where she became a partner in 2013. The company now partners with Pfizer to produce and deliver the phenomenally effective mRNA Covid-19 vaccine. Thus, two small pharmaceutical houses, one led by European scientists (including two Muslim Turks) barely known until last year in the US, the other Moderna, a uniquely American success story with a Black female lead scientist, both came to the rescue.

Pause to consider how these stories might be written. Are being written. Much ink is being shed about the greed of Big Pharma. As if that were the whole story. There is another story. It is the story of the creation of mRNA vaccines. Blind luck, as some might have it? There is another story.

In 2008, three years after her breakthrough discovery of how mRNA might effectively be slipped into cells to crank up the protein synthesis machinery, her daughter Susan Francia (photo) went to Beijing and won Olympic gold in rowing. Four years later, in 2012, the year before Karikó left Penn's employ to join BioNTech, Francia pulled it off again, winning her second gold in London. Motivation, just maybe, enough. Meanwhile Karikó and her colleague Weissman are packed for Stockholm. But their intellectual property remains at Penn, which repaid her in 2013 by refusing to reinstate her to tenure-track status.

 But of course now, as recognized Queen of mRNA and money-pump for Penn, in an appropriate but rather empty gesture Karikó is still pictured on the university's website as an adjunct. In a 2020 interview, she reflected that "I thought of going somewhere else, or doing something else. I also thought maybe I'm not good enough, not smart enough. I tried to imagine: everything is here, and I just have to do better experiments." And so she did.

Was it all a random walk? In no way does the mRNA vaccine story resonate with either of the traditional narratives of how science is "supposed" to work: 20th century triumphalism versus a leveling and often cynical postmodernism. Failure to explain or understand science has thrown the popular narrative, especially in our post-covid dawn, to the disinformationist wolves. Academic authors are just beginning to catch up by asserting more nuanced narratives of how science works, and hence why we should at least provisionally trust the Karikós and Faucis of the world.

To conclude these micro-biographies, I should add that the choice to spend substantial time on Latour and Karikó has a lot do with how each in their own way illustrates the problem of trust. Who can find a trustworthy overarching truth narrative in science? Especially once you actually personify it, take it down to the level of the individual life lived. In some ways we've outlived the usefulness of heroes. But, maybe, in some ways, not so much. Another recent biography to instruct us is a recent account by Johns Hopkins historian Daniel Todes of Ivan Pavlov's life lived. This work also conveys the same nuanced understanding.

In an interview Todes veered close to Latour, evidenced in this quote from his own university's magazine, describing himself as "... basically a realist. I believe that there's an objec­tive reality independent of our consciousness. I don't think science is just a matter of opinion. But it's a deeply human endeavor, and reality being infinite, there's an infinite number of ways into it. Metaphors define paths into this reality—the questions that are asked and aren't asked." Thus we're left with narratives of the search for truth in science and medicine that at some level are compatible with all of the flavors of meta-narrative, from Kuhn to the very latest attempt. That, to wit, is The Knowledge Machine, a promising new (2020) version of the narrative of science from NYU professor Michael Strevens. I hope to discuss it here soon.

One final irony seems worth pointing out before we move on. The academic critique of science and medicine was far from eroded by the forces of the right. The notion of "alternative truth" has in fact been embraced by the right. The year 2017 was a banner year for those open arms. Orwell had sort of predicted it in his "newspeak," but in 2017, after 45 was inaugurated, his senior advisor told Chuck Todd that the president's press secretary was merely disseminating a different flavor of truth: "alternative facts."

And speaking of irony: while the right embraced the possibility of "alternative fact," it was ultimately the left that found every-man-his-own-truth wholly discomfiting. Yet the "truth" as portrayed by the left, like Henry Ford's choice of Model T colors, could also prove pretty confining.


D. From the Ridiculous to the Sublime: The Provider and The Patient

In this final, shorter section I'd like to pull the focus back from the broad, shambolic bloviators sprinkled throughout our political and intellectual elites. For elites of all persuasions, it seems the Covid-19 pandemic has been a pivotal time for public engagement: seeking either to emit or to combat disinformation. Pull the focus to a level more sublime, that of individual relationships between clinical actors. What's happening between physicians and patients as they migrate from face to face encounters to telemedicine? What's happening between physicians and patients as face to face encounters shrink down to fifteen minutes?  What happens when much of that fifteen minutes is deflected, for the physicians, from high-touch and hands-on to the creation of the perfect electronic note? What happens when that document creation is conducted with eyes deflected away from the patient and toward the flickering screen? How does trust between the two parties fare with these changes when they are coextensive with the outside rise of social media?

I found instructive hints in a recent piece in Media and Communication, an open-access journal of applied research in communications and media technology. In this article a team from Madrid and Bournemouth make the point that patients looking for a plan to understand their illness—e.g., some illness mimicking coronavirus—will more than likely be let down and leave the office confused. He or she will leave carrying a thick sheaf of papers purporting to convey the "after visit review," aka the AVR or "Clinical Summary." In the majority of instances, nowhere in that thick pile of papers, a cumbersome list-of-lists, lurks any real plan. Hence the AVR lacks any information even while "it takes only a few clicks to find a reputable health advice source to refute [disinformation]" that may include "virus spreading through mobile phone networks" or "radiation from such networks suppresses the immune system against the virus." It's not a fair fight. Lacking information they can actually use, the patient joins "many people [who] break lockdown rules [and] pour onto the street to smash ... phone masts in many countries."

[Note added post-publication, with thanks to fellow HCR blogger Anne Peticolas: A quite similar view was just expressed by the blogger and Down Mainer country doctor Hans Duvefelt. In his plaint, "Some People Don't Think Like Doctors," he notes that "in a patient’s medical record, we have a fundamental need to know in what order things happened. ... But [omitting] that seems to be how people with a bookkeeping mindset prefer to view the world." And indeed, the genesis of the electronic health record, and what sustains it to a significant degree, originate in hospital back offices. That's where managers—it's the CFO who finds the exorbitant scratch needed to pay for an EHR—have always counted the beans. And now, with the EHR, as Dr. Dorio's recent HCR piece amply demonstrates, that's where they can dictate their own chosen surrogate markers of "productivity."]

I suspect, however, that most patients and more than a few health care providers don't know is that new rules governing all such matters are now just around the corner for information sharing. As a result of the 21st Century Cures Act, starting this spring, access to their own electronic health records must now be given to patients. A decade or so ago, in anticipation of such information-sharing requirements, a new movement sprouted. However improbable it might have seemed at the time, the Patient Portal suddenly sprouted from small start-up companies. Soon they were being acquired by the large, "big iron" EHR companies, unless in some cases those folks decided to roll their own portal platforms. Either way, and with a few recent exceptions such as cross-institutional sharing, document uploads, limited messaging and future appointment requests, such portals continued to offer the same limited usefulness as the Clinical Summary.

The AVR was that big wad of paper handed to the patient as he or she left the office. The portal was more like a keyhole through which the patient could peer at their own living document, containing, however, often misdescribed, medication and other lists. Evolving as an afterthought, the AVR was—and still is—most useful for wrapping fish. Hiding in plain sight within it was a big, black hole at its center. What should have filled that hole was supposedly some description of the actual plan contemplated as the result of this particular visit. Not the incompletely reconciled meds list. Not the mostly-irrelevant list of earlier diagnoses of gouty toe and earwax. Not the irrelevant list of future routine follow-up appointments within a vast hospital-based system. In other words, not the wholesale data-dump that could be parsed by the computer, deemed to be sufficiently discrete to fit this list of lists—but was in fact wholly useless for this visit.

Garbage in, garbage out.

Why such a remedial oversight? The actual plan for the patient, in case after case, was either too slippery or too time- and energy-comsumptive for the provider within that fifteen minute stretch. The default alternative was hence just to push out a document with that black hole in the middle. Such a meaningful plan would have had to be discursive, likely to contain at least a couple of if-then statements and, above all, tell the story. The story, how to plan going forward, is what the patient needs. Conversely, the story, with at least an implied plan (don't succumb to the vaccine-mongers) and look-forward with rationale (conspiracy!): this is what the patient gets from disinformationists.

The story is what the physician lacks time to craft properly for the patient at some appropriate point late in that fifteen-minute visit. The patient is left vulnerable, an opportunity missed. As a physician I blush to think that other professionals, including most lawyers, notwithstanding their oft-contorted and -ontrived ways of near-impenetrable prose, fully understand the need to tell the plan. But we don't. Why? Why have we abdicated compliance with this obvious need? Are we that pervasively controlled by our paymasters? And why have our paymasters abdicated asking us to provide it?

Oh, wait. Maybe it's simple. Measure what you can count, simple as that. "Meaningful Use" of the EHR has required that everything be measured—viz., the numbers of e-prescriptions, the numbers of usually-inaccurate problem lists, "medication reconciliation" that is anything but reconciled. But what's most meaningful is what just happens to be less easily mensurable. 

And besides, lawyers actually get paid to do this stuff. Explaining and planning stuff. Sometimes in legalese. But they do it.

Doctors don't. Ever. Or ... hardly ever.

It turns out, however, that there are actually ways to empower providers and patients with beneficent technology to counter this sad lack of information symmetry. (It's asymmetry, think about it, both within and without the exam room.) With the advent of the Patient Portal the health professions have already yielded to the lately-acknowledged need for greater openness. Further, some patients are already beginning to benefit from an even more radical beneficent information initiative. A lucky few are now blessed with full access to their electronic records, through the OpenNotes movement pioneered by Harvard's Thomas Delbanco.

One next step must thus be the enhancement of the AVR so that it becomes a truly useful tool. In a future essay, I'll outline strategies with which to fashion such an enhancement. If successful, such methods could finally, along with portals and OpenNotes, level the information playing field. 

Disinformation is thus a broad and scalable concept with sort of fractal features. It works at the level of the dyad of physician and patient. It scales to institutions, then to societies with all their tribal animosities, and then, ultimately, to problems of international cooperation. Disinformation is like a virus. It's pernicious in the way it insinuates itself into life's interstices. But counter-measures are out there. Marshalling such counter-measures requires, however, a concerted effort of of will. Most critically, countering disinformation requires sheer perseverance. It requires the grit of people like Katalin Karikó, if trust is to be restored and this brackish disinformation flood is finally to be stemmed.

___________________

*Misinformation is a term often used to explain bad outcomes such as that experienced when homeless persons are unable to get assets such as stimulus payments or vaccinations. Disinformation seems to connote, for some, more agency on the part of the one seeking to impart "information" that's not merely disrupted but purposely distorted.

**New York Times "Opinion Today," 9 April 2021.

†Of course we're not alone in this myth-making. The French have their own cherished myth of laïcité. Once upon a time the Germans had the myth of cultural purity. Useful myths are remarkably persistent. The problem is that their stewards all too often preserved the wrong myths. On the other hand, now abandoned by many as unfortunate myths are notions such as "truth," and "science," actually the very ones we need to revive. Then perhaps struggle to agree on the basic meanings of other notions such as "infrastructure," "speech" or "bipartisanship."

‡The HCR piece referenced in the preceding sentence, with its link to the rag (1960-?) started by Arthur Sackler (1913-1987, features a link to his Medical Tribune. That link seems now to be broken. Some discussion of the family's playing on the culturati role as compensatory for the hard-driving PR behavior is in the still-available WaPo obituary. The magazine, which reached 600,000 physicians, is still available in one or more archives. In the paragraphs immediately following, see also my discussion of other pharma-associated actors' use, in high and low places, of the media megaphone, with a link to the superb recent article on which much of it is based. Just as I complete the writing of the present meditation, a new biography of Arthur Sackler and his family, New Yorker writer Patrick Radden Keefe's Empire of Pain, hits the bookstores. I have not seen an advance copy but it is getting much notice in traditional media. This includes a forthcoming NY Times review that states "Arthur may have been the first to blur the lines between medicine and commerce, and he pioneered modern drug marketing, but his sins pale compared with those of the OxySacklers."

§It's worthwhile recalling that only Zuckerberg, of course, became a Zuckerberg

¶Typically, on the street, one hears this particular trope translated as "mistrust of all science and mistrust of Big Medicine—but not my own doctor." [My paraphrasis.] This in itself can be a problem, given the number of resurgent medical messiahs we've been seeing.


Sunday, April 04, 2021

A Few Leaders of Big Health Care Corporations Hesitate in Their Support of Extreme Politics and Insurrection, But Will Anything Really Change?

 Some recent but not well publicized articles suggests how big health care corporations are still enabling some of the worst aspects of health care and larger political economic dysfunction.

Introduction - Health Care Corporate Political Donations Become More Partisan and Ideological

A long time ago in a galaxy far, far away big health care corporations in the US had an apparently straightforward philosophy of political giving.  They gave contributions more or less equally to both major political parties.  Apparently the theory was that the corporate giving would be remembered favorably by whoever won elections and got governmental power.  Corporate contributions raised major concerns about their ability to purchase access and influence policy far beyond those of less wealthy groups and the public at large.  At least, however, it was overtly non-partisan, and ostensibly not ideological.

However, things changed, and health care (and larger corporate) political giving became more partisan, and and more ideological. As we discussed here

- In June, 2018, we first noted how the huge pharmacy chain CVS, had been secretly making contributions to America First Policies, an ostensibly non-profit organization.  CVS claimed that it helped fund AFP because it supported tax reform.  Actually, AFP acted to promote Trump administration policies. AFP encouraged repeal of the Affordable Care Act (ACA), and building a wall on the US southern border.  These seemed at odds with CVS claims about its social responsibility.  


- In September, 2018, we noted that big health care corporations often make high-minded public pledges about supporting patients' and the public's health, and sometimes social responsibility, but have been found to be covertly supporting policy initiatives that seemed to subvert these goals, using "dark money."  The dark money groups they used to channel this money often had explicitly partisan leadership and direction, usually right-wing and Republican.


 

- In October, 2018, we discussed important but incomplete revelations about corporate contributions to such dark money groups that mainly favored again right-wing ideology, the Republican party, and Trump and associates.

- In November, 2018, we noted that health care corporations funneled funds through dark money organizations to specifically attack designated left-wing, Democratic politicians.

- In March, 2019, we discussed a study of the personal political contributions of CEOs of large corporations.  In the 21st century, the CEOs' contributions were increasingly partisan, that is individual CEOs gave predominantly or exclusively to one party, and for the vast majority, to the Republican party. 

- In October, 2020, we discussed the apparent relationship between the support to Trump provided by large pharmaceutical corporations and his inclination to outsource his coronavirus pandemic management to them. 

Corporate leadership's enthusiasm for Trump, his policies, and his associates seemed to arise from  economic interests of the corporations and the self-interest of their top management, but without consideration of how Trump and associates' actions may have harmed larger corporate, social, or national interests.  As discussed in a Washington Post article on January 8, 2021:

Business groups big and small largely stuck by Trump as he broke one norm after another over the past four years, including insulting immigrants, appearing to empathize with white supremacists in Charlottesville and clearing a Black Lives Matter protest in Washington for a photo op. They stuck by him still after he pressured the Ukrainian president in a bid to help his own election chances, after his impeachment, after he intentionally downplayed the effects of the novel coronavirus and last week after he was recorded pressuring the Georgia secretary of state to overturn the election results.

Even Trump supporters admitted the corporate leaders' extreme compartmentalization:

'It isn’t going to affect tax rates. How about monetary policy? Allow me to stay pure to my turf,' Art Laffer, a supply side economist who is close with White House economic officials and speaks to the president, said in a brief interview.

One observer described their thinking thus:

'Their attitude was: ‘Let’s take the big tax cuts and hold our noses for the obvious xenophobia and authoritarianism.’ It was a classic Faustian bargain,' said Rep. Brendan Boyle (D-Pa.), a member of the House Ways & Means Committee. 'They should have known from the beginning.'

However, the Trump administration's actions and policies often seemed to directly contradict the stated values, visions and missions of health care corporations.  For example, Pfizer declares its values to be:

customer focus, leadership, quality innovation, collaboration, respect for people, integrity, and performance

How would the value "respect for people" align with Trump's hostility toward immigrants, or sympathy for white supremacists?  How would the value "integrity" align with Trump's pressure on the Ukraine to influence his election, or his pressure on officials in the state of Georgia to alter the election results in his favor?  

Nonetheless, until very recently, hardly anyone seemed to notice that large health care corporations had changed their political giving so as to make its effects antithetical to the corporations' declared principles and values.  

Trump's Attempt to Overturn the 2020 Election Inspire A Few in Corporate Leadership to Rethink Its Political Support for Him and His Associates

Yet things apparently changed after Trump's attempts to overturn the election, including claims that he actually won despite obvious evidence to the contrary, baseless legal challenges to the election results that were almost all dismissed by the courts, and an attempt by Trump supporters in Congress to challenge and possibly override the election results in congressional proceeding.  That crossed a line.

Within days, corporate leaders who had generally been quiet about Trump administration's actions and policies that ran counter to their organizations' stated goals and mission began to speak up.  Several hundred signed a statement:  

Congress should certify the electoral vote on Wednesday, January 6. Attempts to thwart or delay this process run counter to the essential tenets of our democracy.

Most of those who signed lead financial firms, but the list did include Albert Bourla, CEO of Pfizer, a firm that had been one of Trump's favorites (see above).

Then, Trump's exhortation to his supporters at a rally to march on the Capitol while congress was debating Trump's supporters' challenge to the election results, which led to an insurrection and armed occupation of the Capitol building,  which was eventually beaten back by law enforcement with significant casualties led some corporate leaders to rethink their positions. 

The next day, per the Washington Post:

The mob scenes at the Capitol attracted harsh and unusual criticism from business groups, including the chief executive of one of the nation’s largest banks saying he is 'disgusted' and a manufacturing trade group calling it 'sedition' and suggesting that President Trump must be removed from office immediately.

It was a stunning series of rebukes for a president who had received widespread support from corporate America for most of his turbulent term, especially for his efforts to cut government regulations and reduce corporate tax rates.

But what occurred Wednesday seemed finally to be too much. Trump staged a rally in Washington a short walk from where Congress was counting the electoral college votes, with Trump whipping up his followers with fabrications about election results and urging them to march to the Capitol to protest. Later, Trump appeared to sympathize with the mob and support the violent actions.

 The National Association of Manufacturers soon after released an extraordinary statement from its president, Jay Timmons, saying Vice President Pence 'should seriously consider working with the Cabinet to invoke the 25th amendment to preserve democracy.'

At that time, one more CEO of a pharmaceutical company that had been one of Trump's favorites spoke up:

Alex Gorsky, the chief executive of Johnson & Johnson, said in a statement that he is 'devastated by this assault on what our country has stood for since its founding: free, fair and peaceful elections.' He said it is time to stand for unity, 'not face-to-face in conflict — and to chart our path to a better and healthier future.'

Furthermore, some large corporations, including health care corporations, announced a review or freeze on political donations through their corporate political action committees (PACs). Per the New York Times, January 11, 2021:

A flurry of companies have since reviewed political giving via their corporate political action committees.... Blue Cross Blue Shield, Boston Scientific... are taking a similar, targeted approach to donation freezes.

On January 12, 2021, StatNews summarized responses by health care corporations:

 The list, so far, is short: the Blue Cross BlueShield Association, an insurer federation, said this week it would pause contributions specifically to candidates who effectively voted to overturn the results of the U.S. presidential election.  Drug manufactures Gilead Scientific and Amgen, as well as BIO, the biotech lobbying group, said they would pause contributions to all candidates regardless of how they voted on election certification, according to spokespeople.  UnitedHealth Group and Boston Scientific, the medical device giant, said the same.

Others, like CVS Health and the insurance lobby group America's Health Insurance Plans, were more cautious, saying they would review their future giving.

However,

Many other health care corporations and lobby groups... have not responded publicly.

The article also noted:

Many of the GOP lawmakers who voted against certifying the Electoral College results are those whom the drug industry and other health care sectors have long viewed as allied.  

The list included Republicans in Congress whom may be regarded as extreme supporters of Trump, eg Rep Devin Nunes (R-CA), and Rep Andy Harris (R-MD).

I found one other report of a big health care corporation which changed its political donation policy in response to the attempt to overturn the election.  Per the Kansas City Star, January 13, 2021:

Cerner Corp. will suspend political donations to Sen. Josh Hawley and other politicians who it determines helped to incite the violent mob that attacked the U.S. Capitol building last week.

The North Kansas City-based healthcare IT firm is the latest to seek distance from Hawley, a Missouri Republican, and others who have supported baseless allegations of voter fraud in the November presidential election. 

A company spokesperson said:

'Effective immediately, Cerner PAC will suspend contributions to any candidate or official who took part in or incited violence last week in Washington, D.C.,' the statement said. 'Focusing on the health and well-being of the American people transcends partisan politics, and we will continue working with all elected leaders to advance policies that put the patient at the center of their care.'

I found another report of a big industry group which planned a "review" of its giving.  The American Hospital Association announced on January 14, 2021:

The tragic events last week at the U.S. Capitol were an assault on our democracy. This prompted the AHA to begin an immediate review of our political giving practices to ensure they are guided by our Association’s vision and mission, as well as the democratic values we share as a nation.

But that was it, a total of six large health care corporations and three industry groups announced a pause or review of political contributions (apparently limited to those from corporate PACs) to some of the politicians who voted to challenge the election results.  The Potter Report, authored by health care insurance whistle blower Wendell Potter, noted

There’s been a lot of talk this week about big corporations such as Amazon, Verizon and Comcast deciding to stop giving money to House and Senate Republicans who voted to overturn last year’s election. 

Guess which giants aren’t on that list? America’s big for-profit health insurers

Over the past two election cycles, Big Insurance has donated to just about all the 147 House and Senate Republicans who voted against certifying the election. That includes Cigna and Humana, where I once worked, and Centene and CVS/Aetna. Plus, the industry’s lobbying group, the American Health Insurance Plans (AHIP).

 The Blue Cross Blue Shield Association, which represents a lot of nonprofit insurers and for-profit Anthem, says it’s suspending donations to those Republicans. And UnitedHealth says it will 'pause' its political donations. But let’s see how long these 'pauses' actually last. 

So far, we haven’t heard a peep from AHIP or the other big for-profits, all of which have made huge profits during the pandemic, thanks largely to having lawmakers on both sides of the political aisle in their pockets. 

Big Insurance donated more than $9 million to House and Senate candidates during the 2020 cycle. Among their favorites? Ted Cruz and Josh Hawley, who led the effort to overturn the election. All the big for-profits donated to Cruz, and all but CVS/Aetna donated to Hawley. 

Note that no health care corporation announced changes in the donations by its top management.  Certainly none even mentioned political contributions through dark money groups (like those that CVS had been revealed to be making, see above).  So the attempt at overturning the election to keep Trump in office, first by quasi-legal maneuvering, then by an armed insurrection, had little effect on continuing underwriting by big health care corporations of the politicians who acquiesced to or actively supported this assault on the fundamentals of our representative democracy 

Two Months Later, Health Care Corporations "Back to Bankrollling Insurrectionists"

Within months, some of the few health care corporations who paused donations again seemed ready to cozy up to anti-democratic politicians.  As reported by the Daily Beast, March 24, 2021:

After the Jan. 6 insurrection, more than 120 corporations swiftly vowed to suspend campaign donations to Republicans who objected to certifying the 2020 election....

But it took less than two months for Pfizer to break that pledge. Their PAC gave $15,000 to the National Republican Senatorial Committee, led by one of eight GOP Senators who voted to decertify election results—Rick Scott of Florida—on Feb. 23.

In total, The Daily Beast identified four companies that appear to have gone back on their suspension of donations to GOP election objectors: AT&T, Cigna Health, Ford Motors, and Pfizer.

[Note that I had not earlier found notice that Cigna Health, a for-profit insurance company, had suspended donations.]

Summary

So as far as I can tell, while Trump is out of office, the big health care corporations that provided plentiful financial support for his initial election and attempts at remaining in office, through electoral and anti-democratic means, are back to supporting the political party that has become his personal sandbox.

 It is increasingly evident that big health care corporations, despite their protestations of social responsibility and non-partisanship, now are actively supporting one wing, an extreme one, of the political spectrum.  This raises big questions: cui bono? Who benefits?

It is obvious why a pharmaceutical company, for example, might want to defeat legislation that would lower its prices or raise its taxes.

It is not obvious why it would want to consistently support actions by one party, or by people at one end of the political spectrum, even if some such people seem generally "pro-business."  After all, for years big corporations and their executives openly gave money to both US parties and their candidates, apparently in the belief that this would at least allow more visibility for the corporations' priorities no matter who was in power.

Now, the most obvious theory is that the new practice of secret donations only in right-wing, Republican, pro-Trump, and/or anti-democratic directions, which must be orchestrated by top corporate management, and which are not disclosed to employees or smaller corporate shareholders, are likely made to support the top managers' self interest more than the broad priorities of the corporations and their various constituencies. By virtue of being top management of a corporation, particular individuals can control political funds far beyond what they may be able to control as private persons, and to do so anonymously.  This could present many temptations, but the rationales for particular managers directing their corporations' fund to particular politicians or organizations remain unknown.  

Thus not only is more investigation needed, at the very least, "public" corporations ought to fully disclose all donations made to outside groups with political agendas.  This should be demanded by at least the corporations' employees and shareholders, but also by patients, health care professionals, and the public at large. Furthermore, it is not unreasonable to ask that all organizations disclose all political funding which allows their leaders and managers to leverage their own political intentions.

Meanwhile we are left with the suspicion that top health care corporate management is increasingly merging with the Trumpist movement in one giant corporatist entity which is not in the interests of health care, much less government by the people, of the people, and for the people.

 

ead more here: https://www.kansascity.com/news/politics-government/article248457745.html#storylink=cpy

 


Read more here: https://www.kansascity.com/news/politics-government/article248457745.html#storylink=cpy

 


 

Sunday, March 07, 2021

Political Leaders Continue to Spread Disinformation and Advocate Policies and Take Actions Based on It

The coronavirus pandemic in the US seems past its third peak, but daily case rates have now plateaued at a level similar to the last peak.  While hospitals and health care professionals are not totally overwhelmed, they are working extremely hard and continuing to burn out.  People are still getting sick, some seriously, chronically, or fatally. With the continuing rapid spread of the virus, mutations have occurred. New viral variants may be more contagious, and possibly more deadly. While three efficacious vaccines are now available, a majority of people in the US do not have immunity to the virus.  

At least we are now hearing evidence-based guidance from federal leaders who no longer must kowtow to Donald J Trump. They have been urging patience and continued mask wearing, social (that is, physical) distancing, handwashing and other preventative measures until herd immunity is achieved through new vaccines.   Yet


Another big source of disinformation since the onset of the pandemic has been Trump's faithful followers, including politicians at national, state, and local levels in the US. We first noted the onset of disinformation about the virus propagated by Trump supporters here, including the case of Senator Tom Cotton (R-AK), who pushed the erroneous idea that the coronavirus originated in a Chinese laboratory in Wuhan. Since then we have noted many other cases in which Trump supporting US politicians have peddled disinformation about the pandemic, most recently here. However, since Trump left office,  political leaders who support the former president continue to spread disinformation, and advocate policies and take actions informed by disinformation, not by evidence-based public health.

We present the latest cases of politicians spreading disinformation, and politicians acting on or promoting policies based on such disinformation, in chronological order by the dates of relevant publications.

Spreading Disinformation

Senator Ron Johnson (R-WI) Promotes Unproven Treatments for COVID

As reported by the New York Times, December 7, 2020, Sen Johnson convened a hearing of the Homeland Security and Governmental Affairs Committee in which he featured witnesses who pushed unproven treatments for the virus  

Mr. Johnson’s lead witness on Tuesday, Dr. Jane M. Orient, has cast doubts on coronavirus vaccines and has pushed for the use of hydroxychloroquine, an antimalarial drug pushed by Mr. Trump, as a treatment. She helps run a group that believes government vaccine mandates violate human rights.

After numerous trials, there is no good evidence that hydroxychloroquine has benefits that outweigh its harms in the treatment or prevention of COVID-19.  The hearings also included

the Washington cardiologist Ramin Oskoui, [who] said on Fox News last month that it was 'settled science' that 'social distancing doesn’t work, quarantining doesn’t work, masks don’t work.' On the contrary, it is settled science that all three are effective in limiting the spread of the virus.

Two others promote the use of ivermectin, a drug often used to fight lice and pinworms, to treat coronavirus patients, despite the National Institutes of Health’s recommendation against its use outside clinical trials.

Dr Ashish Jha, dean of the Brown University School of Public Health, called the hearing "a powerful reminder that not even Congress is immune to toxic conspiracy theories." So much for  the "world's greatest deliberative body." (Look here

Representative Bob Good (R-VA) Says the Pandemic is "Phony"

As reported by the Washington Post, December 14, 2020:

Rep.-elect Bob Good took the stage at Freedom Plaza on Saturday afternoon and looked out at a sea of masklessness. Thousands had come to march for President Trump — some carrying signs declaring the novel coronavirus a hoax.

They were just the kind of group, Good told the crowd, who 'gets that this is a phony pandemic.'

'It’s a serious virus, but it’s a virus. It’s not a pandemic,' said Good (R), who will become Virginia’s newest congressman in the 5th Congressional District on Jan. 3. 'It’s great to see your faces. You get it. You stand up against tyranny.'

Good’s denial of the existence of a pandemic flies in the face of an unprecedented surge in coronavirus infections, which have claimed the lives of nearly 300,000 Americans — including more than 300 in Good’s congressional district, according to a Washington Post analysis of coronavirus data.

Note that the death toll is now over 500,000.

Rep Good also has advocated for actions informed by the canard that the pandemic is "phony," actions that could increase transmission of the virus during a time when more infectious, and possibly more deadly variants are spreading

'We have got to stop the insanity, and stop accepting the hoax that says forcing people to wear a mask, forcing businesses to close, prohibiting worship services, and keeping kids out of school will make a significant difference in whether or not we will die from this virus,' Good wrote on Twitter.

Rep Good has himself acted in such a way.

Good showed disdain for virus precautions throughout his campaign, opting not to wear a mask or encourage them at his events, and saying businesses should not be restricted in the interest of limited spread.

Even though members of congress can easily access world-class experts in medicine, health care, public health and epidemiology, Rep Good chose to spread dangerous nonsense about the pandemic, the sort of nonsense these experts have been dubunking since the pandemic began. 

Republican Representatives Deride Face Masks

Politico reported on January 22, 2020 that after President Biden issued an executive order requiring the wearing of face masks on US property:

'The Biden administration is already headed in the wrong direction,' Rep. Lauren Boebert (R-Colo.) said on Friday. 'Continued federal overreach won’t end the Covid-19 pandemic or put food on the table.'

Not to put too fine a point on it:

A month ago, Rep. Chip Roy (R-Texas) was chiding Biden’s mask mandate idea on Twitter. 'On day one,' he said, 'I will tell you to kiss my ass.'

How is that for dignified debate?

Vaccine Opponent, Who Said "Proper Studies" About Vaccines are Lacking, Appointed Chair of Ohio House of Representative Health Committee

As reported by the Cleveland Scene on February 8, 2021:

Rep. Scott Lipps, R-Franklin, has pushed legislation to weaken Ohio’s vaccine laws; called in to video conferences hosted by anti-vaccine groups; made public statements about the need to slow or stop the COVID-19 vaccine rollout; and alleged a lack of 'proper studies' about the COVID-19 vaccines.

House Speaker Bob Cupp, R-Lima, renamed Lipps to the top health post for the two-year legislative session that started last month. 
Results of the controlled trials of the three COVID-19 vaccines currently available under a US emergency use authorization are actually widely available, eg here. It would have taken a few minutes on a web search engine for Rep Lipps to find that out.

Multiple Republican State Lawmakers Spread Various Disinformation

Again and again, Republican Trump fans in state legislatures have pushed nonsense packaged into disinformation. 

A summary article by the Associated Press on February 28, 2021 (per ABC News here) reported numerous instances in which

in their own comments or by inviting skeptics to testify at legislative hearings, some GOP state lawmakers are using their platform to promote false information about the virus, the steps needed to limit its spread and the vaccines that will pull the nation out of the pandemic.

These included

Last week, YouTube pulled down a video of committee testimony in the Ohio House after a witness inaccurately claimed COVID-19 wasn't killing children

A House Oversight Committee meeting in Michigan

did include Jayme McElvany, a virus skeptic who also has posted about the QAnon conspiracy and former President Donald Trump's unfounded claims of election fraud. Founder of a group called Let Them Play, McElvany questioned mask mandates and the science behind state COVID-19 data during a legislative hearing that didn't feature any witnesses from the other side.  

Also,

In Tennessee, a Republican lawmaker is pushing legislation that would ban most government agencies from requiring anyone to get COVID-19 vaccines, which isn't a mandate anywhere. Rep. Bud Hulsey has tried to drum up support downplaying the seriousness of the disease.

While testifying, he ticked off selective statistics that COVID-19 has a lower death rate among children and falsely alleged that the vaccines could cause genetic modifications.

In Alaska, a state legislator called current COVID-19 vaccines 'experimental,' despite the results of large randomized controlled trials [see above].

Also,

In Idaho, Rep. Heather Scott opened the legislative session in January by declaring, 'The pandemic is over.' She said Idaho's 1,600-plus COVID-19 deaths at that time amounted to 'nowhere close to a pandemic.'

But

The average number of daily COVID-19 cases is falling in Idaho, but the death toll has risen.

Finally,

In Virginia, Republican Del. Dave LaRock, who attended the Trump rally in Washington, D.C., that preceded the attack on the U.S. Capitol, warned a state House Health committee in late January that COVID-19 vaccines couldn't be trusted. He said they were especially risky for several communities, including the elderly and people of color.

At CPAC, Governor Ron DeSantis (R-FL) and Senator Mike Lee (R-UT) Called Lockdowns"Tyranny"

Per the Independent on February 26, 2021:

Opening the gathering’s first day in Orlando, Mr DeSantis began his speech in a triumphant mood: 'For those of you who aren’t from Florida, welcome to our oasis of freedom!'

Mr DeSantis contrasted his state with 'a country that’s suffering under the yoke of oppressive lockdowns', lamenting that in other states he sees 'schools closed, businesses shuttered, and lives destroyed.'

'And while so many governors over the last year have kept locking people down, Florida lifted people up.'

However,

While the state’s authorities have used a fairly light touch in recent months, they were forced to impose lockdown measures in the summer of last year when cases spiked. And while Florida does have lower per capita rates of Covid-19 deaths and hospitalisations than many states which locked down hard, it also compares favourably to many states that didn’t – and it is currently seeing more cases and hospitalisation per million than Democratic-run California, where restrictions have been much tougher. At 142 deaths per million as of 26 February, the state is in the middle of the pack nationally speaking.

Also,

Utah Senator Mike Lee, ...delivered a speech bluntly stating that 'faith in government' would lead the US down the road to tyrannical rule akin to that he said was suffered under the 18th century British crown.

He then linked that idea to

a broadside against coronavirus lockdown measures – including an upbeat rant at the expense of 'sad, sad California'

Taking Actions and Advocating Policies Based on Disinformation

Republican governors and state legislators have not merely spouted disinformation.  They have acted on it. 

Iowa Republican Governor Reynolds Lifted Pandemic Restrictions with no Explanation

As reported by the Washington Post on February 10, 2021:

Last weekend, Iowa Gov. Kim Reynolds (R) lifted all pandemic restrictions. There was no explanation, no warning. Nor did the governor consult with the state’s Public Health Department before removing mask mandates and limits on gatherings and indoor dining. Whatever thin protections separated Iowans from the coronavirus were just gone. The announcement came the same week that new variants of the virus were detected in the state and just one day after Iowa surpassed 5,000 deaths.

Since the governor provided no justification for her decision, she certainly did not provide any justification based on clear evidence and reasoning.

North Dakota House of Representatives Made Mask Mandates Illegal

As reported by KYFR on February 22, 2021:

By only two votes, the North Dakota House of Representatives passed a bill that would make mask mandates illegal in the future....

A small group of lawmakers said no level of government should be allowed to order the use of masks, arguing it was an infringement of freedoms.

'Our state is not a prison camp,' Rep. Jeff Hoverson, R-Minot, said.

However, opposers of the bill said while they don’t like wearing masks, they said there are times when public health and safety must take a higher priority.

 Note that states which are not prison camps mandate various articles of attire and other aspects of public behavior.  

South Dakota Republican Governor Noem Deceptively Defended Her Failure to Require Masks, Social Distancing, or Business Closures 

As reported by the Independent on March 1, 2021:

South Dakota governor Kristi Noem claimed to have successfully responded to her state’s Covid-19 pandemic, and took aim at widespread restrictions, as she addressed conservatives on Saturday.

Per the Washington Post 

Per the Washington Post on February 28, 2021, her justification was that such restrictions would have been economically disastrous, claiming.

that states who ordered Covid-related restrictions 'crushed the economy' created by Donald Trump.  

She continued: 'Everybody knows that almost overnight we went from a roaring economy to a tragic, nationwide shutdown.'

Also,

'South Dakota is the only state in America that never ordered a single business or church to close,' she said to applause and cheers. 'We never instituted a shelter-in-place order. We never mandated that people wear masks. We never even defined what an essential business is.'

However, as the Independent noted

Ms Noem, who refused any widespread mask wearing, social distancing, or business closures in South Dakota, went on to oversee more cases and deaths from Covid per capita than many states

In particular, per the Post,

South Dakota ranks second nationally for the most coronavirus cases reported per capita, eighth for total deaths per capita and ninth for peak hospitalized count per capita

While the governor provided no clear evidence of the economic success of her policy, she certainly provided no good argument that any such success was worth the resulting harms including disease and death.

Texas Republican Governor Abbott and Mississippi Republican Governor Reeves Ended Pandemic Restrictions Without Clear Justification

As reported by the Washington Post on March 3, 2021:

 On Tuesday, Texas Gov. Greg Abbott (R) ended his state’s mask mandate and boasted in all-caps on Twitter that 'Texas is OPEN 100%. EVERYTHING....'

in Mississippi ...Gov. Tate Reeves (R) announced similar plans Tuesday

 In particular,

Abbott on Tuesday issued an executive order allowing Texas businesses to operate at full capacity and revoking a statewide mask mandate. The order also curtailed local officials’ ability to impose tougher restrictions in their communities, by barring countywide mask mandates and removing jail time and other penalties for those who do not follow local coronavirus rules....

In a similar move, Reeves announced Tuesday that businesses in his state would be allowed to fully reopen Wednesday and that masks would no longer be required by the state.

Gov Reeves justified his action by saying

we are not going to continue to use the heavy hand of government when it is no longer justified by the reality we see around us.

Again, as noted above, nearly all state and local governments make it illegal to walk around naked, whatever the weight of the hands required to do so.

On the other hand, the Texas Tribune reported on March 3, 2021 that:

 Abbott’s team of medical advisers appeared to play a minimal role in the decision. Three of the four said Wednesday that Abbott did not directly consult with them prior to the drastic shift in policy. The fourth said he couldn’t say whether the move was a good idea.

One such adviser expressed overt reservations about the move.

Furthermore, 

many experts said both states are still in dangerous territory. Texas had the fifth-highest number of daily deaths per capita and was ninth in daily reported cases per capita as of early Wednesday, according to a Washington Post analysis. Mississippi also ranked among the top 10 states for per capita daily deaths.

So while the governor provided no clear rationale for his actions, they clearly go against the best recommendations of local and national public health experts. 

Conclusions

While the coronavirus pandemic daily claims new victims, political leaders who supported Donald Trump while he was president continues to spread disinformation about the pandemic, and act and propose policies consistent with that disinformation, but hazardous to public health.  How did we get here?

A long time ago, hazy golden memories of the past suggest that politicians once hesitated to comment on issues that were perceived as being in the domain of expert professionals, like those in the medical, health care and public health realms, without the advice of scientists, or health care and health care professionals. 

During the Trump regime, things changed.  Perhaps inspired by examples from Trump himself, various political/ government leaders began to publicly say ignorant or downright stupid things about such topics. For example, in September, 2017, we noted a series of examples showing some basic ignorance of health policy, including fundamental confusion about the nature of health insurance.  In August, 2018, we noted that Trump had long been an apologist for asbestos, which is known to cause asbestosis, lung cancer, and mesothelioma, claiming that those opposing use of asbestos were associated with organized crime, while more recently Trump's EPA seemed willing to relax regulation of asbestos, at a time when Russia seemed ready to become the major US supplier of it.

The COVID-19 pandemic supercharged the problem.  Although he would not acknowledge it at the time, his interviews with Bob Woodward showed that President Trump was aware of the potential severity of the COVID pandemic by February 7, 2020.  Per the Washington Post, September 9, 2020, Trump then said:

You just breathe the air and that’s how it’s passed,... And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flus.

This is deadly stuff,

Nonetheless, he initially played down its severity, ostensibly to avoid "panic,"  

I wanted to always play it down,... I still like playing it down, because I don’t want to create a panic.

but more likely because he feared that the pandemic could distract from his agenda and diffuse his political power.


 

Later, he discouraged mask wearing (look here), and promoted quick, but dubious COVID treatments, again to promote his political agenda.  Cumulatively he became a major source of pandemic disinformation (look here).

His political cronies and sycophants took up the banner of COVID disinformation (look here).  At one point, it appeared that they suffered from the Dunning-Kruger cognitive bias, that is, they were unaware of the limitations of their knowledge and ability.  However, now it looks like their actions are more cynical.  With Trump out of power they may see promoting disinformation as a way of appealing to the extreme elements of the Trump "base" by affirming what they want to believe.

For example, An analysis in the Washington Post on March 5, 2021 suggested:

The decision this week by Gov. Greg Abbott of Texas to end his state’s mask mandate and lift all restrictions on business reflects a broader move by politically ambitious Republican governors to channel the rising anger of conservative constituents over government efforts to curb the coronavirus.

Furthermore, 

the move by Abbott demonstrates how GOP governors hostile to ­pandemic restrictions are taking center stage as the party considers a post-Trump future.

The governors — responsive to a Republican electorate radicalized by the pandemic and inflamed by animus against experts and government regulations — are jockeying to present themselves as chief adversaries to President Biden.

In addition, the moves by Abbott and company may appeal to

Republican voters influenced by Internet-inspired arguments portraying opposition to public health guidelines as a cultural battle against liberal elites.

That is, some politicians may be pandering to an increasingly extreme voting bloc by telling them what they want to hear, no matter how nonsensical or bizarre it is, and regardless of the implications for their or the whole public's health.  

So, why trust politicians who suddenly proclaim themselves experts on public health and epidemiology and promote nonsensical theories and unproven solutions to the worst pandemic of the last 100 years? Would you trust a politician who suddenly proclaimed himself an expert on nuclear physics and tried to promote his personal design for a nuclear reactor?   

Finally, those of us who are health care professionals should combat politically motivated pandemic disinformation whenever we can, and call out and condemn its perpetrators.  History will not look kindly on them, but it will not look kindly on us if we stand by and do nothing when there are lives in jeopardy.