Sunday, March 03, 2019

Don't Know Much About Health Care and Public Health: Politicans' and Pundits' Unjustified Statements About Causation, Benefits and Risks

A major focus of Health Care Renewal has been problems in leadership and governance of health care organizations, which we believe became major causes of health care dysfunction. We have discussed how leadership is often ill-informed.  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research. Instead, people trained in business management have largely supplanted health care professionals as leaders of health care organizations.  This is part of a societal wave of "managerialism."  Most organizations are now run by such generic managers, rather than people familiar with the particulars of the organizations' work.  Obviously health care and health policy decisions made by ill-informed people are likely to have detrimental effects on patients' and the public's health.

Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014, here, on the mishandling of a patient with Ebola in a hospital system led by generic managers; and in 2013, here, on a luxurious hospital led by a former hotel executive).  Others were top executives of pharmaceutical corporations (e.g., in 2011, here, on previous Pfizer CEOs).

However, since 2016, when we all seem to have stumbled into an alternative universe, most of the examples we have found of ill-informed health care leadership have come from politicians, government officials, and pundits.  Cases have lately been coming thick and fast, so here is our latest round-up, in chronological order by date of publication.

Kentucky Governor Matt Bevins (R) Stated that Television Shows About Zombies Cause Mass Shootings

In November, 2018, the Washington Post reported,

Kentucky Gov. Matt Bevin (R) has been forthright about what he believes are the root causes of mass shootings. A few months ago, he blamed gun violence on children’s access to smartphones, video games and psychotropic drugs.

Most recently, he blamed society’s obsession with a specific genre of violent entertainment.

'Seriously, what’s the most important topic that seems to be in every cable television network for example? Television shows are all about what? Zombies,' he said in an interview Tuesday with conservative Kentucky radio host Leland Conway.

Mass shootings point to deep cultural problems, Bevin said, particularly in a society that consumes daily doses of violence through the media. He acknowledged tying zombie shows to gun violence might be perceived as 'trite and simplistic.' But, he argued, American culture is 'inundated by the worst things that celebrate death,' including the forms of entertainment young people consume.

Needless to say, he cited no evidence, and I am aware of no good evidence that television shows about zombies cause people to stage mass shootings.

Governor Bevin, according to Wikipedia, had a career in finance and business management, and has no background in health care or public health.

Tennessee Republican Representative Elect Dr Mark E Green Stated Concern that Autism is Caused by Vaccine Preservatives

In December, 2018, the Tennessean reported,

'Let me say this about autism,' Green said. 'I have committed to people in my community, up in Montgomery County, to stand on the CDC’s desk and get the real data on vaccines. Because there is some concern that the rise in autism is the result of the preservatives that are in our vaccines.'

'As a physician, I can make that argument and I can look at it academically and make the argument against the CDC, if they really want to engage me on it,' Green said.

While it is very hard to disprove the hypothesis that vaccines or their preservatives cause autism, the CDC and the American Academy of Pediatrics have stated that there is no good evidence that they cause it.  Interestingly, the Tennessee Department of Public Health quickly made a similar statement to refute Representative Green's concern (look here).

Rep Green is definitely a physician, apparently in emergency medicine.  Whether he has had any training in evidence-based health care is unknown.

Kentucky Governor Matt Bevin (R) Implied that Exposure to Severe Cold Weather is Harmless

On January 29, 2019, the Louisville Courier-Journal reported,

Gov. Matt Bevin prodded Kentucky school districts to toughen up in the face of dangerously frigid winds that are blowing through the region.

Speaking on 840 WHAS radio Tuesday, host Terry Meiners reminded Bevin that he would be up late tonight with his children because of classes being canceled on Wednesday.

'Now we cancel school for cold, I mean —  Bevin said.

'It's deep freeze; this is serious business,' Meiners responded.

'Come on, now,' Bevin said. 'There's no ice going with it or any snow. What happens to America. We're getting soft, Terry, we're getting soft.'

The upcoming weather forecasts for that time were:

Arctic air from the polar vortex has gripped the country, causing several school districts in the Louisville area — including Jefferson County Public Schools and Catholic schools — to be closed Wednesday as temperatures are expected to dip to a low of 5 degrees.

With the wind chill on Wednesday morning, forecasters say that it could feel as cold as minus 10 or 20 degrees in parts of Louisville.

Note that school children may have to be exposed to such conditions for considerable time when they are walking to or waiting at school bus stops.  The hazards for frostbite and hypothermia increase as wind chill gets worse.  Wind chill near minus 25 degrees (F) can cause frostbite in 30 minutes per the National Weather Service (look here).

We discussed Gov Bevin's lack of health care and public health background above.

Arizona State Legislators Considering Declaring Pornography a Public Health Crisis

According to the Arizona Republic, on February 7, 2019,

Citing concerns about the proliferation of erotic images online and their 'toxic' effect on behavior, Arizona lawmakers are pushing to declare pornography a public health crisis.

State Rep. Michelle Udall, R-Mesa, introduced a measure that declares the crisis and states porn 'perpetuates a sexually toxic environment that damages all areas of our society.'

'Like the tobacco industry, the pornography industry has created a public health crisis,' Udall told lawmakers.

There is no good evidence that pornography is a serious public health problem.  As the Republic noted,

There are numerous conflicting studies about the affects of pornography viewership. Some studies document negative affects on relationships and addictive behavior.

But other researchers say there isn't evidence to show porn is addictive in the same way as alcohol or tobacco, though the perception of addiction can lead to psychological distress.

In some countries, instances of sexual assault declined after porn was legalized, leading some to hypothesize that it provides a safe outlet for sexual expression.

Note that a number of other state legislators have made similar claims, as we discussed here.

Fox News Pundit Pete Hegseth Stated that "Germs are Not a Real Thing," and that Handwashing is Unnecessary

On February 11, 2019, per the Miami Herald, Mr Hegseth stated,

'As I told you my 2019 resolution is to say things on air that I say off air ... I don’t think I’ve washed my hands for 10 years,' Hegseth said, inexplicably.


'Really, I don’t really wash my hands ever,' Hegseth continued.

'I inoculate myself. Germs are not a real thing. I can’t see them. Therefore they’re not real,' Hegseth insisted.

'So you’re becoming immune to all the bacteria,' Bila replied.

'Exactly,' said Hegseth. 'I can’t get sick.'

If germs are not real, how can one be immune to them? Setting aside this apparent self-contradiction, the germ theory of disease was considered already well established by the early 20th century.

Hegseth is a Fox News pundit with no background in health care or public health, according to Wikipedia.

Darla Shine, Wife of White House Communications Director, Stated that Having Measles Prevents Cancer

On February 15, 2019, the Washington Post reported,

Darla Shine, the outspoken wife of White House communications director Bill Shine, has been tweeting about childhood diseases, claiming that illnesses such as measles, mumps and chickenpox 'keep you healthy & fight cancer.'
According to the Daily Beast, she also tweeted:

Here is a study from Scientists at Mayo Clinic who were interviewed by CNN and they say they have clinical studies that #Measles Virus kills #Cancer
However, the Washington Post article noted,

Len Lichtenfeld, interim medical director of the American Cancer Society, told The Washington Post on Thursday there is no evidence that contracting measles makes a person healthier later in life or helps prevent cancer.

In addition, Lichtenfeld said, 'It’s easy to forget the disease burden that came with measles when we were young.'

'It is a real illness with real consequences,' he said. 'Fortunately, for most people, those consequences were not serious, but it is an infection, and it can cause life-threatening events. It can cause pneumonia, and it can cause meningitis. Fortunately, those complications are rare but do occur — and children did die as a result of measles infections.'
And, as the Daily Beast noted, the study to which Ms Shine referred used a modified measles virus that was engineered to reduce its disase causing ability, and so the study was not likely applicable to the native version of the virus.

It is hard to find biographical information on Darla Shine, but there are some reports that she was a television producer, and no indication she has a health care or public health background.  (I included her in this post because I thought her position put her in a position to be a pundit, but one could debate that.)

Texas State Representative Bill Zedler (R) Implied that Antibiotics are an Effective Treatment for Measles, and Hence Measle Vaccination is Unneeded

On February 26, 2019, the Texas Observer reported,

Texas state Representative Bill Zedler doesn’t understand the fuss over the resurgence of infectious diseases. 'When I grew up, I had a lot of these illnesses,' he said, listing measles, mumps and chickenpox.


'They want to say people are dying of measles. Yeah, in third-world countries they’re dying of measles,' Zedler said, shaking his head. 'Today, with antibiotics and that kind of stuff, they’re not dying in America.' Zedler says he’s adamantly in favor of 'freedom of conscience' and against mandatory vaccination. 'This is not the Soviet Union, you know.'

Measles is caused by a virus, not a bacteria.  Antibiotics have no effect on it.  People rarely die of measles in America, mainly because until recently, due to vaccination, very few people were afflicted with measles anymore.

According to Wikipedia, Zedler's highest degree is an MBA, although according to his state legislative webpage, he worked as a manager for various health care related businesses, and currently serves on the Public Health Committee.

Arizona State Representative Kelly Townshend (R) Asserted Vaccines Cause Many Serious Adverse Effects, Based on a Single Personal Anecdote

On March 1, 2019, the Washington Post reported,

Republican State Rep. Kelly Townsend, a five-term state representative who is no stranger to making controversial and befuddling statements on social media, took to Facebook on Thursday to bemoan that Arizona was 'prepared to give up our liberty, the very sovereignty of our body, because of measles.'

Why? Because doing so would be “Communist.”

'I read yesterday that the idea is being floated that if not enough people get vaccinated, then we are going to force them to,' Townsend wrote on Thursday morning. 'The idea that we force someone to give up their liberty for the sake of the collective is not based on American values but rather, Communist.'

Ah, those Communists are at it again.

Why did Rep Townsend feel so strongly about vaccines?  She actually "acknowledges the voluminous studies supporting the need for and safety of vaccines," however

Townsend says her opposition is rooted in her experience. The legislator’s 22-year-old daughter has significant medical problems that she blames on a vaccine she received when she was 10 months old. She says no scientific evidence will convince her otherwise.

'My entire life has been a struggle, and it’s been nothing compared to my daughter’s struggle, and it’s been due to the shots she got at 10 months old,' she said. 'You can have 10 years’ worth of daily articles saying vaccines do no harm and I won’t believe it because it happened to us.'

As we noted above, there is good evidence that measles causes important morbidity to a significant number of people afflicted, and that the vaccine is effective in preventing measles.  While no vaccine is perfectly safe, there is no good evidence that the measles vaccine is particularly dangerous.

Rep Townsend's case is apparently built upon a single anecdote, that her child got some unspecified disease soon after a vaccination.  This is a classic case of anecdotal reasoning, and is logically fallacious.  She appears unaware that two events happening in sequence can often be unrelated.  Suppose her daughter ate chocolate ice cream before she got sick.  Would Rep Townsend be pushing to outlaw chocolate ice cream?

Oddly enough, Rep Townsend reportedly has a masters degree in infant-family practice from Arizona State, which was designed to prepare her "to work in prevention and intervention programs, serving families with infants, toddlers and preschool-age children."


We are seeing increasing numbers of cases of spectacularly ill-informed statements made by people in positions to influence political decisions affecting health care and public health.

It would be too much to expect that health care policy debates would be rigorously evidence-based.  It does seem to me that in the past political leaders at least made some attempt to consult with health care professionals or academics before taking on complex health care issues.  However, lately they seem to be happy to loudly express views devoid of fact justification or sometimes rationality.

We have proposed that ill-informed leadership of health care organizations is often the result of "managerialism."  We have discussed this doctrine, promoted in business schools that people trained in management should lead every type of human organization and endeavor.  Management by people from the disciplines most relevant to the mission and nature of particular organizations should be eschewed.  So managers, not physicians or other health care professionals, should lead health care organizations.  Following that theme, managers, or those like them, rather than health care professionals and health policy experts should lead health policy. 

However, the increasing numbers of spectacularly ignorant utterances made by political figures and newly appointed leaders of government health care organiations cry out for other explanations.  One may be the increasing influence of propaganda and disinformation in the health care space.  Another may be a trend toward anti-intellectualism or what has recently been termed "The Death of Expertise" (see this New York Times review of a book with that title.)  And the extreme relativism of post-modernism, which we also discussed in the context of the current debate on health care reform, could be another.

Facts, however, are stubborn things. Physiologic processes, and pathogenic organisms do not listen to assertions about the existence of "alternative facts."  Evidence is evidence, no matter whether it offends politicians, religious leaders, or corporate executives.  Basing legislation and political decision-making on the sorts of alternative thinking displayed in the cases above could lead in real life to adverse consequences for the sick, injured and vulnerable.  True health care reform requires clear thinking and the input of people who actually know something about health care.

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