Wednesday, December 23, 2020

Trump's Horrendous Mismanagement of the Coronavirus Pandemic: Don't Say You Weren't Warned

 The Washington Post published just the latest in a growing genre, short-term retrospectives on how the Trump administration horrendously mismanaged the coronavirus pandemic.  (See earlier examples here in Vox and here in the New York Times)  While no country was able to cruise through the pandemic, and some arguably have done as badly or worse as the United States, our country seemed uniquely positioned to fight a pandemic and lead the world in doing so.  We were the richest, spent the most on health care, and had an enviable record - at least prior to the Trump administration - pandemic preparedness.

However, so far we have failed, badly, fatally, and shamefully.

We Warned You

We cannot claim any ability to predict pandemics.  We never predicted this one.  However, on Health Care Renewal we published warning starting in early 2016 that were Donald J Trump to be elected president of the US, he would prove to be uniquely badly qualified to lead on health care and public health.

No Health Policy, No Health Policy Advisers, Word Salads in Response to Health Care Questions

In February, 2016 we posted that while Trump was then a leading candidate, he had "no health plan" and "no health care policy advisers." 

His one major health care proposal at the time was to somehow reduce the cost of drugs by $300 billion.  He did not seem to then realize that $300 billion was the then estimated total cost of drug spending. When asked about the mandate provided by the Affordable Care Act his response appeared to be a "word salad."  When asked about health policy during a debate, "Mr Trump only seems to have repeated the notion of selling health insurance across state lines to increase competition, interrupted by non sequiturs insulting Senator Rubio and insurance executives.  The Minnesota Post writer and I could find absolutely no other content."  

My conclusion at the time was:

We live in perilous times when a candidate with such reckless approaches to critical problems continues to attract adulation.

Given this, should it be a surprise that President Trump had no real public health policy, and undermined standard public health approaches to pandemic prevention? 

Per the Vox timeline above, as early as on January 22, 2020, Trump said to CNBC

We have it totally under control.  It's one person coming in from China, and we have it under control.  It's - going to be just fine.

A History of Promoting Health Care Related Scams

In March, 2016, we posted about the Trump Network, a scam that involved the selling of apparently worthless nutritional supplements using equally worthless diagnostic tests. 

The basis of the scam was a "network-marketing" (or allegedly "pyramid marketing") scheme in which individuals got monetary incentives not just for selling vitamins and tests, but for recruiting new marketers. In this case, the company sold "nutritional supplements" supposedly custom-designed for each customer based on results of a proprietary urine test.  However, 

there appeared to be no publicly available data on how the tests worked, what they actually tested, or how accurate they were.  Then there was no data about how the test results could rationally be used to suggest particular mixes of vitamin supplements.  Also, there was apparently no public data about what vitamins were in the potions sent to consumers, their purity, their strength, etc.

Worse, there was no evidence that any of this provided any benefits to the people who ended up taking the vitamins.

Trump bought the company that initially innovated this scheme and rebranded it the Trump Network in 2009.  He then enthusiastically marketed its products, and careers marketing them. Marketing videos that include Mr Trump are still readily available online,

In the video, Mr Trump said "Americans need a new plan. They need a new dream. The Trump Network means to give millions of people a new hope." 

Nonetheless, by 2011 the Trump Network was finished. 

My conclusions then were:

What damage could such a leader do to health care?  And what other damage could a man who so cavalierly fleeced the little people with his dubious nutritional product marketing scheme  do, especially to the little people who now so unconditionally support him?

Is there a better example showing why we as a society need to completely rethink who gets to become our leaders?  My only hope is we can do that rethinking in time to prevent a disaster.  

How did that work out for you? 

Based on this, is it any surprise that President Trump promoted unproved "cures" for COVID-19 such as hydroxychloroquine; hired "experts" who promoted herd immunity in lieu of a vaccine, which would likely result in millions of deaths were it to be implemented; and even suggested that people should ingest bleach to prevent infection?

According to the Vox timeline, as early as on March 19, 2020, "Trump incorrectly claims that the Food and Drug Administration approved the antimalarial drug hydroxychloroquine for treating Covid-19."

Denying Asbestos-Related Disease, PTSD and Chronic Traumatic Encephalopathy, Asserting Vaccines Cause Autism and Pornography is a Major Public Health Hazard

In November, 2016, just before the election, we posted a catalog of medical/ health care/ public health nonsense that Donald Trump had disseminated.  

These included denying that asbestos is an important health hazard; that post-traumatic stress disorder is a manifestation of weakness, not a mental health problem; that chronic traumatic encephalopathy is "a little ding on the head," not a potentially severe neurological condition; and that vaccines cause autism.  In addition, the 2016 Republican Party platform that Trump endorsed asserted that pornography is a major public health hazard.  

My conclusion at the time was:

It is disturbing when one candidate for the most powerful political office in the US repeatedly disregards the best clinical and public health evidence, and offers ill considered opinions about public health that could potentially harm patients.

Based on this, is it surprising that during a pandemic, President Trump seemed to declare war on biomedical, clinical and public health science, and on professionals who try to implement scientifically based health care and public health?

According to the Vox timeline, as early as on April 17, 2020, "Trump calls on his supporters ... to 'liberate' Michigan, Minnesota, and Virginia...." Those supporters later threatened health care professionals advocated a more scientific approach. 


The history was there.  We were warned.  We paid a tremendous price.  Will we be smarter next time? Will we survive next time?

Friday, December 04, 2020

All the President's Disinformationists

The coronavirus pandemic has been accompanied by a pandemic of disinformation, sometimes called the "infodemic."  In the US, while it would have seemed unthinkable up to 5 years ago, the biggest source of disinformation has been President Donald Trump (look here).

Trump lost the 2020 election, and barring an overt coup attempt may be gone by January 20, 2021.  However, that does not mean we should expect the infodemic to go away as well.  In fact, 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 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. We present here some notable cases that have gotten attention in the news media, in chronological order by publication date.

Joanne Wright, candidate for US House of Representatives in California, Promoted Conspiracy Theories about Pandemic Origin

Sen Cotton's ill-conceived theories quickly inspired other Trump true believers.

As reported by The Hill, March 2, 2020:

A GOP House candidate in California has repeatedly tweeted conspiracy theories regarding the novel coronavirus, a fast-spreading flu-like disease that has spurred a wave of online misinformation.

The tweets, from Republican hopeful Joanne Wright, underline how widespread coronavirus-related conspiracy theories have become as even politicians tout debunked claims linking the disease to governments and public figures.  

Wright has tweeted multiple times over the last few weeks about the coronavirus, suggesting the virus may be manmade or even connected to prominent Democrats, the Los Angeles Times first reported.

In one tweet, from Feb. 28, Wright questioned whether Microsoft founder Bill Gates is connected to the virus, a conspiracy theory that has made its way from the fringes of the online ecosystem to the center. She also tied the coronavirus, also known as COVID-19, to Democratic mega-donor George Soros and former Democratic presidential candidate Hillary Clinton

'Doesn’t @BillGates finance research at the Wuhan lab where the Corona virus was being created?' Wright tweeted, earning hundreds of retweets and likes. 'Isn’t @georgesoros a good friend of Gates? Isn’t it always when @HillaryClinton tweets that fire and brimstone hits us? Check Gates Foundation and Clinton Foundation for stock sells.'

The day before, responding to a tweet espousing a largely debunked theory on the origins of the virus from Sen. Tom Cotton (R-Ark.), Wright tweeted, 'The Corona virus is a man made virus created in a Wuhan laboratory. Ask @BillGates who financed it.'

Wright was defeated in the primary election, but other Republicans soon jumped into the fray.

Former Congressman Ron Paul (R-TX), Father of Current Sen Rand Paul (R-KY), Dismisses Coronavirus Death Rate Estimates

As reported on March 18, 2020 by Politifact:

Calling Fauci 'the chief fearmonger of the Trump Administration,' Paul wrote in a column on his website that Fauci 'testified to Congress that the death rate for the coronavirus is 10 times that of the seasonal flu, a claim without any scientific basis.'

At the time, Politifact said that in fact there was good, if incomplete evidence for Dr Fauci's estimate of the death rate.  The current consensus is still that the coronavirus death rate is approximately ten times that of seasonal influenza.

Fooling people into thinking that COVID-19 is no worse than seasonal influenza likely would lead them to think they need no more precautions against it than they take for influenza.  It also distracts them from considering that one reason that influenza is now not so much feared is that a relatively effective vaccine for it is widely available.

Rep Louis Gohmert (R-TX) Claimed Germany has a "Powder" that can Cure Coronavirus

On April 20, 2020, the Independent reported:

 Republican congressman Louie Gohmert falsely claimed that Germany is using a powder to help prevent health care workers from contracting Covid-19.

Earlier this month, during an interview with KLTV in Texas, Mr Gohmert claimed that health care workers were being protected from coronavirus by the substance.

'It is being used in Germany as a mist,' Mr Gohmert said. 'Health care workers go through a misting tent going into the hospital and it kills the coronavirus completely dead not only right then.'

'Any time in the next 14 days that the virus touches anything that’s been sprayed it is killed.'

This was nonsense

Head of the German Hospital Association, Dr Jörn Wegner, told Ms Mekelburg [of Politfact] that the congressman’s claims are incorrect.

'What your congressman said is absolute nonsense,' Dr Wegner said. 'There are no such tents and there’s no powder or magical cure.'

Note that Rep Gohmert had scoffed at wearing a mask to prevent infection, but then became infected with  COVID-19 (look here).

Deceiving people into thinking that effective chemical measures to eliminate COVID-19 exist may lead to them neglecting simple preventative measures that actually may work. 

Republican Speaker of the Pennsylvania House of Representatives Mike Turzai Said Children Without Underlying Conditions Are Not at Risk from COVID-19

As reported by the Philadelphia Inquirer, May 14, 2020:

 'Guess what, they’re not at risk unless they have an underlying medical issue,' said Turzai, whose comments came in a video he recorded from his Allegheny County home and later shared on social media.

Note that

Turzai declined to provide any evidence that he relied on when he made this claim.


it’s true that children are far less susceptible than adults. But his claim that other children are totally safe is incorrect, according to a study published recently in the medical journal JAMA Pediatrics.

Again, fooling people into thinking that COVID-19 is less dangerous that it is may lead them to neglect public health guidelines.

Republican Candidates for the US House of Representatives Promoted Trump's Use of Hydroxychloroquine to Prevent COVID-19

On May 23, 2020, the Daily Beast reported:

'@realDonaldTrump taking hydroxychloroquine to ward off coronavirus is a kick-ass move that proves why he is the bravest and strongest of all American presidents,' James P. Bradley, a Republican U.S. House candidate in California, tweeted. 

'You’d have to be extremely naïve to believe that none of these Democrats knocking @POTUS are also taking hydroxychloroquine as a preventative measure,' Errol Webber, a GOP congressional candidate in California, tweeted after Trump touted taking the drug. 

In an interview, Lauren Boebert, a Republican congressional candidate in Colorado running to the right of GOP incumbent Scott Tipton, criticized those who were quick to go against the treatment. 

'With the way the media hates President Trump, if taking hydroxychloroquine was truly bad for him, they’d be encouraging it rather than having a meltdown,' Boebert tweeted on May 20.


In Congress, two sitting House members also promoted in media interviews their own experience with the drug, including Roger Marshall. The Kansas doctor is running in a crowded GOP U.S. Senate primary in the reliably red state and looking to win out over longtime Trump supporter Kris Kobach. 

He told The Wall Street Journal earlier this week that he and members of his family were taking the drug prophylactically.

'I would encourage any person over the age of 65 or with an underlying medical condition to talk to their own physician about taking hydroxychloroquine and I’m relieved President Trump is taking it,' Marshall told the Journal


A conspiracy-filled approach to the issue came from Josh Barnett, an Arizona GOP challenger in the state’s deeply Democratic 7th District whose chances at making it to the House are slim. 

He tweeted: 'If hydroxychloroquine is soooooo dangerous then why are Democrats so against @realDonaldTrump taking it? Do they suddenly care about him and his health? LOL NO! Its because it works and they don't want anything to fix Covid and rev this economy back up.'

However, the article also noted that by the time of its publication

By late April, Trump’s own Food and Drug Administration warned that 'hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.'

Research on the drug has continued to be troubling since. A new study published Friday by The Lancet also failed to show a 'a benefit of hydroxychloroquine,' when it comes to COVID-19 and more alarmingly described 'a greater hazard for in-hospital death with COVID-19.' 

Note that Bradley, Webber and Barnett lost in the general election.  However, Boebert won a seat in congress, and Marshall won a seat in the Senate. 

Again, pretending that effective treatments for COVID-19 exist may lead to people to neglect prevention measures. 

North Carolina Lieutenant Governor Dan Forest Announced Masks "Don't Work"

As reported by WRAL on July 8, 2020:

Lt. Gov. Dan Forest, who’s running for governor against incumbent Democrat Roy Cooper, said scientific evidence doesn’t support mask mandates.

'There have been multiple comprehensive studies at the deepest level held to scientific standards in controlled environments that have all said for decades, masks do not work with viruses,' he told a reporter for The Hendersonville Times-News.


His statement overlooks recent studies, news stories, CDC guidance and the advice of one of President Trump’s top pandemic advisors. While face coverings alone can’t guarantee protection from a virus, recent studies show they do reduce the risk of spreading the virus. 

Clearly, deceiving people into thinking that masks have no benefits will mitigate against them using face coverings that may reduce viral spread and reduce their own likelihood of infection

Rep Dan Crenshaw (R-TX) Minimized COVID-19 Risk

Per the Intercept on July 17, 2020:

Between Memorial Day and mid-June, Texas’s hospitalization rate shot up by 36 percent, a fact that Crenshaw has downplayed. 'If you just hear 36 percent increase, that does sound like a lot. … In reality, it’s under 500 additional hospitalizations out of a state of 30 million people,' he said on his podcast. 'So it’s really not a lot. … We’re so far away from being in over-capacity or even close to it that it’s laughable.'

When a Harris County judge said around the same time that Texas 'may be approaching the precipice of a disaster' Crenshaw blasted her for 'pure and simple fear mongering.'

In response,

More than 100 doctors, medical professionals, and emergency room physicians in the Houston area have signed their names to a letter condemning Republican Rep. Daniel Crenshaw for spreading misinformation during the Covid-19 pandemic, which has been ravaging the Texas city hard in recent weeks.


Dan Crenshaw, on the other hand, has spewed lies for the past four months — minimizing the threat we face and spreading dangerous disinformation for self-indulgent headlines

Of course, people who believe Crenshaw's disinformation are less likely to take actions to reduce the spread of the virus and their own risk of infection. 

Former Kansas Secretary of State, then Republican Senate Candidate Kris Kobach Claimed that Death Rate from COVID-19 was Inflated to Hurt Political Chances of President Trump

The Independent reported on July 28, 2020:

Kris Kobach, who is running for a Senate seat in Kansas and previously served as its secretary of state, appeared on a YouTube channel and claimed the number of cases and deaths was a lie.

'I believe that the numbers are being cooked,' he said. 'The books are being cooked.'

During his interview on the show National File, Mr Kobach said hospitals were misdiagnosing coronavirus cases and repeated Mr Trump's claims that more testing would result in higher numbers.

'There are so many things that are happening that indicate that they are overstating the positive numbers. Of course, we've all heard about hospitals, they will test someone who comes in for a liver problem, or for an auto accident, and they test positive and they are – or people who die of something else, but they're also Covid-positive, they'll be treated as a Covid death,' Mr Kobach said.

'And of course, the fact that we have whatever the number is, five times, four times as many tests now as we did in March. And so, if you're testing a greater population, you're going to see a proportional increase in the number of positive results.'

Kobach offered no proof of his allegations of "cooked" numbers, and no evidence that these numbers were exaggerated has appeared since.  His claim that high numbers are mainly a result of increased testing has been refuted by later increases in hospitalization and death rates.  The claim amounts to the logical fallacy of the appeal from ignorance (also called appeal to ignorance), that is, per Logically Fallacious:  

The assumption of a conclusion or fact based primarily on lack of evidence to the contrary.  Usually best described by, 'absence of evidence is not evidence of absence.'

Kobach (and Trump and many others) implied that if we were to try less vigorously to find cases of COVID-19, there would be fewer cases of it.  In reality, there would just be fewer diagnosed cases.  People who had COVID-19, but were undiagnosed, would be more likely to spread the disease than those who were correctly diagnosed, and less likely to receive medical care that might reduce their symptoms or risk of death.

Kobach lost in the Kansas primary.

Republican Arkansas State Senator Jason Rapert Promoted Hydroxychloroquine as COVID-19 Cure

On August 31, 2020, reported:

Republican State Senator Jason Rapert used his position as chair of a key legislative committee to hear from doctors who support the use of hydroxychloroquine in the fight against COVID-19 and to grill the state health secretary over the department's guidance when it comes to prescribing the drug.

'I've got people in this state, in my own district, who were given Hydroxychloroquine and it turned them around,' said Rapert of Conway, who co-chairs the Joint Insurance and Commerce committee.

He chaired a hearing in which hydroxychloroquine proponents provided anecdotes of patients who received the drug and got better.  However, there is no good evidence that the drug benefits patients with COVID-19.  Some people who got the drug may have gotten better, but that does not mean that the drug caused them to get better.

Again, conning people into believing that there are simple, cheap drugs that effectively treat the disease may lead them to think there is no point in trying to prevent the spread of infection.

Sen Joni Ernst (R-IA), and Senator-Elect Roger Marshall (R-KS) Claimed COVID-19 Death Rates were Exaggerated

First on September 2, 2020, the AP reported:

Ernst said she ... is 'so skeptical' of the official numbers.

'These health care providers and others are reimbursed at a higher rate if COVID is tied to it, so what do you think they’re doing?' she said to the crowd on Monday, according to a report by the Waterloo-Cedar Falls Courier.


'I heard the same thing on the news. ... They’re thinking there may be 10,000 or less deaths that were actually singularly COVID-19. ... I’m just really curious. It would be interesting to know that.'

At that point,

The Centers for Disease Control and Prevention report that the disease has infected more than 6 million people in the U.S. and killed about 185,000 Americans. Of those deaths, 1,125 were reported in Iowa, according to the state website at midday Wednesday.  

Sen Ernst's skepticism may have derived from posts from supporters of conspiracy theory QAnon,

In recent tweets, supporters of QAnon misrepresented CDC figures, stating that the government’s health agency had reduced the number of U.S. COVID-19 deaths to just over 9,000. Trump tweeted the false information, which was later taken down by Twitter for violating platform rules.

Of course, it would be easy for a sitting US Senator to see the best evidence available about COVID-19 death rates, and to get advice from experts in public health about such rates.  

So, Per the Iowa Starting Line, September 4, 2020:

Condemnation from across the Iowa medical community has been relentless this week in the wake of Sen. Joni Ernst’s suggestion hospitals are inflating the number of COVID-19 cases and deaths for financial gain. 

On  September 6, 2020, The Hill reported that then Representative

Marshall, who is a doctor, pointed to the theory based on the 6 percent statistic in a Facebook post Sunday.

'This week the CDC quietly updated its COVID-19 data to reflect the number of deaths from COVID-19 only,' he wrote, adding that it was 'only 6%,' according to a screenshot posted by KSNT.

Facebook removed the post, with a spokesperson saying it violated 'our policies against spreading harmful misinformation about COVID-19 since it misstates CDC data about the deadliness of the disease.'

It would appear to be unethical for a physician to deliberately spread such disinformation that might mislead people into thinking that COVID-19 is not a serious problem.

Sen Rand Paul (R-KY) and Michigan Senate Majority Leader Mike Shirkey (R-Clarklake) Claimed Herd Immunity is Beneficial

On September 23, 2020, Forbes reported:

Dr. Anthony Fauci slammed Sen. Rand Paul (R-Ky.) during a Senate hearing on the federal response to the coronavirus pandemic Wednesday when Paul incorrectly claimed that the high number of infections in New York show that lockdowns don’t work, and when Fauci challenged him, noting the current low positive test rate in the state, Paul erroneously said it is lower because of herd immunity.

Fauci said Paul 'misconstrued' what happened in New York, adding that Paul has done so 'repetitively in the past,' and while mistakes were made, the state has gotten its positive test rate to '1% or less' because they’ve followed CDC guidelines—and Fauci accused Paul of “not listening” to what CDC Director Robert Redfield said about the infection rate and not understanding herd immunity. 

Ashish Jha, the dean of Brown University’s School of Public Health said Paul 'almost' understands the complex issues of immunity and cross-reactivity and keeps sharing 'nonsense that is largely incorrect,' while 'Dr. Fauci patiently lays out the facts.'

Again, as a Senator Paul could easily get access to the best data and opinions from top experts.  Again, Rand Paul is a physician, so it would appear to be unethical for Paul as a physician to be spreading such "nonsense." 

On October 10, 2020, reported:

Michigan’s top Senate Republican lawmaker says he is in favor of rolling back many of the measures put in place by Gov. Gretchen Whitmer’s administration to limit COVID-19 spread and believes 'an element of herd immunity' needs to happen in the state.

In comments to MLive following a rally protesting strict COVID-19 restrictions, Michigan Senate Majority Leader Mike Shirkey, R-Clark Lake, said he feels Michigan residents understand that COVID-19 is real, contagious and requires precautions.

'I just simply don’t believe we need to continue to have the oppressive mandates that we’ve had,' he said. 'There’s no business that I know of that will put their customers, their employees, their patrons, their families at risk.'

In response, as reported by the Detroit News on October 12, 2020, a group of experts including

Dr. Joshua Sharfstein at Johns Hopkins Bloomberg School of Public Health; Dr. Thomas File, president of the Infectious Diseases Society of America; Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention; Dr. Ashish Jha at the Brown University School of Public Health; and Dr. Carlos Del Rio at Emory University School of Medicine

Wrote a letter

'If 'herd immunity' were to begin after about 80% of the state’s population has been infected, as some believe, then 6.5 million more Michiganders would still need to contract COVID-19,' the experts wrote. 'At the current mortality rate, this would mean ​more than 30,000 additional deaths — more than four times the number of deaths to date.'

So by promoting "herd immunity" as a public health policy in the absence of a vaccine, these legislators would likely condemn many people to die.  Such promotion of herd immunity may approach a crime against humanity, given that the definition of such crimes according to the United Nations includes:

any of the following acts when committed as part of a widespread or systematic attack directed against any civilian population, with knowledge of the attack: 


Other inhumane acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health.

South Dakota Republican Governor Kristi Noem Said Increased Testing Led to an Apparent Surge in Cases

On October 14, 2020, the AP reported:

South Dakota Gov. Kristi Noem on Tuesday blamed South Dakota’s recent surge in coronavirus cases on an increase in testing, even as the state saw a new high in the number of people hospitalized by the virus.

There are currently no open general-care hospital beds in the southeastern part of the state, which contains the two largest hospitals, according to the Department of Health. Hospitals are dealing with both an increase in COVID-19 patients and people needing other medical care. The hospitals in Sioux Falls do have about 41% of their Intensive Care Units available.

'We have triple the amount of testing that we are doing in the state of South Dakota, which is why we’re seeing elevated positive cases,' Noem said. 'That’s normal, that’s natural, that’s expected.'

The Republican governor did not explain how an increase in hospitalizations would be connected to an increase in testing. The state has also seen one of the nation’s highest positivity rates for testing in the last 14 days, according to Johns Hopkins researchers. The roughly 23% positivity rate is an indication there are more infections than tests are indicating.

Note that Governor Noem again seemed to be employing the appeal from ignorance logical fallacy.  Her use of this fallacy to deceive people into thinking that the virus is less prevalent than it is could lead them to neglect reasonable precautions to prevent its spread.

Sen Ron Johnson (R-WI) Claimed Wisconsin had "Flattened the Curve" While Cases were Increasing, and Promoted Hydroxychloroquine as a Treatment of COVID-19

 On October 21, the Milwaukee Journal-Sentinel reported:

Wisconsin on Wednesday reported a record 48 deaths from the coronavirus and admitted its first patient at a field hospital as U.S. Sen. Ron Johnson falsely claimed the state had flattened its curve of COVID-19 deaths. 

The Republican from Oshkosh contended the public had been tricked into 'mass hysteria' a day after state Rep. Joe Sanfelippo, the chairman of the Assembly Health Committee, maintained there is nothing more the government can do to combat an illness that had killed 1,681 in Wisconsin as of Wednesday. 

'Generally deaths are still pretty flat because we've flattened the curve,' Johnson said during a call hosted by business lobbying group Wisconsin Manufacturers & Commerce. 'We've gotten better at treating it.'


He made the comments just hours before the state released figures showing the last seven days were the deadliest of the pandemic, with 173 deaths due to the virus between Oct. 14 and Wednesday.


 Health officials don't see the issue the way Johnson does.

'Of course the curve has not flattened and we don't have the virus under control,' said Patrick Remington, a former Centers for Disease Control and Prevention epidemiologist and director of the preventive medicine residency program at the University of Wisconsin-Madison.

 Then, on November 20, 2020, the Journal-Sentinel reported that during a Senate hearing:

held this week by U.S. Sen. Ron Johnson, R-Wisconsin, about controversial treatments for COVID-19, including hydroxychloroquine — a drug that studies have found to be ineffective and in some cases dangerous when treating the disease.

During the hearing, Johnson pushed a baseless theory that the medical community was working to deny patients drugs such as hydroxychloroquine because they were cheaper than other treatments.


The U.S. Food and Drug Administration revoked the emergency use authorization for hydroxychloroquine in June because of its lack of effectiveness and cited its potential for serious cardiac adverse events and other potential serious side effects.

Dr Ashish Jha, Dean of the Brown University School of Public Health

later tweeted, 'Today was a very, very odd day.'

He added that 'the hearing was a testament to how politicized science has become.'

'I shared evidence of studies that have failed to find benefit of HCQ,' Jha tweeted. 'Three other witnesses shared personal experiences. And suggested my testimony was reckless because it would deny people access to lifesaving HCQ.'

He added, 'I found myself defending evidence, doctors, and scientists. There are key issues we need Congress to be airing right now. Hydroxychloroquine isn't one of them.'


Once upon a time, politicians usually realized what they did not know about science, health care, and medicine, and so consulted with experts before making pronouncements on such topics.  Now they seem not to know what they do not know, and may delight in propagating rank disinformation for political benefit.

So, since the beginning of the coronavirus pandemic in the US, prominent Republican politicians have asserted:

- conspiracy theories about the origins of the pandemic (eg, it came from a Chinese laboratory, Bill Gates was somehow responsible, etc)

- that the case rates and death rates have been exaggerated, partly by "excess testing," or by health care professionals for financial gain, or by others to politically damage President Trump

- that unproven therapies actually can treat the infection

- but that herd immunity without a vaccine can be safely achieved 

All were false, and all mirrored similar disinformation spread by President Trump and his associates (look here). 

In the US, the pandemic is currently out of control.  Cases,  hospitalizations, and deaths are at record levels.  A major cause of this disaster is that many people in the US are refusing to follow reasonable public health guidelines, including remaining physically distant from other people as much as is practical, wearing a face covering when such distancing is not possible, and frequent hand washing.  Much of this resistance is fueled by ignorance, misleading information, and disinformation.  President Trump has been a major source of disinformation, along with his followers and supporters, and with hostile foreign powers and various anonymous sources.

Trump may be on his way out, but his followers seem committed to propagating disinformation.  Some of his most influential are Republican politicians, including members of congress, members of state legislatures, and various state and local officials.  All of them could easily have access to accurate information and expert opinion the pandemic.

Shame on them for ignoring evidence and logic, and instead spreading disinformation that may be increasing disease, disability, and death.  

It is up to all of us to combat such disinformation whenever we can, and call out and condemn its perpetrators.  History will not look kindly on them.  Meanwhile, there are lives to save.


Wednesday, November 11, 2020

Update: State of Play in US Health Care Dysfunction Prior to the Coronavirus Pandemic

 Introduction: the Sorry History of US Health Care Dysfunction

We have been talking about health care dysfunction for a very long time, starting with a publication in 2003.

To better understand health care dysfunction, I interviewed doctors and health professionals, and published the results in Poses RM.   A cautionary tale: the dysfunction of American health care.  Eur J Int Med 2003; 14(2): 123-130. (link here).  In that article, I postulated that US physicians were demoralized because their core values were under threat, and identified five concerns:

1. domination of large organizations which do not honor these core values
2. conflicts between competing interests and demands
3.  perverse incentives
4. ill-informed, incompetent, self-interested, conflicted or even corrupt leadership
5.  attacks on the scientific basis of medicine, including manipulation and suppression of clinical research studies

After that my colleagues and I have tried to raise awareness of these and related issues, now mainly through the Health Care Renewal blog.  We also set up FIRM - the Foundation for Integrity and Responsibility in Medicine,  a US non-profit organization, to try to provide some financial support for the blog.

It has been a slog.  For years  health care dysfunction, at least we we defined and discussed it, was practically a taboo topic.  From 2003 through 2016 we felt there were only a few incremental improvement in some aspects.  However, the advent of Donald Trump and his "base," and the first years of the Trump presidency expanded the scope and increased the intensity of health care dysfunction.  It got bad enough that the phrase "health care dysfunction" actually made it to a presidential debate, albeit a Democratic primary debate, in November, 2019.  On that occasion we summarized what we thought were the ongoing issues. 

Since then, things have only gotten worse. Then in 2020 the coronavirus pandemic spread around the globe.  That only provided more opportunities for the Trump administration to amplify dysfunction.

Now, on the occasion of the Trump administration's apparent defeat in the presidential election (setting aside for the  moment any legal or extra-legal challenges to the results), I will update what the state of play in health care dysfunction was prior the pandemic.  At a later time we will discuss how the pandemic gave Trump et al an opportunity to supercharge health care dysfunction.

The Multiple Dimensions of Health Care Dysfunction Pre-Pandemic

Since 2003 we have broadened our thinking about what constitutes and causes US (and more global) health care dysfunction. Early on we noticed a number of factors that seemed to enable increasing dysfunction, but were not much discussed.  These factors notably distorted how medical and health care decisions were made, leading to overuse of excessively expensive tests and treatments that provided minimal or no benefits to outweigh their harms.  The more we looked, the more complex this web of bad influences seemed.  Furthermore, some aspects of it seemed to grow in scope during the Trump administration.

A brisk summary of these often complex issues follows.

 Threats to the Integrity of the Clinical Evidence Base

The clinical evidence has been increasingly affected by manipulation of research studies.  Such manipulation may benefit research sponsors, now often corporations who seek to sell products like drugs and devices and health care services.  Manipulation may be more likely when research is done by for-profit contract research organizations (CROs). When research manipulation failed to produce results to sponsors' liking, research studies could simply be suppressed or hidden.  The distorted research that was thus selectively produced was further enhanced by biased research dissemination, including ghost-written articles ghost-managed by for-profit medical education and communications companies (MECCs). Furthermore, manipulation and suppression of clinical research may be facilitated by health care professionals and academics conflicted by financial ties to research sponsors.

These issues did not get much attention since November, 2019, during the Trump presidency, pushed aside by the administration's "flooding of the zone" with distractions.

 Deceptive Marketing

The distorted evidence base was an ingredient that proved useful in deceptive marketing of health care products and services. Stealth marketing campaigns became ultimate examples of decpetive marketing.  Deceptive marketing was further enabled by the use of health care professionals paid as marketers by health care corporations, but disguised as unbiased key opinion leaders, another example of the perils of deliberate generation of  conflicts of interest affecting health care professionals and academics.

These issues also did not get much attention since November, 2019.

Distortion of Health Care Regulation and Policy Making

Similarly, promotion of health policies that allowed overheated selling of overpriced and over-hyped health care products and services included various deceptive public relations practices, including orchestrated stealth health policy advocacy campaigns.  Third party strategies used patient advocacy organizations and medical societies that had institutional conflicts of interest due to their funding from companies selling health care products and services, or to the influence of conflicted leaders and board members.  Some deceptive public relations campaigns were extreme enough to be characterized as propaganda or disinformation.

More recently,  as we noted here, we became aware of efforts by foreign powers to spread such disinformation for political, not just financial gain, e.g., in April, 2019, we discussed evidence that Russia had orchestrated a systemic disinformation campaign meant to discredit childhood vaccinations, particularly for the measles, which was likely partly responsible for the 2019 measles outbreak

Furthermore, companies selling health care products and services further enhanced their positions through regulatory capture, that is, through their excessive influence on government regulators and law enforcement.  Their efforts to skew policy were additionally enabled by the revolving door, a species of conflict of interest in which people freely transitioned between health care corporate and government leadership positions.

In the Trump era, we saw a remarkable increase in the incoming revolving door, people with significant leadership positions in health care corporations or related groups attaining leadership positions in government agencies whose regulations or policies could affect their former employers (look here).   We found multiple managers from and lobbyists for big health care corporations being put in charge of regulation of and policy affecting - wait for it - big health care corporations, a staggering intensification of the problem of the revolving door.

Since November, 2019, cases of US government officials traversing the revolving door continued (look here).

Bad Leadership and Governance

Health care leadership was often ill-informed.  More and more people leading non-profit, for-profit and government have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Lately, during the Trump administration, we began to find striking examples of top government officials expressing ill-informed, if not outright ignorant opinions about medical, health care and public health topics look here).  We had not previously expected leaders of government to be personally knowledgeable about health related topics, but traditionally they consulted with experts before making pronouncements.

Health care leaders often were unfamiliar with, unsympathetic to, or frankly hostile to their organizations' health care mission, and/or health care professionals' values. Often business trained leaders put short-term revenue ahead of patients' or the public's health.  In addition, we began to see evidence that leaders of health care corporations were using their power for partisan purposes, perhaps favoring their personal political beliefs over their stated corporate missions, patients' and the public's health, and even  corporate revenues. Then, we started seeing appointed government health care leaders who lacked medical, health care or public health background or expertise but also whose agenda also seemed to be overtly religious or ideological, without even a nod to patients' or the public' health (look here).
Leaders of health care organizations increasingly have conflicts of interest.  Moreover, we have found numerous examples of frank corruption of health care leadership.  Some have resulted in legal cases involving charges of bribery, kickbacks, or fraud.  Some have resulted in criminal convictions, albeit usually of corporate entities, not individuals.

In the Trump administration, corrupt leadership extends from the corporate world to the highest levels of the US government.  We discussed the voluminous reports of conflicts of interest and corruption affecting top leaders in the executive branch, up to and including the president and his family (look here). 

Since November, 2019, periodic updates about the President Trump and family's extensive conflicts of interest, and particularly how some of his conflicts appear to violate the US Constitution (eg, look  here).  Not unexpectedly, the latest version of Transparency International's Corruption Perception Index showed that the public perceived the US government under Trump has a worsening corruption problem (look here). 

One cannot expect effective enforcement of ethics rules and anti-corruption laws in such an environment.

Abandonment of Health Care as a Calling

A US Supreme Court decision was interpreted to mean that medical societies could no longer regulate the ethics of their members, leading to the abandonment of traditional prohibitions on the commercial practice of medicine.  Until 1980, the US American Medical Association had  ruled that the practice of medicine should not be "commercialized, nor treated as a commodity in trade."  After then, it ceased trying to maintain this prohibition. Doctors were pushed to be businesspeople, and to give making money the same priority as upholding their oaths. Meanwhile, hospitals and other organizations that provide medical care are increasingly run as for-profit organizations. The physicians and other health care professionals they hire are thus providing care as corporate employees, resulting in the rise of the corporate physician.  These health care professionals may be further torn between their oaths, and the dictates of their corporate managers. 

 These issues also did not get much attention since November, 2019.

Perverse Incentives Put Money Ahead of Patients, Education and Research

We have extensively discussed the perverse incentives that seem to rule the leaders of health care. Financial incentives may be large enough to make leaders of health care organizations rich.  Incentives often prioritize financial results over patient care.  Some seem to originate from the shareholder value dogma promoted in business school, which de facto translates into putting current revenue ahead of all other considerations, including patient care, education and research (look here).

These issues also did not get much attention since November, 2019.

 Cult of Leadership

Health care CEOs tend now to be regarded as  exalted beings, blessed with brilliance, if not true "visionaries," deserving of ever increasing pay whatever their organizations' performance.  This phenomenon has been termed "CEO disease" (see this post).  Afflicted leaders tend to be protected from reality by their sycophantic subordinates, and thus to believe their own propaganda.

 These issues also did not get much attention since November, 2019.


Leadership of health care organizations by managers with no background in actual health care, public health, or biomedical science has been promoted by the doctrine of managerialism which holds that general management training is sufficient for leaders of  all organizations, regardless of their knowledge of the organizations' fundamental mission.

These issues also did not get much attention since November, 2019.

Impunity Enabling Corrupt Leadership

Most cases involving corruption in large health care organizations are resolved by legal settlements.  Such settlements may include fines paid by the corporations, but not by any individuals.  Such fines are usually small compared to the revenue generated by the corrupt behavior, and may be regarded as costs of doing business.  Sometimes the organizations have to sign deferred prosecution or corporate integrity agreements.  The former were originally meant to give young, non-violent first offenders a second chance (look here).  However, in most instances in which corruption became public, are no negative consequences ensue for the leaders of the organizations on whose watch corrupt behavior occurred, or who may have enabled, authorized, or directed the behaviors.

These issues also did not get much attention since November, 2019.


Some of the above topics rarely appeaedr in the media or scholarly literature, and certainly seem to appear much less frequently than their importance would warrant. We have termed the failure of such issues to create any echoes of public discussion the anechoic effect.

Public discussion of the issues above might discomfit those who personally profit from the status quo in health care.  Those involved in the leadership and governance of health care organizations and their cronies, also have considerable power to damp down any public discussion that might cause them displeasure. In particular, we have seen how those who attempt to blow the whistle on what really causes health care dysfunction may be persecuted.

However,in the Trump administration,  we began to also note examples of government officials attempting to squelch discussion of scientific topics that did not fit in with its ideology, despite constitutional guarantees of speech and press free from government control (look here).

These issues also did not get much attention since November, 2019.


In 2017, we said that it was time to consider some of the real causes of health care dysfunction that true health care reform needs to address, no matter how much that distresses those who currently most personally profit from the status quo.

Furthermore, in 2019 we asserted that all the trends we have seen since 2017 are towards tremendous government dysfunction, some of it overtly malignant, and much of it likely enabling even worse health care dysfunction.

Now that there is the prospect of a new US administration, we hope health care and public health professionals, patients, and all citizens will have a much more vigorous response to it.  US health care dysfunction was always part of the broader political economy, which is now troubled in new and dangerous ways. As the coronavirus pandemic rages, the need to make our health care and public health less dysfunctional is increasingly apparent.  If not now, when? 

Saturday, October 31, 2020

The President Baselessly Accuses Physicians of Inflating COVID-19 Case Rates for Financial Gain. Will Health Care Leaders Finally Challenge Him?

Introduction: the Trump Administration's Attacks on Whistleblowers

A major component of US (and global) health care dysfunction has been the anechoic effect, the ability of those in power to silence discussion of topics that might put them in a bad light.  At risk is anyone who might become a whistle-blower about poor quality care or patient safety problems; malfeasance, corruption or crime; etc.    Whistle-blowing is never easy for health care professionals.  Those who do so have been ostracized, lost jobs or been subject to lawsuits.  


The Trump administration has a history of intimidating health care whistle-blowers.  For example, in 2019 we noted how the administration silenced scientists in the NIMH who might disagree with a Trump tweet about mental health and violence, and a CDC official about the relationship between climate change and public health.  In February, 2020, we noted how the administration tried to intimidate a whistle-blower at the DHHS who reported deficiencies in early management of coronavirus patients. In May, 2020, we noted how Trump himself tried to verbally intimidate the President of the American Association of Nurse Practitioners when she complained in a White House meeting about the lack of personal protective equipment in facilities caring for COVID-19 patients. 

That was bad enough, but then I heard the news today, oh boy. 

Trump Claims Doctors Over-Report COVID-19 to Make More Money

In the last week, at the end of the run up to the election, President Trump doubled down.  He blamed the entire US medical profession for inflating the severity of COVID-19, which is at odds with his happy talk message that we have "turned the corner" on the virus.

On Oct 26, 2020, per

At a campaign rally in Waukesha, Wisconsin on Saturday, Trump told his supporters that 'doctors get more money and hospitals get more money' if they say people died from COVID-19 rather than their comorbidity — a conspiracy theory that has been debunked — as the president pressed his case that the United States is 'rounding the turn' on the pandemic, despite public health officials stressing repeatedly that the opposite is true.

On Oct 31, 2020, per CNN:

President Donald Trump on Friday baselessly claimed that doctors are inflating the coronavirus death count for monetary gain while cases, hospitalizations and deaths surge across the country.

'Our doctors get more money if someone dies from Covid. You know that, right? I mean our doctors are very smart people. So what they do is they say 'I'm sorry but everybody dies of Covid,' ' Trump said, without citing any evidence, at a rally in Waterford Township, Michigan.

In addition, per another CNN report on the same date, he also said:

'With us, when in doubt -- choose Covid,' Trump said. 'Now they'll say 'Oh that's terrible what he said,' but that's true. It's like $2,000 more, so you get more money.'

Meanwhile, we learned that this attack on physicians was part of a long-standing strategy.  Per CNN on October 28, 2020:

President Donald Trump's son-in-law and senior adviser, Jared Kushner, boasted in mid-April about how the President had cut out the doctors and scientists advising him on the unfolding coronavirus pandemic, comments that came as more than 40,000 Americans already had died from the virus, which was ravaging New York City.In a taped interview on April 18, Kushner told legendary journalist Bob Woodward that Trump was 'getting the country back from the doctors' in what he called a 'negotiated settlement.' 

'Trump's now back in charge. It's not the doctors.'

The statement reflected a political strategy. Instead of following the health experts' advice, Trump and Kushner were focused on what would help the President on Election Day. By their calculations, Trump would be the 'open-up president.'

So Trump was willing to disregard the advice of public health and health care professionals, and to verbally attack and intimidate them to support the happy talk of his election strategy, even if that meant more disease, more morbidity, and more deaths.  

Finally, Influential Health Care Professionals Speak Out

Numerous individual health care professionals, particularly those on the front lines of the pandemic, have spoken out about the Trump administration's mismanagement of the crisis. They have emphasized issues such as the lack of adequate personal protective equipment in health care facilities; the need for personal action to reduce the spread of infection; and the folly of premature reopening of the economy (look here and here).  They have actively fought disinformation about the pandemic, including that disseminated by Russia and other Trump allies, and by Trump himself (look here). Yet until the last week there were only a few instances of physicians in positions of leadership and influence willing to support their colleagues on the front lines in their challenge to President Trump.

In September, after the Trump administration's total mismanagement of the coronavirus pandemic had become manifest, and in response to its efforts to turn the CDC, the lead US public health agency, into a propaganda outlet, we complained that no health care leaders, "no chairpersons, deans, chancellors, vice-presidents for health affairs, university presidents; or journal editors, hospital executives, leaders of professional societies, executives of health care corporations, etc, etc were willing to publicly challenge Trump and his top collaborators.  Such leaders so far have also been unwilling to challenge Trump's efforts to spread disinformation."

Since then, editors of two major British medical journals have condemned the actions of the Trump administration.  Lancet Oncology and the prestigious British Medical Journal have published editorials calling out Trump.  

Yet the first instance of a real challenge to Trump from the leaders of US health care did not come until October, 2020.  At least it was from the editor and editorial board of perhaps the best-known American medical journal, the New England Journal of Medicine. They called for Trump to be voted out of office for "dangerous incompetence."

Now that Trump has tried to intimidate physicians in general, days before the election, there is the beginning of pushback from a few leaders of medical societies and academic institutions.  Per

The American College of Emergency Physicians issued a statement rebutting Trump’s  claim, calling it 'reckless and false' that doctors are over-counting deaths related to COVID-19.

'To imply that emergency physicians would inflate the number of deaths from this pandemic to gain financially is offensive, especially as many are actually under unprecedented financial strain as they continue to bear the brunt of COVID-19,' the group wrote. 'These baseless claims not only do a disservice to our health care heroes but promulgate the dangerous wave of misinformation which continues to hinder our nation’s efforts to get the pandemic under control and allow our nation to return to normalcy.'


 Ashish Jha, dean of the Brown University School of Public Health, didn’t mince words. 

'This is crap,' he wrote of the conspiracy theory pushed by the president. 'Everyone knows it.'

In a thread on Twitter, he laid out in detail the debunking of the theory, blasting Trump for continuing to peddle it. 

'While doctors and nurses are dying on the front lines, our leaders aren’t working to get them protective equipment,' Jha wrote. 'Instead, they are falsely accusing our front line providers of fraud. It’s reprehensible.'

Per Forbes on Oct 31, 2020:

The president of the American College of Physicians characterized Trump's comments as 'a reprehensible attack on physicians' ethics and professionalism.'

Per CNN:

Susan Bailey, the president of the American Medical Association, said in a statement that the claim that doctors are overcounting Covid-19 patients or 'lying to line their pockets is a malicious, outrageous, and completely misguided charge.' 


Better late than never. Kudos to the ACEP, ACP, AMA, and the Dean of the Brown School of Public Health. (Full disclosure: I am a voluntary faculty member at the Alpert Medical School at Brown University.)  

But where are all the leaders of the other medical societies, and all the other US academic medical institutions, not to mention the leaders of US hospitals and other health care organizations? The pandemic is getting worse and the election in three days.

We said in May:  

So health care professionals trying just to uphold their mission to put patients' and the public's health first have stumbled into a conflict far beyond anything we have seen in our lifetimes.  Upholding the mission will be difficult, unpleasant, quite likely dangerous.  The danger is not just from the virus, but from our fellow humans.  That does not make the mission any less important.  Innocent lives are still hanging in the balance.

We could retreat in fear from the powerful opposition we have stirred up.  That would allow complete politicization of the management of the coronavirus pandemic, doubtless leading to increased disease and death (and ironically, even worse economic disruption).  Retreating would betray our patients and make a mockery of our mission.  Or we could persist.  What will it be? 'And if not now, when?'

It is Halloween, October 31, 2020.  Again, "if not now, when?"



Thursday, October 15, 2020

Adding (Corrupt Financial) Insult to (Coronavirus Pandemic) Injury

We have frequently discussed the voluminous evidence that President Trump, his family and his cronies have many more conflicts of interest, and have acted corruptly orders much more frequently than any other US administration (see this summary).  These conflicts of interest and corrupt actions likely have badly hurt the country and its people.  

Now a new story suggests that the administration's selective dissemination of information about the coronavirus pandemic may have enabled the enrichment of its supporters while simultaneously endangering public health.  This may be a new low.

Warning Donors and Supporters While Deceiving the Public

A report by the New York Times on October 15, 2020 suggested that early on top Trump administration officials warned favored donors and supporters that the coronavirus was much more dangerous than the administration had admitted publicly.  This allowed the recipients to personally profit: 

On the afternoon of Feb. 24, President Trump declared on Twitter that the coronavirus was 'very much under control' in the United States, one of numerous rosy statements that he and his advisers made at the time about the worsening epidemic. He even added an observation for investors: 'Stock market starting to look very good to me!'

But hours earlier, senior members of the president’s economic team, privately addressing board members of the conservative Hoover Institution, were less confident. Tomas J. Philipson, a senior economic adviser to the president, told the group he could not yet estimate the effects of the virus on the American economy. To some in the group, the implication was that an outbreak could prove worse than Mr. Philipson and other Trump administration advisers were signaling in public at the time.

The next day, board members — many of them Republican donors — got another taste of government uncertainty from Larry Kudlow, the director of the National Economic Council. Hours after he had boasted on CNBC that the virus was contained in the United States and 'it’s pretty close to airtight,' Mr. Kudlow delivered a more ambiguous private message. He asserted that the virus was 'contained in the U.S., to date, but now we just don’t know,' according to a document describing the sessions obtained by The New York Times.

The document, written by a hedge fund consultant who attended the three-day gathering of Hoover’s board, was stark. 'What struck me,' the consultant wrote, was that nearly every official he heard from raised the virus 'as a point of concern, totally unprovoked.'

The consultant’s assessment quickly spread through parts of the investment world. U.S. stocks were already spiraling because of a warning from a federal public health official that the virus was likely to spread, but traders spotted the immediate significance: The president’s aides appeared to be giving wealthy party donors an early warning of a potentially impactful contagion at a time when Mr. Trump was publicly insisting that the threat was nonexistent.

Those Who Got the Information Were Trump Cronies and Supporters

 Note that those most likely to hear about the more realistic and dire, but non-public predictions of Trump insiders were people who were supporters of and donors to Trump et al at the Hoover Institute, whose board

includes the media mogul Rupert Murdoch and the venture capitalist Mary Meeker, neither of whom attended the meetings in February


The Hoover Institution has close relations with the Trump administration, and the White House has pulled from its ranks to fill top positions. Joshua D. Rauh, one of the White House economists addressing the Hoover crowd on Feb. 24, has returned to the institution, where he worked previously. Kevin Hassett, who moderated the panel and has served as the chairman of the White House Council of Economic Advisers, is now a Hoover Institution fellow.

Receiving Information Enabled Personal Profit

Those who heard about the Trump administration insider's non-public concerns soon acted on them, thus profiting from their enhanced knowledge of the pandemic to come:

'Short everything,' was the reaction of the investor, using the Wall Street term for betting on the idea that the stock prices of companies would soon fall.

That investor, and a second who was briefed on the Hoover meetings, said that aspects of the readout from Washington informed their trading that week, in one case adding to existing short positions in a way that amplified his profits


Corruption that Endangered Public Health

 Note that the Times article stated

it is not apparent that any of the communications about the Hoover briefings violated securities laws. The Justice Department and the Securities and Exchange Commission would have several hurdles to clear before establishing that Appaloosa or other funds that received insights from Mr. Callanan, either directly or through intermediaries, acted improperly.

However, consider this: The Trump administration had a duty to manage the growing coronavirus pandemic so as to protect the lives and health of the American people.  The administration had access to considerable information about the pandemic which was not widely available.  We know from reporting by Bob Woodward that President Trump knew how serious the pandemic was likely to be, but concealed that information to prevent "panic." In particular, per Reuters, September 9, 2020:

'I wanted to always play it down,' Trump told author Bob Woodward on March 19, days after he declared a national emergency. 'I still like playing it down, because I don’t want to create a panic.'

Yet, the Trump administration did not act on the information it had.  Many public health experts believe its inaction resulted in the loss of thousands of lives, and resulted in many more cases of COVID-19, some quite morbid that might have been prevented by more forceful action.  Trump avoided effective action while constantly reassuring the public. Meanwhile, his appointees were giving Trump supporters and donors cause to think that the pandemic would actually be quite serious.  Some of them took advantage of that information to make financial transactions, like selling stocks short, enabling them to personally profit.

Transparency International defines corruption as

Abuse of entrusted power for private gain

Whether or not they were legal, the actions above by Trump and his political appointees appeared to have abuse their entrusted for the private gain of their supporters and donors.

We have frequently discussed, most recently here, the many conflicts of interest affecting and corrupt action by Trump, his family, and his cronies.  This case above adds to that list.  

We know of one way that the conflicts of interest generated by Trump's continued ownership of the Trump Organization may have enabled his mismanagement of the coronavirus pandemic. We discussed here and here how concerns about financial losses incurred by the Trump Organization due to lockdowns and other restrictions by state and local public health authorities to manage the pandemic may have influenced Mr Trump to urge premature reopening of the economy.  Thus he may have prioritized his personal finances over public health.

However, the danger of the apparent corruption revealed by the newest case seems more direct. Trump and cronies' restricted dissemination of information about the pandemic allowed enrichment of their supporters while endangering the population at large. In any case, once again, private profit trumped public health.

Yet up to now, protests of his conflicts of interest and corruption have been feeble, while the country has been distracted by each new surprise from a presidency run like a reality television show.  How much longer can the country survive our lack of focus on how we are threatened?