Friday, February 28, 2020

The Virus This Time: Ill-Informed, Incompetent Leadership Enabling Suppression of Free Speech, Intimidation of Whistleblowers, Propaganda and Disinformation

Unfortunately, the rapid progression of coronavirus is providing a demonstration of the dysfunction, and worse, that can be produced by bad leadership in health care and public health.

Ill-Informed Leadership

During the Trump regime 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.  We had not previously expected leaders of government to be personally knoweldgeable about health related topics, but traditionally they consulted with experts before making pronouncements.

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.

Now the Trump administration's leadership on the coronavirus epidemic seems similarly ill-informed.

Trump's Unjustified Optimism

As the epidemic has progressed, Trump has repeatedly made extremely rosy predictions without providing any factual basis for them.

StatNews reported on January 22, 2020:

'It's one person coming in from China," Trump said in Davos, Switzerland, during an appearance on CNBC.  'We have it under control.  It's going to be just fine.'

Meanwhile, the count of cases and fatalities was growing.

Later, per USA Today on February 11, 2010, at a rally President Trump

told the crowd that 'in theory' once the weather warms up Coronavirus, which he referred to as 'the virus,' will 'miraculously' go away. Trump did not offer any scientific explanation to back up his claim.

He continued in the vein on his trip to India, as reported by CNN on February 25, 2020:

'I think that's a problem that's going to go away,' Trump said during a trip to India, expressing confidence that the epidemic will not seriously harm the global economy.

This at best appears to be wishful thinking. 

While the count of cases and fatalities was rising, and more nations were reporting cases, as reported by CNN on February 28, 2020, Trump was hoping for an intervention from on high:

'It's going to disappear. One day it's like a miracle, it will disappear,' Trump said at the White House Thursday

Was he claiming direct communication from on high?

Nevertheless, remember that Trump should be easily be able to access very expert opinion and the latest data from the Centers for Disease Control and Prevention (CDC), US Food and Drug Administration (FDA), National Institutes of Health (NIH), and Department of Health and Human Services (DHHS).  However, if he add used this access, the effects on his thinking are not apparent. 

The Acting Secretary of the Department of Homeland Security (DHS) is Confused

As reported by the Washington Post on February 25, 2020, Acting Secretary of the DHS demonstrated confusion about some basic issues regarding coronavirus, although his agency is being tasked with many responsibilities in order to control the disease.

Appearing in front of a Senate appropriations subcommittee, Wolf was on the receiving end of a brutal line of questioning from Sen. John Neely Kennedy (R-La.). Throughout the exchange, Wolf struggled to produce basic facts and projections about the disease. Perhaps most strikingly, the hearing came at a time of heightened fears about the disease, with the stock market plunging over new estimates about its spread into the United States. It’s a moment in which you’d expect such things to be top of mind for someone in Wolf’s position.

Wolf got started on the wrong foot almost immediately, when Kennedy asked him how many cases of the coronavirus there were in the United States. Wolf stated there were 14 but was uncertain about how many cases had been repatriated back to the United States from cruise ships, placing the number at '20- or 30-some-odd.'

Asked how many DHS was anticipating, Wolf didn’t have an answer and suggested this was the Department of Health and Human Services’ territory. 'We do anticipate the number will grow; I don’t have an exact figure for you, though,' Wolf said.

'You’re head of Homeland Security, and your job is to keep us safe,' Kennedy responded, asking him again what the estimates might be. Wolf talked around the question, which led Kennedy to say, 'Don’t you think you ought to check on that, as the head of Homeland Security?'

Wolf also seemed confused about what was known about human-to-human virus transmission, the mortality of the virus versus that of influenza, the availability of respirators, and the likely time course of vaccine development

The Acting Deputy Secretary of the DHS Asked on Twitter How to Find Coronavirus Information Online

Again, despite his theoretical ability to get expert opinion and data from the CDC, FDA, NIH, DHHS etc, in an op-ed in the Washington Post on February 26, 2020, Max Boot noted:

Meanwhile, the acting deputy secretary, arch-nativist Ken Cuccinelli, took to Twitter to ask for the public’s help in accessing an online map from Johns Hopkins University tracking the virus’s spread. Imagine if the head of U.S. Strategic Command asked the public for helping in learning about nuclear weapons, and you start to comprehend the scale of the problem.

New Coronavirus Czar Mike Pence's Bizarre Beliefs About Science and Promotion of Sectarian-Based Health Care

President Trump named Vice President Mike Pence was named the "czar" of the effort to control coronavirus. Pence is a politician without background in medicine, biomedical research, health care, public health or epidemiology.  Worse than that, he has a record of professing bizarre beliefs about the relevant science.  As summarized by Newsweek on February 27, 2020,

'Time for a quick reality check,' Pence wrote in an op-ed back in 2000. 'Despite the hysteria from the political class and the media, smoking doesn't kill.'

He then went on to list smoking-related statistics: Two out of three smokers do not die from smoking-related illnesses. (False—it may be the opposite: two in three smokers die as a result.) Nine out of ten do not get lung cancer. (It makes it 15 to 30 times more likely you will.) But he did add 'smoking is not good for you' and suggested those 'reading this article through the blue haze of cigarette smoke' should quit.

The scientific consensus, as per the U.S. Centers for Disease Control (CDC): 'Smoking is the leading cause of preventable death.'

Pence also disputed the ability of condoms to protect against sexually transmitted disease, possibly because he espouses abstinence as a method of contraception, and refused to say whether he believes in evolution.

Furthermore, as we discussed here, Pence seems to be on a mission to align all of US health care with his extreme fundamentalist beliefs, regardless of the responsibility of government health care agencies to support the health of all Americans, regardless of their religious beliefs.  In particular, he allegedly engineered the appointment of people with similar sectarian beliefs to positions of responsibility in DHHS.

A person who is at best skeptical about some pretty well-established medical premises, and who espouses health care policies apparently mainly based on extreme religious beliefs for coronavirus "czar?" What could possibly go wrong?

Incompetent Leadership- President Trump's Word Salads about Coronavirus and Related Issues

Previously, we had discussed  ill-informed and incompetent leadership in terms of leaders who had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.

However, we began to note concerning examples suggesting that the top leader of the US executive branch, President Trump himself, could be cognitively impaired perhaps from a dementing, neurological or psychiatric disorder.

- In October, 2017, we first started cataloging pronouncements by President Trump on health care and related topics that started with a grossly cavlier attitude toward health policy (e.g., it is only about fixing somebody's back or their knee or something," and ended with word salad

As we were taught in medical school, word salads may be produced by patients with severe neurological or psychiatric disorders.

- In January, 2018, we discussed more examples of Trump's confused, incoherent comments on health care.

- In May, 2018, we noted attempts by Trump Organization functionaries to intimidate Trump's former personal physician, presumably to prevent him from revealing details of the president's medical history.

- In December, 2018, we cataloged Trump's counter-factual, and often severely incoherent pronouncements - basically more examples of word salad - about public health, health care and other topics, at times interspersed with claims of his high intelligence.

Now Trump has produced more word salad about coronavirus.  For example, as reported by Presswatchers on February 27, 2020:

This will end. This will end. You look at flu season. I said 26,000 people. I never heard of a number like that: 26,000 people, going up to 69,000 people, doctor, you told me before. 69,000 people die every year — from 20 to 69 — every year from the flu. Think of that. That’s incredible. So far, the results of all of this that everybody is reading about — and part of the thing is, you want to keep it the way it is, you don’t want to see panic, because there’s no reason to be panicked about it — but when I mentioned the flu, I asked the various doctors, “Is this just like flu?” Because people die from the flu. And this is very unusual. And it is a little bit different, but in some ways it’s easier and in some ways it’s a little bit tougher, but we have it so well under control, I mean, we really have done a very good job.

The video of this is below:

Another example from that press conference was reported by Esquire the same day.

Suppression of Free Speech by Scientists, Health Care Professionals, and the Media

While President Trump has been proclaiming the wonders of his handling of the coronavirus, his message has been contradicted by scientists and health care professionals working in his government.  So now he seems resolved to better "control the message," that is, to suppress the views of those who disagree with him, even if they are far more expert and better able to justify their views with facts.  As reported by the New York Times on February 28, 2020:

The White House moved on Thursday to tighten control of coronavirus messaging by government health officials and scientists, directing them to coordinate all statements and public appearances with the office of Vice President Mike Pence, according to several officials familiar with the new approach.


The vice president’s move to control the messaging about coronavirus appeared to be aimed at preventing the kind of conflicting statements that have plagued the administration’s response. The latest instance occurred Thursday evening, when the president said that the virus could get worse or better in the days and weeks ahead, but that nobody knows, contradicting Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infectious Disease. At the meeting with Mr. Pence on Thursday, Dr. Fauci described the seriousness of the public health threat facing Americans, saying that 'this virus has adapted extremely well to human species' and noting that it appeared to have a higher mortality rate than influenza.

'We are dealing with a serious virus,' Dr. Fauci said.

Dr. Fauci has told associates that the White House had instructed him not to say anything else without clearance.

IMHO, to best defend against an epidemic we need transparent communication about relevant facts and policies.  Suppressing expert opinion and data to make politicians look good could be disastrous for public health, and eventually disastrous for the politicians responsible.

The same is true about attempts to suppress reporting by the media.  Nonetheless, on February 26, 2020, CNN reported

the president has been blaming the media for this predicament, reverting to the same tactics that he has employed ever since taking office.

On Wednesday, in a widely-criticized tweet, he claimed that CNN and MSNBC 'are doing everything possible to make the Caronavirus look as bad as possible, including panicking markets, if possible.'

He misspelled coronavirus and the typo is still visible on his Twitter profile more than eight hours later.

CNN also explained why health care professionals are worried about Trump's repeated attempts to "control the message" about coronavirus

'When you learn you have a dangerous disease, you need to be able to trust your doctor. When entire populations face a dangerous public health crisis, they need to be able to trust their governments,' Dr. Leana S. Wen, a visiting professor at George Washington University's Milken Institute School of Public Health, wrote in a Washington Post op-ed last month.

That's a problem in this environment, where trust is in short supply. Multiple polls have shown that only one in three Americans believe he is honest and trustworthy.

The President's lies have given the public ample reason to distrust what he says -- and this has negatively affected perceptions of his administration as a whole.

'This president has lied about everything from trade deficits to Russian interference in US elections. He has disparaged experts at almost every opportunity,' said Daniel W. Drezner, professor of international politics at Tuft University's Fletcher School of Law and Diplomacy and author of the forthcoming book "The Toddler in Chief."

'At a time when people are looking to the federal government for reassurance,' Drezner said, 'he will be hard-pressed to provide any.'

Finally, on February 28, 2020, the New York Times reported that Trump surrogates on jumping on the media intimidation bandwagon:

Mick Mulvaney, the acting White House chief of staff, on Friday blamed the media for exaggerating the seriousness of coronavirus because 'they think this will bring down the president, that’s what this is all about.'

Intimidation of Whistleblowers

In the same vein, on February 28, 2020, the New York Times reported that a whistleblower charged DHHS with sending staff to meet quarantined Americans arriving from overseas without adequate preparation or equipment, and that the DHHS response was to attempt to intimidate the whistleblower:

In a narrative prepared for Congress, the whistle-blower painted a grim portrait of staff members who found themselves suddenly thrust into a federal effort to confront the coronavirus in the United States. The whistle-blower said their own health concerns were dismissed by senior administration officials as detrimental to staff 'morale.' They were 'admonished,' the complainant said, and 'accused of not being team players,” and had their “mental health and emotional stability questioned.'

After a phone call with health agency leaders to raise their fears about exposure to the virus, the staff members described a 'whitewashing' of the situation, characterizing the response as 'corrupt' and a 'cover-up,' according to the narrative, and telling the whistle-blower that senior officials had treated them as a 'nuisance' and did not want to hear their worries about health and safety.

Given Trump and cronies' attempts to control the message, how will we know when things are going wrong without whistleblowers?

Propagation of Propaganda and Disinformation

We just discussed how disinformation is distorting the conversation about and maybe the response to coronavirus.  Things are only getting worse.  the President and his allies continue to spread propaganda to make his administration look good and his perceived enemies look bad, regardless of the effect on the public's health.

On February 28, 2020, Politico reported:

President Donald Trump accused congressional Democrats early Friday morning of unfairly blaming the coronavirus’ threat to Americans on his administration, tying the global health epidemic even closer to domestic politics.

'So, the Coronavirus, which started in China and spread to various countries throughout the world, but very slowly in the U.S. because President Trump closed our border, and ended flights, VERY EARLY, is now being blamed, by the Do Nothing Democrats, to be the fault of ‘Trump,’' the president wrote on Twitter just after midnight.

In another message roughly half an hour later, Trump suggested Democratic lawmakers had been 'wasting time' on other legislative priorities and efforts to denigrate Republicans as the coronavirus outbreak proliferated.

'The Do Nothing Democrats were busy wasting time on the Immigration Hoax, & anything else they could do to make the Republican Party look bad, while I was busy calling early BORDER & FLIGHT closings, putting us way ahead in our battle with Coronavirus. Dems called it VERY wrong!' Trump wrote.

That post mirrored a similar tweet the president issued Thursday evening but later deleted, in which he charged that Democrats were “wasting their time on the Impeachment Hoax” as he sought to implement preventative measures to combat the coronavirus.

Neglecting a dangerous disease to fight perceived political enemies could ultimately leave all the humans involved worse off.

While the misinformation provided by Trump and his administration may be a product of their lack of knowledge and competence, it can directly hurt public health.  In StatNews on February 26, 2020, an opinion piece summarized some of the major misconceptions and lies promoted by the administration and explained their possible adverse effects.

'It’s really important for the U.S. government to be speaking with one common voice about these issues right now,' said Tom Inglesby, an infectious diseases physician and director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

Without that, experts caution, the public will be left confused about their risks and what they can do to help curb the spread of the virus, such as staying home when sick.

Inglesby noted that health officials are working hard to prepare and plan for the spread of the virus within the U.S. But that work needs to be regularly and clearly communicated to the public — without conflicting statements from other officials.

'It will erode confidence in the effort if one part of the government says something in the beginning of the day, and another part of the government says something contradictory at the end of the day,' he said.

The specific examples of misinformation and lies the article used were:

Containment is ‘pretty close to airtight’ — Larry Kudlow, director of the National Economic Council, in an interview with CNBC Tuesday

The fatality rate is ‘similar to seasonal flu’ —Chad Wolf, acting secretary of the Department of Homeland Security, in testimony before Congress Tuesday

‘There’s a big difference between Ebola and coronavirus’ —Trump, in remarks in India Tuesday, when asked about decision to evacuate ill Americans from the Diamond Princess cruise ship, given his past criticism of the evacuation of an American health worker infected with Ebola

‘We’re very close to a vaccine’ —Trump, also in remarks in India

The virus might go ‘away in April, with the heat’ —Trump, speaking at a governor’s meeting earlier this month

Finally, just to ice this particular cake, Trump supporter and Trump's Medal of Freedom awardee is spreading some rank disinformation in support of his fearless leader.  On February 25, 2020, the Guardian reported,

The coronavirus outbreak is being 'weaponised' by the media to bring down Donald Trump when in fact it is simply a version of the 'common cold', the conservative radio host and presidential medal of freedom recipient Rush Limbaugh claimed on Monday.

His actual words were:

'It looks like the coronavirus is being weaponised as yet another element to bring down Donald Trump,' Limbaugh said on his Monday show. 'Now, I want to tell you the truth about the coronavirus. I’m dead right on this. The coronavirus is the common cold, folks.'

'The drive-by media hype of this thing as a pandemic, as the Andromeda strain, as, ‘Oh, my God, if you get it, you’re dead’ … I think the survival rate is 98%. Ninety-eight per cent of people get the coronavirus survive. It’s a respiratory system virus.'

That was complete nonsense, so

His comments were widely condemned: more than 80,000 people are known to have contracted the virus worldwide and 2,700 are known to have died. Authorities are struggling to cope in China, Iran, Italy and Tenerife.

That did not stop various pundits who regularly cheer for Trump on Fox News.  The Washington Post reported on February 28, 2020, that Sean Hannity, Tucker Carlson, Laura Ingraham, and Stuart Varney all joined the fray.


The Trump administration's response to the coronavirus seems more about their political fortunes, ideologies, and sectarian beliefs than about the health of the public.  If they do not change their ways, or the US does not change its leadership, it could be the death of at least some of us. Those in the US who uncritically support Trump should realize that viruses do not care about peoples' politics, so the Trump fans are just as much at risk as are the anti- and never-Trumpers.

Saturday, February 22, 2020

Rising Tide of Disinformation about Coronavirus: the Roles of Ideologues, Quacks, Russians, and US Politicians

Introduction: Propaganda and Disinformation in Health Care

We used to write about propaganda and disinformation used to promote health care goods and services (stealth marketing campaigns), and advocate for policies favorable to private health care organizations (stealth health policy advocacy and stealth lobbying).  Some stealth marketing, lobbying and policy advocacy campaigns encompass not just propaganda, but disinformation.  For example, consider the health insurance company campaign to derail the Clinton administration's attempt at health reform as described by Wendell Potter in Deadly Spin (look here).  The tactics employed in that campaign included: use of front groups and third parties (useful idiots?); use of spies; distractions to make important issues anechoic; message discipline; and entrapment (double-think).

In fact, towards the end of its existence, the USSR sponsored a disinformation campaign which spread the notion that HIV was a bio-weapon invented by a US laboratory (look here).  Although false ideas associated with that campaign persisted for years, the risk that health care disinformation would be used by hostile state actors seemed to die off as the cold war ended.

But now we have a new (ab)normal that includes propaganda and disinformation in the service of hostile authoritarian foreign states meant to disrupt more democratic governments, whatever the cost in human health and lives.  For an example look here at  how starting around 2015 Russia was spreading disinformation about measles and measles vaccination over the internet, using new technology like bots.

Now they seem to be doing it again, this time about coronavirus.

Disinformation About Coronavirus

On January 29, 2020, the Washington Post reported on a new disinformation campaign:

As China attempts to contain the spread of a new coronavirus that has left more than 100 people dead, rumors and disinformation have spread amid the scramble for answers.

Some of the speculation has centered on a virology institute in Wuhan, the city where the outbreak began. One fringe theory holds that the disaster could be the accidental result of biological weapons research.

The story started circulating in right-wing media:

The British newspaper Daily Mail was among the first to suggest the possibility of a link between the newly spreading virus and the Wuhan National Biosafety Laboratory, reporting last week that the lab, which opened in 2014 and is part of the Wuhan Institute of Virology, had been the subject of safety concerns in the past.

A separate article published by the Washington Times, a conservative newspaper in Washington, took the theories a step further, suggesting in a headline that the 'Coronavirus may have originated in lab linked to China’s biowarfare program' and pointing to the Wuhan Institute of Virology.


Despite little public evidence, the theory has spread widely on social media, to conspiracy theory websites and in some international news outlets.

Yet there was no good evidence to support this theory.

'Based on the virus genome and properties there is no indication whatsoever that it was an engineered virus,' said Richard Ebright, a professor of chemical biology at Rutgers University.


Milton Leitenberg, an expert on chemical weapons at the University of Maryland, said he and other analysts around the world had discussed the possibility that weapons development at the Wuhan lab could have led to the coronavirus outbreak in a private email chain but that no one had found convincing evidence to support the theory.

Then the bioweapon theory started appearing on more extreme sites.  BuzzFeed reported on January 31, 2020:

A popular pro-Trump website has released the personal information of a scientist from Wuhan, China, falsely accusing them of creating the coronavirus as a bioweapon, in a plot it said is the real-life version of the video game Resident Evil.

On Wednesday, far-right news site Zero Hedge claimed without evidence that a scientist at the Wuhan Institute of Virology created the strain of the virus that has led the World Health Organization to declare a global health emergency.

Note that

Zero Hedge, which describes itself as a financial blog, has more than 50,000 followers on Facebook and more than 670,000 followers on Twitter and is run by Daniel Ivandjiiski, a Bulgarian-born, US-based, former investment banker, who writes the majority of the posts published by the pseudonym Tyler Durden. The site regularly amplifies conspiracy theories from anonymous message board 4chan and writes frequently about the deep state, doomsday prep, bitcoin speculation, and New Age pseudoscience.


The new focus on the scientist is the culmination of several conspiracy theories that have gained traction since the beginning of the outbreak early in January. One version of the hoax began in Facebook Groups run by supporters of the pro-Trump QAnon movement and the anti-vax community, where users claimed the outbreak was a population control plot by former Microsoft CEO Bill Gates.

The Zero Hedge take has been propagated widely:

The Zero Hedge article has been posted on Twitter over 10,000 times and shared close 2,000 times on Facebook in the last 24 hours.


The rumors and lies are also being spread across 4chan. A user linked to the Zero Hedge article in a 4chan thread titled, 'All hail [the scientist], creator of Corona-Chan.' In another 4chan thread, users claimed the scientist had created a mutant superbug.

The hoaxes surrounding the coronavirus have become so prevalent that 'uncensored' subreddits about the outbreak are being created for users on Reddit who want to share the theories.

In summary, an unsubstantiated theory about the coronavirus, one that could both increase public anxiety, if not panic, and stir up hostility between China and the US, started circulating in right-wing, including extremist, web-sites and media, and soon bled into the larger social media. But why?  Cui bono? Who could benefit from this?

Using Disinformation and Extreme Ideology to Sell Dubious Products

One answer appear to be people selling quack products.

A New York Times article on February 6, 2020 focused on World Health Organization (WHO) efforts to fight disinformation about coronavirus (see below). It included the opinions of "Andrew Pattison, manager of digital solutions at the W.H.O."  He suggested:

Medical misinformation on the virus has been driven by ideologues who distrust science and proven measures like vaccines, and by profiteers who scare up internet traffic with zany tales and try to capitalize on that traffic by selling 'cures' or other health and wellness products.

'There are self-appointed experts, people working from anecdote, or making up wild claims to get traffic or notoriety,' said Mr. Pattison of the W.H.O.


Sarah E. Kreps, a professor of government at Cornell University, considers the people deliberately spreading distortions to be practitioners of 'algorithmic capitalism,' in which people scare up traffic and sell against it.

Examples abound. Infowars, the far right website that purveys conspiracy theories and fake news, and others are now banned on several leading social media sites but are still advertising pseudoscientific remedies directly through their own shops. An early distortion of the coronavirus news appeared in an Infowars video on Jan. 22 — claiming that the virus could be part of some man-made plot to thin the population.

'The globalists and the deep state have declared war on humanity,' a host on the video said. 'They hate human life. This is why they kill babies.'

Next to the box in which the video appears is an advertisement for an immune gargle product that, the ad claims, 'is designed to support your immune system like no other,' and that is 'scientifically proven.'

However, the Mayo Clinic reports that the ingredient mentioned in the product, colloidal silver, has not been proved safe or effective in treating disease. And even the Infowars shop where the product is listed reads at the bottom: 'This product is not intended to diagnose, treat, cure or prevent any disease.' 

Whether these disinformationists are primarily cynical businesspeople hiding behind extreme ideology, or extreme ideologists who found a way to profit from these beliefs, or both is not clear.
The Russian Connection

 Furthermore, it appears that once again the Russians are involved, demonstrating their updated disinformation techniques that take advantage of the internet and social media.

On February 14, 2020, an article in Foreign Policy discussed Russian involvement in disinformation about coronavirus:

The overarching theme of the stories that appear across the Russian media, from fringe websites to prime-time television, is that the virus is the product of U.S. labs, intended to kneecap China’s economic development. Some articles have flirted with the idea that Bill Gates or Kremlin nemesis George Soros might have had a hand in the outbreak.

Note that:

Right now, the main audience is largely domestic, with a sprinkling of conspiratorial reports across the different language services of Sputnik, the more tabloid of Russia’s international broadcasters. The conspiracy theories haven’t featured prominently on English-language Russian government-backed international broadcasters such as RT and Sputnik, however, according to Bret Schafer, a fellow at the German Marshall Fund’s Alliance for Securing Democracy who studies disinformation. While these channels have historically played around the edges of conspiracy theories, 'they still want that veneer of being a legit international broadcaster,' Schafer said. 

The Russian disinformation did not appear to be focused on the escaped Chinese bio-weapon theory, but that particular theory might not be the point. 
The Russian messaging fits a now well-established pattern in that it doesn’t look to persuade audiences of a single alternative truth. That would take effort, planning, and persuasion. Modern-day Russian propaganda has instead been described by the Rand Corp. as a 'firehose of falsehood,' a steady stream of underdeveloped, sometimes contradictory conspiracy theories intended to exhaust and confuse viewers, making them question the very notion of objective truth itself.

On February 22, 2020, the Guardian provided considerably more detail, and now it is coming from official US State Department sources:

State department officials tasked with combatting Russian disinformation told the AFP false personas were being used on Twitter, Facebook and Instagram to advance Russian talking points in multiple languages.

'Russia’s intent is to sow discord and undermine US institutions and alliances from within, including through covert and coercive malign influence campaigns,' said Philip Reeker, acting assistant secretary of state for Europe and Eurasia.

'By spreading disinformation about coronavirus, Russian malign actors are once again choosing to threaten public safety by distracting from the global health response,' he said.

Some accounts have falsely claimed the US is waging “economic war on China” and that the virus is a biological weapon manufactured by the CIA.


Several thousand online accounts – previously identified for airing Russian-backed messages on major events such as the war in Syria, the Yellow Vest protests in France and Chile’s mass demonstrations – are posting “near identical” messages about the coronavirus, according to a report prepared for the state department’s Global Engagement Center and seen by the AFP.

The accounts are run by humans, not bots, and post at similar times in English, Spanish, Italian, German and French. They can be linked back to Russian proxies, or carry messages similar to Russian-backed outlets such as RT and Sputnik, the report said.

'In this case, we were able to see their full disinformation ecosystem in effect, including state TV, proxy websites and thousands of false social media personas all pushing the same themes, said Lea Gabrielle, head of the Global Engagement Center, which is tasked with tracking and exposing propaganda and disinformation.

This is now looking like a big-time Russian disinformation effort aimed at further destabilizing the west,

A state official said Russian operatives appeared to have been given 'carte blanche' to attack the US.

'Whether or not a particular theme is being directed at the highest levels doesn’t matter,' the official said. 'It’s the fact that they have freelance ability to operate in this space to do whatever damage they can, which could have seismic implications.'

All from the same folks who are trying to meddle in the upcoming election, in favor of their preferred candidate, President Trump (look here).

A Prominent US Senator Helps Propagate Disinformation

During the early phases of the measles disinformation campaign, we noted that in February, 2015, the New York Times discussed the strange inability of some then Republican candidates for the presidency to discuss the issue clearly.

Now a Senator Tom Cotton (R-AK) is adding to the confusion about coronavirus.  The New York Times reported on February 17, 2020 (updated February 18):

Speaking on Fox News, Senator Tom Cotton, Republican of Arkansas, raised the possibility that the virus had originated in a high-security biochemical lab in Wuhan, the Chinese city at the center of the outbreak.

'We don’t have evidence that this disease originated there,' the senator said, 'but because of China’s duplicity and dishonesty from the beginning, we need to at least ask the question to see what the evidence says, and China right now is not giving evidence on that question at all.'

Note that he raised doubts while suggesting the plausibility of the escaped Chinese bio-weapon theory, but did not dwell on the evidence.  Instead, the Times noted he seemed to complain about the lack of relevant evidence:

Speaking to the Fox News anchor Maria Bartiromo, Mr. Cotton suggested that a dearth of information about the coronavirus’s origins was raising more questions than answers.

'We don’t know where it originated, and we have to get to the bottom of that,' he said on the program 'Sunday Morning Futures.'

But there is nothing to suggest that he used his position as a US Senator to learn more about what facts are currently known, and what public health experts currently think.  Surely organizations like the CDC and WHO could have helped him with that before he jumped into the discussion.  It would also have been possible for him to access the US State Department's information about the Russian  coronavirus disinformation campaign and about the possible malign effects of further spreading disinformation about this new disease.  But no, Sen Cotton appeared to be attending to other sources, like these mentioned in the Times article:

Last month, Mr. [Steve] Bannon [former Trump campaign manager in his 2016 campaign, former owner of Breitbart News]  invited Bill Gertz, a Washington Times reporter, to be a guest on the inaugural episode of his radio show 'War Room: Pandemic,' a spinoff of his 'War Room: Impeachment,' which defended Mr. Trump during the Senate impeachment trial.

'Bill Gertz had an amazing piece in The Washington Times about the biological labs that happen to be in Wuhan,' Mr. Bannon said on his Jan. 25 show. Mr. Gertz appeared on another show several days later to continue putting forward the bioweapons theory.

Fox News has also dabbled in the theory, in one article drawing a connection between a 1980s thriller by Dean Koontz that 'predicted coronavirus.' The book is about a Chinese military lab that creates a biological weapon.

In addition, although the NYT article suggested that Sen Cotton then attempted to "walk back" his original statements, on January 19, 2020, Fox News reported he had reiterated it:

Sen. Tom Cotton, R-Ark. stood by his earlier suggestion that the deadly coronavirus may have originated in a high-security biochemical lab in Wuhan, China, telling 'The Story' Tuesday that we 'need to be open to all possibilities' in exploring the origins of the outbreak that has sickened more than 75,000 people around the world.

When host Martha MacCallum pressed the Senator on his startling and unverified claim, Cotton cited a study published by Chinese scientists in The Lancet, which he called a 'respected international science journal.'

'I'm suggesting we need to be open to all possibilities and we need to demand that China open up and be transparent so a team of international experts can figure out exactly where this virus originated,' Cotton said.

He also brought up the 'questions' surrounding the biosafety level 4 'super laboratory' in Wuhan, the city where the virus is believed to have originated.

In epidemiology, it may be wise not to dismiss even theories that appear far-fetched, at least in the initial phases of an investigation, but there should be some effort to assess the plausibility of the competing hypotheses.  Again, notice that a US Senator with no obvious public health or epidemiological expertise was continuing to talk off-the-cuff about a major public health issue, sans any reference to the sorts of expertise and evidence he could easily access.


The problem of disinformation about medicine, health care, and public health only seems to be getting worse. It appears to be fueled in part by the good old fashioned profit motive, but often focused on the profits from useless, possibly harmful pseudo-remedies.  It may be justified, or actually generated by extreme ideologies, all of which so far seem to be on the far-right end of the political spectrum.   Particularly disquieting is the proclivity, at least in the US, for politicians of a certain stripe to not merely downplay it, but aid in its dissemination, meanwhile ignoring all the possible resources available to them that could supply some evidence and rational assessment of same.

One small cause for hope are the growing efforts to combat it.  For example, as discussed in the New York Times, the WHO is now actively trying to combat the "infodemic" of coronavirus disinformation.

Clearly, health care professionals should be doing their part in fighting disinformation and active measures that seek to distort medicine, health care and public health.  National and local health departments, and agencies such as the CDC and FDA in the US all should be joining the WHO and the US State Department in fighting current disinformation campaigns, and preparing for future ones.  Needless to say, politicians regardless of political philosophy should be supporting these efforts, should base their remarks on evidence and logic, and certainly should not be helping the spread of disinformation.

Yet, as Chris Cilllizza wrote for CNN re Sen Cotton's dissemination of coronavirus disinformation, we are living

in a sort of post-truth world, one if not created, then pushed by President Donald Trump. Trump's candidacy was born in a conspiracy theory (former President Barack Obama wasn't actually born in the United States) and he has embraced any number of conspiracy theories in his days as President. (Millions of illegal votes were cast in the 2016 election, Obama ordered the phones at Trump Tower wiretapped, etc.)

Trump has mainstreamed conspiracy theories and convinced lots and lots of people they are true with much the same tactic Cotton used on Sunday, which amounts to this: I am not saying this is true, I am just saying people are talking about it and we owe it to ourselves to ask the question. But simply because Trump has made this sort of stuff commonplace doesn't mean it's OK. It isn't. After all, there's a difference between a random post on some Reddit message board and a US senator spinning conspiracy theories on national TV. Or at least, there should be.

However Trump, and maybe Cotton too, seem to benefit from the barrage of disinformation and active measures emanating from Russia. We just heard that the US intelligence community says Russia is once again using active measures to influence the upcoming US election - on behalf of Trump (look here). It is also hard to ignore that Sen Cotton is a big fan of US President Donald Trump (look  here) as is Trump of him.

So, it may be too much to expect them to change their ways. Instead, we may need to change our political leadership, and charge our political operating system to make it less vulnerable to hacking by hostile foreign nations, like Russia.

Monday, February 10, 2020

What the Heck Happened to Surprise Billing Legislation? (Or, it’s never too late for the lobbyists to win.)

With constituents pressing for something to remedy unexpected liabilities incurred from “surprise” medical bills, it was expected that surprise medical bill legislation would pass federally in December 2019 as part of an end-of-year legislation package. House and Senate committees had worked for months on consensus legislation that was ready to go, but that fell through at the last moment. What happened?

Some background on the issue: Surprise bills are something of a battleground between payers (insurers) and providers (doctors/hospitals). Insurers want to lower bills, and providers want to raise them. More and more, hardball is being played. If large groups of specialty providers remain out-of-network, they can often make a great deal more money than if they signed a contract for a number agreeable to the insurer. Patients – who can get nightmarish huge bills and be legally liable for them – are the roadkill in this tug-of-war. Private equity firms, who are now buying up group medical practices on the assumption that they can increase earnings substantially, have recently become a major player in the dynamic. Dr. Poses had a good post in September on their role and on their lobbying/advertising efforts. Private equity firms like Blackstone and KKR put a TON of money into the radio and TV ads that urged people to call their legislators to oppose "government rate-setting."

We’re not talking chump change, here. A recent analysis showed that surprise billing charges in excess of negotiated rates amount to as much as FORTY BILLION dollars annually.

Surprise billing legislation – state and federal - to date has taken two approaches. One approach is to fix the bill with out-of-network doctors based in some way on what an in-network doctor makes. This “benchmarking” approach advantages the insurance companies and self-funded employers.

The other is to rely on arbitrators to settle the dispute about amounts between provider and insurers. Experience has shown that this is in practice highly advantageous to the provider – to hospitals and to specialty groups (and in some cases to their private equity investors). This second approach drives up already-high U.S. medical costs. This major downside, in my opinion, makes it far more in the public interest to lean toward the benchmarking type of solution, while striving for fairness.

The bipartisan consensus agreement, known as the Murray-Alexander bill after Democrat Patty Murray and Republican Lamar Alexander, was initially based on a benchmarking approach, but after compromises that were made, had room for outside arbitration for amounts over $750. The Congressional Budget Office estimated that its passage would save TWELVE BILLION dollars in insurer medical costs, enabling lowering of premiums (this does not even include out-of-pocket patient savings). But, of course, those twelve billion dollars in saved costs are also twelve billion dollars in lowered revenue to providers and their owners.

And so, this bipartisan deal was torpedoed at the last moment by another bipartisan team, Democrat Richard Neal (House Ways and Means committee chair) and Republican Kevin Brady. Everything also indicates that Senate Minority Leader Chuck Schumer – who pushed Murray to back off from her support - was instrumental in killing the deal. Nancy Pelosi, too, was an enabler, allowing Neal to kill the bill. She was heard assuring industry representatives that "we are not going to give a handout to big insurance companies."

As journalist Jon Walker tweeted:
Disgraceful. @SpeakerPelosi is going around trying to keep your premiums sky high to pay off private equity firms and bad actor hospitals.

Everything about the spiking of the deal indicates that money talks, and loudly, with large donations having been made to Schumer’s Senate Majority PAC by the Greater New York Hospital Association and with donations too to Richard Neal from private equity.

And so the legislation is dead until and unless Schumer and Neal can get their preferred (and price-raising) approach adopted. Meantime, real people are suffering from getting huge bills they have no control over. As Elizabeth Rosenthal observed recently, practices that are both routine and legal in the medical industry are nonetheless in essence fraudulent. The business model of U.S. medicine is fraud – and a very profitable business model it is.

NOTE 1: Although a number of states have passed surprise bill legislation, it is critical to get something passed on a federal level, because most large employer-based plans are federally regulated and state laws don’t apply.

NOTE 2: Benchmarking and arbitration are not the only possible approaches. Another suggestion is to abolish the practice of separate bills from doctors for services provided in hospitals.

Friday, February 07, 2020

The Big Spin Out: 2020 Revolving Door Update

In  2020, cases of the revolving door accumulated quickly. 

The Old School Outgoing Revolving Door

Let us begin with cases of the old fashioned outgoing revolving door, that is, of people leaving leadership positions in governmental bodies which regulate health care or make health care policy, then soon obtaining jobs in the health care industry, particularly organizations which they previously regulated or were affected by the policies they made.

Dr Vindell Washington from National Coordinator for Health Care Information Technology to Alphabet

Per FierceHealthCare, January 7, 2020:

Alphabet, the parent company of Google and Verily Life Sciences, continues to bolster its ranks of healthcare experts with the latest hiring of Vindell Washington, M.D.

Verily Life Sciences hired Washington as its new chief clinical officer as part of its health platforms team, Verily Life Sciences representative Kathleen Parkes confirmed to FierceHealthcare Tuesday.

Washington served as the national coordinator for health IT from August 2016 to January 2017.

As one of the highest health IT policy leaders, Washington brings to Verily a deep understanding of the industry. He is an emergency medicine physician by training.

So he moved from a position with significant influence over government health IT policy to a big IT company involved in health care.  Admittedly though, this moves comes three years after he left the ONC.

Dr Kate Goodrich from Chief Medical Officer of the Center for Medicare and Medicaid Services (CMS) to Humana Inc

Per Louisville Business First, January 17, 2020:

Humana Inc. has hired away a key regulatory insider from the federal government.

Dr. Kate Goodrich will leave the chief medical officer role at Centers for Medicare & Medicaid Services in February. Politico reported Thursday Goodrich will become a senior vice president for the company.

CMS is the agency that oversees both Medicare and Medicaid, the government-backed health plans. Goodrich was also director of the Center for Clinical Standards and Quality, the CMS website states.

Note that Humana's business is heavily influenced by the actions of CMS.

Humana's core business is providing Medicare Advantage plans, a private version of the federal health plan for seniors. It has about 4.1 million members in Medicare Advantage plans, according to its latest financial disclosure.

The Medicare Advantage segment brought in about $37.1 billion of revenue in the nine months ended Sept. 30, 2019.

Mary Sumpter Lapinski from Government Affairs at Bristol-Myers-Squibb to Counselor to the Secretary of the Department of Health and Human Services (DHHS) for Public Health and Science, then to Vice President of Global Governance Affairs for Greenwich Biosciences

Note that in this case, someone recently reported as transiting the outgoing revolving door has also had in the past transited the incoming revolving door.

Per a Buzzfeed News article, January 24, 2020 (which also discussed the larger revolving door problems involving the pharmaceutical industry and the Trump administration):

Mary-Sumpter Lapinski, who worked in government affairs for Bristol-Myers Squibb from 2002–2007, served as a counselor to the health and human services secretary for public health and science. As of April 2019, Lapinski is the vice president of global government affairs for biopharmaceutical company Greenwich Biosciences.

Again, most recently she moved from a senior position in DHHS affecting public health and science to a biotech company.

Roxana Weil, Lead Toxicologist from the Center for Tobacco Products at the Food and Drug Administration (FDA) and Gabriel Muniz who inspected tobacco manufacturers for the FDA to Juul Labs Inc

Per Bloomberg (via the Detroit News, February 5, 2020):

Juul Labs Inc. has hired former Food and Drug Administration employees and is recruiting more researchers as it prepares for a crucial regulatory hurdle that will determine the future of the top U.S. e-cigarette maker.


Roxana Weil, formerly a lead toxicologist at the agency’s Center for Tobacco Products, joined Juul as principal scientific adviser in September. Gabriel Muniz, who worked in an FDA division that inspects tobacco manufacturers, joined Juul last month as a director of regulatory compliance.

Note that

The company and its peers must submit applications to the FDA by May 12 in order to continue selling their products. The deadline is a defining moment for the e-cigarette industry, which has been under fire following a surge in teen vaping and a lung-injury outbreak that sickened thousands and was later tied to THC.

For Juul, securing a swift clearance is critical. The company has seen its once-rich valuation drop since the broader vaping backlash began. Failing to win the FDA’s blessing could shut it out of a market it has dominated.

So they moved from regulating tobacco to a company essentially involved in selling tobacco analogues.  Note that the tobacco company Altria made a major investment in Juul (look here.)

The Au Courant Incoming Revolving Door

In the Trump era, many people have come through the incoming revolving door, that is, people with significant leadership positions in health care corporations or related groups have attained leadership positions in government agencies whose regulations or policies could affect their former employers.

There are two recent examples

Brad Smith, Chief Operating Officer of Anthem's Diversified Business Group to be Director, Center for Medicare and Medicaid Innovation (CMMI) at the DHHS

Per FierceHealthcare, January 6, 2020:

The Trump administration has selected Brad Smith to serve as the director of the Center for Medicare and Medicaid Innovation (CMMI), where he will oversee the creation and stewardship of value-based payment models.

Smith most recently was the chief operating officer of Anthem’s Diversified Business Group, a division of the insurance giant that includes provider services. He was also the co-founder and CEO of palliative care services company Aspire Health.

Anthem is a health insurer which provides Medicare supplements and Medicare Advantage programs, so its business is greatly affected by any changes in how Medicare or Medicaid makes payments.

Amanda Adkins, Executive for Cerner Corp, Now Running for the House of Representatives as a Republican

This could be called a running start that will likely lead through the incoming revolving door.

Per the  Kansas City Star, January 23, 2020:

Cerner executive Amanda Adkins has taken a leave of absence from the company to focus on her campaign to unseat Democratic Rep. Sharice Davids.

Adkins, a former Kansas Republican chair, launched her bid for Kansas’ 3rd congressional district in September, but initially planned to remain as Cerner’s vice president of strategic growth through the campaign.

But as of last week, according to a company spokeswoman, Adkins went on unpaid leave after from her role after 15 years with the health care IT giant.

Note that the Star article, unlike the others quoted above, provided at least a slightly detailed discussion of why this (potential) move poses a conflict of interest:

The Kansas City-based company is a major federal contractor with a $10 billion contract to design a new health care records system for the U.S. Department of Veterans Affairs. The new system is expected launch later this year.

Federal election rules prohibit federal contractors from giving directly to federal candidates. Craig Holman, a lobbyist for Public Citizen, a national group which advocates for tougher ethics standards, said Adkins’ unpaid leave protects Cerner from violating this rule.

But Holman said the fact that she can return from leave after the election still raises questions about a conflict of interest since she could end up on committees with oversight of the company’s contracts if elected to Congress.

'The conflict still persists,' Holman said in a phone call. 'The fact that she has not resigned and remains an employee of Cerner means that conflict of interest remains front and center.'


Sigh.  So while there is much discussion of corruption in high places, and its potential link to high crimes and misdemeanors, the revolving door quietly spins on well-oiled hinges, as it has for years, including many years before the current administration.  

So as we have repeatedly said,  most recently in October, 2019, ...

The revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption.  As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.

The ongoing parade of people transiting the revolving door once again suggests how the revolving door may enable certain of those with private vested interests to have disproportionate influence on how the government works.  The country is increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism. The latest cohort of revolving door transits suggests that regulatory capture is likely to become much worse in the near future.

Remember to ask: cui bono? Who benefits? The net results are that big health care corporations increasingly control the governmental regulatory and policy apparatus.  This will doubtless first benefit the top leadership and owners/ stockholders (when applicable) of these organizations, who are sometimes the same people, due to detriment of patients' and the public's health, the pocketbooks of tax-payers, and the values and ideals of health care professionals.  

 The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health.  Once again, true health care reform would cut the ties between government and corporate leaders and their cronies that have lead to government of, for and by corporate executives rather than the people at large.