Addressing threats to health care's core values, especially those stemming from concentration and abuse of power - and now larger threats to the democracy needed to advance health and welfare. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.
Showing posts with label whistle-blowers. Show all posts
Showing posts with label whistle-blowers. Show all posts
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.
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.
'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.
'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.'
So,
'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 Boston.com:
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.'
Also,
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.'
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.'
Conclusion
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?"
Physicians and other health care professionals are sworn to put patients' interests ahead of all else, and to uphold the integrity of education and science in health care. This may put them in the uncomfortable position of speaking up when doing so offends vested interests. Whistle-blowing is never easy for health care professionals. Those who do so have been ostracized, lost jobs or been subject to lawsuits.
So we were not surprised when cases appeared of health care professionals who spoke out about unsafe hospital practices during the coronavirus pandemic. Hospital management were not pleased at being made to look bad, so the whistle-blowers were warned, threatened, and sometimes fired. We had seen a precursor case in which hospital professionals got in similar kinds of trouble for blowing the whistle on unsafe practices in caring for Ebola virus patients in 2014 (look here).
During the coronavirus pandemic, health care professionals have tried to educate patients and the public about the effects of the disease, and what it takes to mitigate a pandemic in the absence of effective prevention or treatment approaches. That may have not seemed like whistle-blowing. What powerful people could such education possibly offend? Yet many of the professionals who did so have found themselves more directly threatened then were the whistle-blowers who protested actions by health care organizations in an earlier era.
We have previously discussed one set of illustrative examples. Health care professionals who sought to educate demonstrators who
advocated quickly "reopening" the economy about the perils of
doing so were subject to screams, insults, and charges they were "crisis actors" (look here).
Journalists discovered that the "reopening" protests attracted political extremists, and were funded and organized by opaque
right-wing groups, President Trump's supporters, and shady
plutocrats. The protests seemed not to be about the economic
damage pandemic mitigation measures had done to workers and small
businesses. It seemed that in our new political reality, powerful
political interests are vested in pushing a rapid reopening not only in
their economic self-interest, but in the interests of politicians who wanted to make the economy appear to thrive, no matter what the human
cost.
Continuing efforts by health care professionals to educate patients and the public about coronavirus have thus made them into targets of powerful political interests.
Trump Stirs Up His Supporters Against Health Care Professionals Who Might Question His Word
President Trump himself has berated qualified health care professionals who tried to speak the truth, even in the mildest terms, about the coronavirus pandemic. We previously discussed his charges that those who complained about lack of personal protective equipment (PPE)
were only motivated by a desire for personal fame (look here).
A
nurse found out Wednesday what happens when you contradict President
Donald Trump on how well coronavirus response efforts are going while
standing near him in the Oval Office.
Trump clapped
back at that nurse, Sophia Thomas, who said that access to sufficient
supplies of personal protective equipment 'has been sporadic.' Her
comments came during a National Nurses Day event at the White House
meant to honor those first responders.
Trump upon
hearing a less-than-glowing description of the front lines, quickly shot
back, 'Sporadic for you, but not sporadic for a lot of other people.'
Note
that Ms Thomas speaks from some authority. She is President of the
American Association of Nurse Practitioners. As such, she seemingly
tried to defuse the conflict, but Trump would have none of that:
After Trump’s testy response, Thomas said, 'Oh, no, I agree Mr. President.'
But Trump continued, folding his arms, 'Because I’ve heard the opposite.'
'I’ve heard that they are loaded up with gowns now.'
'And
initially we had nothing, we had empty cupboards, we had empty shelves,
we had nothing, because it wasn’t put there by the last
administration,' he said, referring to former President Barack Obama.
Trump
then noted that he had traveled to a Honeywell factory in Phoenix a day
earlier, to tour a production line that is making 'millions of masks a
month.'
'We have other factories being built now for
masks, and for the most part I mean, that was fine,' Trump said,
referring to the nurse.
'But I’ve heard that we have tremendous supply to almost all places,' he said.
'Tremendous supply.'
Never mind that the Trump administration has been in power for over three years, and thus had plenty of time to remedy any shortages that may have been left by the previous administration. Never mind that Ms Thomas' view was supported by
a
report by the inspector general for the federal Health and Human
Services Department found that hundred of U.S. hospitals were
experiencing serious shortages of PPE as well as equipment including
thermometers and diagnostic testing kits.
Of course, Trump would have none of the IG's report either, either:
Trump, who disputed the report’s findings, last week moved to replace that inspector general, Christi Grimm.
It was in Trump's political interests to make it appear that his administration had made short work of the coronavirus pandemic. Beyond that, his message seemed to be that the word of Trump overrides evidence and logic. Like the Ingsoc movement in Orwell's 1984, he claims the power of making "2+2=5"
Online Attacks On Health Care Professionals Who Tried to Educate about COVID-19
So it also should not be surprising that health care professionals
who sought to educate the public and patients, online or in-person about coronavirus were subject to ad hominem invective, but also attacks on their facts and logic.
Eric Sartori arrived home on April 19 after working in the COVID-19 unit of a community hospital in Arizona. After reading social media posts claiming the virus was a hoax, the intensive care nurse opened Facebook and vented.
'While we're busy working to save people's lives we're also growing really concerned about the conspiracy theory BS that's seeming to become a bigger problem than #covid19,' he wrote.
What happened next?
Sartori’s Facebook post was shared more than 22,000 times. He’s received support from the post, but it has also attracted conspiracy theorists. 'I've had people asking me if I'm paid by Bill Gates. They think I'm a crisis actor. It shows me how easily people can be manipulated.'
Furthermore, he got this response from one man:
'He just kept pushing and pushing, and he was saying horrible things. He called me a faggot. He said I should die. A whole bunch of horrible, nasty things,' Sartori said. 'And then I found out that he actually works in health care. He works for some organizations that deliver things to my hospital.'
Then there was the case of the nurse who
blocked family members and friends on social media after they began spreading claims about the virus not being real and calling for stay-at-home orders to end. 'I have hidden so many people that my Facebook feed is essentially just ads at this point,' she said.
People who used to come to Swiers for health advice now view her work with suspicion.
At the end of another long shift treating coronavirus patients, Dr. Hadi Halazun opened his Facebook page to find a man insisting to him that 'no one's dying' and that the coronavirus is 'fake news' drummed up by the news media.
Hadi tried to engage and explain his firsthand experience with the virus. In reply, another user insinuated that he wasn't a real doctor, saying pictures from his profile showing him at concerts and music festivals proved it.
'I told them: 'I am a real doctor. There are 200 people in my hospital's ICU,' said Halazun, a cardiologist in New York. 'And they said, 'Give me your credentials.' I engaged with them, and they kicked me off their wall.'
Also,
'These anti-vaccination people were telling me I'm a sheep,' Halazun said. 'Dr. Fauci this, Bill Gates that. And I don't really care what you think about Bill Gates. It doesn't affect me. But it does affect me when they tell me what we're doing is not real and that the hospitals are really empty. It hurts.'
So,
Halazun has since stopped engaging with the trolls on Facebook, some of whom claimed that 'the hospitals are empty' and that the virus was part of a plot to vaccinate or microchip U.S. citizens — just two of the many conspiracy theories that have swirled around the coronavirus.
Essentially these health care professionals attempts to educate the public about the science of pandemic, and the logical measures that could be used to manage them. They were met not just with insults, but with claims their facts were a "hoax," and what they are doing "is not real." These responses to health care professionals represents only some of the disinformation about the coronavirus pandemic now rampant on social media and the internet.
The identity and the motivations of the people propagating this disinformation are unclear. It is known, though, that coronavirus disinformation has been promoted by the Trump administration, its supporters, and President Trump himself (look here). It has also been spread by ideologues, people selling quack cures, and various national governments, including that of Russia (look here).
Patients Refusing to Wear Face Masks in Medical Facilities
The attacks on the evidence and logic used by health care professionals to educate the public and patients about the coronavirus pandemic are now shading into direct attacks on the professionals and their patients.
A urologist in Florida, who requested anonymity because of fear of losing his job, tells Vox he had his first patient refuse to wear a mask on May 13. The doctor works at a private clinic, which recently instituted a policy requiring all patients to wear a mask while in the building to minimize transmission of the virus. The patient was given a mask at the front desk, but refused to put it on.
'The nurse asked him to put his mask on if he wanted to be seen,' the urologist said. 'He got verbally aggressive with her, saying he had a right not to wear a mask, and that we were denying his constitutional rights.' The clinic manager was summoned to speak with the patient, and explained that the mask was to protect both him and the medical staff. 'He continued to refuse, so the administration asked him to leave.'
At that point, the patient called 911 to complain he was being denied medical care. 'We’re a private property, not an emergency room,' the urologist said. 'We’re not required to treat him, and he was not having an acute emergency. I think he just had a very poor understanding of what his rights were.'
The dispatcher declined to send an officer to the scene, but the clinic then called the police. 'He ended up walking out of the building before the cops showed up.'
Note that the US Constitution is about the roles and limitations of the
US government, not about how private organizations manage their
affairs.
There have been other examples:
The patient was 'ranting and raving,' she says. 'He said he had been trying to get it and hadn’t caught it, so he didn’t think he needed to wear a mask. I wish I could be that confident and willing to take everyone in this building’s lives into my hands.'
Despite his refusal to don a mask, the patient was cared for, although staff wore gowns and masks as if he had Covid-19.
And this:
Ryan Shannon, an ER doctor in Florida, describes a patient refusing to wear a mask, even though she was in a room next to an immunocompromised person at high risk of severe Covid-19 illness and death. 'She refused, threw the mask on the floor, and proceeded to berate myself and my staff for being a part of the ‘conspiracy and hoax’ that is Covid-19,' he wrote in a May 11 Facebook post.
After the patient’s refusal to follow guidelines, her husband insisted on sitting in the part of the waiting room designated for patients with respiratory complaints like Covid-19, instead of in his car as he was instructed.
And this:
Sue Krohn-Taylor is an administrator at a 72-apartment low-income senior living facility in the large town of Grand Island, Nebraska, where a resident has tested positive for Covid-19. She says she’s been battling some residents who refuse to wear masks, and is exhausted.
'This week, the son of one of the residents told me I was taking away their liberties by making them wear a mask in the common areas,' she says. 'If they were only harming themselves, I would back off, but they are placing each and every resident here, and my staff, and our families in harm’s way.'
'I can fight the virus, but fighting the lies is what becomes overwhelming,' she says.
Now it is patients who call straightforward epidemiology a "hoax." Not only do some patients vilify health care professionals who profess evidence and logic about the coronavirus pandemic, but now they physically resist logical measures to suppress the pandemic. Who might be encouraging them who has a vested interest in ... people not wearing masks?
Once again, the question may have a political answer. As we discussed here, President Trump has repeatedly refused to wear a mask in public, as have other members of his administration. This behavior went against the recommendations of the Centers for Disease Control and Prevention (CDC). The reasons he has publicly subverted his own administration's experts'
recommendations is not clear, but in the post above, we noted an AP news story on May 7, 2020
Trump has told advisers that he believes wearing one [a mask] would 'send the wrong message,'
according to one administration and two campaign officials not
authorized to publicly discuss private conversations. The president said
doing so would make it seem like he is preoccupied with health instead of focused on reopening the nation’s economy — which his aides believe is the key to his reelection chances.
Now others are imitating
his behavior in a way that threatens health care professionals and other
patients. Once again, health care professionals seeking to protect their patients' and their own safety have fallen afoul of the vested political interests of those in control of the executive branch of the US government.
Trump Campaign Tries to Line Up Physician Cadre to Parrot His Views
Not only has President Trump exhibited hostility to health care professionals who contradict his magical thinking about the coronavirus, his campaign is trying to develop a cadre of physicians willing to parrot his message, and discredit any messages from health care professionals seen as competing with his. The campaign is looking for physicians willing to amplify the message that "2+2=5"
Republican political operatives are recruiting 'extremely pro-Trump' doctors to go on television to prescribe reviving the U.S. economy as quickly as possible, without waiting to meet safety benchmarks proposed by the federal Centers for Disease Control and Prevention to slow the spread of the new coronavirus.
The plan was discussed in a May 11 conference call with a senior staffer for the Trump reelection campaign organized by CNP Action, an affiliate of the GOP-aligned Council for National Policy. A leaked recording of the hourlong call was provided to The Associated Press by the Center for Media and Democracy, a progressive watchdog group.
CNP Action is part of the Save Our Country Coalition, an alliance of conservative think tanks and political committees formed in late April to end state lockdowns implemented in response to the pandemic. Other members of the coalition include the FreedomWorks Foundation, the American Legislative Exchange Council and Tea Party Patriots.
A resurgent economy is seen as critical to boosting President Donald Trump’s reelection hopes and has become a growing focus of the White House coronavirus task force led by Vice President Mike Pence.
Tim Murtaugh, the Trump campaign communications director, confirmed to AP that an effort to recruit doctors to publicly support the president is underway, but declined to say when the initiative would be rolled out.
The implied goal is to find physicians who will uncritically accept the word of Donald J Trump
Murtaugh said the campaign is not concerned about contradicting government experts.
'Our job at the campaign is to reflect President Trump’s point of view,' Murtaugh said. 'We are his campaign. There is no difference between us and him.'
So this an effort to use tame physicians to cloak in their white coats Trump's political agenda which contradicts CDC pandemic management recommendations. It is apparently meant to undercut any arguments about the potential public health effects of premature "reopening" of the economy. The AP interviewed Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University’s Mailman School of Public Health as saying:
having doctors relay contradictory information on behalf of the president is 'quite alarming.'
'I find it totally irresponsible to have physicians who are touting some information that’s not anchored in evidence and not anchored in science,' El-Sadr said. 'What often creates confusion is the many voices that are out there, and many of those voices do have a political interest, which is the hugely dangerous situation we are at now.'
The Trump campaign seems to want to specifically minimize the danger of COVID-19 infection. AP talked to Matt Schlapp,"chairman of the American Conservative Union, which hosts the annual Conservative Political Action Conference attended by conservative luminaries," who participated in the call:
It’s important to get the message out there that most people recover from corona. Most people are not in mortal danger with corona and that we can safely open up the economy.
However, this contradicts well known data, for example
As of Tuesday, more than 1.5 million Americans had tested positive for COVID-19, with more than 91,000 deaths reported nationwide.
The effort to develop a cadre of physicians who uncritically accept the word of Trump already seems to be underway. As The Hill Reported on May 21, 2020,
More than 600 physicians signed a letter organized in part by a conservative group that warns President Trump against a lengthy economic shutdown because of the coronavirus.
The doctors call such closures a "mass casualty" event.
The letter was spearheaded by Simone Gold, a California emergency medical specialist. Jenny Beth Martin, the cofounder of Tea Party Patriots, helped organize the letter and get it to the White House.
It was released as the Trump campaign has been actively soliciting the support of pro-Trump physicians, according to The Associated Press.
Note that the Tea Party Patriots is one of the right-wing political organizations
that has tried to line up a cadre of physicians who uncritically
"reflect President Trump's point of view." It has also been an
organizer of the "reopen" protests, including those in which included
the vilification of health care professionals who tried to
counter-protest in support of social distancing and other pandemic
control measures, and to warn of disease resurgence were reopening
rushed (look here).
The Hill stated that the first author of the letter, Dr Gold
said
in an interview with The Hill she doesn't want to be seen as political,
and is merely concerned about the negative medical impacts of the
shutdown. Gold described it as a 'grassroots' effort and rejected
characterizations of it as a 'political movement.'
However, the AP article noted that Dr Gold
is listed as a member of the Save Our Country Coalition on the group’s website. She has recently appeared on conservative talk radio and podcast programs to advocate for the use of hydroxychloroquine, an anti-malaria drug that Trump says he is taking because he believes it can prevent COVID-19 even though his own administration has warned it can have deadly side effects. Gold said she has prescribed the drug to two of her patients with good results.
The Food and Drug Administration warned health professionals last month that the drug should not be used to treat COVID-19 outside of hospital or research settings due to sometimes fatal side effects.
Also,
Gold told AP on Tuesday she started speaking out against shelter-in-place and other infection control measures because there was 'no scientific basis that the average American should be concerned' about COVID-19. Like the president, she is advocating for a fast reopening, and argues that because the majority of deaths so far have been the elderly and people with preexisting conditions, younger people should be working.
One wonders why a physician who
is not "political" would choose to do such interviews. One also wonders
why she has been advocating for for hydroxychloroquine in the absence
of any clear evidence that it does more good than harm for patients with
COVID-19? One further wonders where she found "scientific basis" to say the average person should not be "concerned" about the pandemic?
So the Trump campaign, in league with a group that sponsored "reopen" protests, is cultivating a group of pet physicians who are happy to "reflect" the word of Donald J Trump, even when the word is the epidemiological equivalent of "2+2=5".
Discussion
As we said before, many dooctors and other health care professionals traditionally have not
been very interested in health policy, and often have avoided activism,
much less any appearance of partisanship. Pushed by the suffering of
COVID-19 patients and their own vulnerability in the pandemic, many have
tried to educate the public about the need to suppress the pandemic
through social distancing and various physical measures.
This has given some an impetus to protest unsafe conditions in health care facilities (look here),
and to try to educate "reopening" protesters about the medical and
public health risks of premature efforts to decrease the economic
effects of the pandemic (look here).
Yet that put them in uncomfortable positions. Hospital managers did
not appreciate their protesting when it put management in a bad light.
Some "reopening" protesters responded to their educational
counter-protesting with anger and vilification. Now extreme political interests, specifically including President Trump and his supporters have targeted health care professionals whose educational efforts might undercut Trump's message of triumph over the pandemic resulting in a "transition to greatness." Thus, while health care professionals have sought to educate about the facts and logic of an epidemiological approach to pandemic management, the Trump administration has contradicted obvious truths, and proclaimed delusional solutions.
The health care professionals have been saying the equivalent of "2+2=4" when the country's leadership proclaims its power to say "2+2=5" Whether health care professionals like it or not, Trump and company have
turned health care education, and science-based reasoning, into political acts.
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?"
1931 Soviet propaganda poster by Yakov Guminer, via WikiMedia
Under cover of a pandemic, managers and executives of hospitals, hospital systems, and other organizations that provide direct patient care are trying to silence health care professionals who point out leadership's failings. We have seen a distressing parade of whistle-blowers intimidated and punished.
On March 25, an article in Medscape stated the basic problem.Per an anonymous orthopedic surgeon:
'It’s very
clear; no one is allowed to speak for the institution or of the
institution,' he said in an interview. 'We get a daily warning about
being very prudent about posts on personal accounts. They’ve talked
about this with respect to various issues: case numbers, case severity,
testing availability, [and] PPEs.'
This clearly is not rare.
The
silencing of physicians by hospitals about PPE shortages and other
COVID-19 issues has become widespread, said Nisha Mehta, MD, a physician
advocate and community leader who writes about PPE on social media.
Physicians are being warned not to speak or post publicly about their
COVID-19 experiences, including PPE shortages, case specifics, and the
percentage of full hospital beds, Dr. Mehta said in an interview. In
some cases, physicians who have posted have been forced to take down the
posts or have faced retribution for speaking out, she said.
'There’s
definitely a big fear among physicians, particularly employed
physicians, in terms of what the consequences may be for telling their
stories,' Dr. Mehta said. 'I find that counterproductive. I understand
not inducing panic, but these are real stories that are important for
people to understand so they do stay home and increase the systemic
pressure to get sufficient PPE, so that we can preserve our health care
workforce for a problem that is going to get worse before it gets
better.'
Here is our round-up of specific cases, in the order that they came to light
Three Cases, Two Anonymous of the Silencing of Health Care Professionals who Blew the Whistle about Coronavirus Safety Issues
The Medscape article included:
an Indiana hospitalist who took to social media to ask for masks for hospitals in his area says he was immediately reprimanded by his management after the posts came to light.
Another frontline physician who works at a large New York hospital, said staff have been cautioned not to talk with the media and to be careful what they post on social media regarding COVID-19. The general rule is that only information approved by administrators can be shared
The Medscape article also detailed this case:
[a] nurse, Lauri Mazurkiewicz, sent an email to staffers at Northwestern Memorial Hospital stating the surgical masks provided by the hospital were less effective against airborne particles than were N95 masks, according to a lawsuit filed March 23 in Cook County Circuit Court. Ms. Mazurkiewicz was terminated the next day in retaliation for her email, the lawsuit alleges.
In the short time since that article was published, more specific, and egregious examples have appeared
Emergency Physician Employed by TeamHealth, Owned by Private Equity Firm Blackstone, Fired at the Behest of PeaceHealth for "Inciting Public Fear"
Dr. Ming Lin worked at PeaceHealth St. Joseph Medical Center for 17 years until he was removed on Friday by TeamHealth, a national staffing firm under contract to provide the hospital’s emergency department personnel. Lin became a national avatar for frustrated health care professionals during the COVID-19 outbreak by speaking up in the press and on social media with pleas for more medical supplies and stronger standards to protect health care workers combating the virus.
On March 16, Lin posted a letter on Facebook he’d sent to PeaceHealth St. Joseph’s chief medical officer, outlining how the hospital was mismanaging patient COVID-19 testing and exposing health care personnel and patients to unnecessary risks. He decried the hospital’s internal bureaucracy that prevented some doctors from ordering coronavirus tests, including a 'ludicrous' requirement that a flu test be completed before providing patients coronavirus screenings. Lin also criticized the hospital’s lack of a triage tent outside the emergency room to screen and test patients, to limit exposure of other patients and staff to potential infection.
'PeaceHealth is so far behind when it comes to protecting patients and the community, but even worse when it comes to protecting the staff,' Lin’s letter said.
The hospital's immediate response was to ask Dr Lin to "retract" or "recant" what he said. When he refused, first
TeamHealth said Lin technically was not fired and remains employed by the company, but will no longer work at PeaceHealth St. Joseph Medical Center. A PeaceHealth St. Joseph spokesman on Friday confirmed Lin’s termination but declined to comment further because Lin was not directly employed by the hospital.
Note that:
TeamHealth was acquired by the Blackstone Group, a private equity firm, in 2016 for $6 billion. Since then, the company came under fire for a pattern of suing uninsured and low-income patients who were unable to pay their medical bills, but discontinued the practice after it gained public attention in the news.
An April 6, 2020 article in the Seattle Times disclosed the hospital's rationale for firing Dr Lin
Richard DeCarlo, chief operating officer of PeaceHealth, which operates Bellingham’s St. Joseph Medical Center, likened Lin’s public warnings about workplace coronavirus concerns to 'yelling fire in a crowded theater.'
that is,
allegedly inciting public fear by criticizing the hospital’s emergency precautions.
thus begging the question of what it was the public might fear. Perhaps he was afraid they would fear going to his hospital, thus suppressing its revenues?
Note further that Mr DeCarlo, according to his official PeaceHealth biography, has no apparent experience of expertise in medicine, health care, or public health. The CEO apparently is a registered dietitian with no recent experience in medicine, health care, or public health.
NYU Langone Health Threatens to Fire Physicians who Talk to Press Without Authorization
The Wall Street Journal reported on March 31, 2020 that after the head of the Department of Emergency Medicine at NYU Langone sent a message to physicians implying that they should consider withholding ventilators from some critically ill patients, the physicians
also got got a reminder not to speak to news reporters without permission from NYU Langone's Office of Communications and Marketing.
Kathy Lewis, executive vice president for communications and marketing, said in an email that NYU Langone's longstanding policy required faculty, residents and staff to forward all media inquiries to her.
'Anyone who does not adhere to this policy, or who speaks or disseminates information to the media without explicit permission of the Office of Communication and Marketing, will be subject to disciplinary action, including termination,' Ms Lewis wrote.
free speech and academic freedom do not become less important during a crisis, and that it’s critical that faculty members — many of them serving on the front lines of the pandemic — be able to share information with the broader public.
'It is precisely in times of crisis that it is most important that lines of communication to the public be open,' said Robert Shibley, FIRE’s executive director. 'These faculty members are there because they’re the experts. Inhibiting their ability to communicate important information about COVID-19 presents enormous risks.'
Consider also the source of the threat. Note that according to her official bio,
Kathy Lewis, executive vice president for communications and marketing, is responsible for the advancement of NYU Langone Health’s unique brand identity as one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education.
Furthermore, Ms Lewis' qualifications to threaten physicians with termination appear to be limited to:
a BA from Montclair State University and an MA from Seton Hall University.
So the implication is that even in the midst of a deadly pandemic, the managers running NYU Langone think upholding the organization's brand identity comes before transparency and honest communication.
Note that this is not the first time Langone has put its brand identity ahead of transparency about disaster preparedness. Back in 2012, after the medical center suffered a blackout and other problems due to super-storm Sandy, its board chairman, Mr Kenneth Langone, whose name the medical center carries, vociferously tried to avoid institutional accountability for poor disaster planning (look here.) Mr Langone, a founder of Home Depot, who as described here had previously boasted
Other New York Hospitals Warn Health Care Professionals Not to Talk to Journalists
On April 1, 2020, Politico reported
As hospitals across New York City are filling up with patients gasping for air, health care executives are slapping gag orders on their workers to control the narrative amid the coronavirus pandemic.
Specific instances were:
Northwell Health recently sent medical professionals an email informing them all interviews with news media must first be cleared through the public relations department, a hospital employee told POLITICO.
Also,
Mount Sinai distributed its own set of guidelines discouraging speaking to the press and dictating social media policies as more health care professionals stepped forward to report problems in their hospitals. The guidance coincided with images shared on social media of employees wearing trash bags over their regular gear — an alarming picture from inside one of New York City’s premier and deep-pocketed health systems that has shaped public opinion of the shortage of personal protective equipment.
The email did not contain any reference to the ongoing pandemic or disciplinary action that could be taken, though some employees said the threat is present.
'I am very afraid I would be fired for [sharing the guidance with a reporter], which just makes me think they are more afraid of their image than actually having the patients cared for,' said one employee, who requested anonymity for fear of retaliation. 'I am a valuable asset, yet the fact that I am speaking up for my patients, colleagues and myself would have me terminated is not okay. It is an injustice that they overrule us with fear.'
'Do not respond or speak to any reporters, as well as current or former employees, regarding a pending news story,' wrote David A. Feinberg, the chief marketing and communications officer at the Mount Sinai Health System, in an email to all faculty and students on March 26.
In response,
health care workers on a coronavirus task force at Mount Sinai said they are demanding 'zero tolerance of employer retaliation or threats against those who are speaking up,' in a letter distributed among staffers and obtained by POLITICO.
Finally,
Eleven medical professionals across various health systems in New York City told POLITICO they signed nondisclosure agreements, had contracts that stipulated they not speak with the press without consent from their employer or feared losing their jobs if they spoke out publicly.
Mississippi Physicians Fired After Speaking Out
Health care professionals outside of states with the highest current coronavirus prevalence are not necessarily protected from punishment if they speak out. On April 5, 2020, Mississippi Today reported:
An Oxford doctor is one of at least two Mississippi physicians claiming they were terminated for speaking out about their employers’ safety measures during the coronavirus pandemic.
Dr. Samantha Houston says she lost her job of four years at Baptist Memorial Hospital-North in late March for 'disruptive' behavior. In the weeks prior, Houston, a hospitalist, used Facebook to organize a local donation drive for masks and baby monitors so that hospital staff could cut down on face-to-face interactions with patients.
Houston, 34, also says she sent several emails to colleagues raising concerns about the availability of personal protective equipment, or PPE, for some workers.
'Every idea I had was just shut down and dismissed, and I just got very frustrated,' Houston told Mississippi Today. 'I just feel like they were not advocating for our safety, and that was what was so frustrating for me. And it really wasn’t even my safety. I felt safe enough because I had an N95 mask and I was able to get in there, but I felt like the nurses were not as safe.'
Also
Dr. Jennifer Bryan, who chairs the Mississippi State Medical Association board of trustees, told Mississippi Today that she knows of at least one other doctor in the state who was also fired for advocating for stronger safety measures.
A Los Angeles and Another New York Health Professional Punished
'They’re very protective of their reputation in the community,' said Jhonna Porter, a nurse who was suspended from West Hills Hospital in Los Angeles after raising safety concerns in a private Facebook group and publicly on her own page, including appeals for equipment. 'If anything seems like it might make them look bad, they’re going to stomp on it quick.'
And,
A doctor at Lincoln Medical and Mental Health Center in the Bronx, Deena Elkafrawi, was reprimanded after the British publication Metro quoted her as saying, 'I am scared that going to work could kill me,' according to the Committee of Interns and Residents, a national association that represented her.
Reactions to Silencing Health Care Professionals
Physicians Societies
Two physicians' societies have condemned hospital managers threatening or punishing health care professionals who spoke out about problems with hospitals' responses to the coronavirus pandemic. Per an April 4, 2020 Medscape article,
'Physicians have a professional and ethical responsibility and need to be able to speak out on these types of issues,' Robert McLean, MD, president of the American College of Physicians, told Medscape Medical News
The ACP is one of several professional organizations that have come out against attempts to silence physicians in recent days. Earlier this week, the ACP released a statement supporting physicians who shared concerns about their workplace conditions and lack of adequate PPE, while also rebuking attempts by hospital systems to silence clinician complaints or activism.
'We as a college felt the need to speak out about that and indicate that this is completely wrong,' said McLean. 'Physicians who are speaking out to make people aware of issues of public health and of public health concern should not be at risk of having their employment terminated or otherwise disciplined.'
According to the ACP's ethics policy, physicians who are able should speak out about public health issues for their safety and the safety of their patients, he said. 'The benefit to patients is that problems are identified and not swept under the rug.'
On Wednesday, the American Medical Association (AMA) also put out a short statement in support of physicians' right to advocate for their patients in the current climate:
'In recent weeks, as physicians have battled the COVID-19 pandemic, the question of when and how to express concern about conditions and safety has become a flashpoint for physicians and their hospital employers.'
The hospital managers trade association responded by minimizing the problem.
When contacted by Medscape Medical News to comment on these reports, the American Hospital Association (AHA) referred to a letter sent by AHA President and CEO Richard Pollack on March 27 to the consumer advocacy group Public Citizen, in response to a complaint filed by the group on behalf of themselves and 54 other organizations.
'Outside of the anecdotal reports you shared, the AHA has not heard any reports of hospitals or health systems restricting the free speech of physicians, nurses, or others regarding the conditions related to COVID-19,' the letter reads.
I wonder if the AHA is now aware of all the cases listed above?
Frontline Health Care Professionals
An April 9, 2020, article in StatNews discussed widespread anger among health care professionals over responses to coronavirus from health care leaders, including local and national government leaders, but also hospital leadership. In particular,
Among the physicians, there’s a growing fear that they’ll face repercussions if they speak out.
Specifically,
'The thought of being fired right now, when my patients need me the most, is even more terrifying than the idea of potentially getting ill from Covid-19,' the Los Angeles primary care physician said.
Whistleblower International Network
The Whistleblower International Network (WIN) wrote a protest letter saying the coronavirus pandemic has led to "the largest attack on whistleblower in the world."
Coronavirus whistleblowers have been exposing inadequate health system capacity and delivery, public procurement problems, violations of health and safety and labor law, inequitable and ill-prepared global supply chains, unfair competition practices and market abuses, and large-scale violations of personal privacy rights. Employers and public authorities have responded to many of the doctors, scientists, and other frontline workers who told the truth by firing them. In countries like the US, UK, and Italy, such termination of employment is illegal whistleblower retaliation, but that hasn’t stopped employers. Other countries such as China, India, and Poland, employees don’t have any whistleblower rights on paper at all. In either scenario, employer retaliation chills others from engaging in public interest speech, which serves the overall mission of preventing the truth from getting to the community. The act of keeping the truth from the public during a pandemic is gross negligence, which is the deliberate and reckless disregard for the safety and reasonable treatment of others. Every time a whistleblower is retaliated against, the public’s rights are being trampled on too. Indeed, we are all victims in the wake of the largest attack on whistleblowers in the world.
The letter concluded:
Suppressing the truth is a clear and present danger to public health and safety that could turn the pandemic into a modern Black Plague. Employers and governments are silencing their early warning systems, but the effect is trans-national. The outrage must be as well.
Why Are Hospital Managers So Quick to Silence Health Care Professionals?
Thus threats against physicians and other health care professionals who
blow the whistle about patient care and safety issues, and dangers to
health care professionals in the era of the coronavirus pandemic are
likely to continue.
In medicine and health care, there is a long and sorry history of management trying to silence whistle-blowers who might put the leadership in a bad light. As noted in the March 25 Medscape article,
John Mandrola, MD, a Louisville, Ky.–based cardiologist who has written about the recent muzzling of frontline physicians with respect to the coronavirus, said he is not surprised that some hospitals are preventing physicians from sharing their experience
'Before C19, in many hospital systems, there was a culture of fear amongst employed clinicians,' he said. 'Employed clinicians see other employed physicians being terminated for speaking frankly about problems. It takes scant few of these cases to create a culture of silence.'
We have been posting about problems with management and governance in health care for a long time. Some of these problems seem to be grossly manifest in cases in which whistleblowers were threatened or punished to inspire silence, and may explain why the practice continues even in a time of pandemic.
In some cases above, the executives threatening to silence health care professionals were themselves not health care professionals, and seemed to have no direct medical, health care, or public health care experience. In two cases, executives in charge of communications or marketing intimidated professionals to secure their silence. This implicates managerialism as a source of the problem.
Per an article from the June, 2015 issue of the Medical
Journal of Australia (look here):
- businesses of all types are now largely run by generic managers,
trained in management but not necessarily knowledgeable about the
details of the particular firm's business
- this change was motivated by neoliberalism (also known as economism or market fundamentalism)
- managerialism now affects all kinds of organizations, including health care, educational and scientific organizations
- managerialism makes short-term revenue the first priority of all organizations
- managerialism undermines the health care mission and the values of health care professionals
Such generic managers, who have sworn no oaths to put patient care ahead of all other concerns, may have few qualms about silencing whistle-blowers to protect their organizations' and their own reputations.
Putting Revenue Ahead of Patients' and Health Care Professionals' Safety
In several cases, hospital management seemed more concerned about loss of patients and revenue resulting from degradation of their hospitals' brand identity or reputation than about patients' and professionals' safety.
As noted above, managers of hospitals are increasingly from business, not health care backgrounds. Whatever their background, they seem more likely to be influenced by currently fashionable management dogma. A dominant dogma in management is that pursuit of shareholder value comes before all else. Even though many, but not all hospitals are still ostensibly non-profit, many hospital managers have likely been influenced by this dogma. As we posted here, quoting Lazonick:
in 1983, two financial economists, Eugene Fama of the University of
Chicago and Michael Jensen of the University of Rochester, co-authored
two articles in the Journal of Law and Economics which extolled
corporate honchos who focused on 'maximizing shareholder value' — by
which they meant using corporate resources to boost stock prices,
however short the time-frame. In 1985 Jensen landed a higher
profile pulpit at Harvard Business School. Soon, shareholder-value
ideology became the mantra of thousands of MBA students who were
unleashed in the corporate world.
Lazonick added:
When the shareholder-value mantra becomes the main focus, executives
concentrate on avoiding taxes for the sake of higher profits, and they don’t think twice about permanently axing workers.
They increase distributions of corporate cash to shareholders in the
forms of dividends and, even more prominently, stock buybacks. When a
corporation becomes financialized, the top executives no longer concern themselves with investing in the productive capabilities of employees, the foundation for rising living standards for all. They become focused instead on generating financial profits
So many hospital managers may have no qualms about punishing whistle-blowers to protect their organizations' revenues.
What Needs to Be Done?
In the short run, we must do all we can to protect health care professional whistleblowers, as suggested by the Whistleblower International Network above.
In the long run, hopefully assuming there is one, we further need to address the systemic features of our dysfunctional health care system that enabled the rise of leaders who are happy to silence health care professionals to preserve their organizations' reputations and revenue, no matter what. We need leaders who put patient's and the public's health ahead of all else, and who understand and uphold health care professionals' values. We need hospitals, hospital systems, and other organizations that provide direct patient care that are not responsible for producing profits for their owners or shareholders.
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.
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.
'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
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.
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.
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.
Furthermore,
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 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.'
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.
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.
Summary
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.
