Threats to Democracy Round Up - Selected Topics, Late May, 2023

Influence of Hostile Foreign Powers

We have previously posted lots of words about the anechoic effect: the lack of echoes produced by seemingly important stories about health care dysfunction.  It seemed as if such stories were taboo, presumably because even discussing them was seen as a threat to the rich and powerful who increasingly run health care.  Those involved in the leadership and governance of health care organizations and their cronies also have considerable power to damp down any public discussion that might cause them displeasure. In particular, we have seen how those who attempt to blow the whistle on what really causes health care dysfunction may be persecuted.   

 But as we discussed here, the major issues we discussed prior to 2015 gave way to a new normal with the advent of Trump as a presidential candidate and the MAGA movement as a major force in US politics.  In that 2020 discussion, we noted how the Trump administration acted to squelch discussion of scientific topics that did not fit in with its ideology, despite constitutional guarantees of speech and press free from government control (look here).

Now it appears that the most striking example of the anechoic effect involves discussion of the underlying causes of the anti-democratic turn in the US that threatens the system that permits public discussion, and the possibility of reforming health care dysfunction among other issues.  We continue to see bits of evidence made public about how democracy is threatened by the influence of hostile foreign powers, especially Russia, on US politics, especially elections.  Yet the evidence produces few echoes.

Here are some of the more striking bits of evidence that appeared in just the last two weeks about Russia's malign influence on US democracy.

Russia's Malign Strategy and Tactics

-The April 2023 Indictment for Russian Election Interference and Threats to U.S. Democracy "The Kremlin’s Strategy: Exploiting far left and far right fringes; Exploiting the racial divide; Going local"
https://www.justsecurity.org/86424/the-april-2023-indictment-for-russian-election-interference-and-threats-to-u-s-democracy/

Racism as a National Security Threat "the one big thru-line from the Cold War to today in terms of the  most exploitable vulnerability Russia can weaponize against us:  America’s racial divisions"
https://open.substack.com/pub/asharangappa/p/class-15-racism-as-a-national-security

Evidence of widespread Russian election meddling in other countries: "Kemal Kilicdaroglu, main challenger of Turkish President Tayyip Erdogan,  said ... his party has concrete evidence of Russia's  responsibility for the release of 'deep fake' online content"
https://www.reuters.com/world/middle-east/erdogan-rival-says-has-evidence-russias-online-campaign-ahead-turkey-vote-2023-05-12/

Linkages of Trump and Supporters to Russia

 US Trumpists are increasingly part of a new global fascist axis: "far-right populism of Hungary’s prime minister is helping to inspire  U.S. Republicans' agenda for 2024, a game plan that targets  immigration, LGBTQ rights and... the war in Ukraine"
https://www.axios.com/2023/05/08/gop-hungary-connection-shaping-2024-campaign

Reminder that Trump "is Putin's puppet": He was "repeatedly asked by CNN host Kaitlan Collins if he backed Ukraine in its 15-month conflict with Vladimir Putin’s forces, and repeatedly dodged the question"
https://www.independent.co.uk/news/world/americas/us-politics/putin-ukraine-war-trump-cnn-b2336935.html

Follow the money: Trump Media got financing from Paxum Bank, which "promoted itself...as a way for video streamers of adult content  to coordinate financial transactions across international borders" and is owned by a sketchy Russian businessman
https://www.washingtonpost.com/technology/2023/05/13/trump-truth-social-loan-questions/

[Another Trump-Russia connection?] FBI agents raid condo unit owned by Russians at Trump Towers in Sunny Isles
https://www.miamiherald.com/news/local/article275358451.html

The FBI raided a condo in Trump Tower III in Sunny Isles Beach, FL because its "owner was being arrested... on  charges of illegally selling airplane parts to Russian airline  companies"  
https://www.yahoo.com/lifestyle/days-mysterious-fbi-raid-russians-225454222.html

Putting another Russian asset in the WH: In call to ReAwaken America rally, Trump said he would give Michael Flynn a WH position.  Flynn "entered, then withdrew, a guilty plea of making false statements to the F.B.I" and hung out with Putin in Russia
https://www.thedailybeast.com/trumps-call-in-to-michael-flynns-far-right-roadshow-is-red-meat-for-christian-nationalists

Reminder: "next to Putin at the head table, in the seat of honor, was an American.  Retired Lt. Gen. Michael Flynn, who would later become Donald Trump's  national security adviser"
https://www.nbcnews.com/news/world/guess-who-came-dinner-flynn-putin-n742696

Trump and Supporters' Techniques to Downplay their Connections to Russia: The Durham Investigation 

It was supposed to show how the investigation of Trump/Russia was a witch hunt.  It didn't

Not with a bang.... Trump fans hyped the Durham investigation. Trump fans will likely keep spinning it, but it "delivered underwhelming results... securing a guilty plea from a little-known FBI employee [and] ...losing ...2 criminal cases"
https://apnews.com/article/durham-trump-russia-probe-7e84f94ca9cf7905cbc5eddc108575b3

"Durham’s...report revealed little substantial new information  about the inquiry...failed to  produce the kinds of blockbuster revelations... that...Trump  and his allies suggested Mr. Durham would uncover"
https://www.nytimes.com/2023/05/15/us/politics/trump-russia-investigation-durham.html

"Durham...scolded the F.B.I. but failed to... uncover a politically motivated 'deep state' conspiracy.... charged no  high-level F.B.I. or intelligence official with a crime and acknowledged...Clinton’s 2016 presidential campaign did  nothing prosecutable"
https://www.nytimes.com/2023/05/17/us/politics/durham-report-trump-russia.html

Despite the failure of the Durham investigation to find any important misconduct much less "deep state" politicization of the Trump-Russia investigation, to Trump fans it  "was Watergate times 10, or 100"
https://www.nytimes.com/2023/05/16/us/politics/durham-report-conservative-reaction.html

Russia, Trump and the 2016 election "Russia tried to swing the 2016 election to Trump; FBI had reason to investigate a tip suggesting Trump campaign involvement; Trump campaign welcomed help from Russia:  ‘Steele dossier’ proved to be a red herring"  
https://www.washingtonpost.com/politics/2023/05/17/truth-about-russia-trump-2016-election/

Russian Propaganda and Disinformation

"hate crimes in America are often influenced by online chatter that's  increasingly linked to Russian sites or pro-Russian narratives on more  obscure parts of the internet. The Kremlin doesn't seem to mind"  
https://www.axios.com/2023/05/09/american-extremists-russian-sites-shootings

Conflicts of Interest, Corruption, Crime

Since 2015, we have asked (here) how the US (and the world) can possibly reduce health care corruption, a major cause of global health care dysfunction, under a thoroughly conflicted and corrupt Trump administration.  Since the end of that administration, Trump has campaigned to be president again.  Meanwhile, the evidence of his and his supporters' conflicts of interest, corruption, and criminality continue to grow.  Recent examples include:

Trump's Conflicts, Crimes, and Corruption

Jury finds Trump liable for sexual abuse, awards accuser $5M [When real, reasonable people get to review Trump's conduct while free of his intimidation and bluster they may tend to do so harshly]
https://www.sfgate.com/news/article/jury-to-start-deliberations-in-suit-accusing-18087335.php

"Trump admitted more directly than before on Wednesday that he knowingly  removed government records from the White House and claimed that he was  allowed to take anything he wanted with him as personal records" Confessing to a crime?  
https://www.nytimes.com/2023/05/11/us/politics/trump-documents-white-house.html

He just can't help himself: in his CNN Town Hall appearance, Trump appeared to defame E Jean Carroll again, just days after she won a lawsuit against him for his previous defamation
https://www.nytimes.com/2023/05/11/nyregion/e-jean-carroll-trump-defamation.html

[Even more accusations of sexual misconduct by Trump, even involving his own White House staff] Top aides reveal Trump’s alleged inappropriate conduct towards female staffers
https://www.independent.co.uk/news/world/americas/us-politics/donald-trump-white-house-aides-abuse-b2337881.html

Attacking the rule of law, eve obstruction of justice? - Trump fan politicians go after prosecutors who are investigating or otherwise legally pursuing Trump, including Manhattan DA Bragg, Special Counsel Smith, Fulton County GA DA Willis
https://www.theguardian.com/us-news/2023/may/17/donald-trump-republican-allies-prosecutors-investigations

There is apparently evidence that Trump knew he was committing a crime by walking off with classified presidential records despite his later claims that doing so was legal
https://www.independent.co.uk/news/world/americas/us-politics/trump-mar-a-lago-classified-documents-evidence-b2342010.html

The Conflicts, Crimes and Corruption of Trumpist and/or Far Right Politicians

[Noticing this glaring conflict of interest] Judge to order Wisconsin Elections Commission to reconsider fake elector complaint without the commissioner who joined the scheme
https://www.jsonline.com/story/news/politics/2023/05/08/wisconsin-elections-commission-must-reconsider-fake-elector-case/70195092007/

Are they all sleazy or criminal? Republican "Rep. Bryan Slaton resigned from the Texas House on Monday after an investigation determined that he had an inappropriate sexual relationship with a 19-year-old woman on his staff"  
https://www.chron.com/politics/article/bryan-slaton-pressure-resign-texas-house-18086307.php

TX rep Slaton "proposed banning children from attending drag shows to supposedly shield them from being groomed... resigned after he was found to have engaged in inappopriate sexual  conduct with a 19-year-old intern" Fake morality of the culture warriors
https://www.theguardian.com/us-news/2023/may/09/republican-drag-shows-danger-for-kids-resigns-misconduct-intern

[Again, are they all crooks?] Rep Santos [(R-NY) is accused of using illicit campaign contributions for personal expenses "indictment accusing him of wire fraud, money laundering,  stealing public funds and lying in federal disclosure forms"
https://www.nytimes.com/live/2023/05/10/nyregion/george-santos-charges-news/santos-had-been-under-investigation-for-his-campaign-finances-and-other-activities

Rep George Santos confesses to theft in Brazil to avoid prosecution
https://www.washingtonpost.com/world/2023/05/11/george-santos-brazil-case-theft/

Follow the money: "conservative operatives using sophisticated robocalls raised  millions of dollars from donors using pro-police and pro-veteran  messages....  nearly all the  money went to pay the firms making the calls and the operatives  themselves"
https://www.nytimes.com/interactive/2023/05/14/us/politics/scam-robocalls-donations-policing-veterans.html

[And now reports of sexual misconduct by Trump's lawyer Giuliani] Rudy Giuliani accused of sexual harassment by ex-employee
https://www.bbc.com/news/world-us-canada-65606131

[Are they all thugs, if not crooks?- Louisiana] GOP Rep Clay Higgins filmed shoving activist who questioned Lauren Boebert’s divorce
https://www.independent.co.uk/news/world/americas/us-politics/clay-higgins-shoved-activist-laren-boebert-b2341682.html

Propaganda, Disinformation, Deception

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).

But back in the day, the notion of propaganda and disinformation as a real threat to health care, much less our democratic process and society as a whole, was pretty radical.  That was then.  By 2019 we were writing about a  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.

 It is important to better understand the techniques of the propagandists and disinformationists, so:

Propagandists' and Disinformationists' Toolbox

Reflexive control "Using the name scholars have given to this area of research to  frame the debate baits Rufo’s opponents into arguing about what CRT is and isn’t, which... keeps the exact three words he wants (and  their attendant connotations) in circulation"  
https://open.substack.com/pub/asharangappa/p/erasing-memory

"How can we really engage in these conversations, when the tension is  there before you even pick up the book and open the topic?" [It's hard to  have a rational argument when fanatics are screaming at you]
https://www.axios.com/2023/05/04/us-history-test-results-civics-covid

The Flood the Zone with BS Technique:
[The old-time fast talking snake oil salesman in the internet age] Donald Trump steamrolls CNN’s town hall [It's easier to lie than to rebut a lie.  If someone lies very quickly, you can't respond in real time]
https://www.washingtonpost.com/opinions/2023/05/10/cnn-trump-town-hall-lies/

'"You can’t keep saying that all night long'....[so one]  can rebut him, correct him, interrupt him and otherwise battle with him  over every point, but that’s no match for ceaseless mendacity....'We don’t have time to fact-check every lie'"
https://www.washingtonpost.com/opinions/2023/05/10/cnn-trump-town-hall-lies/

It's the old Steve Bannon (and Russian) tactic: flood the zone with BS. "CNN hasn’t figured this thing out, and it’s a good bet its competitors have no better ideas" It's clear society needs a better solution to the flood the zone tactic.
https://www.washingtonpost.com/opinions/2023/05/10/cnn-trump-town-hall-lies/

"fear is weaponized even more than hate by leaders who seek to spark violence. Hate is often part of the equation...but fear is  almost always the key ingredient when people feel they must lash out to  defend themselves.
https://www.nytimes.com/2023/05/06/opinion/fear-speech-social-media.html

Ways to Combat Propaganda and Disinformation

Ending false equivalence in choice of editorial voices: "will the  newspaper raise the bar for those local or syndicated [supposedly conservative] voices — i.e.,  requiring the commentary to actually engage in a truthful semblance of a  given issue?
https://www.sltrib.com/opinion/commentary/2023/05/08/commentary-will-we-see-honest/

How the media can cover Trump better this time "Focus on 'the stakes' of the 2024 election, not 'the odds'; Explain Trump’s probable agenda;  Don’t make getting access to Republican politicians or projecting 'neutrality and 'objectivity' a main goal"
https://www.washingtonpost.com/opinions/2023/05/09/trump-2024-cnn-town-hall-media-coverage/

Christian Nationalism Threatens Health Care Professionals, Medicine, Health Care, and Public Health

Much of the "culture war" is about attacking particular patient groups (eg, transgender patients, women seeking abortions, needing birth control or care for such conditions as ectopic pregnancy and miscarriage) and the health care professionals who care for them, or about attacking public health professionals (eg, those involved in pandemic policy) or creating phony public health problems, eg, pornography.

Furthermore, while these attacks are often framed in a biomedical, health care or public health context, the motivation behind them seems to come from extreme sectarianism, particularly Christian nationalism.

Leaked data on right-wing physicians group shows its support of extreme sectarian religious beliefs, recruiting "doctors and medical school students seen as holding Christian views," returning US to a time when "evangelical Christian beliefs" were favored
https://www.wired.com/story/american-college-pediatricians-google-drive-leak/

The state's near-total abortion ban is forcing providers to leave the state "she had to tell a patient that her  pregnancy had a significant fetal abnormality.... her hands were tied. She  couldn’t offer any more care- they had to go elsewhere"
https://www.huffpost.com/entry/idaho-abortion-ban-crisis_n_6446c837e4b011a819c2f792

[Attempting intimidation for taking care of patients] Texas AG Ken Paxton probing Austin children’s hospital [but] "It’s not clear what law Paxton believes Dell Children’s has broken;  Texas does not currently have age limits on gender-affirming care"
https://www.texastribune.org/2023/05/05/ken-paxton-trans-care-investigation-dell-childrens/

Fearing legal repercussions, doctors in Texas say they are risking grave patient harm to comply with new abortion restrictions [abortion bans'  adverse effects:  Extreme sectarian based medicine hurts patients]  
https://www.newyorker.com/news/dispatch/in-the-post-roe-era-letting-pregnant-patients-get-sicker-by-design

Reminder that movement against abortion imposes extreme sectarian religious beliefs on those of other faiths: "Jewish law dating back to the Torah has established that abortion is not murder."
https://www.charlotteobserver.com/opinion/article275261916.html

Confluence of far-right politics and health care nonsense: After DeSantis' coup, New College will host Dr Scott Atlas as commencement speaker. He was a  member of the Trump administration who promoted herd immunity as solution to COVID
https://www.tampabay.com/news/education/2023/05/09/new-college-picks-trump-covid-adviser-scott-atlas-commencement-speaker/

[How sectarianism and superstition creeps into public health] Ladapo's wife who "studied traditional naturopathy, plant and herbal medicine, and shamanism" convinced Ladapo to go to  counseling that that caused him to believe he was following "God’s plan"  
https://www.orlandosentinel.com/2023/05/13/joseph-ladapo-says-anti-vaccine-crusade-was-gods-plan-it-cost-him-his-peers-trust-2/

[More threats to health care] Abortion Clinics Are Dealing with More Arson, Stalking, and Anthrax Threats Now-  Abortion providers feared they’d see an increase in harassment and threats if Roe v Wade was overturned. They were right.
https://www.vice.com/en/article/v7bday/rise-in-abortion-clinic-harassment-after-roe

[Turning sexual hangups into policy? Theocrats go after porn as a public health threat, and...] There’s ‘nothing more timid’ than a man watching porn, Josh Hawley says "There is no risk involved, no exposure to hardship or danger in the least" Promoting sex and relationships that are risky, difficult, dangerous?
https://www.kansascity.com/news/politics-government/article275458201.html

KS Republican county chair says LGBTQ friendly pastors "signed a contract with Satan," plans to "make it hostile to that group of people...small sliver of society...have them move elsewhere, that does a huge amount to shut this  down,”
https://themercury.com/news/republicans-revel-in-divine-plan-to-turn-kansas-into-conservative-sanctuary/article_4a9bbd54-a6fd-5d05-b06f-41785cf4eff6.html

Apparently afraid of prosecution under anti-abortion laws, doctors told patient threatened with a miscarriage "at high risk of life-threatening complications" they could do nothing.  Violating law requiring hospitals to treat patients in emergencies?
So anti-abortion laws make doctors damned if they do (abort pregnancy for patient facing high risk of severe complications) and damned if they don't (by failing to provide emergent care).
https://www.propublica.org/article/two-hospitals-denied-abortion-miscarrying-patient-breaking-federal-law

[More physicians driven away by bans on caring for patients demonized by sectarian extremists] Austin doctors who treated trans kids leaving Dell Children’s clinic after AG Paxton announces investigation
https://www.chron.com/news/houston-texas/article/talk-investigation-forces-tx-doctors-treat-trans-18098101.php

After quacky COVID herd immunity proponent and former Trump administration staffer Dr Scott Atlas invited to speak at DeSantis transformed New College commencement, students raise money to support alternative event
https://wusfnews.wusf.usf.edu/education/2023-05-10/with-former-trump-appointee-speaking-at-their-graduation-new-college-students-plan-alternative-commencement

Doctors forced out by laws restricting treatment of patients with pregnancy complications pushed by extreme sectarians: "Doctors... fleeing the state due to new abortion restrictions....[fearing] 'Being tried as a felon simply for saving someone’s life'"  
https://www.cnn.com/2023/05/13/us/idaho-abortion-doctors-drain

[Reminder: laws based on extreme sectarian religious views impose them on those of other faiths, and harm doctors and patients] Texas doctors depart as attorney general investigates hospital’s gender-affirming care
https://www.theguardian.com/us-news/2023/may/18/texas-hospital-inquiry-doctor-exodus

Follow the Money: Who Funds Attacks on Democracy

It's not just Russia and hostile foreign powers who threaten democracy behind the scenes.  Domestic greed is still a factor. 

Another example of how big national right-wing dark money came to small town to finance local school board candidates who wanted to ban books. We need to figure out who is paying for this, and what's in it for them  
https://www.bostonglobe.com/2023/05/06/nation/how-school-board-race-blue-state-illinois-became-nationally-funded-cage-match/

"Republicans...play this...game of supporting the  wealthy and big business behind the scenes... but making it appear...that they're on the side of the little person....going after the wokeness is a good way to do it...that's not  a bread and butter issue"
https://www.bbc.com/news/business-65428204

[One big corporation refuses to bow down to DeSantis' anti-woke threats.  Will others realize pumping money into extremists' political coffers is bad for business?] Disney Pulls Plug on $1 Billion Development in Florida
https://www.nytimes.com/2023/05/18/business/disney-ron-desantis-florida.html

 

 

Threats to Democracy Round Up - Early May, 2023

Influence of Hostile Foreign Powers


Reminders of how the US home-grown anti-democratic movement has been egged on by hostile foreign powers, chiefly Russia:

- How tied to Russia much of the far-right in the US now are: "the most energetic Kremlin propagandist around today" tells Tucker Carlson "We'll happily offer you a job if you wish to carry on as a presenter and host!"
https://www.businessinsider.com/russia-to-tucker-carlson-run-for-president-visit-moscow-2023-4

- Russian propaganda broadcaster RT to Tucker Carlson after he was fired- "Hey @TuckerCarlson .... You can always question more with @RT_com"
https://www.nytimes.com/2023/04/24/business/media/tucker-carlson-fox-news-dismissed-controversy.html

- [Re coordination of Trumpist and Russian propaganda/disinformation] Russia Is Not Happy About Tucker Carlson Leaving Fox News- Kremlin propagandists are mourning the departure of Carlson from Fox – and offering him jobs on Russian state TV

https://www.vice.com/en/article/pkab7z/tucker-carlson-russia-fox-news


Trump and Associate's Conflicts of Interest and Corruption


As we have said before, it is very difficult to reduce conflicts of interest and corruption in health care when a good chunk of societal leadership is conflicted and corrupt. A good example is our former President and his cronies:

-Trump, sued for defamation by E Jean Carroll, attacks her on social media during the trial.  Did he just violate a "federal obstruction statute that outlaws efforts to corruptly influence  or intimidate a juror, whether in a criminal or civil trial"
https://www.nytimes.com/2023/04/26/nyregion/carroll-trump-trial-testimony.html

- [Were they always dirty tricksters?] Guiliani admits using ‘dirty trick’ to suppress Hispanic vote in 1993 mayoral race [by telling people in Hispanic areas that they would need to prove immigration status to vote]
https://www.theguardian.com/us-news/2023/apr/29/rudy-giuliani-hispanic-vote-suppression-new-york-election

- "Trump behaves in predictable patterns and seeing the big picture  helps to illuminate those patterns....  the various  investigations spanning New York, Georgia, and DOJ almost all involve  some combination of financial fraud and election manipulation"
https://open.substack.com/pub/asharangappa/p/mindhunter-the-trump-files

- Judge says Trump "endeavoring, certainly, to speak to his quote-unquote public, but, more troubling, the jury in this case about stuff that has  no business being spoken about" That appears to be jury tampering, a criminal offense
https://www.theguardian.com/us-news/2023/apr/26/trump-rape-trial-e-jean-carroll-testify


Propaganda, Disinformation, Deception

 Some ideas for challenging rampant propaganda and disinformation

 

- "look closely at the way that people respond to criticisms of their theories. Do they engage directly...  resort to ad hominem attacks and red herrings... call on 'special pleading'...?"
https://www.theguardian.com/science/2023/apr/24/fake-or-fact-how-to-recognise-a-conspiracy-theory

- "To debunk a false belief, it may be better to target a person’s system  of beliefs rather than trying to change the false belief itself"
https://neurosciencenews.com/false-belief-system-23098/

- How to cover RFK Jr responsibly "Provide context without pushing a narrative; Explain the history; Call a  lie a lie; Avoid false balance; Take care with the headlines; Only allow debates on policy; Have compassion for his followers"
https://www.statnews.com/2023/04/24/robert-f-kennedy-jr-antivax-presidential-campaign/

- The press is in peril. Here’s how to save it- reader-funded journalism is free to hold power to account, and it’s spreading
https://www.theguardian.com/commentisfree/2023/may/03/press-in-peril-reader-funded-journalism-world


Political Propaganda and Disinformation Damaging Health and Health Care
 

Note that the really damaging material often comes from the extreme right, extreme sectarians especially Christian nationalists, and hostile foreign powers, viz:

 

- Thomas Jefferson hospital president has ‘liked’ tweets critical of COVID-19 vaccines, among other controversial topics [Then pleaded that he did not understand "liking" a Tweet somehow meant liking a tweet. If he was that ignorant of Twitter, why was he using it?]
https://www.inquirer.com/news/thomas-jefferson-mark-tykocinski-twitter-covid-20230429.html

- There is a "nexus between anti-trans and anti-vaccine ideas... anti-vaccine figures like Sherri Tenpenny... and Stew Peters... share news  articles and posts... stoking hatred and panic about trans issues...LGBT SATANIC Cult"
https://www.vice.com/en/article/93ky48/americas-most-influential-conspiracy-theorists-are-going-all-in-on-transphobia

- Making vaccines for COVID-19 look bad, presumably for political gain: How DeSantis' Florida Surgeon General reported "an increased risk of cardiac-related death among men 18-39" is "a dramatic story of how science should not be done"  
https://open.substack.com/pub/yourlocalepidemiologist/p/evolution-of-florida-vaccine-analysis

- Debunking the latest anti-COVID vaccine disinformation: "Social media posts are misrepresenting what Fauci said about masks and COVID-19 and omitting part of his response"    
https://apnews.com/article/fact-check-fauci-interview-face-masks-covid-406605262832

- Turning the concept on its head: NE Democrat who has transgender child accused of therefore having a conflict of interest - Such reasoning would suggest anyone who has a medical condition, or a relative with one has a conflict of interest.
https://www.washingtonpost.com/politics/2023/04/27/nebraska-senator-megan-hunt-complaint-trans/

- The latest in anti-vax disinformation "portrays a striking but false narrative - claiming that swathes of people are suddenly and suspiciously dropping dead in large numbers, and that Covid  vaccines are to blame"
https://www.bbc.com/news/blogs-trending-65412798


"Culture War" and Theocracy/Christian Nationalism


Much of the "culture war" is about attacking particular patient groups (eg, transgender patients, women seeking abortions, needing birth control or care for such conditions as ectopic pregnancy and miscarriage) and the health care professionals who care for them, or about attacking public health professionals (eg, those involved in pandemic policy) or creating phony public health problems, eg, pornography.

Furthermore, while these attacks are often framed in a biomedical, health care or public health context, the motivation behind them seems to come from extreme sectarianism, particularly Christian nationalism.

- DeSantis' "culture war" on Disney is about religious extremism: "American Family Association, a right-wing religious organization...[against] LGBTQ. rights, rallied...evangelical groups to boycott Disney [when]...it extended...benefits to gay employees"
https://www.nytimes.com/2023/04/26/us/politics/desantis-disney-republicans.html

- [First the religious fanatics came for the transgender kids, but I didn't have one so I did nothing...] Montana Governor Signs Law Banning Transgender Care for Minors [with apologies to Niemoller]
https://www.nytimes.com/2023/04/29/opinion/zooey-zephyr-montana.html

- Son asked Montana governor to veto anti-trans bill. It didn’t work. [They are so far gone that they won't even listen to your own children.  The family of @RepGosar was an early example]
https://www.washingtonpost.com/nation/2023/04/28/montana-lgbtq-gianforte-son-gender/

- [They don't need no stinkin' separation of church and state: TX] Senate OKs bill to allow construction of anti-abortion monument on state Capitol grounds "[other] senators...[said] the statue seems to promote anti-abortion and religious beliefs"
https://www.chron.com/politics/article/texas-senate-monument-life-abortion-capitol-17919805.php

- [Forcing their sectarian beliefs about morality onto those of other faiths] MI Republicans fight...repeal [of] ban on unmarried cohabitation: "This law was not passed to be mean … it was passed for the betterment of society, particularly for children"
https://www.theguardian.com/us-news/2023/apr/21/michigan-republicans-repeal-ban-unmarried-cohabitation

- Far-right politics is about pushing extreme religious beliefs on non-believers, eg to far-right NC governor candidate "gay and transgender people are 'filth', homosexuality...abominable sin...transgender movement...'demonic'...'spirit of the antichrist'
https://www.theguardian.com/us-news/2023/may/05/mark-robinson-republican-north-carolina-governor-race

- 14-year-olds could serve alcohol under a new Wisconsin bill [sponsored by Republicans.  And they say they are all about the children?]
https://www.washingtonpost.com/business/2023/05/01/wisconsin-alcohol-teens-work/


But these attempts to impose rules based on extreme sectarian beliefs on people who believe otherwise often have adverse effects:

Far-right politicians attacking pornography, ostensibly to protect children, but per the ACLU "requiring adults to verify their ages – and expose their identities –  before accessing...websites will inevitably deter them from going to those sites"
https://www.theguardian.com/us-news/2023/may/03/pornhub-utah-age-verification-law

DIY trans care evades barriers in Missouri, other states [Anti-trans laws are generating a black market in health care. Just what the doctor didn't order]
https://www.sfgate.com/news/politics/article/diy-trans-care-evades-barriers-in-missouri-other-17998457.php

- An attempt to smear a health care institution based on far-right hostility to transgender patients fails "Investigation" of Washington University Transgender Center by a Republican AG whose staff ranted about "far left activists" turns up no major problems
https://apnews.com/article/missouri-transgender-youth-health-care-attorney-general-84da1c977c44bba9907f13b2d3a7141f

- "researchers have found repeatedly that a gun in the house makes people more likely to be  murdered, not less. 'People living in homes with firearms have higher  risks for dying by homicide,' according to a 2022 study in the Annals of Internal Medicine."
https://www.nytimes.com/2023/04/22/opinion/american-shootings-guns.html


Threats to Free speech, Expression


For health care professionals to use science to improve clinical care, via evidence-based health care, or simply by doing health care related science there must be a context of free speech and free expression.
Likewise, to change policy to reduce health care dysfunction reformers need to operate in a democratic context which protects free speech and expression.

However, the extreme right-wing movement threatens free speech and expression on many levels.


- What the Right-Wing [fascist] Takeover of a Progressive College Looks Like "Twitter under @elonmusk ...looked the same...degraded into a completely different experience.....'turning a top-rated academic institution into a third-rate athletic facility'"
https://www.nytimes.com/2023/04/29/opinion/new-college-florida-republican-desantis.html"

- "citizens...are white, Black, brown, gay, straight, Christian, non-Christian... no...portion of the community  should dictate what the rest...have access to.... because you don’t want to read... or see it, it doesn’t give you the right to deny others"
https://www.independent.co.uk/news/world/americas/louisiana-banned-books-library-jeff-landry-b2324440.html

"1,477[+] attempts to ban 874 individual book titles within the first half of the 2022-2023 school year... a nearly 30 per cent spike... over the previous year....Overwhelmingly, book ban attempts target stories by and about people of colour and LGBT+"  
https://www.independent.co.uk/news/world/americas/book-bans-censorship-lgbt-b2325804.html

"fear leads to self-censorship and heightened caution — long before the  laws take effect.... 'That’s how  authoritarianism works'" So in DeSantis' fascist Florida, a college student asks a reporter: "is this conversation we’re having … legal?"
https://www.washingtonpost.com/opinions/2023/04/19/desantis-higher-ed-reforms-students-concern/

"local officials came to their school library in... Granbury [TX] and started carrying away boxes of books....stories about gender, sexuality and race" If we don't stop them, the sectarian far-right will erase free speech and our religious beliefs  
https://www.independent.co.uk/news/world/americas/texas-book-bans-granbury-lgbt-b2324468.html

- How to get involved in the fight against book bans "Read banned books; Reach out to your local officials; Donate to organisations; Get vocal; Vote"
https://www.independent.co.uk/news/world/americas/fight-against-book-bans-us-b2326814.html

The Gravest Threats to Campus Speech Come From States, Not Students "The ironic truth is that laws that prohibit the teaching of 'divisive  concepts' are themselves attempts to indoctrinate students into seeing  the world through one lens"
https://www.nytimes.com/2023/04/21/opinion/free-speech-campus-states-not-students.html

[He don't need no stinkin' free speech]  DeSantis accidentally handed Disney a potent weapon against him  "pretty clear statements from Governor DeSantis that he is  seeking to punish a corporation for its speech....  prohibited by the First Amendment"
https://www.washingtonpost.com/opinions/2023/05/02/ron-desantis-disney-lawsuit-wokeness-donald-trump-2024/


Who Pays for and Benefits from Attacks on Democracy?

 

It is hard to challenge the wide-ranging attacks on health and health care, and the democratic context needed to promote them, without knowing who is supporting and funding them.

- Another under the radar far-right advocacy group,pushing to ease child labor laws, funded by "broad swath of ultraconservative and Republican donors-eg the Ed Uihlein Family Foundation and 85 Fund, a nonprofit connected to political operative Leonard Leo"
https://www.washingtonpost.com/business/2023/04/23/child-labor-lobbying-fga

- How big corporations benefit from funding far-right politicians "DeSantis... rightwing Republican governor of Florida...handed favors to his big-money donors in the insurance industry at the expense of cash-strapped residents of his state...report claims"
https://www.theguardian.com/us-news/2023/may/03/ron-desantis-insurance-industry-donors-florida-governor
 

Who Cares If Hunter Biden Owns a Laptop? Red Herrings and Reflexive Control

 Introduction: Propaganda and Disinformation in Health Care and Elsewhere

 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).

But back in the day, the notion of propaganda and disinformation as a real threat to health care, much less our democratic process and society as a whole, was pretty radical.  That was then.  By 2019 we were writing about a  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.

And in 2023, propaganda and disinformation are in the headlines all the time.  But it is still important for health care professionals and the public at large to appreciate the mechanisms of both, and how to mentally defend against them.  In 2023, despite the headlines, the propagandists and disinformationists are not slowing down.  So it's time to review how they operate again. Let me present a recent example that caught my eye.

Who Cares if Hunter Biden owned a Real Laptop?   

As Elon Musk's Twitter gets increasingly raucous, the propaganda and disinformation that appear therein has gotten back to basics, providing some stark examples of the techniques used.  For example, see this 5 word Tweet from Rep Elise Stefanik (R-NY), a Harvard educated Congresswoman who has become a prime booster of Trump. 

Hunter Biden’s laptop is real.

What could it mean? Is there a debate going on whether Hunter Biden (the son of President Biden) owns a laptop? Who would care?

Of course, it turns out that there is a very big controversy, promoted by people who support Trump, about whether some aspects of a laptop ostensibly once owned by Hunter Biden suggest that both Bidens are unethical, corrupt, or worse.  For example, Washington Post reporters tried to analyze the controversy and the various questions raised about the provenance of the allegedly incriminating data:

217 gigabytes of data provided to The Post on a portable hard drive by Republican activist Jack Maxey. He said the contents of the portable drive originated from Hunter Biden’s MacBook Pro, which Hunter reportedly dropped off at a computer repair shop in Wilmington, Del., in April 2019 and never reclaimed.

The vast majority of the data — and most of the nearly 129,000 emails it contained — could not be verified by either of the two security experts who reviewed the data for The Post. Neither found clear evidence of tampering in their examinations, but some of the records that might have helped verify contents were not available for analysis, they said. 

It's clear there was no clear chain of custody spanning Hunter Biden, the laptop, its hard drive, the data on that hard drive, and the data eventually given to the Washington Post.

Furthermore, the significance of this electronic data and the strengths of any arguments about the behavior of Hunter Biden, President Biden, or other people based on it are very unclear.

So what was the point of Rep Stefanik's stark statement (and many others like it)?

The Red Herring Logical Fallacy

One simple explanation is that Rep Stefanik et al were employing the Red Herring Logical Fallacy.  One definition of this fallacy is:

Attempting to redirect the argument to another issue to which the person doing the redirecting can better respond. While it is similar to the avoiding the issue fallacy, the red herring is a deliberate diversion of attention with the intention of trying to abandon the original argument.

So this is like the many other examples of the use of logical fallacies to advance self-serving arguments about health care, policy, or other issues that we have discussed. 

Reflexive Control

However, Rep Stefanik's 5 word assertion may actually be part of something more sophisticated.

It may be part of a larger strategy of reflexive control.  Discussions of reflexive control used to mainly appear in fairly esoteric places, eg in considerations of military and intelligence strategies, game theory, etc. Here is some background from the Georgetown Security Studies Review from 2017:

With confusion swirling around 'alternative facts,' the effects of disinformation and Russian meddling are just beginning to take hold. This phenomenon may be new to American politics, but it’s an old strategy in the Kremlin. To understand and combat the effects and goals of disinformation, we must understand the concept of reflexive control and how it fits into greater Russian strategy.

Reflexive control is a 'uniquely Russian' concept based on maskirovka, an old Soviet notion in which one 'conveys to an opponent specifically prepared information to incline him/her to voluntarily make the predetermined decision desired by the initiator of the action'. That is, reflexive control is a sustained campaign that feeds an opponent select information so that the opponent makes the decisions that one wants him/her to. Methods of reflexive control include spreading false information, leaking partial information at opportune moments, and projecting a different posture of oneself than what may actually be the case. The goal of reflexive control is to ‘control’ the ‘reflex’ of the opponent by creating a certain model of behavior in the system it seeks to control. The most fundamental way to do this is to locate the weak link in the system and exploit it through moral arguments, psychological tactics, or appeals to specific leaders’ character.

This concept has a long history in Russian military strategy, with the Soviet and Russian Armed Forces studying reflexive control at both the tactical and operational levels. Reflexive control has also long been taught at various Russian military schools and training programs, and is codified as Russian national security strategy in the Gerasimov Doctrine. Today, reflexive control is a key component in Russia’s idea of hybrid warfare.

 

Here is a useful summary from the PropWatch Project about how it's done:

 A messaging strategy of reflexive control conveys specially prepared information to an opponent to incline that opponent to voluntarily make the predetermined decision desired by the initiator of the action.' In other words, reflexive control is a way to get an opponent to willingly defeat himself. 

First introduced in the former Soviet Union by mathematician and psychologist Vladimir Lefebvre, reflexive control is a concept that has been perfected by Russia since the 1960's. A strategy of reflexive control can be reduced down to four basic components, also called the 4Ds:

Dismiss - to simply deny any involvement in a matter and discredit the accuser.
Distort - to warp, twist, or fabricate your own facts.
Distract - to introduce certain novel information into the mix or accuse your accuser of the same. 
Dismay - to play with emotions by using fear-mongering tactics.

Accusing one's political enemy of denying the existence of an object (a laptop) when the real questions are complicated ones about the truthfulness of evidence and the best way to interpret it seems to fit right in.

Conclusions

The problems of propaganda and disinformation in health care and policy no longer seem esoteric.  Instead they have become central problems of our time, and a clear challenge to our ideals of democratic government.  Without a functioning democracy, IMHO trying to make incremental changes in health policy to reduce health care dysfunction becomes an exercise in frustration, if not futility.

Health care professionals and the general public must better understand and learn to defend against both crude and sophisticated attempts to warp policy and politics, and corrupt democracy to prevent the onset of a new dark age.

We on Health Care Renewal  will continue to try to do our small part to defend against these dark arts.

Threats to Democracy Round Up

 

Influence of hostile foreign powers

[Like the late 1930s or peak of the cold war] Russian spy network operating in North Sea- spy ships disguised as fishing vessels to monitor potential sabotage targets

[Feels so much like the 1930s or depths of the cold war] Russian ‘ghost ships’ mapping wind farms [near the UK] in sabotage plot

Russian propaganda, disinformation, and related active measures

Another Russia/ US military angle: Sarah Bils, a former US Navy aviation electronics technician is allegedly behind a pro-Russian social media accounts 'Donbass Devushka' which allegedly  posted classified documents leaked by Air Guardsman Jack Teixeira

[More about Russian disinformation and active measures] U.S. charges four Americans with aiding Kremlin efforts- Charges are the latest Justice Department effort against secret foreign propaganda networks on U.S. soil

Kremlin tries to build antiwar coalition in Germany "marrying Germany’s extremes is an explicit Kremlin goal and was first proposed by senior officials in Moscow in early September" [active measures to encourage far-right and left- also seen in the US]

Marjorie Taylor Greene’s defence of Pentagon leaker is just absurd and dangerous "In the past, a massive tranche of documents being published would lead  to Republicans wanting to throw the book at the person who published  them"  

Hundreds of Russian and  Chinese state propaganda accounts are thriving on Twitter after @elonmusk  wiped out the team that fought these networks

Russians boasted that just 1% of fake social profiles are caught [raising the chances that the weird pro-Trump troll disparaging your Tweets is a bot or human from Russia]  

Conflicts of interest, corruption, crime

U.S. Treasury faces a wave of criticism over faltering push to unmask anonymous companies and track dirty money "quest to build a database of company owners [including those of]... shell companies ... beset  by delays and multiplying disagreements"

Judge rejects Trump’s last-minute bid to delay rape and defamation trial “It does not sit well for Mr. Trump to promote pretrial publicity and  then to claim that coverage that he promoted was prejudicial to him and should... support...delay”

"the United States is a nation of laws if you are an ordinary citizen.  However, with a little money and a little power — or at least a seat on  the Supreme Court — the law becomes less of a directive and more of a  suggestion"

Are they all mafioso?  "Sheriff...Clardy is heard discussing with commissioner... Jennings, investigator...Manning and jail administrator... Hendrix, the hiring of 'mafia hitmen' one of them claimed to know to  kill the newspaper’s owners and journalists"

[The company they keep] Charted: Trump’s web of indicted allies

[The eternal huckster] Trump boasts about making $4.6m from NFT cards that actually plummeted in value

Are they all criminals? "Timothy Teagan, a prominent member of the far-right anti-government  Boogaloo movement, pleaded guilty to gun- and drug-related charges... could spend 13 months in federal prison"

SCOTUS Justice Thomas' conflicts of interest, etc

Harlan Crow, SCOTUS Justice Thomas benefactor, makes his ideas clear, when in doubt, blame it on the leftists: "But I think that the media, and this ProPublica group in particular,  funded by leftists, has an agenda to destabilize the [Supreme] Court"

Plot of Justice Thomas' conflicts of interest thickens.  His generous benefactor Crow was affiliated with Club for Growth which "did have business before SCOTUS  while Thomas was on the bench" and "groups that ... lobbied [it via]...'amicus briefs'"

Inaccurate reporting: Justice Thomas "reported... his  family received rental income totaling hundreds of thousands of dollars  from a firm called Ginger, Ltd., Partnership" But that firm shut in 2006, transferred its assets to a similarly named company  

Ostensibly moralist Republicans and sexual crimes

How Trump fan Rep @Jim_Jordan (R-OH) intimidates opponents, eg  "calling a wrestler’s aging parents and asking them to persuade their son  to back off the charge that [then coach] Jordan knew about the abuse [by a team doctor] and did  nothing"  

Ali Alexander, the organizer of the “Stop the Steal” rally that preceded the Capitol riots, has apologised after being accused of asking teenage boys for sexual photographs.

[Are they all sleazy harassers?] TN "state Rep. Scotty Campbell (R)" resigns after violating harassment policy after "allegations...brought against him by an intern"

Trump's foreign entanglements

[Reminder of Trump's considerable conflicts of interests involving China, which Trump fans who constantly raise alarms about China ignore] China Paid Trump Millions In Rent. Then He Left The White House  

[A summary of his foreign entanglements, ie conflicts of interest, and likely violations of the foreign emoluments clause of the US Constitution] Trump made up to $160 million from foreign countries as president

Propaganda, disinformation, deception

New York Is a Hellscape, Republicans Say. A Cabby Told Them So - A look at the stagecraft behind the House Judiciary Committee hearing on “Victims of Violent Crime in Manhattan.” [And New Yorkers always believe what cabbies say - right]

Rush to judgment in SF: "part of a long-term phenomenon in which the public's fear of random violence has been fed by law enforcement advocates to burnish the image of police as the only bulwark  against a perilously unpredictable world"  

New data indicates declining confidence in childhood vaccines of up to 44 percentage points in some countries during the COVID-19 pandemic [due to] "growing access to misleading information, declining trust in expertise, and political polarisation"

What disinformation wrought: Man allegedly shot teen knocking on his door was "down the right-wing rabbit hole...doing the election-denying conspiracy stuff...COVID conspiracies and disinformation... buying into the Fox News, OAN" says grandson

[Are they all dishonest?] Trump-appointed judge Matthew Kacsmaryk, while under review to the Senate, concealed an article he wrote "criticizing Obama-era protections for transgender people and those seeking abortions" [and was this dishonesty illegal?]  

Propaganda/disinformation and reproductive and sexual politics

2 of the most influential people "discussed the non-existent population crisis... @elonmusk  blaming 'birth control, abortions'...on the impending  collapse of civilization....@TuckerCarlson asked how the 'urge to have sex'...has been 'subverted'" Really?

[Do as we say,  not as we do: the colossal hypocrisy of the Christian nationalist morality police]  Clip resurfaces of Rudy Giuliani in drag as Republicans target performers

The use of "abortionist" and "unborn human" have a clear purpose:  Readers are meant to infer that while the fetus is a human, the doctor  is not. [Use of "abortionist" suggests] "their occupation is the sum total of their humanity"

Follow the money re propaganda/disinformation

"All this, trial or no trial, makes clear what Fox News really is. It’s a  service provider. That service is the maintenance of a reality bubble  and the deference to beliefs that Fox’s hosts helped shape"  

Fox News settlement turns Dominion into private equity gold [Trust not in private equity: could Dominion's private equity owners have prioritized its lawsuit as a source of revenue, not as a defense of the truth]

"Dominion does not exist to serve the public interest.... It is a for-profit company owned by Staple Street Capital, a small private equity firm.... It’s not uncommon for a company to turn its back on the public good for the sake of enriching its owners"

Fascism, Nazism, white supremacy, neo-Confederacy, theocracy/Christian nationalism

"red states are maneuvering to block the federal government and their own  largest metropolitan areas from resisting their systematic attempt to  carve out...a 'nation within a nation,' operating with its own constraints on civil rights and liberties"  

[They want to persuade you that resistance is futile.  Don't believe them] The day the book banners lost in Pennsylvania’s culture wars "right-wingers who thought they had 'banned' a climate-change book in Kutztown only made it more popular"

Trying to disqualify Trump via the 14th Amendment "which prohibits  any 'officer of the US' who...'engaged in insurrection or  rebellion...' after... taking an oath to  support the Constitution — from serving in any federal office"

Laws based on extreme ideology are hazardous to your health "'stand your ground' laws were linked to an 8% to 11% increase in homicide rates, or roughly 700 additional deaths each year"

[Taking us back to the 19th century] Iowa Republicans pass law to allow child labour "allows children as young as 14 to work six-hour night shifts, as young  as 15 to work in plants on assembly lines, and as young as 16 to serve  alcohol"

How democracy could fail: "an organized, purposeful minority seizes strategic positions within the  system and subverts the substance of democracy while retaining its shell  — while the majority isn’t well organized, or doesn’t care enough, to  resist"

[They don't need no stinkin' voters, at least voters who aren't for them] Top GOP lawyer decries ease of campus voting in private pitch to RNC

"drop in applications, particularly for OB-GYN residencies, could exacerbate the lack of maternal health care in those states, which already have the highest maternal mortality rates" Living in far-right run states may be hazardous to your health

Christian nationalists rewriting "story of America through the lens of a narrow, fringe view of Christianity that will not tolerate any deviance  from... narrative that says that America was intended...to be Christian, white, heterosexual and run by men”

[Historical reminder] Why Did Madison Write the Second Amendment? [To prevent the US government from rendering state militias, "on which the South relied for slave control," useless by disarming them]

[Extreme fundamentalism can be profitable. Follow the money] Demons be gone: meeting America’s new exorcists "among evangelical Christians, deliverance is serious business – and it’s big business too"

Trump touts authoritarian vision for second term: ‘I am your justice’ - deploying the military domestically, purging the federal workforce and building futuristic cities [Mussolini promised to make the trains run on time.  Hitler built the autobahns]

Popularity is optional as Republicans find ways to impose minority rule "finding workarounds, using cogs in the machine  that have...received less attention from activists, journalists  and voters" [ie, they have hacked our rickety system of democracy]

[They don't want school children exposed to books on race and gender, but] South Dakota governor says her two-year-old grandchild has several guns [and they say they are pro-life and care about children?]

Christian nationalism and sexual/reproductive politics

[It's all about extreme sectarian religion] Leaks "reveal the deeply evangelical bent of the anti-trans movement....littered with false claims ... [eg] that show the group believes  they’re doing God’s work by targeting a vulnerable minority group"

[Worrying about early fetuses while smelling the benzene] In a town plagued by an environmental crisis, a local abortion debate consumes public attention  “It’s amazing, how those pro-birth people can get all that attention,”

The ruling against mifepristone cited Comstock who "became an anti-'obscenity' advocate: one of the most  ideological and extreme enforcers of public morality in the nation’s  history" How far they want to take us back

The [Republican] party of ‘freedom’ finds another way to squash it with NC drag show bill "It’s not just drag that could be threatened by this bill — it’s free expression altogether"  

Missouri to Restrict Medical Care for Transgender Adults, Citing Consumer Protection Law [in which a state AG, using a consumer protection act, decides he knows more about what harms patients than do health care professionals]

[Anti-trans campaign is all about extreme sectarian religious beliefs] the religious right went searching for an issue that would re-energize supporters and donors [but why should these beliefs be imposed on those who believe otherwise?]

Extreme sectarian right-wingers seem to dread trans people as having some sort of supernatural powers, eg Florida Republican calls trans people ‘demons’ and ‘imps’ during committee meeting  

Corporate funding of fascism, etc

"The rich are different from you and me: They have immensely more power.  But when they try to exercise that power they can trap themselves —  supporting politicians who will, if they can, create a society the rich  themselves wouldn’t want to live in"

When GOP Attorneys General Embraced Jan. 6, Corporate Funders Fled. Now They’re Back. [including health care corporations Walgreen's and Johnson and Johnson]

DeSantis' fascist Florida

[Turning to fascism in Florida] How DeSantis became Florida’s most powerful governor in a generation “The man is an instinctive authoritarian and practicing bully,”

Outrage as Florida Republicans pass ‘fascist’ bill to remove trans kids from parents [First they came for the transgender children, but I did not have any so I did nothing... then they came for...]

Antisemitism

Why did Trump say "This lunatic special prosecutor named Jack Smith—I wonder what it was prior to a change?" It's "a classic anti-Semitic slur" suggesting Jews changed their names after emigration as part of a sinister plot  

[They no longer hide their antisemitism] Rep. Paul Gosar (R-AZ) promotes pro-Hitler and Holocaust-denying site after it praised him for attacking “Jewish warmongers”

Neo-Nazis Hacked Porn Star Riley Reid and Tried to Recruit From Her Millions of Followers "they view pornography as a Jewish plot to weaken society"

Attacking freedom of speech and the press

Book Bans Rising Rapidly in the U.S., Free Speech Groups Find [The far-right, revealing themselves as fascists, are killing off First Amendment rights  piecemeal]


TN bill that allows students to report professors who teach 'divisive concepts' passes House and Senate [reminiscent of having children turn in parents in the Soviet Union]

Trump's Coup

[Are they all crooks?] Trump operatives had access to "breached" (ie, stolen?) voter data: "In mid-January 2021, two men hired by ...Trump’s  legal team discussed...what to do with data obtained  from a breached voting machine in a rural county in Georgia"

"In some state and local offices... election denialism is still recasting how elections are  conducted.... Republican  officials are gumming up the mechanics ... making it harder to cast a vote...tally votes...get results in a timely fashion"

Introducing the Threats to Democracy Roundups

 We started Health Care Renewal in 2004 to address the worsening dysfunction in health care, primarily in the US.  We were about

Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

But starting in 2015, we began to realize that challenging health care dysfunction can only be done in the context of a reasonably stable and functional democracy.  As threats to democracy ramped up in the US and globally, we realized that our usual discussions of issues such as conflicts of interest and corruption in health care, poor management, lack of transparency, etc became increasingly suffused with the complications induced by ongoing threats to democracy.

Ultimately, we decided to pause Health Care Renewal while we took stock of our role in a changing and increasingly perilous world.

So now we are going to get back in the fray again.  I plan to author a new Health Care Renewal feature, more or less weekly, entitled the Threats to Democracy Roundup.  It will be essentially an old school link list, but focused on key threats to democracy.  Tentatively, we will be listing them under topics such as:

- Hostile foreign influnce

- Conflicts of interest, corruption, and crime

- Propaganda, disinformation, and deception

- Fascism, Nazism, white supremacy, neo-Confederacy, and theocracy/Christian nationalism

I will try to put these in a health care context when appropriate. 

As usual, we appreciate your questions and comments.

In Memoriam: Ahnold, Our Faithful Watchdog Mascot

 RIP, April 10, 2023

Haunted by the Impunity of Rich Business Leaders - Will One Criminal Conviction make a Difference? The Trump Organization Chief Financial Officer Pleads Guilty

 Impunity: an Introduction

We believe that unaccountable leadership is a major cause of health care dysfunction.  Impunity is an extreme form of unaccountable leadership.

We have noted that despite numerous legal settlements made by health care organizations of allegations like fraud, bribery, and kickbacks, almost never do top leaders who presided over these actions face any negative consequences.  Lack of deterrence caused by such impunity appears to be a major cause of  the epidemic of continuing unethical behavior, crime and corruption on the part of large health care organizations. How executives got to the point of having such impunity has never been clear.

But consider two important cases.  

Columbia/HCA CEO Not Held Responsible for Defrauding the Federal Government in 2003

 In 2010, we described the case of early dominant for-profit hospital system Columbia/HCA, which, after investigations beginning in the late 1990s, settled charges of defrauding the federal government.  The company paid a fine of $1.7 billion, a record amount at that time, but did not admit guilt.  More importantly, the company CEO, Rick Scott, was not charged with anything, suffered no negative consequences even though it was on his watch that the company was involved in apparently fraudulent behavior, and retired with a large golden parachute.  

Mr Scott then went on to be elected Governor of, then Senator from Florida as a Republican.  He is still in the Senate, and has become a big supporter for former President Trump.

In 2010 we wrote:

we have noted a parade of legal settlements involving and guilty pleas and criminal convictions by  health care organizations, (or often just subsidiaries conveniently available to take the rap).  As we have noted, resulting fines may be just be treated as costs of doing business by health care leaders.  Almost never have the people who authorized, directed, or implemented wrong-doing almost never suffer negative consequences.

Instead, they may just continue to haunt health care and society at large

.

and

as I have repeated seemingly infinitum, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.

Purdue Pharma Executives Convicted in 2007

In 2007, we made quite a lot about criminal convictions for Purdue Pharma, and of three of its executives for the "misbranding" of Oxycontin.  (That was just the beginning of the legal problems for Purdue, and other manufacturers and distributors of "legal" narcotics and their contribution to the epidemic of narcotic abuse.)  At the time, we marveled that

At least in the Purdue Pharma/ Oxycontin case top company leaders were prosecuted, plead guilty, and will personally have to pay substantial financial penalties. Maybe this will convince the leaders of health care organizations that deceptive marketing practices may not be in their long term interests.

Of course, at the time we did not realize that Purdue Pharma was a privately held corporation run largely by the family that owned it, the Sacklers.  While the three executives had some responsibility for company operations, they were not as powerful as the top executives of publicly held health care companies, and so their convictions did not really end the impunity even of the top leaders of even one important health care corporation.

Trump Organization CFO to Plead Guilty of 15 Felonies Involving Tax Cheating in New York Court

Today, as the New York Times reported:

 One of Donald J. Trump’s most trusted executives stood before a judge on Thursday and pleaded guilty to 15 felonies, admitting that he conspired with Mr. Trump’s company to carry out a scheme to avoid paying taxes on lavish perks — even while refusing to implicate the former president himself.

As part of the plea deal with the Manhattan district attorney’s office, the executive, Allen H. Weisselberg, is required to testify at the company’s trial if prosecutors choose to call on him, and to admit his role in conspiring with Mr. Trump’s company to carry out the tax scheme. That testimony could tilt the scales against the company, the Trump Organization, as it prepares for an October trial related to the same accusations. 

This demonstrates that in 2022, it is still big news if an apparently top corporate executive is convicted of a crime involving his management of the corporation.  We have progressed so little.

In particular, we certainly have not yet progressed to the point at which the actual top leaders of big corporations are held accountable for their misbehavior.  The Trump Organization is a closely held private corporation.  Its top leader is generally acknowledged as Donald J Trump, and its other top leaders are likely his children.  None of them so far have been charged in this case.

Donald J Trump as leader of the Trump Organization had a very long record of impunity as leader of the Trump Organization (look here).  It is possible that had he been held to account for his earlier actions, we might never have run for President of the United States.  Trump as President was accused of a long list of conflicts of interest and corrupt acts (look here).  He has denounced the 2020 election, which he lost, as "rigged" despite no evidence in support of that.  He currently is under investigation for leading an insurrection to overturn the election and stage an auto-coup.

Conclusion

We are still haunted, now dangerously haunted, for our failures as a society to hold rich, top business leaders accountable for their actions.

When will we ever learn? Will be learn before it is too late?

 

The New Business Coup? Increasing Evidence that Large Health Care Corporations are Funding Threats to Democracy

Introduction: Health Care Corporations' Political Contributions: From Bipartisan to Trumpian

 At one time, leadership of large health corporations were circumspect in their financial support for US politicians and political causes. They provided some funds directly to politicians and political organizations, but often amounts given to different parties and organizations with different ideologies were balanced. Presumably, the goal was to promote access to whomever was in power at any given time. 

 

With the rise of Donald Trump, things changed. Many leaders apparently went all in for Trump and his Republican supporters.  In June, 2018  we discussed how CVS channeled money to a "dark money group," that promoted Trump administration policies, including repeal of the Affordable Care Act (ACA). In October, 2018, we discussed important but incomplete revelations about corporate contributions to such dark money groups that mainly favored again right-wing ideology, the Republican party, and Trump and associates. In November, 2018, we noted that health care corporations funneled funds through dark money organizations to specifically attack designated left-wing, Democratic politicians. In March, 2019, we discussed how in the 21st century, health care corporate CEOs' personal political contributions were increasingly partisan, that is individual CEOs gave predominantly or exclusively to one party, and for the vast majority, to the Republican party. 

Some corporations paused some of their political giving after a mob whipped up by Trump at a January 6, 2021, rally violently stormed the US Capitol to try to prevent the certification of the 2020 election. However, within two months they started giving again in support of Republicans in Congress who voted not to certify the election (see this April, 2021, post, this July 7, 2021, post, and this September 7, 2021 post).

Now just after the anniversary of an insurrection that almost prevented the certification of the 2020 US presidential election results, there are new indications that leaders of big health care corporations are continuing to support Republicans in Congress who voted to overrule the results of that election.

Health Care Corporate Sponsorship of the Attempt to Overturn the 2020 Election 

Citizens for Responsibility and Ethics in Washington (CREW) has updated their report on corporate sponsorship of the politicians who wanted to overturn the election.  The January 3, 2022 version is entitled "The Corporate Insurrection: How companies have broken promises and funded seditionists." It described the "717 corporations and industry groups have donated over $18 million to 143 of the 147 members of Congress who objected to the results of the 2020 presidential election, as well as the National Republican Senatorial Committee and the National Republican Congressional Committee."  It referred to the updated data about the largest corporate funders appearing in the current version of CREW's previous report.  The health care corporations that appear in this list of 80 are:

Pfizer                                        $71,000

Merck                                      $68,000

Eli Lilly                                   $42,000

Johnson & Johnson                   $38,500

Anthem                                   $32,500

Cigna                                       $30,000

CVS Health                            $30,000 

AstraZeneca                           $26,500

Humana                                $15,000

Blue Cross & Blue Shield         $15,000 

Keep in mind that these amounts only reflect corporate donations directly to members of Congress, their own leadership PACs, and to the national Republican campaign committees, which must be disclosed by law. They do not include any amounts given by corporate executives, or amounts given to various kinds of dark money organizations, which do not have to be disclosed according to law.  Thus they may seriously undercount the financial support given by health care corporations to support those who wanted to nullify the election. But at least these figures suggest that 5 large pharmaceutical/ biotechnology companies, 4 health care insurance companies, and one diversified pharmacy company continue to be strong supporters of legislators who were willing to do so.  

Furthermore, as noted in a January 5, 2022, article in Fierce Pharma, spokespeople for some of these corporations declared they were no longer worrying about whether politicians support democracy or tried to overturn an election, but only about whether the politicians support policies that would improve their corporate bottom lines.  For example, see this from Pfizer:

Pfizer’s PAC supports policymakers who value innovation and expanded access to breakthrough medicines and vaccines that change patients’ lives,

And see this from Eli Lilly: 

[the company] supports candidates across the political spectrum who understand the value of a vibrant pharmaceutical ecosystem to address unmet patient needs.

Billionaires Who Made Their Money from Health Care Corporations Who Supported the Attempt to Overturn the Election  

A January 6, 2022 article in Forbes listed the "more than 50 billionaires [who] donated in the second half of 2021 to legislators who voted against certifying the presidential election, according to an analysis of Federal Election Commission records."  Two the billionaires made their fortunes from health care corporations.  They were: 

- Phillip Frost, worth $2,500,000,000, described as "a long-time health care investor, inventor and founder, Phillip Frost now runs diagnostics-maker Opko Health." He "joined Key Pharmaceuticals in 1972, reformulated its asthma drug and sold the company in 1986 for $836 million." Also, he "founded Ivax, a generic drugmaker, in 1987. He sold it to Teva Pharmaceuticals for $7.6 billion in 2005"  Frost supported Sen Hawley (R-MO). 

- James Leininger, worth $1,500,000,000, described as having "made his fortune founding medical devices company Kinetic Concepts (KCI), which focuses on wound care." He also runs "Medcare Investment Funds, which manages $1 billion in assets." Leininger supported Rep Cloud (R-TX). 

 Discussion

 As we said before, most health care corporations publish high-minded aspirational statements that promise pluralism, support of the community, and of our representative democratic society. Data revealed recently and discussed in our previous three posts increasingly show that some leaders of  large health care corporations saw fit to direct contributions to politicians who promoted anti-democratic policies. Funding political leaders who would challenge election outcomes in the absence of very clear evidence of election irregularities seems to violate high-minded corporate pledges of inclusiveness.

Is it that health care corporate leadership just are more interested in making money than in bettering society, despite their aspirational mission statements? As we previously discussed, that is a plausible formulation.  For example, per the Washington Post in January, 2021,

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

Also, the quotes above support the idea that corporate leaders put their own bottom lines ahead of supporting the republican form of government that partially made their revenues possible.

On the other hand, maybe it is not just about money.  Again, as we said before, by virtue of being top corporate managers, particular individuals can control political funds far beyond what they would  be able to control as private persons, and to do so quietly and sometimes anonymously.  Corporate leaders may thus be able to promote their own interests through their corporations' political giving.  Those interests may go beyond just personal enrichment.   Some may also be interested in personal political power, or have other ways they might benefit from anti-democratic, authoritarian, even openly fascist national political leadership.  

Big industrialists have backed authoritarian and openly fascist regimes in other countries before, some to make more money, but in retrospect, some for darker reasons. (See, for example, this article on how German industrialists financially bailed out the Nazi party in 1932.)  

There was at least one previous instance in which US business leaders tried to effect a coup to oust a President they considered too left wing.  This was sometimes called the "business coup."  According to a Washington Post article from 2021, its sponsors included "included J.P. Morgan Jr., Irénée du Pont and the CEOs of General Motors, Birds Eye and General Foods."  Their goal was to depose President Franklin D Roosevelt and 

install a dictator who was more business friendly. After all, they reasoned, that had been working well in Italy

The plot failed because the former military officer they chose to lead it informed the government.  So far, the attempt by now former President Trump and his followers to do something similar has also failed. That does not mean, however, that the next attempt will not succeed.

 

IMHO, all citizens need to wake up and  protect our republic.  Furthermore, all medical and public health professionals specifically need to take action to wake up and protect our republic specifically from self-interested health care corporate leaders.  Imagine what health care and public health might be like were they to exert near absolute control facilitated by an authoritarian they installed in office