Feb 06 2022

Just for Show?

by at 7:57 pm under Uncategorized

Noting that nothing in today’s blog represents anyone’s opinion but mine, I need to get something off my chest. On Friday night, Harriet and I watched “Real Time with Bill Maher” on HBO. The host is very bright, funny, abrasive, contrarian and provocative. He ticks off a lot of people, and seems to like it. His end-of-show monologue typically takes a steely eyed look at current events from the perspective of an enlightened libertarian with a bit of mean streak. More often than not, I take away something useful from it. But not too much on Friday.

Maher took aim at medicine and research, scorning ideas and guidance that, in retrospect, were either flat out wrong or slow to adapt to rapidly changing knowledge. He tore into the way AIDS was approached, conveniently neglecting that within a decade of its appearance, effective therapies emerged that have added decades, not years, to people’s lives. Could we have done better? Of course. But can you imagine the scourge of that disease had it emerged in 1880 or even 1950? And now, with the COVID pandemic, he seems to conveniently minimize the utterly extraordinary fact that today, a mere two years following the recognition that COVID was even a thing, we have widely available vaccines that are highly effective in preventing severe illness and death, and an emerging arsenal of effective antiviral therapies that can mitigate the severity of illness in those who develop symptomatic disease. In other words, he dismisses a miracle that unfolded before our very eyes.

He primarily targeted the way COVID has been managed, chiding public health experts and governmental agencies for taking excessive precautions, especially early in the pandemic, with respect to masking, wiping down groceries and closing down businesses. He believes that only the old, sick and vulnerable in our society should have been protected — perhaps he might have liked to see a modern leper colony (that is my editorial comment) — leaving the rest of us, especially children, to live our lives normally. He implies that “we” know nothing, and cannot be trusted.

Methinks he doth protest for the sake of protesting. Medicine has always had to mix science and art. Art is necessary because science rarely provides unimpeachable answers to complex, multifactorial medical problems. We rarely have all the knowledge we need to make ironclad predictions and prescriptions. In the beginning of COVID, we had a smidgeon of information that had not yet aggregated into a body of knowledge that could reliably inform either physicians at the bedside, global health experts who inform policy, or governmental officials charged with developing and executing those policies.

Hippocrates instructed physicians, “above all, do no harm.” As the pandemic unfolded, and even to this day, adherence to that timeless advice is wise. So, why on earth would anyone with responsibility for the lives of others be cavalier with recommendations that could lead to deaths? Until we knew for sure the dominant means of viral transmission was respiratory, why not wipe down groceries and wear gloves? Why would we not protect everyone until we knew who was safe and who was not? We needed to rely on the art until science gave us the answers we needed.

My visceral reaction to Mr. Maher’s prescriptions for this particular crisis aside, he does make some good points. He seems to be against broad vaccine mandates, and at this point I am not sure he is wrong. I have preached that everyone who is eligible should get vaccinated and boosted. I am proud of that; it saves lives. But by now, everybody knows about the vaccines and they are highly available. People who choose to live unvaccinated lives surely know the risks by now and have made the conscious choice to either take those risks or deny their existence. I wish them well, even though their choices also risk the welfare of others. All physicians interact with patients who choose to not follow what we believe to be lifesaving recommendations, and all we can do is our best and accept that our patients have agency in making decisions about their health. That too is part of the art in medicine.

Maher seems to think that masking and social distancing rules are ridiculous, and are increasingly unenforceable. These practices reduce viral transmission, but at some point we must always keep in mind that, on occasion, the perfect is the enemy of the good. Those practices primarily protect the vulnerable — most notably, the unvaccinated — who don’t want us to protect them. Other vulnerable groups can be dealt with in ways that are specific to their individual (e.g., immunosuppressed people or health care workers) or collective (e.g., nursing home residents) situations. The data do not suggest that children are especially vulnerable, though the loss of any child is, in my view, unacceptable. When the Omicron surge has more fully receded, I believe it will be very important to deal with this issue.

It is time to engage in serious discussion and real action to modify how we deal with this pandemic and begin to reopen society. Bill Maher makes excellent use of his retrospectoscope, but I think history will judge that the pandemic was handled clumsily in many ways, but remarkably well in others. Science saved the day. We were very careful when it was necessary to protect lives, and now that lives have been protected, let’s think about how to protect our way of life.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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