Sex, Drugs, and Public Health

August 15, 2021

“Does Your Mother Love You?”

Filed under: Uncategorized — cbmosher @ 5:12 pm

            A friend who has had a flamboyant career as a print and T V journalist over the past six decades – – – (Oh, no! Am I THAT old? Yes. Finish your thought) – – – tells the story of a well known CBS reporter’s first day on the job.

            Boss (Editor): “Does your mother love you?”
            New (Cub) Reporter: “Of course.”
            Boss: “How do you know?”
            Cub: “[?]”
            Boss: “Ask her.”
            So Cub calls his mother at home and asks her. She confirms that she does, and Cub reports back to his new boss.

            Boss: “Now you KNOW.”

            The Cub now had a FACT.

            Also decades ago, in Med School, I was trained on how to “present a case.” When asking for advice or referring a patient to another physician, we must start with the Chief Complaint. What it was that brought the patient to us initially. It should always be phrased: “the patient STATES that – – – .” Because, until the investigation is done, we don’t know the FACTS of the case. We can’t report the patient’s complaint as a medical Fact.   

            A case illustrating this “Does your mother love you?” and “patient states” search for Facts was the middle-aged man who came into the ER where I worked. He was accompanied by his wife.

            “He just has indigestion,” the wife shrilled before the guy could say anything. “He has it a lot. I told him not to bother you, Doctor. Give him some antacid and we’ll leave. He has work to do at our store.” She glared at me with eyes both icy and burning with fury. She had given me the diagnosis and an order of what to do. Her priorities, where her husband was concerned, were obvious. And terrifying.

            There followed an uncomfortable and bizarre discussion wherein it was impossible to get much info from the patient – his wife answered for him every time – and wherein the wife refused to wait outside while we cared for him.

            He was, of course, having a heart attack.

            Point is – you can’t report accurately nor make an accurate diagnosis without getting accurate Facts.  Accepting what you believe, or what someone else believes, may lead to being wrong. In some situations, that can be catastrophic.

            Public Health tools :

            In the clinical situation, my stethoscope, otoscope, EKG machine, lab tests and X-rays are crucial tools. These help me gather Facts and avoid the pitfall of accepting a diagnosis which was wrong. In Public Health, one of our best tools is statistics. I know that’s off-putting to many. After all, statistics are math. And, for many, boring. But it’s a crucial tool for quantifying Facts as Data. With Data, we can arrive at an accurate Public Health diagnosis of a population – a community. Might as well use Covid as the example.

            We are currently at a fascinating and critical turning point in the Covid pandemic. And it’s a perfect example of the long and winding road Science must travel to pursue Facts. Unfortunately, it’s also an example of flawed Public Messaging.

            On May 13, the CDC Director said that Americans who were fully vaccinated could go without masks or physical distancing in many cases, even when they are indoors or in large groups. This caused a whiplash in behavior and confusion with the Public. Many mis-interpreted the message as meaning that all restrictions were lifted. That the pandemic was over.

            While that CDC message – if correctly interpreted – was relatively accurate based on data at that moment, the virus wasn’t standing still. And now the Delta variant has shown us how wrong the Public’s mis-interpretation of the CDC’s massage has been.

            What went wrong?

            Mostly, it was our powerful desire to get back to “the way things used to be.” Not unlike our heart attack victim’s wife who wanted things to be unchanged. Or our Cub reporter who wanted to believe his mother’s love without checking the Facts.

            The Scientific Method:

            Humans have wrestled with this problem since forever. In the face of a society-upsetting disease, we want simple answers and want them quickly. Since Nature doesn’t work that way, the door is open to Quacks and Liars, as depicted in paintings of the Black Plague epidemic. You’re seeing the same thing going on right now. Not knowing how to differentiate between what’s true and what’s not can cause fear, insecurity and a tendency to follow someone who promises simple answers quickly.

            That almost never works out.

            Thus, during the Renaissance, humans developed the Scientific Method to uncover the Facts about how Nature works. You know, gravity, the sun’s daily rising, DaVinci’s vision of flying. Applies to the science of Medicine and Public Health, too. Goes like this:

  1. Observation
  2. Hypothesis (of how a specific thing works)
  3. Test hypothesis with Studies
  4. Obtain Data
  5. Revise hypothesis if new observations or data crop up.

            We act on currently available Data as the best Facts we have until new information challenges the hypothesis.

            COVID’S Curveball :

            The Observation was that Covid is caused by a virus. The Hypothesis is that this virus, like almost all viruses, can be combatted by antibodies which vaccines can stimulate. Tested with studies, first during vaccine development, and now with data from millions of vaccinated people out there. Here’s some of that Data:

            Vermont is the most vaccinated population in the U S at 67.4%.  That State’s Case Rate is just 3979 per 100,000 people so far.

            Mississippi is the least vax’ed at only 34.3%. Case Rate is a whopping 11,541 per 100,000.

            Of all recently hospitalized Covid cases, 97% are un-vaccinated.

            The hypothesis has been tested in the real world. The best Facts are that vaccination works. Thus the CDC’s May 13 announcement that the Vaccinated won’t need masks.

            Oops. Along comes the Delta variant (a mutation of the original Coronavirus). Science brings new Data:

  • 75% of new Coronavirus infections in Singapore are among the Vaccinated
  • Massachusetts testing reported on July 4 shows that the Vaccinated shed viruses as do the Un-vaccinated.
  • A study posted July 12 from China reveals that Delta has a shorter incubation time and faster replication in the body, producing up to 1200 times as many virus particles as the original virus. Explains its increased transmissibility.
  • A study of the Pfizer vaccine showed effectiveness falls after six months from 96% to 84% (reported July 28).

            So, while it’s true that Un-vaccinated folks are primarily driving the pandemic, there’s more infection – and possible transmission – occurring among the Vaccinated than we previously knew. You can almost think of it as a new disease.

            The Good News is – – – vaccination is still effective against severe disease and death. Most of the cases of infection in the Vaccinated referred to in the Singapore and Massachusetts studies were found on testing in people who had no symptoms or just mild cases.

            So Science did not fail us. It did exactly what it’s designed to do – modify the hypothesis based on new Data. Now we have more Facts to drive our decisions. Thus the CDC changes its recommendations to reflect the new Facts.

            We’ve been learning about this virus at the same time as we’ve been fighting it. We’ll continue to learn new Facts as we go. The Coronavirus looks like it’s not going away anytime soon. Just because we may not like the Facts that Coronavirus hurls at us doesn’t mean we should believe the Quacks and Liars.

            Just like the Cub reporter, we have to check our beliefs against the Facts from time to time. Science will do that for us.

            And, hey. Call your mother.

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