COVID, Vaccine, Racism, and Masks: Changing for better or for worse?

We are not yet out of the COVID pandemic. Not in the world, where hot spots linked to both bad luck and irresponsible arrogant governments continue to rage in such places as Brazil and India, as well as in some countries in Europe and in other parts of the world. Not in the US, despite the CDC indicating that it is now ok for those who are vaccinated to stop wearing masks. People are still dying in large numbers, people are still being infected, and this map of the US does not show all light-colored, low-risk counties (the gray counties, and state of Alabama, have to do with nonreporting).

But things are getting better. We no longer have an ignorant, evildoer in the White House who is intent on ensuring that as many Americans die as possible (while he himself got every a

vailable treatment when he was sick, and indeed got vaccinated), but there are still plenty of Americans who are loyal and faithful to him (or to the myth of him), and to the wacko conspiracy theorists on the dark part of the web. Many of these folks are vaccine-hesitant or vaccine-resistant.

A lot of the coverage of these attitudes has been in minority, and particularly Black, communities. There is definitely resistance there, and to a large degree it is based on the experiences of those communities with the health care system. Some of this may be, in fact, the oft-cited historical examples of exploitation and experimentation on Black people in this racist nation. These include (probably most famous) the Tuskegee study of the “natural history” of syphilis in Black men that continued even after a cure (penicillin) was discovered; they were not treated. They also include the work of the “father of gynecology”, Dr. J. Marian Sims, whose discoveries were based on non-consented (of course) surgery on Black slave women, for a foretaste of Nazi doctors. They include, more recently, the fact that the HeLa cell line, derived from a cancer in a Black woman, Henrietta Lacks, has been basis of many discoveries to treat cancer, but she was not cured and neither she or her family received recognition (or money, despite much going to researchers) for it.

Many Black Americans know these stories, and it is probably true that, to some degree, they influence the reluctance of some people to put their fates in the hand of the healthcare system and to trust the government, including the CDC. But I would posit that a larger reason is not these near-mythical (although very real) abuses, but the more mundane, everyday abuses that people, especially poor and minority people, have experienced at the hands of that system. It is no fun to be sick, no pleasure to need treatment, and the arrogance of much of our health-system culture to its patients is very often confusing, frustrating, unpleasant, and demeaning to even well-insured and well-to-do White people. How much greater are all of these indignities – and too often abuses – if you are not insured or poorly-insured? If the massive health care institutions that have been built in pursuit of profit do not really want to care for you, or offer you their special magic bullets available to those with more money? How much greater than even that is it when you are Black, and endure the overwhelming manifestations of American structural racism as delivered by the healthcare system? When the presumption is you are more likely to be the cause of your own problems, because of your behaviors, or your self-abuse, when the presumption is that you are guilty of not-always-clearly-stated malfeasances, that you are stupid and ignorant and not to be trusted?

Sure, Tuskegee and Sims and HeLa came from the same racism, but you don’t need to even know about them at all to know that the health system is stacked against your, and your family, and your friends, and your community, and not always to be trusted. So maybe you’re not sure about getting that vaccine. And many Black Americans, and other minorities are not sure. But they aren’t the majority of the “vaccine skeptical”, despite getting more attention. The “traditional” anti-vax community is largely White, educated, upper-income and centered on the coasts, especially the West Coast. It is represented by a legion of celebrities and other famous people, including Robert Kennedy, Jr., Jennie McCarthy, Mayim Bialik, even (until recently) Oprah Winfrey. In the COVID pandemic, they have been joined by another much larger cohort, overall less educated and wealthy but just as White – the Trumpers. Following the incorrect and dangerous information that continues to spew from their leader, they now believe that the vaccine is ineffective, probably bad for you, and likely a result of a conspiracy of foreigners. You can look into the Dark Web, or QAnon to find this information, or just turn your dial to FoxNews. And while there are organized efforts by Black leaders, including celebrities, to urge folks to receive the vaccine, there is no comparable campaign among by the heroes of the White right.

Many articles have appeared documenting the degree to which our emergence from the COVID shutdown is going to depend upon adequate numbers of people receiving the immunizations. Health authorities, nationally and in state after state, have dropped the age criteria for being immunized, so that at this point in many jurisdictions, only infants are ineligible. And folks are still being immunized; while the rate of immunization has decreased from the peak, it is still being actively pursued by many people. But what is scary is that there are so many who will not receive it. And they won’t wear signs.

Were you worried about a third wave of COVID? Or is it now fourth? I forget. Anyway, good idea to worry. The CDC has indicated that those people who are fully vaccinated can now not wear masks in public. There is actually good scientific evidence for this, and it would certainly help people to feel like a corner has been turned. Except – they won’t wear signs. As reported by the Associated Press on May 15, 2021, while many small businesses are embracing the new opening and taking down their signs requiring masks, not wanting to “have to play police” any more, many large chains are continuing their mask policies.

‘As many business owners pointed out, there is no easy way to determine who has been vaccinated and who hasn't.’ 

‘And the new guidelines, issued Thursday by the Centers for Disease Control and Prevention, essentially work on the honor system, leaving it up to people to do the right thing.’

Right. The honor system. The folks who stormed the US Capitol, who stood with guns outside the Michigan State Capitol to oppose masking (in the state which now has the highest COVID rates in the US), who believe that COVID is a hoax, that Trump won the election, that Nancy Pelosi is the devil, and that Jews have space lasers, will be honorable enough to wear masks when they haven’t been vaccinated.

Good luck with that.

"There's a sucker born every minute": False and inflated health claims

“There is,” in a phrase rightly or wrongly attributed to P.T. Barnum, “a sucker born every minute.” To Barnum, and to countless others before and since, this was a business opportunity. They can get rich off us because we want stuff to be true even when every input from our senses should show us that it isn’t; we want magical, easy cures and money-making schemes, even when we know that they only work for the scheme’s designers, not the suckers who take the bait. Betsy DeVos, the recently approved Secretary of Education, who knows nothing about education and devalues public education (I could go on, but that’s another story…) is the beneficiary of such desires. She is in the position that she is in because of her great wealth which has bought her great influence, and that great wealth, at least the portion from her husband’s side, derives from the Ponzi scheme known as Amway. It is clear that Amway was in fact the path to wealth that it was claimed to be, for the DeVoses anyway.

The persistent and widespread greed of people despite evidence that the odds are stacked way against them is testimony to either optimism or stupidity, or some of both. It is one of the oldest memes in literature, from the alchemists who would turn lead into gold (or Rumpelstiltskin who would weave it) to Faust who would sell his soul to the devil (and maybe so did guitarist Robert Johnson) to Ralph Kramden (and his cartoon successor Fred Flintstone) and George “Kingfish” Stevens, doubly oppressed and vulnerable, being poor and black. And the outcome is always the same, the little guy gets screwed.

We could go on and on with this theme. The temptation to tie it to the election and reign of Donald Trump is enormous; people want something to be true (that they’ll get good jobs back, that their streets will be safe, that they can have all the health care they want and need without paying for it when they don’t need it, whatever) and Trump promised it all, and of course he is not and will not deliver, but many still love him. If you want a good article about this, try Matt Taibbi in Rolling Stone, “The end of facts in the Trump era”. But, after all, this blog is about public health and medicine, and there is no shortage of examples in those fields. After all, con men and grifters, whether low level hucksters, Amway merchants, or Wall Street bankers are all regularly called “snake oil salesmen”, and what was snake oil but a promise of better health? And the liniment sold by these folks might have worked a bit since it had red pepper, a bit like current capsaicin. When they were convicted it was because their oil did not come from snakes, not because it was a fraudulent cure.

You’d think that people would wonder why, if there is a miracle easy (and sometimes even relatively cheap) cure for all their ills that everyone else hasn’t benefited from it. Ah, but that is part of the attraction – being in the know about something everyone else isn’t. Is that not the way that inside traders work? Isn’t that how they fix sporting events, how your brother-in-law knows that this 100-1 shot will come in at Santa Anita? Is that not how Arnold Rothstein got rich? So, sure, it’s done in health. Watch daytime television sometime. It is mostly about medicine, from Dr. Oz (a font of misinformation), to an electric scooter you can get FREE (or at no cost to you, other than as a taxpayer paying into Medicare), or a miracle drug that will allow you to have even better relief from your arthritis or asthma or will keep your blood from clotting even better than warfarin, at only 1000 times the price, and at great potential risk to your immune system.

The hucksters present not only misinformation about individual medical care, but also public health. The most obvious, and likely most serious, current issue is that of vaccines. Despite there being no evidence linking vaccines to autism, and strong evidence showing there is no link, the myth persists. The price will likely be serious outbreaks of vaccine-preventable diseases, especially measles, as discussed by Peter J. Hoetz in his NY Times Op-Ed “How the anti-vaxxers are winning”, February 7, 2017. Water fluoridation suffers from similar myths. Public health may be even more susceptible to such hype than medical care, since so many of its benefits are things (like measles, or tooth decay) that don’t happen, rather than those that do. We rarely wake up saying “Gee, I’m glad I don’t have cholera today because we have clean water”; indeed, we mostly worry about water quality when something specifically bad is happening, like lead poisoning in Flint. People are susceptible to liars and charlatans who tell them things that they want to believe, as well as things that seem to make sense, but as I tell students, something that seems to make sense is called a research question; only when the study is done will we know if it is true.

But it is not only the more obvious (to the discerning, anyway) scams. Mainstream medicine does it often. Every new discovery, every potential ameliorant (if not cure) is trumpeted by both the companies that manufacture it and, at an earlier stage, the university for which they work. Of course, most of these discoveries are scarcely the magic breakthroughs that they are initially claimed to be. That is the nature of science; things are learned and knowledge grows incrementally. But a new discovery by a scientist at your university is worth a lot of publicity! Maybe it is a cure for Alzheimers! Or at least a step in that direction! Certainly worth millions of dollars more in NIH funding! There is nothing wrong in incremental discoveries; the problem is when they are hyped as the Holy Grail. Indeed, on July 16, 2010, I wrote about Rosiglitazone and the "Holy Grail", and how disappointed diabetes advocates were that Avandia® was being taken off the market just because it caused heart disease, because it did lower blood sugar! (A diabetes advocate noted that lowering blood sugar was the “Holy Grail”.) This story is a terrific example of the peskiness caused by the human body being an integral organism; something that is very good for one condition may still cause big problems. And so, maybe we should wait before we hype it too much. On the other hand, what an opportunity we have to get big publicity before that happens…

A recent example involves using low-dose CT screening for lung cancer. The US Preventive Services Task Force recommends it (as a “B” recommendation) for men 55-80 years old with a history of smoking. This “B” recommendation is worth a lot to the CT manufacturers and radiologists who read them, since the ACA requires insurers to cover USPSTF “A” and “B” recommendations. But a big Veterans Administration study just published in JAMA shows that it is not quite as good as previously thought. “Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer.” Does this mean that it is a bad idea to get screened? Not necessarily; if I had a patient with a significant smoking history, I would discuss the risks inherent in getting this procedure but prepare them for the probability that even a positive test would likely not mean they had cancer, and that they might have to undergo more procedures with some risk to find out. The point is not that this is a bad idea, but it is not some amazing breakthrough, as touted.

Just because you want to get rich quick, or avoid needle sticks, or find the magic cure for your arthritis or cancer that has been denied you, and someone is selling something that claims to do it, doesn’t make it true. If you think so, I’ve got a couple of bridges to sell you.