Physicians united: Here’s why pulling out of WHO is a big mistake

Andis Robeznieks
American Medical Association
Originally published 8 July 20

Here is an excerpt:

The joint statement builds on a previous response from the AMA made back in May after the administration announced its intention to withdraw from the WHO.

Withdrawal served “no logical purpose,” made finding a solution to the pandemic more challenging and could have harmful repercussions in worldwide efforts to develop a vaccine and effective COVID-19 treatments, then-AMA President Patrice A. Harris, MD, MA, said at the time.

Defeating COVID-19 “requires the entire world working together,” Dr. Harris added.

In April, Dr. Harris said withdrawing from the WHO would be “a dangerous step in the wrong direction, and noted that “fighting a global pandemic requires international cooperation “

“Cutting funding to the WHO—rather than focusing on solutions—is a dangerous move at a precarious moment for the world,” she added

The message regarding the need for a unified international effort was echoed in the statement from the physician leaders.

"As our nation and the rest of the world face a global health pandemic, a worldwide, coordinated response is more vital than ever,” they said. “This dangerous withdrawal not only impacts the global response against COVID-19, but also undermines efforts to address other major public health threats.”

The info is here.

COVID-19 is more than a public health challenge: it's a moral test

Thomas Reese
religionnews.com
Originally published 10 July 20

The time is already past to admit that the coronavirus pandemic in the United States is a moral crisis, not simply a public health and economic crisis.

While a certain amount of confusion back in February at the beginning of the crisis is understandable, today it is unforgivable. Bad leadership has cost thousands of lives and millions of jobs.

A large part of the failure has been in separating the economic crisis from the public health crisis when in fact they are intimately related. Until consumers and workers feel safe, the economy cannot revive. Nor should we take the stock market as the key measure of the country’s health, rather than the lives of ordinary people.

It can be difficult to see this as a moral crisis because what is needed is not heroic action, but simple acts that everyone must do. People simply need to wear masks, keep social distance and wash their hands. Employers need to provide working conditions where that is possible.

These are practices that public health experts have taught for decades. Too many in the United States have ignored them. Warnings about masks, for example, have been ignored.

For its part, government needs to enforce these measures, expand testing on a massive scale, do contact tracing and help people isolate themselves if they test positive. Instead, government, especially at the federal level, has failed. Businesses, especially bars, restaurants and entertainment venues, have remained open or been reopened too soon.

That it is possible to do the right thing and control the virus is obvious from the examples of South Korea, Thailand, New Zealand, China, Vietnam, most of Europe, New York, Massachusetts and Connecticut.

There is also the sin of presumption of those who trust in God to protect them from the virus while doing nothing themselves. Those who left it to the Lord forgot that “God helps those who help themselves.” There is also an arrogance in seeing ourselves as different from other mortals like us. Areas where people insisted they were somehow immune to this “blue” big-city virus have now been hit with comparable or worse infection rates.

The info is here.

Donald Trump: a political determinant of covid-19

Gavin Yamey and Greg Gonsalves
BMJ 2020; 369  (Published 24 April 2020)
doi: https://doi.org/10.1136/bmj.m1643

He downplayed the risk and delayed action, costing countless avertable deaths

On 23 January 2020, the World Health Organization told all governments to get ready for the transmission of a novel coronavirus in their countries. “Be prepared,” it said, “for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread.” Some countries listened. South Korea, for example, acted swiftly to contain its covid-19 epidemic. But US President Donald Trump was unmoved by WHO’s warning, downplaying the threat and calling criticisms of his failure to act “a new hoax.”

Trump’s anaemic response led the US to become the current epicentre of the global covid-19 pandemic, with almost one third of the world’s cases and a still rising number of new daily cases.4 In our interconnected world, the uncontrolled US epidemic has become an obstacle to tackling the global pandemic. Yet the US crisis was an avertable catastrophe.

Dismissing prescient advice on pandemic preparedness from the outgoing administration of the former president, Barack Obama, the Trump administration went on to weaken the nation’s pandemic response capabilities in multiple ways. In May 2018, it eliminated the White House global health security office that Obama established after the 2014-16 Ebola epidemic to foster cross-agency pandemic preparedness. In late 2019, it ended a global early warning programme, PREDICT, that identified viruses with pandemic potential. There were also cuts to critical programmes at the Centers for Disease Control and Prevention (CDC), part and parcel of Trump’s repeated rejections of evidence based policy making for public health.

Denial
After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science. From January to mid-March, he denied that the US faced a serious epidemic risk, comparing the threat to seasonal influenza. He repeatedly reassured Americans that they had nothing to worry about, telling the public: “We think it's going to have a very good ending for us” (30 January), “We have it very much under control in this country” (23 February),
and “The virus will not have a chance against us. No nation is more prepared, or more resilient, than the United States” (11 March).

The info is here.

Stop Blaming Mental Illness

Alan I. Leshner
Science  16 Aug 2019:
Vol. 365, Issue 6454, pp. 623

The United States is experiencing a public health epidemic of mass shootings and other forms of gun violence. A convenient response seems to be blaming mental illness; after all, “who in their right mind would do this?” This is utterly wrong. Mental illnesses, certainly severe mental illnesses, are not the major cause of mass shootings. It also is dangerously stigmatizing to people who suffer from these devastating disorders and can subject them to inappropriate restrictions. According to the National Council for Behavioral Health, the best estimates are that individuals with mental illnesses are responsible for less than 4% of all violent crimes in the United States, and less than a third of people who commit mass shootings are diagnosably mentally ill. Moreover, a large majority of individuals with mental illnesses are not at high risk for committing violent acts. Continuing to blame mental illness distracts from finding the real causes of mass shootings and addressing them directly.

Mental illness is, regrettably, a rather loosely defined and loosely used term, and this contributes to the problem. According to the American Psychiatric Association, “Mental illnesses are health conditions involving changes in emotion, thinking or behavior…associated with distress and/or problems functioning in social, work or family activities.” That broad definition can arguably be applied to many life stresses and situations. However, what most people likely mean when they attribute mass shootings to mental illness are what mental health professionals call “serious or severe mental illnesses,” such as schizophrenia, bipolar disorder, or major depression. Other frequently cited causes of mass shootings—hate, employee disgruntlement, being disaffected with society or disappointed with one's life—are not defined clinically as serious mental illnesses themselves. And because they have not been studied systematically, we do not know if these purported other causes really apply, let alone what to do about them if true.

The editorial is here.

Stop Posturing and Start Problem Solving: A Call for Research to Prevent Gun Violence

Kelsey Hills-Evans, Julian Mitton, and Chana Sacks
AMA Journal of Ethics. January 2018, Volume 20, Number 1: 77-83.
doi: 10.1001/journalofethics.2018.20.01.pfor1-1801.

Abstract

Gun violence is a major cause of preventable injury and death in the United States, leading to more than 33,000 deaths each year. However, gun violence prevention is an understudied and underfunded area of research. We review the barriers to research in the field, including restrictions on federal funding. We then outline potential areas in which further research could inform clinical practice, public health efforts, and public policy. We also review examples of innovative collaborations among interdisciplinary teams working to develop strategies to integrate gun violence prevention into patient-doctor interactions in order to interrupt the cycle of gun violence.

An Ethical Obligation to Address Gun Violence

More than twenty survivors of the Pulse nightclub massacre traveled together to Boston, Massachusetts, in the days before the one-year anniversary of that horrific night. They met with a group of physicians, nurses, social workers, administrators, and others at our hospital to talk about their experience. They recounted their memories of the sounds of gunfire, the screams of those around them, and the moans from those felled beside them. They described the ups and downs that have characterized their attempts to rebuild in the year since gunfire shattered their sense of normalcy. They shared their stories in the hopes that if more people could understand what it means to be affected by gun violence, then we, as a nation, would be compelled to act.

The article is here.

Tell it to me straight, doctor: why openness from health experts is vital

Robin Bisson
The Guardian
Originally published August 3, 2017

Here is an excerpt:

It is impossible to overstate the importance of public belief that the medical profession acts in the interests of patients. Any suggestions that public health experts are not being completely open looks at best paternalistic and at worst plays into the hands of those, such as the anti-vaccination lobby, who have warped views about the medical establishment.

So when it comes out that public health messages such as “complete the course” aren’t backed up by evidence, it adds colour to the picture of a paternalistic medical establishment and risks undermining public trust.

Simple public health messages – wear sunscreen, eat five portions of fruit and veg a day – undoubtedly have positive effects on everyone’s health. But people are also capable of understanding nuance and the shifting sands of new evidence. The best way to guarantee people keep trusting experts is for experts to put their trust in people.

The article is here.

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP

Guest Post by Nathan Emmerich
BMJ Blogs
Originally posted October 5, 2016

Here is an excerpt:

Consider the following thought experiments. Imagine a drug that could be taken to significantly lessen the risk that a smoker would develop lung cancer, or a drug that would lessen the risk of ‘at risk’ individuals developing diabetes. In such cases would we be inclined to refuse public funds for such drugs merely because such individuals could lessen their risks even more by giving up smoking, or by losing weight and eating a healthy or, at least, healthier diet?

There is, certainly, something regrettable about having to spend public money on a drug that offsets risks generated by an individual’s own behaviour. Nevertheless, from an epidemiological – and therefore public health – perspective, the notion that an individual makes a choice about whether or not to smoke, or to have a bad diet, is too simplistic, even when we place the issue of addiction to one side. Thus, even when smoking cessation programmes are available and even when nutritional advice is within easy reach (as it increasingly is), plenty of people still smoke and consume a less than healthy diet.

Smoking and bad diets are correlated with a variety of demographic factors, and our choices are always made within particular cultural and socio-political contexts. Even so, some have questioned if the NHS should be funding stomach-stapling operations for those who are overweight, or if smokers and non-smokers can expect to receive the same level of treatment and care.

The entire blog post is here.

Are There Still Too Few Suicides to Generate Public Outrage?

Lytle MC, Silenzio VB, Caine ED.
JAMA Psychiatry. Published online August 17, 2016.
doi:10.1001/jamapsychiatry.2016.1736.

Suicide is the 10th leading cause of death in the United States, with the overall rate increasing 28.2% since 1999, driven by a 35.3% increase in suicides among persons 35 to 64 years of age.1 Suicides surpassed road traffic deaths in 2009, and the 42 773 suicides reported were more than double the 16 324 homicides in 2014. When coupled with deaths from other deliberate behaviors, research suggests that the mortality from self-directed injury exceeds 70 000 lives, making it the eighth leading cause of death while the death rates of cardiovascular diseases (CVDs), cancers, and human immunodeficiency virus (HIV)/AIDS continue to decrease.

The entire piece is here.

Epigenetics in the neoliberal 'regime of truth'

by Charles Dupras and Vardit Ravitsky
Hastings Center Report - 2015

Here is an excerpt:

In this paper, we argue that the impetus to create new biomedical interventions to manipulate and reverse epigenetic variants is likely to garner more attention than effective social and public health interventions and therefore also to garner a greater share of limited public resources. This is likely to happen, we argue, because of the current biopolitical context in  which scientific findings are translated. This contemporary neoliberal “regime of truth,” to use a term from the historian and philosopher Michel Foucault, greatly influences the ways in which knowledge is being interpreted and implemented. Building on sociologist Thomas Lemke’s Foucauldian “analytics of biopolitics” and on literature from the field of science and technology studies,  we present two sociological trends that may impede the policy transla-tion of epigenetics: molecularization and biomedicalization. These trends,  we argue, are likely to favor the clini-cal translation of epigenetics—in other words, the development of new clinical tools fostering what has been called “personalized” or “precision” medicine.

In addition, we argue that an over-emphasized clinical translation of epigenetics may further reinforce this biopolitical landscape through four processes that are closely related to neoliberal pathways of thinking: the internalization and isolation (liberal individualism) of socioenvironmental determinants of health and increased opportunities for commodification and technologicalization  (economic liberalism) of health care interventions. Hence, epigenetics may end up promoting further the mobilization of resources toward technological innovation at the expense of public health and social strategies. Our analysis therefore first presents how the current biopolitical landscape may bias scientific knowledge translation and then circles around to explain how, in return, the outcome of a biased translation of epigenetics may strengthen our contemporary neoliberal “regime of truth.”

The paper is here.

Is Gun Violence a Public Health Crisis?

Science Friday Podcast
Ira Flatow is the Host and Executive Producer

On Wednesday, a mass shooting in San Bernardino, California left 14 people dead, making it one of the deadliest in modern American history. In fact, there have been more mass shootings than there have been days in 2015 so far. Of course, gun violence in the United States isn’t restricted to mass shootings—firearm homicides and suicides far outpace the number of mass-shooting fatalities. Taken together, an estimated 32,000 people die as a result of gun violence in the United States annually, and an additional 180,000 to 190,000 people are injured, says Sandro Galea. He’s the dean of Boston University’s School of Public Health and one of a number of researchers calling for firearm deaths to be treated as a public health issue. Another is Garen Wintemute, of the UC Davis School of Medicine, who has done extensive research on the effects of access to guns. Wintemute and Galea join Ira to discuss why they see gun violence as a public health issue and what research must be done and steps taken to address the problem.

The podcast is here.

Broadening Bioethics: Clinical Ethics, Public Health and Global Health

By Onora O'Neill
Nuffield Council on Bioethics

Medical ethics is the most discussed field of bioethics, and has been mainly concerned with clinical ethics.  It has often marginalized ethical questions about public health.  A focus on the treatment of individuals has highlighted patient choice and informed consent.  It can be widened to discuss the just distribution of health care, but is useless for considering many other interventions and policies that matter for public health.  Many public health interventions are non-distributable goods, so cannot be allocated to individuals or subjected to individual choice requirements.  In marginalizing public health, work in medical ethics also often marginalized questions about global health issues, where public health interventions matter hugely, and entrenched a deep separation of medical from environmental ethics.

Work that takes public and global health seriously needs to be anchored in political philosophy, to look beyond informed consent and individual choice, and to ask which interventions are permissible without the consent of those who they may affect, and which are not.  Public health encompasses more than health 'promotion' and 'nudges' - and these too require justification - and even clinical interventions that are directed to individuals presuppose standards, technologies, and structures that cannot be matters of choice.

The entire article is here.