I am a primary care doctor and have been a big fan for a long time. Your common sense science-based approach to problems has given me an anchor to which to give reasonable and rational recommendations for the care of my patients. You’ve (largely) stood above the clamor of the masses, the pressure from pharmaceutical companies, and the wishes of politicians and have stood on the evidence, the science.
But things got a lot harder last year, didn’t they? Suddenly there as an unprecedented situation with COVID-19 that put you front and center. To make matters worse, it was an election year in a very divided country. While you continued to try to remain above the fray, politicians, pundits, and even the common person on Facebook had a very strong opinion about how you were operating, what you were saying, and how you were (or weren’t) leading.
I know it was a difficult circumstance. People don’t realize that science is a process, and we were all faced with a threat about which we knew very little. Do we wear masks? Do we socially distance? Do we close schools? What treatments are effective, what treatments are ineffective, and what treatments are unclear and need further study. I realize science works that way (it’s been that way ever since I became a doctor), but for most people this was their first glimpse into the often unclear nature of the scientific process. We go from a point of not knowing and accumulate data to come up with best answers. But many times those best answers are met with new data that contradicts and causes those best answers to need changing. It’s confusing to people when the CDC changed what they recommend, but it’s science.
You did your best. The politicians and pundits (not to mention the attention-seeking “experts” on YouTube and Facebook) are largely to blame for the confusion, and certainly they didn’t accept science for what it is. They wanted the “right” answers now! That’s not how it works, and I realize that.
So I approach this with great caution. I want you to know how much I like and respect you, and feel like you’ve done a pretty good job, considering just how horrible the political stuff has been around you.
But I think you are getting the vaccine all wrong.
That there are indecent people in the world is not a matter of doubt. The confusion appears to be in identifying the cretins.
The American hospital provides the perfect case study. On the face of it, hospitals are houses of virtue, providing aid to those during dark times. The billboards dotting the landscape of cities proclaim it. Dakota University Hospital Cares About YOU. There is almost no limit to the money these modern day incarnations of Florence Nightingale spend to convince wider society about their good deeds. One wonders how many non-profit organizations casually spend $5 million dollar for 30 second super bowl advertisements just to let citizens know they exist to help you. One wonders how anyone would have known about Mother Teresa’s good will if not for her Calcutta PR team.
These organizations don’t just think they are charitable organizations. They are regarded as such by the Internal Revenue Service. Two thirds of the nation’s 5,000 hospitals declare themselves as “non-profits”, an important designation that allows them to avoid paying property taxes, state or federal income taxes, and no sales tax. There are some very specific requirements charities fulfill to receive this largesse. The IRS declares:
The organization must not be organized or operated for the benefit of private interests, and no part of a section 501(c)(3) organization’s net earnings may inure to the benefit of any private shareholder or individual.
It may not attempt to influence legislation as a substantial part of its activities
Yet somehow, the healthcare market has evolved to allow hospitals to launder vast sums of tax-free money into the pockets of hospital executives and physicians. The compensation packages at the top run into the tens of millions of dollars, while the deans and chairs of big-ticket departments make millions of dollars a year. What’s worse is that the river of money that flows to these institutions are a direct result of a massive amount of dollars spent over the years to rig the market by writing favorable legislation. In 2018, the lobbying arm for the hospitals – the American Hospital Association – spent almost $24million to keep the gravy train running. The arcane legislative items these dollars are used to influence won’t be brought up over dinner, but have a return of billions of dollars.
The most successful hospitals then go onto individually spend millions of dollars on top of this to influence local and national legislation.
There are a few truths that seem to be glaringly ever more important in contemporary society. One is that the feelings of the elite trump facts. Another is that the capture of venerated institutions is so complete that they are frequently used to present feelings as fact.
No better example of this relates to the always contentious physician gender pay gap problem that is examined in a recent study published in the esteemed New England Journal of Medicine. The study seeks to examine the different practice patterns of men and women physicians to understand why men in medicine seem to always make more than women in medicine. Most questions have multiple potential answers, but the answer to this particular question is already known by the IYI class of physicians and researchers that torture data to create the type of glossy PR that would make tobacco executives jealous. The researchers use a mediocre study to spin a tale of woe for women physicians despite the fact the results of the study should leave anyone with more than an ounce of objectivity to quite different conclusions. I must also pause to say that the fact that this weak study gets published in the NEJM with an accompanying editorial confirms the journal’s place on the vanguard of the feelings>facts social justice movement.
The job description for those writing these studies that specialize in confabulation is simple. First, find some dataset of men and women physicians, and then manipulate the findings to spin some tale of societal systemic discrimination that oppresses women. Ganguly et. al. are professionals, and don’t disappoint.