Coronavirus Fears

The fears, more so than the virus, are leading people to do strange things. The toilet paper and bottled water hoarding is just one example. I stopped by the grocery store today and it was packed at 1:30 in the afternoon. Schools announced they would shut down for 2 weeks to disinfect, and apparently what you do when the schools are closed to keep the kids from infecting each other is take them to a crowded grocery store instead.

And what the schools are disinfecting is a mystery, since there have been no reported cases of coronavirus (COVID-19) in this or any of the surrounding counties. But I guess the schools will be as germ-free as they have ever been.

I don’t think the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Dr. Anthony Fauci, is doing anyone any favors. He is undoubtedly very knowledgeable on the subject, but his bedside manner leaves something to be desired. With the country in a panic he told Congress, “things will get worse than they are right now. ”

That is the direct truth, perhaps a little too direct. It is understandable from a purely clinical point of view that diseases spread, especially in a population without immunity, but words like that don’t do anything to get people to calm down. They have the opposite effect (to the great delight of the news media). 

So here is another way to think about it. America is very likely better at dealing with such a problem than China. The first case in China was traced to November 17 of last year.

By February 29, we were seeing headlines like this from NPR: “As New Coronavirus Cases Slow In China, Factories Start Reopening.” They were still having some economic problems, but the future seemed brighter.

By March 12 Reuters was reporting: “The Chinese city of Wuhan, ground zero of the coronavirus outbreak, reported just five new cases on Friday, the second day in a row the tally has been less than 10, while no locally transmitted infections were reported in the rest of the country.” Less than four months after the initial outbreak they seemed to be getting a handle on the problem.

That should be encouraging for the rest of us. Though it will likely get worse as Dr. Fauci stated, the first case of coronavirus was already detected in the US just about two months ago. “On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever.”

Now extrapolation can be a little dangerous, and no one can guarantee that we will be out of the woods less than two months from now. But judging from progression of the disease in China and subsequently in Italy, it seems like a decent assumption. Whether it is or not remains to be seen, but taking that point of view is certainly more comforting (and realistic) than listening to the evening news and then hauling the kids off to the store to buy more toilet paper. 

Science, Medicine and Snake Oil

Snake oil is a derogatory term used to characterize fake or fraudulent medical devices, pills, tonics or ointments.  It is based on true events in American history when a man named Clark Stanley did very well for himself selling to credulous consumers his liniment, supposedly (but not really) made from the fat of rattlesnakes.  He claimed it cured any number of medical conditions.  Later the government fined him, declaring the product worthless.

Today the same thing is going on but with a slightly more sophisticated presentation. Last November an Ontario chiropractor appeared on a CBC program, Dragons' Den (known as Shark Tank in the US) to pitch the idea of wearable clips to a panel of venture capitalists.  Called Neuro Connect, these clips were said to “improve a person's balance, strength and joint function almost instantaneously” through a process called quantum entanglement, which is a real term used by scientists but has nothing to do with balance or strength.  After a live demonstration he raised $100,000 in exchange for a 30% share of the company.  (The parts of this article where the inventors explain that they don’t know how it works – it just works, are pretty funny reading.)

The investigative journalist and scientists were more skeptical.  They set up a real test:

“With the help of experts at the University of Toronto's Institute of Biomaterials and Biomedical Engineering, 10 participants were asked to do two tests: a static standing balance test and a grip strength test to measure whether the clips had any effect. 

 “Each participant did the strength and balance test three times — once with Neuro Connect clips, once with a set of name tag clips and once with no clips. It was double-blind — neither those conducting the test nor the participants were told which clips were being used.”

They found no difference in any of the tests and declared the product “snake oil.”  In light of these findings the inventors are not backing down promising to do their own tests.  But since then Health Canada has forbidden the company from selling three other products.

See how the University of Toronto went about their test.  It’s a good example of how science should be done.  They set up a double-blind experiment, based on measurable outcomes, not on a clever sales pitch using fancy scientific-sounding terms and a single demonstration.  They did not rely on personal endorsements.

This should be a concern to all Americans interested in protecting their health and savings.  Sure, this example came from Canada, but in the US the same kind of activity is rampant.  Just last August on BuzzFeed a sub-headline read: “Analysis by BuzzFeed News found that more than half of the most-shared scientific stories about autism published in the last five years promote unevidenced or disproven treatments, or purported causes.”

Look at some reviews of a website called NaturalNews.com with 6.5 million hits per month.  The Skeptoid says: It’s the #1 "worst anti-science website".  Steven Novella, M.D. and assistant professor at Yale University School of Medicine adds: The author is "a dangerous conspiracy-mongering crank."  From Oncologist David Gorski: It’s “the wretchedest, scummiest, and quackiest" website on the Internet.  Another cites it for “pseudo-scientific insanity." Everyone must be more careful, despite the tendency to believe that Natural = Good.  That’s just marketing, not evidence.

Don’t stop there.  The popular Dr. Oz Show, which just ran it’s 1500th program and a related show The Doctors are not without their critics.  After a thorough investigation of the content, one critic wrote:

“The recommendations made on these shows only occasionally follow evidence-based guidelines. Often, we couldn’t find any literature citation (such as a medical study) to confirm the claims made on the show. The costs and harms of the suggested treatments were often overlooked. And, the hosts on the show frequently hawked products made by companies that advertise on the show.”

 So if Americans watch these shows for medical advice rather than entertainment, it’s best to get a second opinion to distinguish valid medicine from snake oil.  A little critical thinking goes a long way.

Critical Thinking About the United Airlines Fiasco

By now everyone has heard the news and seen pictures of the doctor being dragged from the United Airlines flight from Chicago to Louisville.  The Internet and network news went crazy with cell-phone videos of the incident.  The company stock is dropping based partially on talk of a boycott in protest.  The CEO apologized, but it’s too late; the damage is done.  Now Americans are pouring out prayers and sympathy for the doctor, but is this really justified?  

It is clear that the company screwed up to such an extent that they deserve the public relations disaster they are experiencing.  There were clearly other solutions.  Four seats were needed on the plane for crewmembers who had to be in Louisville (and rested) in the morning for uninterrupted service the next day.  Since there were no more flights available that night, the company could have used the thousands of dollars offered in vouchers to pay for ground transportation for the five-hour drive either for the bumped passengers or the crew.  Otherwise, they could have announced that the plane was not moving until that passenger got off and let peer pressure take over.  Instead they called in the airport security goons.

But something is missing.  According to earlier stories, the airline offered vouchers and motel to volunteers but got none.  Then they resorted to a random drawing to choose passengers to give up their seats.  What of the other three passengers?  They were not dragged from the plane, only the doctor.  How was he treated before being forcibly removed and how did he react?  The airline characterized him as "disruptive and belligerent.”  That is an opinion, but in the videos he certainly didn’t appear to be cooperative.

The big question in the midst of this outpouring of sympathy and prayers is, what was the underlying message?  It was there.  If people were alert and thinking instead of emotionally reacting to only the video, they could see it very clearly.  The underlying message from the doctor, and he might as well have stood up and shouted it at the rest of the passengers, was “I am more important than you!”

That’s right.  Three other passengers, who are receiving no media attention, cooperated with the airline in the legal exercise of their authority based on the agreement on every ticket.  “Federal rules dictate a carrier must first check whether anyone is willing to voluntarily give up their seat before then bumping flyers involuntarily if nobody comes forward.”  It’s the law.

So did the doctor react as the others did?  If someone else had been chosen, he would have sat back and enjoyed the flight with the message unspoken.  But when he was chosen, he reacted like a two-year-old who didn’t get his way.  He went limp, forcing security agents to drag him off.  He looked like a protester being removed from a picket line.  But remember what he was protesting – he was protesting his right, his firm belief, that he was better than everyone else on that flight.  If you had been on the flight, the implicit message figuratively being shouted in your face as he was dragged from the plane would have been, “I am more important than you, too!”

With that in mind, give him as much sympathy as you think he deserves, but don’t forget the message.  Also note that one interviewed passenger mentioned that she and her son “were sitting in the row directly behind…the doctor and his wife.”  Wait, yet another solution, if he had patients so desperately in need of attention the following morning, couldn’t he have turned to his wife and said, “Excuse me for imposing, Dear, but you know the situation.  Would you be so kind, and I promise to make it up to you.”  Given that information perhaps the patients were not the issue but merely a pretext for the real message, “I am more important than you.”

Listen to (Don't Ask) Your Doctor

One of the key behavioral dimensions is discipline:  doing what needs to be done in the proper timeframe.  The opposite of discipline may be procrastination, but discipline also includes actions like delaying gratification and impulse control.  The important thing to understand about discipline is that it is not particularly challenging mentally.  It’s usually easy to understand what needs to be done.  All the steps are laid out and reasonable.  The difficult part comes in the doing.

I call discipline the diet dimension.  What needs to be done to lose weight and keep it off is easy to understand and common knowledge, eat less and exercise more.  Actually doing it is the challenge.  People make fortunes selling books and diet programs, some with tricks and secrets, foods to eat and foods to avoid.  Many just provide help with eating and/or exercising.  When the program is over and if it worked, most people gain back what they lost because they lack the discipline to stick to it.

Dieting is not the only example.  Success with personal finances falls into the same category, as does quitting smoking or correcting any other bad habit.  Even little habits we should develop like brushing and flossing, regular medical checkups and eye exams fall into this category.  These aren’t even hard to do; they just require some attention and the ability to stick to a schedule.

Discipline is very important because it can have long-term effects on our health and happiness.  Part of what makes it difficult is that the consequences are often far in the future.  The cancer from smoking, the anxiety-filled retirement from lack of savings and all the diseases associated with obesity are far in the future.  The pain and sacrifice of sticking to a program happen today.  Key here is that by the time delayed consequences strike, it may be too late to take corrective action.

Recent advice from the American Heart Association (AHA) gives another example.  “It is estimated that three out of four Americans do not take their medication as directed.”  This seems like a no-brainer.  Instructions are usually clearly printed on the label and reinforced by the doctor or pharmacist.  Those who have questions can easily find resources to help them out.  This is a clear case of problems with discipline.  And as in the examples above, the consequences are serious and often delayed.  The AHA goes on to say, “poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.”  Remember, costs to the system, costs to society, are costs to you and me.

This advice is not new, but it is now based on clear evidence.  A new, very thorough study looked at outcomes of more than 3,200 heart patients who underwent either bypass surgery or insertion of a stent to keep vital blood vessels open.  That’s a very large sample.  Follow-up exams 12 and 18 months out showed much better results for the patients who took their medications as prescribed.  They “were more than twice as likely to have complication-free survival than those who did not take their medications as prescribed.”  Once again, discipline pays off.

This is why wise parents try to instill a sense of discipline in their children:  eat healthy food before getting dessert, do your homework or set aside the time before enjoying more fun activities, buckle your seatbelt, don’t text while driving and prizes and rewards are earned, not bestowed.  A famous experiment many years ago showed that children with a sense of discipline even at a young age tended later in life to be more successful in academics and careers.

Unfortunately the surest way to instill this sense of discipline in children is to lead by example; and from diets to drugs (legal and illegal), so many Americans struggle with this behavioral dimension.

Scooters for All!

Here is another strong case for the plea:  “Don’t Ask Your Doctor.”  Earlier I pointed out what a delicate position doctors were in, caught between the advertisers and their best judgment, while being pressured by patients who only know what they saw on TV or read in a magazine.  The ask-your-doctor promotional ploy is specifically designed to put doctors into this position of disappointing or even potentially losing a patient whose expectations have been raised by promoters of particular drugs.  Remember, these are the same doctors who pay large sums for malpractice insurance because people are so sensitive about getting flawless care.  If the patient says that he wants a certain pill because he saw it advertised on TV, is it easier for the doctor to prescribe it, or to argue about its appropriateness?

Furthermore, the move to reduce the cost of prescriptions makes the pill less expensive and more desirable.  Then all we need is for the placebo effect to kick in, and the patient thinks the advertising was right and the pill helped, the doctor has avoided a difficult conversation about proper care for the problem, and the drug companies get richer.

A new twist, as this article points out, comes from the scooter industry.  They advertise on TV showing elderly people scooting around, happy and carefree on scooters that may be totally paid for by Medicare.  “Wow, a free scooter, and all I have to do is ask my doctor!”  The down-side should be easy to understand – “hundreds of millions of dollars in unnecessary spending by Medicare, which is only supposed to pay for scooters when seniors are unable to use a cane, walker or regular wheelchair” and the medical profession’s concerned that “seniors who use scooters unnecessarily can become sedentary, which can exacerbate obesity and other disorders.”  Of course it’s easier and more fun to use a free scooter than to walk off the weight or do the physical activity to stay healthy or regain more mobility.  It’s clearly a discipline issue, detrimental to the senior and costly to a healthcare system that can’t afford it.

Again, don’t ask your doctor about an advertised drug, with the preconceived expectation that it’s right for you.  Tell your doctor your symptoms and let your doctor discuss the options with you.  If you force your doctor into a corner you may end up spending more for pills you don’t need or a scooter you shouldn’t have, undermining your own health and driving up the cost of healthcare for everyone.  But as Medicare or insurance is forced to pick up the cost of more and more treatments, these quick-fix solutions are very tempting.