What Have We Done?

There's a (true) story going around about a mom in S. Carolina who's got a kid in the ICU from measles and says she still wouldn't have vaccinated had she known this would happen.

Parents who are grieving or near-grieving, I can't judge...I just can't. Your mind will try to protect you when the worst possible thing happens, especially if it's from your own decisions.

There's a difference between parents who kill their kid by trying to heal their diabetes through prayer alone, and parents who make bad choices about certain types of preventive care.

And in general, no one is telling you to let your diabetic child die unless G-d reaches down with one finger and fixes them. You decided that. You dug that grave.

But with vaccination, there are voices at the highest level of society telling people, "Don't do it!" And there are parallel voices telling us that "expertise" is an illusion, a power-trip, and how can "experts" know more than real people with real common sense? Isn't it obvious that vaccines are bad, that climate change is a hoax?

But there IS a kid in an ICU in S. Carolina right now whose brain is swelling inside his skull while his mom prays and tries not to blame herself. And there will be more like him. Because, dammit, expertise DOES matter.

I mean, anyone who drives across a bridge or gets into an airplane knows, on some level, that this isn't something they could have designed and built themselves. I tell people all the time, "would you drive over a bridge build by an 'alternative' engineer? Then why is ‘alternative medicine’ any different?"

Pubic health and medicine are real sciences. And intuition, as important as it is, isn't a substitute.

This isn't about blindly trusting people who call themselves experts. This is about looking around and finding that four of your kids didn't die of dysentery because we know microbiology and how sewers work. Look at any 18th century graveyard, you’ll get the picture.

But people who are otherwise “skeptical” of experts do get on that plane to Disney World. You trust the plane will take off and land, that the gas station to fill your rental car has plenty to sell, that the lights stay on in the hotel, and the rides are fun and safe. You blindly trust experts every, single day, a hundred times a day.

Medicine and public health allowed you, your friends, your parents, your kids to grow up, and to live longer, healthier lives than any time since we first became humans.

So weigh your experts, decide if politicians who snort cocaine off toilet seats and don't even bother to feel stupid about it are somehow more trustworthy than the folks you and I already know are real experts.

And I can't believe that that sentence reflects our reality. Really.

It is going to take decades for our public health infrastructure to recover from what we've done to it in only a year. And in those decades, kids will die of measles, pandemics will come (because they always do) but without the expertise to stop them. People will get cervical cancer, a disease we can wipe out with vaccines. Real people are going to suffer and die needlessly.

Look, I'm just a doctor, I'm not telling anyone who to vote for in elections. But you will see very soon counties all over this state voluntarily destroying their own public health systems, firing their experts, cutting vaccine programs. And this will rise to the state level depending on who our next governor is.

We've lost our public health umbrella in the CDC, NIH, etc. If our safety nets at the county and state levels go, that’s it. Just look at Texas, Florida, S. Carolina.

What am I asking of you, dear reader? Well, voting matters of course, and paying attention to candidates’ take on health issues is urgent. But let’s remember that we experts aren’t any smarter than antivaxxers, we don’t love our kids more than they do. All of us, except for the worst sociopaths want what’s best for us and our kids.

So I’m asking you to think skeptically—not “skeptically” meaning you are a contrarian and just disagree automatically with expertise or with ideas from another political party. I mean real skepticism where you look at the source of a pronouncement, look at what real experts say, and make the same choices about health that you make when you drive over a bridge.

To be fair, some if this really is on us, the experts. If I’m sitting in an exam room and a patient says, “I don’t want any shots, Doc, they are bullshit,” my correct answer isn’t “you’re nuts, I’m an expert, just do what I say!” That’s patronizing and disrespectful.

The assault on expertise forces us to spend more time listening, going back and forth, and lowering our immediate goals. If we have a real conversation you might not get your shot today, but you might do it tomorrow.

Look, we all make bad choices, often for the best of reasons. The mom who’s kid has the swollen brain wasn’t looking for that outcome. She was looking to raise a healthy, good little human being. Hob rachmones, as my mom would have said. Moms aren’t the enemy.

The fault lies with leaders, with failures of public health, with the assault on expertise. And if we don’t fight back, people die.

-pal