NIH director on why Americans aren't getting healthier, despite medical advances
npr.org
npr.org
If people are presented with accurate medical information and they choose to ignore it, at some point you have to accept their autonomy. At some point "framing" becomes propaganda and if ends justify the means, the authorities would be willing to lie in order to get their message across, making the problem of trust even worse.
I think the 'medical community' is not getting uptake on their scientific credentials because they've destroyed their own credibility. The absolute refusal to acknowledge responsibility for the destruction of their own credibility is abhorrent. It's very similar to how Democratic political strategists are resorting to blaming the voters for Dem's losing.
There's a couple vaccine scientists in my own city who have become active on Twitter during the pandemic, and every once in a while they say something inaccurate or in my opinion unethical. I dont comment, as they have an army of people who praise everything they say. I just silently file it into 'more BS said by person X', which then influences my opinion of everything they say, forever.
When you are in a position of power, you have to hold yourself to a higher standard of communication. One drop of deception in a sea of science will ruin the whole batch.
It is baffling that these people pretend to not know why people don't trust them. It shows a complete lack of empathy, understanding and a refusal to take ownership over something that is their responsibility.
What purpose is there to get information from the “media pipeline”?
CDC.gov , NHS.uk , WHO , Harvard medical, Johns Hopkins, etc.
ask your Dr for medical advice.
That's the great tragedy of this pandemic: it has destroyed trust in institutions, by showcasing a few disturbing things.
The epidemic of nonreproducible scientific studies is... an epidemic and it's astounding nobody pays attention.
Ten years ago I was misdiagnosed with a condition, at least in part because the closet Stalist "doctors" thought my body should fight off the infection... didn't wanna cause any antibiotic resistance, ya know.
When my wife suffered a detached retina, they opened the surgical wing of a regional hospital on a Saturday to fix it. (They did a great job.)
For years I got the PSA as part of my yearly physical. This test has a lot of false positives. Eventually it was positive two years in a row so I was "ok doc, guess you gotta start feeling my prostate". He looked definitely uncomfortable and found an excuse not to do it until the next year. He told me to go research it on the internet. I don't get the PSA any more, it's not the answer to any question: "do you want to know more?"
Let me pause to point out that we're really good at heroic measures which cost a lot of money and not so good at, you know, health. We see this in Covid, where if people are hospitalized we're willing to take all kinds of heroic measures, even if it kills them... but I don't see a lot of interest by the medical establishment in prophylactics or early mitigations (I know it's out there).
Moving on, the "doctor" doesn't want to give me a professional opinion, notwithstanding that he doesn't understand Bayes. "Do you want to know more?": That might be an ok manipulation on a web site, but it has no place in medical care.
We're supposed to be enabled to purchase medical care, but we're not supposed to do it based on price or quality. So I suppose the first thing we're supposed to buy is more information so we can make the right decision because it's "your own fault" if you're ignorant: "do you want to know more?"
Well, I worked at biotechs I at least have NBC safety training.
Crunching data from different sources concerning all things COVID doesn't reach the same conclusions. Stuff is reported and defined differently. Obvious questions from an epidemiologic standpoint aren't answered. Stuff seems to be omitted for curious reasons. Contact tracers can't contact 1/3rd of positives for followup? We don't know the race of 45% of the patients in hospitals? What kind of living and working conditions does it spread in?
As for the vaccine, it is leaky and most definitely not sterilizing. Funny that doctors understand how slathering yourself in antibiotics (mayonnaise optional) leads to resistant bac and it's most def not ok to give them to livestock, but "antibiotics ok"... until the science... the actual science, catches up: https://www.pbs.org/newshour/science/tthis-chicken-vaccine-m...
It's as obvious that the powers that be have no interest in actual public health as it is that they lack the intellect and public trust to do so.
As a student of human nature it is also obvious that belief and science are orthogonal, as quite evidently people can have faith in science without ever exercising the testing and critical evaluation required. It's impossible to understand medical care without understanding the conditions under which it is delivered.
I would argue most Dr in America will give good advice for covid. Certainly better than most media sources!
Having media in between is what I'm arguing against. Media is biased and not objective and should play no role in health.
When it doesn't work out the way they planned when they pull it out their a* they call that a "complication". Seriously.
I think there's operant conditioning at work: It seems like there's less interest in extracting money from us by (cough) "practicing" medicine than in edubicating us that something is "serious" and it's our obligation to learn more about it, and extracting money from us that way.
I think there's a model for this operational paradigm, I think it's the smart phone. They train you to dismiss "alerts". Then they show you inchoate alerts, engendering anxiety and a feeling of lack of control. Then they propose a way you can get "in control" by following their narrative.
Are you really an expert because you're over 50 and you still have college loans to pay off? Really? You're gonna say that with a straight face, doc?
Funny you should mention Covid. Last year I asked for an antibody test, they said they'd do it. They didn't. They lied and said I'd never asked. Then they piled it higher and deeper by telling me that if they had, they'd have had to report the result to the CDC. WTF? Is that a bad thing? My wife was there for both exchanges. Furthermore, because electronic records there is no record of the tests which were ordered, only of the ones they want to tell you about: that is correct, I have no receipt for the blood which was taken or the tests which were ordered. (Lesson learned.)
I suppose it's easy to attribute this to some grand plan, but I'll choose mundane misfeasance as the reaction to errors arising from incompetence.
If there's any question about the efficacy of the treatment or any way for these amateurs to screw it up, why the hell would I trust my life to them?
This is genuinely baffling. Of course "do you want to know more?" is a valid question in healthcare.
Here's one example: https://www.bbc.co.uk/programmes/b038hhs7
The strange thing is that people will say things like this and then .. jump in the sea of deception that is youtube.
> The strange thing is that people will say things like this and then .. jump in the sea of deception that is youtube.
It may be unfair to say that given OP self confessed biases (ex: "pro vaccine")
When people in your own camp show unethical behavior, you start questioning the narrative. The other camp may be worse, but the responsability here fully lies on those who think a drop of deception was acceptable because the ends justifies the means. No, it doesn't and didn't, not now, nor ever.
I love science and I'm extremely sad a few bad apples may result in a future where more and more people distrust science - with good reasons!
After the Tuskegee experiments became mainstream, ethics was put forward to avoid this.
Unfortunately, we didn't learn anything from that: diseases resurfaced in Afghanistan because people learned to distrust the "vaccination campaign" that was just a sham to sequence DNA and try to find terrorists.
This should never have been allowed to happen if we were serious about ethics and not lying.
Look at the old Star Trek, and how the federation always took the moral high ground, regardless of the unfortunate consequences: this is what we should aspire to, instead of lying and cheating to get people to do what we think they should do.
First, I agree that science changes and not all falsehoods are intentional. That said, an important part of maintaining credibility is owning ones mistakes. This means admitting when one is wrong, and what caused the change. Part of this is also admitting uncertainty where it exists.
Second, intentional falsehoods are a real problem and should not be allowed whatsoever. It is not ethical to lie to people even to get a beneficial outcome.
Last, while people and organizations should not be discredited by association, the absolutely need to be responsible for their own statements. If say, a CDC approved statement contains misinformation, the organization should be accountable.
They do understand that youtube contains misinformation, but are looking for a trustworthy source within the sea of misinformation.
> When you are in a position of power, you have to hold yourself to a higher standard of communication. One drop of deception in a sea of science will ruin the whole batch
If I may borrow from the old Spiderman movie and adapt the key line, "With great privilege comes great responsability"
At this point, like it's been with chicken pox and other viruses, it seems less risky to just let our kids contract the Omicron variant than to expose them to a vaccine with the "rare" effect of myocarditis. I've never trusted the pharmaceutical companies in this country, so why should I now? Because "fact-checkers" on Twitter, Facebook and NPR, who receive government funding, tell me to? And yet if I try to express this sentiment in my circles, I risk being called a conspiracy theorist or worse, "anti-vaxxer", even though my wife and I are vaccinated. What's up with that?
Fear and anger leads people to do irrational things. This is on par with 9/11 levels of fear and look at what irrational things we did because of that.
Here's a video of Michael Moore getting booed at the Oscars by the audience for saying we went to war (Iraq) for fictitious reasons.
What institutions? CNN or the CDC? I don't remember the CDC ever coming out and saying something about Joe Rogan, but the CDC and FDA came out and rightfully said taking Ivermectin is a bad idea.
If some private citizen wants to find some quack doctor that prescribes them drano, what can they do?
What this is really about, is two competing medical communities... Joe Rogan's quack doctor and CNN's Sanjay Gupta, but don't make this about some higher level issue about "Institutions" the CDC and FDA are doing its job just fine.
It's understandable that people have issues with Moderna and Pfizer, since they are a new type of vaccine (mRNA-based) and we're not sure what the long-term affects of mRNA vaccines may be, but the J&J vaccine is made the same way that most other vaccines are made and those risks have been known for decades.
"His Doctor" is the person who should really be interviewed and scrutinized.
It's not understandable why they use that as an argument for not taking them.
There might be long term effects to taking the vaccine that will only make themselves known in 20 years. There might also be long term effects to taking the coronavirus raw that will only make themselves known in 20 years.
This is the only valid argument against the vaccines that I have seen so far, and it is just as valid for the opposite side.
Several Chinese and Indian vaccines are traditional vaccines that have been widely used.
Tens of thousands of people received a viral vector Ebola vaccine.
Please don't repeat known lies. it just muddies the conversation and adds to misinformation, which is already a huge problem.
Ivermectin is a drug designed for humans and prescribed to a hundred million people a year.
Compare that with "toxic animal dewormer". If we want to have any productive public discourse about any topic, we need to resist the urge to knowingly repeat lies and misinformation.
Merck began marketing ivermectin as a veterinary antiparasitic in 1981.[7] By 1986, ivermectin was registered for use in 46 countries and was administered massively to cattle, sheep and other animals.[82] By the late 1980s, ivermectin was the bestselling veterinary medicine in the world.[7] Following its blockbuster success as a veterinary antiparasitic, another Merck scientist, Mohamed Aziz, collaborated with the World Health Organization to test the safety and efficacy of ivermectin against onchocerciasis in humans.
Ivermectin is an animal drug that was then used in humans for severe cases of parasitic infestation (i.e., lice, scabies, etc.). It is absolutely not a drug intended for normal human use.
This has been the real sticking point for me throughout this whole thing. As much as I don’t like Joe Rogan, I went and watched some of his conversation with Sanjay Gupta, and I applaud Sanjay for even agreeing to go on Joe’s show at a time when he was (imo) only getting worse. But he really, really, did not do a great job. Specifically, he literally hesitated to answer the question “Do you think it’s a problem that your news network lies?”. Surely Sanjay Gupta knows that CNN had exclusively been running headlines saying Joe Rogan was taking “horse dewormer” even though he was taking the actual human version of ivermectin.
I don’t think it’s the responsibility of public health officials to bend over backwards trying to repeatedly convince people who will not be convinced by any evidence. But I also think they’re between a rock and a hard place, since if they just stop trying, then there’s the question of “well we could have done more and saved more people”. I don’t have any solution, but I don’t think the move is for them to keep doubling down on repeating “the vaccines are safe and effective”. Because although it may be true, it clearly isn’t working.
Given such a system, when they suddenly turn around and offer you a vaccine "for your own benefit, promise!", it is hardly surprising that it becomes a breeding ground for conspiracy theories (amplified by the usual social media issues).
"Just trust us, we know what's better for you. We went to school longer" [0]
This pandemic has highlighted how little the medical system and community value honest, hard working people that are simply afraid for their health.
Here in the US, at least in the Midwest, residential and commercial layouts are completely car centric, there are few places where it’s more convenient to just walk. In contrast, in more densely populated cities, like the ones me and my friends came from, a combination of factors, like traffic, lack of parking spaces and availability of sidewalks makes it way easier to just walk to places.
Regarding food, I think due to the labor/capital balance of the US, people spend way less time cooking from scratch. It’s funny that many recipes have steps of the like of “mix a can of that” or “stir half a packet of such”. I don’t think the effect in health is as much when compared to lack of physical activity, but I’m convinced it’s a factor.
I’m convinced that for those who have access to it, medical care in the US is one of the best, if not the best in the world. But there is only so much that can be done in a medical setting to offset detrimental lifestyle patterns. To me, that is one of the overlooked factors when comparing life expectancy across nations as a measure of the medical system performance. Ceteris Paribus.
It's _advanced_, in the sense that it has an array of expensive techniques available to those who can pay it.
But in the basic humanity and decency department having been to US doctors feels line going to a production line if you don't have any serious condition. There just felt this enormous personal disconnect. And most of the issues that I'll be going to doctors for are just not that rare.
There's no magic words or pills that a doctor can give someone to solve this problem - it cant be outsourced.
[1] - https://www.youtube.com/watch?v=5LTWJOi3bCo [video]
All the consumer warnings in the world won't solve the problem.
I agree, warnings will solve nothing. We've had warnings for a long time. I would expect more drastic measures like presidential executive orders of eminent domain like those used to seize steel mills during WWII. Companies making unhealthy things could become government property and liquidated, maybe. How to get people to not be sedentary? No idea. Draft everyone and put em in boot camp I guess? Half kidding, but I don't know what we can do. Maybe someone will create a virus that targets people with preexisting issues like diabetes and heart disease to wipe the financial burden/liability. Or perhaps a new VR MMO that gets everyone addicted to it and people have to move around a lot, funded using the defense budget. Oh and this system is required to renew your government ID or drivers license. All government offices become "remote only" so everyone needs one. Internet LTE modem built in.
The only solution I think would work is both very simple and very hard.
Convince people that they are responsible for their health behaviors, and have the power to change them if they want.
This is a very heavy lift because most people have been indoctrinated to believe that they are powerless to enact change, and purely products of their environment. This is reinforced by a host of organizations that profit or gain power by people believing this.
Doctors, therapists, governments and others can help people make changes, but can't do it for them. People need to take responsibility for their problems and implementing solutions in order for any help to be effective.
It's not profitable to media producers if you're out and about instead of sitting on your butt consuming some electronic entertainment.
It's not profitable to food manufacturers if you're eating easily available fruits and vegetables instead of foods manufactured to have a long shelf life.
It's not profitable to vehicle manufacturers if you rode a bicycle instead of drove.
It's not profitable to the jails if certain drugs were legalized.
It's not profitable to hospitals if you paid to be healthy instead of paid to have symptoms resolved.
It's not profitable to write a message "eat healthier" and put that next to unhealthy foods. It's not profitable to write a message "exercise healther" and put that next to your transportation or entertainment. It's not profitable to write a message "drugs are illegal".
All of that space would be better served on non-harmful consumer messages like... buy this product! Watch your favorite fantasy! Make your dreary life in traffic less dreary with our brand new (and fresh-smelling) automobile! And there's definitely no harm to consumers if all of those businesses are grouped into huge conglomerates... for efficiency, of course. No harm to consumers whatsoever.
Can't imagine a world in which the "National Institutes of Health" could say, "We're done now, everybody's healthy enough." If finding sick people is their job, they're damned well gonna find some sick people, aren't they?
So I agree, there have been massive health advances in the last century. Not surprisingly the advances/$ drops over time.
That said, translational and implementation research is often more poorly funded which is in part why getting from evidence to clinical practice to widespread societal adoption is problematic. Especially in the biomedical sciences, evidence is actually a poor and lagging predictor of diffusion of innovations; so the fact that good evidence is widely available while adoption is slow shouldn't be surprising at all. Of course, having a functioning health care system where the incentives are all aligned toward healthy persons would help, too.
Recently my son needed to see some doctors. It of course took appointments with a GP to get to a referral. One of the services - the one that is ultimately really important to his quality of life - of course wasn't covered by insurance and of course the doctor to whom he was referred can't be bothered to call to schedule anything. And of course the GP doing the referring can't be bothered to assist us in any way - we could look up the contact info ourselves, of course not even having a name of the doctor to whom they promised to make a referral. So several hundred dollars later, we're no father along than we were.
It's the same basic story why I don't go to a sleep study - it's simply a complete run around to get any kind of actual care. That is why Americans remain unhealthy.