Healthcare policy Archives - Alert & Oriented

Is myocarditis real?

Michel AccadNovember 15, 2021November 21, 2021Healthcare policy, Medical science, Philosophy3 Comments

I highly recommend listening to our latest podcast with Dr. Vinay Prasad, an extremely intelligent, articulate, and courageous physician who has been absolutely phenomenal speaking out against the “unscientific” public health policies of the last 20 months. Vinay is an astoundingly prolific writer—publishing in academic journals and in the lay press—and now has an excellent YouTube channel that I turn to daily to get his analysis of the latest scientific and health policy news.

During our conversation with Vinay, and reflecting on some outlandish positions taken by the CDC on the incidence of COVID-induced myocarditis, Anish startled me by mentioning Michel Foucault and his notion of “regimes of truth,” the idea that the dominant political forces essentially set the framework under which a society comes to an understanding of things. “If knowledge is not power, but power is knowledge, then scientific objectivity may be a myth. What do you think about that!?” Anish challenged Vinay.Continue reading “Is myocarditis real?”

Are the unvaccinated a threat to others?

Michel AccadSeptember 12, 2021October 4, 2021Ethics, Healthcare policy26 Comments

A disputed question argued in the Scholastic style.

Objection 1. The unvaccinated are indeed a threat to others because the pandemic will only be overcome through herd immunity, and herd immunity can only be achieved safely and promptly through widespread vaccination. The unvaccinated are thus postponing the time until herd immunity is achieved and therefore are responsible for the heavy morbidity and mortality caused by this avoidable delay.

Objection 2. Asymptomatic infections with SARS-CoV-2 are known to occur and an unvaccinated person can transmit the virus to innocent bystanders. Therefore the unvaccinated are a threat to others.

Objection 3. The unvaccinated have an irrational fear of vaccines that is not supported by science. They have conspiratorial attitudes that are spreading through campaigns of disinformation, undermining public health institutions, and damaging social cohesion. Therefore the unvaccinated are a threat to others.

Objection 4. By minimizing the danger of the virus, the unvaccinated also dismiss the value of non-pharmacological interventions (NPIs) such as social distancing and masking. Their overall reckless behavior further contributes to the spread of the virus and to much morbidity and mortality. Therefore the unvaccinated are a threat to others.

Objection 5. The unvaccinated are much more likely to be hospitalized with COVID and to suffer severe complications that are costly to society than the vaccinated. Therefore the unvaccinated are a threat to others and should bear the cost of their healthcare if they persist in their refusal to be vaccinated.

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Sed Contra, as it is said, “The healthy have no need of a physician, but the sick do.” Therefore, being healthy, the unvaccinated have no need to be vaccinated and cannot be a threat for failing to do something they have no need to do.Continue reading “Are the unvaccinated a threat to others?”

The pandemic war analogy: turning natural disaster into violent civil conflict

Michel AccadSeptember 11, 2021September 27, 2021Ethics, Healthcare policy2 Comments

The main reason we are seemingly so accepting of lockdowns and vaccine mandates is that we have been conditioned to view a pandemic or an epidemic as a war being waged on our society.

In wartime we naturally expect civil liberties to be suspended. Likewise, the reasoning goes, during a pandemic we need to act in a unified way under some central command to fight this viral existential threat. Individual rights and freedoms must be curtailed for the sake of the greater good.

But that’s a false analogy. A pandemic is not a war. It’s a natural disaster. (Granted, SARS-CoV-2 may not be so “natural” but still, the virus is not an “enemy” waging a war on us.) Continue reading “The pandemic war analogy: turning natural disaster into violent civil conflict”

Letter to a patient seeking a medical exemption to the COVID vaccine

Michel AccadSeptember 9, 2021October 4, 2021Ethics, Healthcare policy, Medical practice12 Comments

[As this goes to press the Biden administration is proposing a sweeping vaccine mandate that may affect an estimated 100 million Americans, making the following considerations all the more relevant]

Dear_________,

I received your message detailing your concerns about receiving a COVID vaccine and requesting a medical exemption. I understand that your employer is now mandating a vaccine unless you can obtain such an exemption (or perhaps a religious one). I find your concerns perfectly legitimate but, unfortunately, they do not justify a medical exemption.

As you’ve noted yourself, there is no evidence that a history of prior myocarditis or prior atrial fibrillation increases the risk of getting myocarditis from the Pfizer or Moderna vaccines. And even if there was such evidence, then the J&J vaccine would be the alternative immunization to address that particular concern.

I also understand that your worries go beyond the possibility of having another bout of myocarditis (however small the chance may be). You have serious misgivings about these vaccines because you’ve lost confidence in the medical profession, the pharmaceutical industry, or the public health authorities (or perhaps all three).

Who can blame you? Can anyone deny that self-interest is all too often a prime motivator in healthcare—even in public health—and all too often at the expense of patients or the public? Abuses of confidence by doctors and hospitals, greediness in the pharmaceutical industry, and ideological or political pressure in the public health sector are all plainly evident and warrant at least some degree of skepticism. Your distrust is not paranoid, it is actually rational.Continue reading “Letter to a patient seeking a medical exemption to the COVID vaccine”

The Great Barrington Declaration: A Few Words of Caution

Michel AccadOctober 7, 2020October 4, 2021Healthcare policy6 Comments

With the recently issued “Great Barrington Declaration,” the anti-lockdown movement has received a shot in the arm.

The proposal, introduced this past Sunday by 3 prominent epidemiologists and scientists at a summit sponsored by the American Institute for Economic Research, seems to offer a welcome alternative to current policies of blanket lockdowns.

The authors of the Declaration recommend policies of “Focused Protection” and have already received the support of tens of thousands of public health professionals, medical practitioners, and members of the general public.

While I welcome the proposal as an excellent development and would view its adoption as a likely improvement over the current situation, I must nevertheless point out a few significant difficulties with this Declaration.Continue reading “The Great Barrington Declaration: A Few Words of Caution”

COVID herd immunity: At hand or forever elusive?

Michel AccadJuly 26, 2020October 4, 2021Articles, Healthcare policy, Medical science5 Comments

With cases of COVID-19 either disappeared or rapidly diminishing from places like Wuhan, Italy, New York, and Sweden, many voices are speculating that herd immunity may have been reached in those areas and that it may be at hand in the remaining parts of the world that are still struggling with the pandemic. Lockdowns should end—or may not have been needed to begin with, they conclude. Adding plausibility to their speculation is the discovery of biological evidence suggesting that prior exposure to other coronaviruses may confer some degree of immunity against SARS-CoV2, an immunity not apparent on the basis of antibody seroprevalence studies.Continue reading “COVID herd immunity: At hand or forever elusive?”

It’s not about tradeoffs

Michel AccadMay 8, 2020October 4, 2021Healthcare policy, Philosophy5 Comments

It is tempting to oppose the harmful effects of COVID-related lockdown orders with arguments couched in terms of trade-offs.

We may contend that when public authorities promote the benefits of “flattening the curve,” they fail to properly take into account the actual costs of imposing business closures and of forced social distancing: The coming economic depression will lead to mass unemployment, rising poverty, suicides, domestic abuse, alcoholism, and myriad other potential causes of death and suffering which could be considerably worse than the harms of the pandemic itself, especially if we consider the spontaneous mitigation that people normally apply under the circumstances.

While I have no doubt that lockdown policies can and will have very serious negative consequences, I believe that the emphasis on trade-offs is misguided and counterproductive. It immediately invites a utilitarian calculus: How many deaths and how much suffering will be caused by lockdowns? How many deaths and how much suffering will occur without the lockdowns? How exactly are we to measure the total harm? What time frame should we consider when we ponder the costs of one option versus the other?Continue reading “It’s not about tradeoffs”

The case against shared-decision making

Michel AccadJuly 14, 2018October 2, 2021Articles, Ethics, Healthcare policy4 Comments

In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been fulfilled—and even if the treatment is widely considered to be clinically justified.

For example, in a recent issue of JAMA, an editorial approvingly reports that the Center for Medicare and Medicaid Services will soon refuse to pay physicians and hospitals for the implantation of cardioverter-defibrillators unless the decision to implant these life-saving devices was “shared” with the patient. Although the announcement is short on details regarding the formal process by which SDM must be documented to have occurred, the new policy certainly testifies to the unquestioned status SDM has rapidly acquired as a general principle of medical ethics.

Where does the idea of shared decision-making come from and how did it suddenly emerge to represent the highest of bedside virtues? I will present historical development of that concept in this post and examine its highly problematic aspects in more detail in subsequent articles.Continue reading “The case against shared-decision making”

How to rid medicine of its cronyism

Michel AccadJune 10, 2018July 9, 2021Articles, Ethics, Healthcare economics, Healthcare policy, Medical practice4 Comments

We just did a fantastic interview with the legendary G. Keith Smith, MD, co-founder of the Surgery Center of Oklahoma.

Early in the interview, Dr. Smith speaks of the motivation that pushed him and his partner, Dr. Steven Lantier to divest themselves from the government-insurance-hospital system back in the late 1990s: They wanted to stop enabling what Smith identified as “financial serial killers,” so-called non-profit institutions that end up charging astronomical prices for healthcare yet have no qualms about bankrupting defenseless patients who are unable to pay those prices.Continue reading “How to rid medicine of its cronyism”

“No tears for you!” say the pharmascolds

Michel AccadMay 20, 2018Articles, Healthcare policy, Medical science2 Comments

One of the most tiresome clichés in health care policy is the one that asserts that drug companies can mesmerize patients and doctors into using ineffective pharmaceuticals simply by way of an advertising campaign.

That claim was just made in the editorial pages of JAMA Internal Medicine and promptly spread via social media. The editorial purports that Allergan has managed to make vast sums of money in sales of Restasis, a dry eye treatment, even though the medication is demonstrably ineffective.

Anish and I examine the claim and find it seriously wanting. Here are the time stamps and the video (total watch time ~ 20 minutes):

A tweet catches Michel’s attention 0’30”
Anish summarizes the paper 1’30”
How do we know the drug “doesn’t work?” 4’20”
Anish presents his own market research…surprise, surprise, it’s Fake News! 9’05”
The “pharmascolds” are ideologues with no credibility 13’20”
Michel’s personal experience with dry eyes 16’04”