"Humankind cannot bear very much reality."
T.S. Eliot
"You have to understand, we are just at the beginning of this thing. What we tell you this week is based on the best available information we have right now. But six weeks from now, with new information, we may be saying something entirely different. That's science. That's the way it works."
--Dr. Rich Conit, podcast "This Week in Virology" 2020, speaking of the COVID pandemic.
I was going to title this blog post, "Of Snake Oil, Hulk Hogan and Brain Worm," but the chance to echo C.S. Lewis prevailed.
Listening to Pete Hegseth unwittingly quoting "Pulp Fiction," and presenting it as Ezekiel 25:17, using scripture to establish his war cred, I thought, what could be more illuminating?
Seeking authority often entails claiming to possess the Truth, to have true knowledge. There are several ways to come by knowledge:
1. You can do the hard work of science: observation, record keeping, tabulation and publication so others can try to disprove or corroborate what you say is true. But this is a tedious, laborious and demanding process.
2. You can refer to a written text, something like the Bible. How often have we heard someone, caressing the Good Book, worn by use, saying, "All the answers are right here, right here in this book." The advantage of quoting the Bible is there is a nifty sounding verse, "Ezekiel: 25:17" which nobody will have time to look up, until the advent of Google, and even after that, there often isn't time, so you can sound erudite with pretty little effort.
3. You can just pretend, play a role, as actors do. This is the path chosen by Bobby Kennedy, Jr., as he refers to some article from the medical literature, as if he has actually read and understood the whole thing, and then he can conclude that more people were harmed by the polio vaccine than were ever saved by it, or that 75% of people given a vaccine were harmed by it.
The thing about science is, unlike "reading the law," you cannot really do it on your own. This is why doctors have "journal clubs" where they read articles from The New England Journal of Medicine, and various specialists will give you the background of why an article was written, how the research was done and what the problems really are with the conclusions. RFKJR does not go to these journal clubs. He just scans articles for sentences which might be construed to support the firmly held convictions he brings to the article and he goes from there. He is "doing his own research," which means, he really isn't reading for understanding; he is scanning for cherry-picked sound bites.
Virtually no scientists doing important and reliable research do their own research; they all operate in a community and they are rivals, teammates and in constant communication.
Anti-vaxers have been particularly animated by RFKJR, but resistance to the whole idea of vaccination has a long history. The forerunner of vaccines, was inoculation, where a small dose of a virus (or material from a small pox pustule) was injected, and a mild case of smallpox ensued, but it wasn't always mild. The idea of giving a healthy person a disease to prevent a worse disease was a hard sell in the eighteenth century, and Cotton Mather, a cleric and Dr. Zabdiel Bolyston, a Boston physician, met agitated resistance: A bomb was thrown into Mather's home, because he advocated for smallpox inoculation.
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| Fear the Smallpox |
It came down to the question: Which are you more afraid of: the disease or the medicine?
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| Small Pox |
When I was a medical resident, I saw what influenza could do. Sometime around midnight, we admitted a 21 year old woman to our intensive care unit at New York Hospital--she was a dusky blue color, in and out of lucidity, and her blood oxygen level was incompatible with life. She died in three hours, despite our efforts. I presented her story to every conference, every doctor I could, trying to figure out what I could have done to save her, but failed to do. Most of the older doctors, who had seen the last influenza epidemic decades before, simply shook their heads and said, "That's what influenza can do."
When I saw her lungs, at autopsy, I understood why we had failed to raise her blood oxygen level: they had turned into the consistency of the liver you'd buy at a butcher's--normal lungs are spongey, full of spaces for air to be captured. She could not move any air through her lungs to her bloodstream.
Years later, now in private practice in the real world outside the hospital, I urged all my patients to get their annual influenza vaccine. One of them, a fifty-two year old woman, developed Guillain-Barre syndrome following her vaccine and she had to be hospitalize for the polio like syndrome. She fell out of her wheel chair in the hospital and broke a hip. When she finally got home, I stopped by to see her, expecting to incur her wrath or the rebuke from her husband, but they were forgiving and pleasant.
"It's a risk of the vaccine," she said. "I knew that."
"I don't think I ever mentioned it to you," I told her. "But, if I had, I would have still urged you to get the vaccine. Guillain-Barre just so rare. You were just the lucky one."
"I know. Of course, I'll never get another flu vaccine."
The risk of something comes down to numbers, to record keeping, to a lot of meticulous, boring, hard work and people who fear and vilify vaccines don't want to do all that. They just want to know, without doing the work.
Science is often a slog.
Before anyone knew about insulin, children with type 1 diabetes were treated with a diet by Elliot Joslin in Boston. He reasoned that because these children were known to have very high blood sugars if you denied them any sugar--or anything in their diet which could be transformed into sugar--you could control their blood sugar. Some children seemed to live a little longer, but they looked like living skeletons and they died anyway.
Then, one summer in Toronto, an irascible former Army surgeon, Frederick Banting, and a PhD student, Charles Best, spent the summer of 1921 chasing down a phantom agent in dog pancreases, dissecting out the pancreases, tying off the pancreatic ducts in their dog victims/patients and inducing diabetes in them, showing the pancreas was the source of something which prevented diabetes, and then they more or less isolated that something, which they called "insulin." It was tedious, frustrating, demanding work, done in a steaming laboratory of a hot Toronto summer, but when they finally had enough data and had gone through enough dogs, they presented their findings to a conference of doctors in New Haven, and Elliott Joslin listened, asked questions and then beamed. You have made my diet a relic. Now we have a new understanding and a new approach which will finally work.
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| Before and After Insulin 1922 |
That's science.
RFKJR never worked that hard at anything. He's never done anything like Banting and Best beyond dissecting out a racoon penis from a road kill raccoon, and calling that science.
For centuries, the Bubonic Plague had ravaged Europe, laying waste to whole populations, sometimes cutting down half of all living human beings, and there were lots of "doctors" and priests who wandered around wearing beaks and carrying whips, the RFKJR's of their day.
Then, Alexandre Yersin, who had trained in Louis Pasteur's laboratory, who knew the techniques for growing bacteria in the laboratory, and he headed off to Hong Kong from his clinic in Vietnam and he managed to capture, identify and raise antisera to the bacterial agent, Yersinia pestis, and when Plague made its way to Vietnam he saved the villagers surrounding his clinic. That was a lot of dangerous, demanding hard work, but he did it.
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| Alexandre Yersin |
RFKJR has never done anything like that.
The thing about science is it has to happen in the real world, not in fantasyland. In fact, a lot of science is simply an effort to understand what is real, and what is not.
It requires creative thought, innovation, but it usually also requires building upon what has been done before you, and using that to understand new stuff.
Ask any middle school kid at Hampton Academy who Banting and Best were or who Alexander Yersin was, or how type 1 diabetes got tamed, or how the plague got controlled and you will get nothing but blank looks. They can tell you who George Washington was, or Robert E. Lee reliably enough, but have they ever heard of Jonas Salk and the polio vaccine story or about small pox vaccines or how observations about milk maids with cowpox led to the small pox vaccination?
We just don't teach that stuff to Americans.
The New York Times reports that over 3 dozen American physicians and nurses are running for Congress, mostly running against RFKJR. Of course, 40 years ago that could never have happened, because 40 years ago most doctors were in private practice and they could not afford closing their businesses to run for Congress. Now 90% of physicians work for corporations, they are hired employees paid by large corporate entities to be "providers." A pediatrician leaving a job with Partners paying $90,000 a year is not a wrenching financial decision.
There have been physicians in Congress, of course, but most were more like Dr. Bill Frist, whose father started the for profit Hospital Corporation of America in Nashville, and when Dr. Frist left the Senate, he did not return to doing transplant surgery; he started a corporation to provide health care. Dr. Frist was frustrated in the U.S. Senate because, unlike in the operating room, he could not just give orders. He found himself having to deal with 99 other Senators who often disagreed with him.
None of those health care providers, if they do win their seats in Congress, will be able to do what RFKJR has done to American health care as a cabinet Secretary. RFKJR has single handedly destroyed the CDC, the FDA, and a host of other lesser known agencies which once did good works for America, and never mind what he's done to the National Institutes of Health or to the thousands of universities where research funded by the NIH was doing good work until RFKJR acted fast and broke things, to the delight of the MAGAmob.
So we have RFKJR, who more Americans can name, recognize and even quote than there are Americans who can identify Banting and Best, Yersin, Jenner, Salk or any of dozens of scientists and doctors who have made far more difference in their lives, the way they live their lives every day than any general or President ever has.
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