The New England Journal of Medicine is the world’s leading medical journal and website. (Specifically “The journal usually has the highest impact factor of the journals of internal medicine”)
In my previous post, I quoted an NPR article about how The New England Journal of Medicine published a very strongly worded article to vote Trump out. Please read what they have to say:
Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.
The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.
We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.
Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2 Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.
Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.
The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.
The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.
Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.
Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.
Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.
Supplementary Material
Disclosure Forms PDF 591KB
References (4)
1.Johns Hopkins University Coronavirus Resource Center. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (https://coronavirus.jhu.edu/map.html).
2.Total number of COVID-19 tests per confirmed case, September 14, 2020. Our World in Data (https://ourworldindata.org/grapher/number-of-covid-19-tests-per-confirmed-case).
3.McGinley L, Abutaleb L, Johnson CY. Inside Trump’s pressure campaign on federal scientists over a Covid-19 treatment. Washington Post. August 30, 2020 (https://www.washingtonpost.com/health/convalescent-plasma-treatment-covid19-fda/2020/08/29/e39a75ec-e935-11ea-bc79-834454439a44_story.html).
Google Scholar. opens in new tab
4.Haberman M. Trump admits downplaying the virus knowing it was ‘deadly stuff.’ New York Times. September 9, 2020 (https://www.nytimes.com/2020/09/09/us/politics/woodward-trump-book-virus.html).
Close References
Citing Article (1)
Janice Hopkins Tanne. (2020) Covid 19: NEJM and former CDC director launch stinging attacks on US response. BMJ, m3925.
FILE – This Dec. 29, 2011 file photo shows the entrance to the editorial offices of the New England Journal of Medicine in Boston. On Wednesday, June 13, 2018, the journal retracted and republished a landmark study on the Mediterranean diet, and issued an unprecedented five other corrections after an obscure report in 2017 scrutinized thousands of articles in eight journals over more than a decade and questioned some methods. The New England Journal’s review did not alter any conclusions and should raise public trust in science, not erode it, said its top editor, Dr. Jeffrey Drazen. (AP Photo/Michael Dwyer)
The Trump administration has “taken a crisis and turned it into a tragedy” in its response to the COVID-19 pandemic, The New England Journal of Medicine says in a scathing editorial that essentially calls on American voters to throw the president out of office.
It is the first time the prestigious medical journal has taken a stance on a U.S. presidential election since it was founded in 1812.
“When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent,” reads the editorial signed by nearly three dozen of the journal’s editors. “We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”
The editors accuse Trump’s government of a massive public health failure – and of worsening the pandemic’s effects by prioritizing politics over sound medical guidance.
The piece, titled “Dying in a Leadership Vacuum” and published Wednesday, does not mention President Trump or his Democratic rival, Joe Biden, by name. But it refers to the Trump administration repeatedly, and its footnotes cite news articles about Trump insisting that coronavirus risks are overblown, pressuring federal scientists, and politicizing the search for treatments.
“Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies,” the editorial states.
The New England Journal of Medicine is at least the third widely respected medical or science journal to call for a change in U.S. leadership. Editor-in-Chief Dr. Eric Rubin says the editorial is rare for two main reasons: It’s one of the handful of times an editorial has been signed by all the editors, and it takes an unprecedented political stand.
“There have been many mistakes made that were not only foolish but reckless,” Rubin tells CNN, “and I think we want people to realize that there are truths here, not just opinions.”
Even though the U.S. has distinct advantages in biomedical research, manufacturing capacity and public health expertise compared with many other countries, the U.S. has recorded more than 212,000 deaths from the coronavirus – the most in the world. Along the way, U.S. leaders have denigrated experts and ceded disease control to the states, the journal’s editors say.
“Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences,” the editorial states. “Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment.”
The editorial acknowledges the difficulties that all countries face in coping with the coronavirus. And it notes that some deaths are unavoidable in a pandemic. But in the U.S., the authors say, “we have failed at almost every step,” from having adequate protective gear to a problematic approach to testing and contact tracing to a failure to follow basic precautions such as wearing face masks.
“In much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures,” the editorial states.
Many of the sentiments echo concerns raised in other venerable journals this year.
Scientific American broke with 175 years of tradition by endorsing Biden last month — a decision that was both unanimous and quick, Editor-in-Chief Laura Helmuth told NPR. And The Lancet called on Americans to make Trump a one-term president back in May.
All three journals took stands against Trump without referring to political parties; Helmuth says the Scientific Americaneditorial purposefully avoided doing so in an attempt to be inclusive for its readers.
In a similar vein, the New England Journal of Medicine editorial states, “Truth is neither liberal nor conservative.”
The opinion piece notes that the U.S. has performed worse than many other developed nations, such as South Korea that had much higher rates of travel to and from China when the coronavirus initially emerged.
The journal’s editors write: “The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000.”
[10-9-20 I have solidly changed my opinion on Rowling’s views. I’ll leave this post here but please read this post]
[original, outdated post is below]
There has been much fierce discussion about JK Rowling’s statements concerning gender and trans-gender issues.
I read JK Rowling’s long post about trans-gender issues. To cut through all the flak, what I read is this “Be cautious about encouraging people to change their gender too quickly.” I fully support that position. Taking such a position supports the health of the person reconsidering their gender.
Here, the lead teacher from Abigail’s almost-kindergarten class at Step One writes his weekly letter to families. I found this letter particularly soothing in these crazy times. Best thing, I feel comfortable posting the photos because all the kids’ identities are hidden behind masks :-) :-(
Dear Room 3 Families,
We have just completed an amazing week at school, finally getting to enjoy some much needed clean air. We want to give you a more detailed snapshot of how we spend our day.
Our morning starts with having the kids sit on the wall after they are dropped off, waiting for all our friends to arrive. Thank you for everyone arriving on time and having your kids ready with their masks on. We want to remind you of some important street safety reminders: pulling up past the bus stop, making sure you are doing any u-turns in a safe place, and remaining in your car.
When we are walking to or from school, we like to remind the kids about walking in the middle squares of the sidewalk, in order to keep them from walking too close to the curb.
Once inside we all come to the rug for circle. At circle we have been singing different good morning songs, reading books, doing movement activities, and having all class discussions. Next week some of the discussions at circle will center around how we want to be treated at school, so we can have them be part of the process of creating a positive classroom environment, where we are all being treated in a kind and respectful way.
After circle we head outside for one of our two hillside times. A popular spot has been “River Rock” where they have been showing some interests in how the water flows and what things can float and make their way downstream. There are blocks on the hillside for them to build with, the digging spot, and the fun “chicken coop” area. Next week we will change up our outside time In the morning (9:00 – 9:45), where we will be up on the hillside (Mon, Wed, and Friday) and be on the lower yard (Tues and Thursday).
Snack and lunchtime happen on our yoga mats. Thank you for supporting us in sending your child’s food in containers that they can open by themselves, helping us reduce the amount of gloves we have to use. We love our eating times, where we get to see the kids without their masks on. Some chores that come with our eating times is having the kids wipe their trays and mats after each meal. This is also a good reminder that your child is capable of helping out at home and beginning to have certain responsibilities.
After our first snack time is our inside time. This is a time where we like to have one teacher led activity and also have free exploration.
This week the kids have been working on drawing their family portraits. It has been fun for us to observe what things the kids are interested in, so we can start to see a pattern in their play that can help us develop a project to explore in our curriculum. Some things we have noticed are: a strong interest in our animals (Zemo the beta fish, Unicorn the girl cockroach, King Boss the boy cockroach, and Queenie the king snake), block building, and lego building to name a few. We are hoping by October to have a possible project to investigate.
One of our recent additions has been a monarch butterfly caterpillar that has now transitioned into a chrysalis.
After lunch we go back up on the hillside until 12:45, when we come back down to get ready for our playground time (1:00 – 1:45).
The tire swing is always popular, as well as the monkey bars.
After our outside time we go in for one more snack time before we: pack up, walk to the pick up area, and end our day. I just got exhausted from writing this and am so amazed at how well the kids do with all the transitions.
Here is our schedule for the upcoming week.
On Monday we will be having our first birthday celebration, Sahil’s 4th birthday. You first need to contact us to let us know what day you would like to celebrate your child. We will arrange to FaceTime or do some other kind of virtual chat to have you be part of our circle. A crown will be made for your child. Depending on how old your child is turning, we ask you to think of one thing for each year that they have been alive that you love about them and your child will think of that many things that they can do now that they couldn’t do when they were a baby. We will light candles (with an extra candle being the wishing candle) and ask them if they want cha chas or no cha chas when we sing happy birthday. We do not have any birthday treats as part of the circle but just want to focus on the child.
On Monday we will be having a special snack in celebration of Rosh Hashanah. If your family has special traditions that you celebrate, please contact us to find out how we can share those traditions with the class.
Please work on your family collage. We will be putting them together into a book for the kids to enjoy and share with their peers.
We hope you have a wonderful weekend and look forward to seeing everyone on Monday.
A friend on FB asked what people are doing to control their anxiety. Here’s my response:
I am learning to control my Doomscrolling, Unfriending those who are assholes (disagreements are ok, just not assholery). I joined Nextdoor where people hollering “Hey, get off my lawn” and “How do I stop those darn gophers?” is refreshing. Making lists of organizations to donate to and then doing it.
Heh, looking back at what I’m doing is remarkably similar to the list of things to do mentioned in a conspiracy theory podcast I quoted just the other day.
The need to reduce uncertainty and make sense of the world
A while back I ordered some latex party balloons on Amazon. Putting them in my mouth to blow up, they tasted TERRIBLE. I couldn’t give them to a kid to blow up! I returned them. I used the Amazon “Customer questions & answers” system to ask some other vendors, “How do they taste when blowing up? Some balloons I’ve gotten taste really bad.” Here’s what I got back.
WTF Amazon?
I asked the same question about 20 similar balloon products. The above was absolutely typical.
There is no useful way to mark an answered question “beyond useless”. Why is this the case?
Megan bought some balloons at Target. They were fine. Feh.
We’ve never backed a presidential candidate in our 175-year history–until now
By THE EDITORS | Scientific American October 2020 Issue
Credit: Ross MacDonald
Scientific American has never endorsed a presidential candidate in its 175-year history. This year we are compelled to do so. We do not do this lightly.
The evidence and the science show that Donald Trump has badly damaged the U.S. and its people–because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic, which cost more than 190,000 Americans their lives by the middle of September. He has also attacked environmental protections, medical care, and the researchers and public science agencies that help this country prepare for its greatest challenges. That is why we urge you to vote for Joe Biden, who is offering fact-based plans to protect our health, our economy and the environment. These and other proposals he has put forth can set the country back on course for a safer, more prosperous and more equitable future.
It wasn’t just a testing problem: if almost everyone in the U.S. wore masks in public, it could save about 66,000 lives by the beginning of December, according to projections from the University of Washington School of Medicine. Such a strategy would hurt no one. It would close no business. It would cost next to nothing. But Trump and his vice president flouted local mask rules, making it a point not to wear masks themselves in public appearances. Trump has openly supported people who ignored governors in Michigan and California and elsewhere as they tried to impose social distancing and restrict public activities to control the virus. He encouraged governors in Florida, Arizona and Texas who resisted these public health measures, saying in April–again, falsely–that “the worst days of the pandemic are behind us” and ignoring infectious disease experts who warned at the time of a dangerous rebound if safety measures were loosened.
Trump repeatedly lied to the public about the deadly threat of the disease, saying it was not a serious concern and “this is like a flu” when he knew it was more lethal and highly transmissible, according to his taped statements to journalist Bob Woodward. His lies encouraged people to engage in risky behavior, spreading the virus further, and have driven wedges between Americans who take the threat seriously and those who believe Trump’s falsehoods. The White House even produced a memo attacking the expertise of the nation’s leading infectious disease physician, Anthony Fauci, in a despicable attempt to sow further distrust.
Trump’s reaction to America’s worst public health crisis in a century has been to say “I don’t take responsibility at all.” Instead he blamed other countries and his White House predecessor, who left office three years before the pandemic began.
But Trump’s refusal to look at the evidence and act accordingly extends beyond the virus. He has repeatedly tried to get rid of the Affordable Care Act while offering no alternative; comprehensive medical insurance is essential to reduce illness. Trump has proposed billion-dollar cuts to the National Institutes of Health, the National Science Foundation, and the Centers for Disease Control and Prevention, agencies that increase our scientific knowledge and strengthen us for future challenges. Congress has countermanded his reductions. Yet he keeps trying, slashing programs that would ready us for future pandemics and withdrawing from the World Health Organization. These and other actions increase the risk that new diseases will surprise and devastate us again.ADVERTISEMENT
Trump also keeps pushing to eliminate health rules from the Environmental Protection Agency, putting people at more risk for heart and lung disease caused by pollution. He has replaced scientists on agency advisory boards with industry representatives. In his ongoing denial of reality, Trump has hobbled U.S. preparations for climate change, falsely claiming that it does not exist and pulling out of international agreements to mitigate it. The changing climate is already causing a rise in heat-related deaths and an increase in severe storms, wildfires and extreme flooding.
Joe Biden, in contrast, comes prepared with plans to control COVID-19, improve health care, reduce carbon emissions and restore the role of legitimate science in policy making. He solicits expertise and has turned that knowledge into solid policy proposals.
On COVID-19, he states correctly that “it is wrong to talk about ‘choosing’ between our public health and our economy…. If we don’t beat the virus, we will never get back to full economic strength.” Biden plans to ramp up a national testing board, a body that would have the authority to command both public and private resources to supply more tests and get them to all communities. He also wants to establish a Public Health Job Corps of 100,000 people, many of whom have been laid off during the pandemic crisis, to serve as contact tracers and in other health jobs. He will direct the Occupational Health and Safety Administration to enforce workplace safety standards to avoid the kind of deadly outbreaks that have occurred at meat-processing plants and nursing homes. While Trump threatened to withhold money from school districts that did not reopen, regardless of the danger from the virus, Biden wants to spend $34 billion to help schools conduct safe in-person instruction as well as remote learning.
Biden is getting advice on these public health issues from a group that includes David Kessler, epidemiologist, pediatrician and former U.S. Food and Drug Administration chief; Rebecca Katz, immunologist and global health security specialist at Georgetown University; and Ezekiel Emanuel, bioethicist at the University of Pennsylvania. It does not include physicians who believe in aliens and debunked virus therapies, one of whom Trump has called “very respected” and “spectacular.”
Biden has a family and caregiving initiative, recognizing this as key to a sustained public health and economic recovery. His plans include increased salaries for child care workers and construction of new facilities for children because the inability to afford quality care keeps workers out of the economy and places enormous strains on families.ADVERTISEMENT
On the environment and climate change, Biden wants to spend $2 trillion on an emissions-free power sector by 2035, build energy-efficient structures and vehicles, push solar and wind power, establish research agencies to develop safe nuclear power and carbon capture technologies, and more. The investment will produce two million jobs for U.S. workers, his campaign claims, and the climate plan will be partly paid by eliminating Trump’s corporate tax cuts. Historically disadvantaged communities in the U.S. will receive 40 percent of these energy and infrastructure benefits.
It is not certain how many of these and his other ambitions Biden will be able to accomplish; much depends on laws to be written and passed by Congress. But he is acutely aware that we must heed the abundant research showing ways to recover from our present crises and successfully cope with future challenges.
Editor’s Note (9/15/20): This article has been edited after its publication in the October 2020 issue of Scientific American to reflect recent reporting.
This article was originally published with the title “From Fear to Hope” in Scientific American 323, 4, 12-13 (October 2020)
When speaking to your conspiracy-theory loving, Trump-supporting friends, it may help to keep the following in mind. It is a podcast / article about what motivates people to believe in conspiracy theories.
By keeping in mind the reasons that people cling to conspiracy theories, you may be able to frame your response to be something different than “But, that’s stupid, here’s a pile of evidence from… everyone… that refutes what you are saying,”. Saying such things isn’t compelling to such people.
I highly recommend listening to the very long running podcast series, The Savvy Psychologist. It is very pleasant to listen to and they get right to the evidence-backed point. I listen on Stitcher.
