Thursday, February 16, 2012

The Scandal of the US Public Health Apparatus: Pissing Away Moral and Social Capital

Frequently you'll read breathless stories about how large numbers of children and adults are not 'properly immunized'.  It is also frequently commented on that most people don't stay home when they have contagious illnesses.  Further, we see a public with extremely low by modern historical standards confidence in the public health system.  This may be part of why there's so much pull towards socializing medicine---the doctors lack the standing that they once had socially.  How did we get here?

Well, for one thing, the public health apparatus doesn't ACT like they're fanatical partisans of public health.  If they did, they'd be constantly screaming holy hell over the failure to maintain the integrity of our borders.  Back in Ellis Island days, preventing the spread of disease into the US was actually taken seriously.  Seriously enough that a lot of diseases USED to be pretty much extinct in the US, including TB.  But no more (this is just the latest story, there have been quite a few over recent years).

Add to this not taking the AIDS matter properly seriously---a serious response would've been extremely heavy handed from a 'civil liberties' point of view with quarantines and sanctions against those that break quarantine being only the beginning.  Here's a hint to doctors:  You're not expected to uniformly WIN all such struggles of protected class VS public health, but you ARE expected to give it the old college try.  When you don't or just phone it in, people get the idea that the health of the public is NOT your highest priority.  That's dangerous, and not just to your income stream.

Mass disease control can be compared to nuclear fission reactions.  Diseases only get really dangerous to societies when each new carrier begets more than one new carrier, analogous to a supercritical chain reaction.  This is where the whole concept of 'herd immunity' comes into play.  See, most vaccinations are nowhere near 100% effective, which is why when there's a minor outbreak, of, say, measles, frequently only half to two-thirds of the infected will be unvaccinated.  Flu shots are even worse, sometimes only reducing your probability of getting the flu personally by a third or so.   Much of the benefit of your vaccination doesn't actually go to you.  It goes to the population in your area as a whole, by lowering the number of new carriers that might otherwise have been produced by you.  The whole affair is very probabilistic and it is based on a utilitarian ethos, which is why this is very rarely discussed openly in public.  To be able to make pronouncements of the form:  You and your kids need to do X, which may be unpleasant or have side effects (which we will keep as quiet as possible) for the benefit of capital-S Society, you need to have moral authority and the requisite standing.  Otherwise the public won't trust you and you'll be in the position of frequently lying to the public about the whole nature of the disease control game, which begets, you guessed it, further degradation in public trust.

The awful standards of research and statistics in medical journals don't help either, but the average person doesn't actually feel that in his gut the way the previous failings rankle.  My recommendation is to work on these failings now, or be ready for a really really nasty surprise should we ever have to contend with something as bad as the Spanish Flu again.

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