This post is just one of the reasons I subscribe. When I was a paramedic I met patients literally where they were. As a PA, I try to do the same as it was taught to me by my mentor.
You can’t physically stop a patient from making what you believe to be a bad decision. I agree that all you can do is have empathy, provide the most factual information you can and discuss the risk.
Keep the conversation going, it’s one of the ways society learns.
Exactly my thought! And help build a bridge from the facts to the personal decision. Consider that public health is very generic and we are all bio-individual. The bridge of curiosity can go a long way.
I know we are wanting to learn how to better communicate, improve our messaging and meet people where they are at, all very Important strategies which I believe will make a difference, but just as important is verifying if this is working and how are they opening themselves to receiving information.
The MAHA request for "clickable links" raises some important questions regarding academic paywalls to research. Countless studies of implementation of the ten essential public health services in state and local public health agencies cites "use of research in practice" as an area where public health fails. Unless we can address the production and ownership of knowledge (research), the criticisms of being captured by pharma and the medical-industrial complex will ring true.
I agree, and it is not a failing unique to public health, but across science. I worked on NIH training grants for postdocs and junior faculty in Implementation Science, studying ways to improve moving research-tested findings into practice. I was talking about it with a friend who is a space scientist and he bemoaned the lack of integration of research findings in that field. Easier access to findings is one step toward that.
That's been our experience in trying to introduce unique clinical observations during the pandemic, establishing collaborative pre-clinical laboratory expertise yielding significant discoveries that have yet to be championed (translated) by formal clinical research or trials. Even brief letters to the editor in open access journals require several thousand dollars in publishing fees. For non-university and un-affiliated practitioners that is a major barrier for disseminating such important information.
That’s wild. I had no notion it was so expensive! Thousands of dollars to submit letters to the editor feels like an anachronistic practice, from the white tower days of academia. (My perception, anyway. Perhaps there are practical considerations I’m not aware of?) Especially these days, when the body of knowledge is expanding so rapidly, this feels like a critical issue.
Agreed, vehemently! I’m a member of the public and I’d love to better understand aspects of public health that apply to me, specifically those involving motherhood, child rearing, etc. I’ve run into paywall issues before and it is gatekeeping, after a fashion. I understand there are nuances, and I usually find ways around but still.
I’ve been thinking about this comment a good deal. Just to circle back, underserved communities aren’t going to struggle access the science on a variety of levels. Trusted communicators only go so far for people who prize autonomy and want to verify information for themselves. I don’t know what the answer is, but man is it frustrating. Removing bars to access for scientific journals might be a start.
There are an increasing number of free access online journals. Public Health could very well identify and use those sources where applicable to the topic
This post resonated so hard with me I got off my a$$ and subscribed because I want to put my money where my mouth is. I'm not a religious person, but IMO you're doing God's work reaching out to the so-called "them" and finding common ground. I wish this nuanced, ego-free, and people-first attitude was more prevalent and taking place in other sensitive high-conflict circles across a broad span of disciplines. We can choose to be "right" or we can choose to work with what we have towards positive change.Thank you from the bottom of my heart. Love, a public health professional feeling slightly better about the world today.
The first example is the same thing MAHA always does. It’s disingenuous and purposeful. Like you said you put in a lot of work. Does she require that amount of work and access from the MAHA nonsense she believes? I would bet not. They live in a bubble of ignorance on purpose.
It doesn’t feel fair that we have to put this much effort in, when we have well-considered science on our side. That doesn’t matter. Honestly, the feedback from that MAHA individual WAS constructive. There is such a distrust in their circles that I could see how having those one sentence summaries make a difference. We meet people where they are.
Their distrust is based on conspiracy. Logic cannot fight that. They require no evidence to believe what they believe, but they require mountains of evidence to even consider (that’s probably to strong of a word) another view point. This is how they are taught to argue by the MAHA leadership because they know it can’t be argued against.
I agree—you can’t reason your way out of a viewpoint you didn’t reason your way into, right? It’s incredibly disheartening. That said, Dr J engaged with this community in good faith, took the criticisms and incorporated the useful bits, and then it was spread within their own community by a trusted member. That’s worth a lot in my book.
Some of us are more trusting in humanity, Josh. I prefer to believe that the MAHA spokesperson is a true mediator and has more of an open-mindedness than her more vociferous MAHA colleagues. She contributed to a civil dialogue and found a common ground so she distributed the essence of another view, Will that make a huge influence on her MAHA colleagues? Maybe not, but even if she gets a few of them thinking a little harder and doing a little more softening of their stances, it will have gone a long way in my opinion.
The problem I have comes down to this, they were given a platform with experts. They can make any wild claim they want (that’s the playbook), at best it will take the actual experts just hours to refute those claims. But that’s irrelevant because the response will be simply that the evidence is tainted. MAHA will come out saying they “won” even though the other side wasn’t there to win or lose anything.
It is cynical, I never tried to claim otherwise. But just because it’s cynical doesn’t make it less true. I would say your viewpoint is extraordinarily naive. I wish it wasn’t. I wish they could actually change minds. But, historically engaging with conspiracy theorists usually causes more harm than good.
I would hope that, if it's not been done already, some of the points you make here could and would be diplomatically worked into the communications with the MAHA folks, attempting to get them to see (and ideally own) the imbalance of evidence required from one side versus the other.
Owning things is not their strong suit. It’s literally why MAHA exists. “Is it poor dietary choices that make me unhealthy… or red dye?” I’m aware it’s far more complex than that, but IMO it demonstrates the problem with good faith engagement.
Completely agree. But the imbalance is a major crux in this situation and in and of itself needs to be addressed as a standalone issue. And yes, it very well may end up being futile.
I view those sorts of stands as "tribal" and it's a challenge to convince your tribe to think broadly with considerations for other tribes, in my opinion.
Absolutely. I imagine that the woman who was with MAHA in the post probably circulated Dr J’s updated pamphlet at some social risk to herself. That said, she did it! Which speaks to the efficacy of Dr J’s strategies—nuance, curiosity, etc.
Josh, I understand your frustration with the MAHA crowd and its probably based on experience. I would venture a guess that the group Kat is meeting with is a little less of this than the typical MAHA follower. Kat has found a small crack in the wall and is going for it to try to bring down the barriers. I have family who are MAHA so I know that most of them are actually very caring and good people. And educated and smart too. So frustrating they allow themselves to be told what to think. But Kat is doing an amazing thing and there is possibility it will work. We need to support her and help her continue to believe so she can continue to be the warrior for us even if we don't believe in what she is doing.
Thanks for being the warrior Kat! We have your back!
One (of many) challenges is explaining or justifying the education behind our recommendations- it’s a little bit of “tooting one’s own horn”. We want to explain why our advice has weight but sometimes it can feel condescending… in the same way it’s very diminishing to compare our advice to a social media influencer.
We check our egos at the door, at least I do, but it feels very defeating; most of all when there is no opportunity to share our hard earned expertise at all.
We, pediatricians, get a vote too. Many/most of our patients demand that their child will not have an unnecessary exposure inside our office. It’s challenging- patients conceal information when making appointments, deny risky exposures, and we discover this once a MA has roomed a patient, we have not taken appropriate safety measures, PPE. Our other patients are tired of seeing us masked and covered up, so we try to balance that, well and sick. But then after you have spent 30 mins w a “well child” they reveal that 2 days ago they tested positive for Covid and now the opportunity to do anything has passed. Should just test ourselves every day without symptoms? Will we spread it to a newborn?
So, adding unvaccinated children, especially to measles at this time, is extraordinarily difficult. Do no harm. It’s becoming difficult.
My pledge to myself had been that no patient should ever get covid from visiting my office. Now it’s measles. Is it fair?
It’s not unlike driving: I could get where I want to be driving badly- speeding, weaving, driving up the shoulder in traffic- but we agree on the road to keep each other safe (most of the time LOL) by following the same rules and laws.
I understand the reticent questioning and worries- truly- and I am committed to working through them. But in a society, we all have to work together. Otherwise everything falls apart. Like I feel is currently occurring.
Thank you so much for all of this, and for encouraging us.
As public health professionals, especially after the last five years, we are *so very tired*, and it can feel frustrating to be told do more, add this, prove this, consider this, etc. But that’s our role, and our job, and our responsibility. Thank you for reminding us of that very important charge.
The Public Conversation Project sustained a dialogue between "pro life" and "pro choice" advocates for a decade. They never changed anyone's point of view, but the pro life movement became less hostile and there were no murders during the years the two groups met. There are many accounts of their process, of which this one might be of interest as it maps on to your experience so far. They didn't change minds but they did come to "love" each other and there was less harm in their respective communities of all kinds. Citation: "Public Conversations Project," selection from Moral Conflict, (Thousand Oaks, California: SAGE Publications, 1997) pp. 181-197. Or, https://whatisessential.org/history
I'm unconvinced that MAHA cares about other people. They have made it very clear that they don't. We have allowed them to become what they are because we haven't enforced vaccine mandates that have been constitutional since 1905. No one has a right to spread a potentially deadly disease to others and we should remove all exemptions except medical exemptions. RFK Jr. is a eugenicist. He's part of the Disinformation Dozen. He's 1 of 12 people responsible for more than 60% of health and vaccine disinformation on the internet and social media. The average person will never be qualified to make these medical decisions for themselves. They have decided that ideology is more important than facts and you haven't taken into account the rampant Dunning-Kruger, the malicious ignorance, or the cognitive dissonance that prevents these people from seeing and accepting facts, no matter how they are presented. They also don't know how to interpret scientific research. We can't give them an inch or they will take miles.
Well done for doing this. It takes real courage to speak to the other side when there is so much animosity. However we all have to learn to do this. The level of contempt people have for the other side is very high and it is as much of a problem on the left as on the right.
This take of both sides are angry at one another implies both sides are affected equally by the other. Anti-MAHA though, is working against ideas that result in measurable harm. It is understandably infuriating when people support a movement that has led to the deterioration of public health and puts people's lives at risk. Obviously MAHA will suffer from this too, but they do not understand that (yet, perhaps). The anger anti-MAHA feels is in response to how they understand the true threats to their wellbeing is valid.
MAHA's animosity, however, is more "don't be mean to be because I refuse to expand my worldview and refuse to believe the experts". The "let me believe what I want even though it harms other and regardless of established research that I have done little to seek out and understand" (which is what the impacts of their beliefs are, as much as they try to deny it) is a good reason to be upset with other people. At this point in time, I think public health should spend more of their time working on the very real issue of how good and accurate information doesn't reach people as much as inaccurate information does.
This was incredible. It’s brave to reach across the aisle, and to take the additional step of editing your vaccination document so that it can be more widely shared was fantastic. I am skeptical as was the previous commenter that clickable links will be read, but if they are that refutes a stereotype.
This is why I subscribe as a layperson; I feel like the world is spinning off its axis but this newsletter is always a voice of reason.
Here is another issue I’d be interested in exploring: the decline in availability of primary care physicians. This is big PH issue as people increasingly do not have access to preventive care. I just had my 3rd PCP in 4 years leave the practice I’m in, and I can’t find another practice that will take a new traditional Medicare patient. I can’t get referrals for preventive tests without an appointment. Everyone I know is experiencing the same (Multnomah County, OR)
PCPs are leaving in droves because working in primary care leads to massive burnout. Primary care is constantly being asked to meet more measures set forth by insurance companies and Medicaid/Medicare, many of which have dubious effects on health outcomes. This translates to having to see many patients in short time slots, and constantly increasing documentation that often ends up being completed after office hours and at home. Add in increasing mistrust and misinformation from the public. No one in their right mind would go into primary care out of med school when they can earn far more in a specialty with less bureaucracy and pay off student loans much quicker. Many PCPs leaving the field are moving toward telehealth for increased flexibility with less stress. If MAHA really cared about preventing chronic illness, they would be advocating for investing in primary care.
You are doing such important work here by trying to build bridges instead of increasing the divide. This is the way back to sane conversations instead of vitriol and mistrust. Thank you for setting this important example.
Thanks, a great and valuable project! (please it going!) Listening to the audio you are all intelligent, well intentioned and caring.
As a person I am speaking as one who had polio as a child (1955) and now has post polio syndrome; as a family doc, in training (Boston - 1968) 10% of my hospitalized patients had active TBC; in practice I in the past I saw measles, and recently whooping cough. Yet with a broad perspective we now live in a different world than the one I have experienced.
These person to person conversations are obligatory and very very important and bravo!
But as an anthropologist, historian, sociologist, and epidemiologist there is really an overwhelming broad contextual problem which needs to be explored and mitigated at a wholly different level:
The MAHA folks, our society and culture (1) has had 2 generations fortunate enough to live in a protective, basically healthy, historically unique bubble, (due to antibiotics and public health success) unchallenged by worries about infectious disease; (2) a culture historically forever characterized by an ethos of rugged individualism (and tolerance, if not endorsement, of racism); (3) doubt in science created by ideologically, commercially and politically formulated perspectives on issues such as smoking, reproductive medical care, firearms, climate change; (4) a confused, challenging and fearful experience during acute COVID; (5) a culture distorted by neoliberal, corporate, capitalist ethos promoting atomization of action and disparaging (to the point of eliminating understanding of) broad social capital, public goods and government action. This broad context has led to blind, maybe arrogant, perspectives on the science side and foreshortened perspectives on the doubters' side. And trust has been destroyed all round.
Finally Public health per se does not fit into our commercial neoliberal world. It works best in anticipation, when it is successful harms are avoided and there are no benefits or profits to count, it depends on social more than individual action; cost benefits have to be epidemiological and theoretical, not seen on a balance sheet.
This makes rebuilding trust and broad social cooperation all the much harder and deserves explicit attention on both sides.
Finally through a TEDMED talk I met Jennifer Reich whose 2018 book CALLING THE SHOTS has a very empirically informed and wise approach to vaccination confusion.
This post is just one of the reasons I subscribe. When I was a paramedic I met patients literally where they were. As a PA, I try to do the same as it was taught to me by my mentor.
You can’t physically stop a patient from making what you believe to be a bad decision. I agree that all you can do is have empathy, provide the most factual information you can and discuss the risk.
Keep the conversation going, it’s one of the ways society learns.
Exactly my thought! And help build a bridge from the facts to the personal decision. Consider that public health is very generic and we are all bio-individual. The bridge of curiosity can go a long way.
I'm curious to know, have any of the MAHA you've been working with shared with you what they in turn have learned from you and your colleagues?
That’s a great question! I haven’t asked, but I will
I know we are wanting to learn how to better communicate, improve our messaging and meet people where they are at, all very Important strategies which I believe will make a difference, but just as important is verifying if this is working and how are they opening themselves to receiving information.
The MAHA request for "clickable links" raises some important questions regarding academic paywalls to research. Countless studies of implementation of the ten essential public health services in state and local public health agencies cites "use of research in practice" as an area where public health fails. Unless we can address the production and ownership of knowledge (research), the criticisms of being captured by pharma and the medical-industrial complex will ring true.
Screaming this from the rooftops. Gatekeeping science is antithetical to the mission of our field. Thanks for pointing this out!
I agree, and it is not a failing unique to public health, but across science. I worked on NIH training grants for postdocs and junior faculty in Implementation Science, studying ways to improve moving research-tested findings into practice. I was talking about it with a friend who is a space scientist and he bemoaned the lack of integration of research findings in that field. Easier access to findings is one step toward that.
That's been our experience in trying to introduce unique clinical observations during the pandemic, establishing collaborative pre-clinical laboratory expertise yielding significant discoveries that have yet to be championed (translated) by formal clinical research or trials. Even brief letters to the editor in open access journals require several thousand dollars in publishing fees. For non-university and un-affiliated practitioners that is a major barrier for disseminating such important information.
That’s wild. I had no notion it was so expensive! Thousands of dollars to submit letters to the editor feels like an anachronistic practice, from the white tower days of academia. (My perception, anyway. Perhaps there are practical considerations I’m not aware of?) Especially these days, when the body of knowledge is expanding so rapidly, this feels like a critical issue.
Agreed, vehemently! I’m a member of the public and I’d love to better understand aspects of public health that apply to me, specifically those involving motherhood, child rearing, etc. I’ve run into paywall issues before and it is gatekeeping, after a fashion. I understand there are nuances, and I usually find ways around but still.
I’ve been thinking about this comment a good deal. Just to circle back, underserved communities aren’t going to struggle access the science on a variety of levels. Trusted communicators only go so far for people who prize autonomy and want to verify information for themselves. I don’t know what the answer is, but man is it frustrating. Removing bars to access for scientific journals might be a start.
There are an increasing number of free access online journals. Public Health could very well identify and use those sources where applicable to the topic
This post resonated so hard with me I got off my a$$ and subscribed because I want to put my money where my mouth is. I'm not a religious person, but IMO you're doing God's work reaching out to the so-called "them" and finding common ground. I wish this nuanced, ego-free, and people-first attitude was more prevalent and taking place in other sensitive high-conflict circles across a broad span of disciplines. We can choose to be "right" or we can choose to work with what we have towards positive change.Thank you from the bottom of my heart. Love, a public health professional feeling slightly better about the world today.
The first example is the same thing MAHA always does. It’s disingenuous and purposeful. Like you said you put in a lot of work. Does she require that amount of work and access from the MAHA nonsense she believes? I would bet not. They live in a bubble of ignorance on purpose.
It doesn’t feel fair that we have to put this much effort in, when we have well-considered science on our side. That doesn’t matter. Honestly, the feedback from that MAHA individual WAS constructive. There is such a distrust in their circles that I could see how having those one sentence summaries make a difference. We meet people where they are.
Their distrust is based on conspiracy. Logic cannot fight that. They require no evidence to believe what they believe, but they require mountains of evidence to even consider (that’s probably to strong of a word) another view point. This is how they are taught to argue by the MAHA leadership because they know it can’t be argued against.
I agree—you can’t reason your way out of a viewpoint you didn’t reason your way into, right? It’s incredibly disheartening. That said, Dr J engaged with this community in good faith, took the criticisms and incorporated the useful bits, and then it was spread within their own community by a trusted member. That’s worth a lot in my book.
I would guess it wasn’t spread in good faith.
Some of us are more trusting in humanity, Josh. I prefer to believe that the MAHA spokesperson is a true mediator and has more of an open-mindedness than her more vociferous MAHA colleagues. She contributed to a civil dialogue and found a common ground so she distributed the essence of another view, Will that make a huge influence on her MAHA colleagues? Maybe not, but even if she gets a few of them thinking a little harder and doing a little more softening of their stances, it will have gone a long way in my opinion.
That’s cynical. I’m not saying you’re wrong, but we can’t operate like that, imo.
The problem I have comes down to this, they were given a platform with experts. They can make any wild claim they want (that’s the playbook), at best it will take the actual experts just hours to refute those claims. But that’s irrelevant because the response will be simply that the evidence is tainted. MAHA will come out saying they “won” even though the other side wasn’t there to win or lose anything.
It is cynical, I never tried to claim otherwise. But just because it’s cynical doesn’t make it less true. I would say your viewpoint is extraordinarily naive. I wish it wasn’t. I wish they could actually change minds. But, historically engaging with conspiracy theorists usually causes more harm than good.
I would hope that, if it's not been done already, some of the points you make here could and would be diplomatically worked into the communications with the MAHA folks, attempting to get them to see (and ideally own) the imbalance of evidence required from one side versus the other.
Owning things is not their strong suit. It’s literally why MAHA exists. “Is it poor dietary choices that make me unhealthy… or red dye?” I’m aware it’s far more complex than that, but IMO it demonstrates the problem with good faith engagement.
Completely agree. But the imbalance is a major crux in this situation and in and of itself needs to be addressed as a standalone issue. And yes, it very well may end up being futile.
I view those sorts of stands as "tribal" and it's a challenge to convince your tribe to think broadly with considerations for other tribes, in my opinion.
Absolutely. I imagine that the woman who was with MAHA in the post probably circulated Dr J’s updated pamphlet at some social risk to herself. That said, she did it! Which speaks to the efficacy of Dr J’s strategies—nuance, curiosity, etc.
It is a challenge and so thankful that Kat has taken on the challenge for us.
It is also POSSIBLE!
Josh, I understand your frustration with the MAHA crowd and its probably based on experience. I would venture a guess that the group Kat is meeting with is a little less of this than the typical MAHA follower. Kat has found a small crack in the wall and is going for it to try to bring down the barriers. I have family who are MAHA so I know that most of them are actually very caring and good people. And educated and smart too. So frustrating they allow themselves to be told what to think. But Kat is doing an amazing thing and there is possibility it will work. We need to support her and help her continue to believe so she can continue to be the warrior for us even if we don't believe in what she is doing.
Thanks for being the warrior Kat! We have your back!
Thanks, Molly. I hope you’re right! I’m also not in the PH field and that might make it a little easier to be optimistic. 😅
One (of many) challenges is explaining or justifying the education behind our recommendations- it’s a little bit of “tooting one’s own horn”. We want to explain why our advice has weight but sometimes it can feel condescending… in the same way it’s very diminishing to compare our advice to a social media influencer.
We check our egos at the door, at least I do, but it feels very defeating; most of all when there is no opportunity to share our hard earned expertise at all.
We, pediatricians, get a vote too. Many/most of our patients demand that their child will not have an unnecessary exposure inside our office. It’s challenging- patients conceal information when making appointments, deny risky exposures, and we discover this once a MA has roomed a patient, we have not taken appropriate safety measures, PPE. Our other patients are tired of seeing us masked and covered up, so we try to balance that, well and sick. But then after you have spent 30 mins w a “well child” they reveal that 2 days ago they tested positive for Covid and now the opportunity to do anything has passed. Should just test ourselves every day without symptoms? Will we spread it to a newborn?
So, adding unvaccinated children, especially to measles at this time, is extraordinarily difficult. Do no harm. It’s becoming difficult.
My pledge to myself had been that no patient should ever get covid from visiting my office. Now it’s measles. Is it fair?
It’s not unlike driving: I could get where I want to be driving badly- speeding, weaving, driving up the shoulder in traffic- but we agree on the road to keep each other safe (most of the time LOL) by following the same rules and laws.
I understand the reticent questioning and worries- truly- and I am committed to working through them. But in a society, we all have to work together. Otherwise everything falls apart. Like I feel is currently occurring.
Thank you so much for all of this, and for encouraging us.
As public health professionals, especially after the last five years, we are *so very tired*, and it can feel frustrating to be told do more, add this, prove this, consider this, etc. But that’s our role, and our job, and our responsibility. Thank you for reminding us of that very important charge.
The Public Conversation Project sustained a dialogue between "pro life" and "pro choice" advocates for a decade. They never changed anyone's point of view, but the pro life movement became less hostile and there were no murders during the years the two groups met. There are many accounts of their process, of which this one might be of interest as it maps on to your experience so far. They didn't change minds but they did come to "love" each other and there was less harm in their respective communities of all kinds. Citation: "Public Conversations Project," selection from Moral Conflict, (Thousand Oaks, California: SAGE Publications, 1997) pp. 181-197. Or, https://whatisessential.org/history
I'm unconvinced that MAHA cares about other people. They have made it very clear that they don't. We have allowed them to become what they are because we haven't enforced vaccine mandates that have been constitutional since 1905. No one has a right to spread a potentially deadly disease to others and we should remove all exemptions except medical exemptions. RFK Jr. is a eugenicist. He's part of the Disinformation Dozen. He's 1 of 12 people responsible for more than 60% of health and vaccine disinformation on the internet and social media. The average person will never be qualified to make these medical decisions for themselves. They have decided that ideology is more important than facts and you haven't taken into account the rampant Dunning-Kruger, the malicious ignorance, or the cognitive dissonance that prevents these people from seeing and accepting facts, no matter how they are presented. They also don't know how to interpret scientific research. We can't give them an inch or they will take miles.
1000% agree. The endgame for MAHA is banning all vaccines. Full stop.
Well done for doing this. It takes real courage to speak to the other side when there is so much animosity. However we all have to learn to do this. The level of contempt people have for the other side is very high and it is as much of a problem on the left as on the right.
This take of both sides are angry at one another implies both sides are affected equally by the other. Anti-MAHA though, is working against ideas that result in measurable harm. It is understandably infuriating when people support a movement that has led to the deterioration of public health and puts people's lives at risk. Obviously MAHA will suffer from this too, but they do not understand that (yet, perhaps). The anger anti-MAHA feels is in response to how they understand the true threats to their wellbeing is valid.
MAHA's animosity, however, is more "don't be mean to be because I refuse to expand my worldview and refuse to believe the experts". The "let me believe what I want even though it harms other and regardless of established research that I have done little to seek out and understand" (which is what the impacts of their beliefs are, as much as they try to deny it) is a good reason to be upset with other people. At this point in time, I think public health should spend more of their time working on the very real issue of how good and accurate information doesn't reach people as much as inaccurate information does.
I appreciate what you're trying to do and I truly hope it helps. Just ... be careful. Be very, very careful.
Thank you for participating in this initiative and sharing your learning from it here. Very important!
Autonomy has limits. You cannot enjoy total personal freedom and live in community with others at the same time--you give up some autonomy. MAHA people do not realize that. But, SCOTUS has ruled, and confirmed its ruling several times that health care mandates can be constitutional. Read more about that ruling here: https://stevensclark.typepad.com/coronavirus_news_and_view/2023/02/vaccine-mandates-have-long-passed-constitutional-muster-.html
This was incredible. It’s brave to reach across the aisle, and to take the additional step of editing your vaccination document so that it can be more widely shared was fantastic. I am skeptical as was the previous commenter that clickable links will be read, but if they are that refutes a stereotype.
This is why I subscribe as a layperson; I feel like the world is spinning off its axis but this newsletter is always a voice of reason.
Here is another issue I’d be interested in exploring: the decline in availability of primary care physicians. This is big PH issue as people increasingly do not have access to preventive care. I just had my 3rd PCP in 4 years leave the practice I’m in, and I can’t find another practice that will take a new traditional Medicare patient. I can’t get referrals for preventive tests without an appointment. Everyone I know is experiencing the same (Multnomah County, OR)
PCPs are leaving in droves because working in primary care leads to massive burnout. Primary care is constantly being asked to meet more measures set forth by insurance companies and Medicaid/Medicare, many of which have dubious effects on health outcomes. This translates to having to see many patients in short time slots, and constantly increasing documentation that often ends up being completed after office hours and at home. Add in increasing mistrust and misinformation from the public. No one in their right mind would go into primary care out of med school when they can earn far more in a specialty with less bureaucracy and pay off student loans much quicker. Many PCPs leaving the field are moving toward telehealth for increased flexibility with less stress. If MAHA really cared about preventing chronic illness, they would be advocating for investing in primary care.
You are doing such important work here by trying to build bridges instead of increasing the divide. This is the way back to sane conversations instead of vitriol and mistrust. Thank you for setting this important example.
Thanks, a great and valuable project! (please it going!) Listening to the audio you are all intelligent, well intentioned and caring.
As a person I am speaking as one who had polio as a child (1955) and now has post polio syndrome; as a family doc, in training (Boston - 1968) 10% of my hospitalized patients had active TBC; in practice I in the past I saw measles, and recently whooping cough. Yet with a broad perspective we now live in a different world than the one I have experienced.
These person to person conversations are obligatory and very very important and bravo!
But as an anthropologist, historian, sociologist, and epidemiologist there is really an overwhelming broad contextual problem which needs to be explored and mitigated at a wholly different level:
The MAHA folks, our society and culture (1) has had 2 generations fortunate enough to live in a protective, basically healthy, historically unique bubble, (due to antibiotics and public health success) unchallenged by worries about infectious disease; (2) a culture historically forever characterized by an ethos of rugged individualism (and tolerance, if not endorsement, of racism); (3) doubt in science created by ideologically, commercially and politically formulated perspectives on issues such as smoking, reproductive medical care, firearms, climate change; (4) a confused, challenging and fearful experience during acute COVID; (5) a culture distorted by neoliberal, corporate, capitalist ethos promoting atomization of action and disparaging (to the point of eliminating understanding of) broad social capital, public goods and government action. This broad context has led to blind, maybe arrogant, perspectives on the science side and foreshortened perspectives on the doubters' side. And trust has been destroyed all round.
Finally Public health per se does not fit into our commercial neoliberal world. It works best in anticipation, when it is successful harms are avoided and there are no benefits or profits to count, it depends on social more than individual action; cost benefits have to be epidemiological and theoretical, not seen on a balance sheet.
This makes rebuilding trust and broad social cooperation all the much harder and deserves explicit attention on both sides.
Finally through a TEDMED talk I met Jennifer Reich whose 2018 book CALLING THE SHOTS has a very empirically informed and wise approach to vaccination confusion.