The fates of Dr. Li Wenliang and Dr. Anthony Fauci will be irrevocably linked in our current times. Both physicians were muted by their respective political overlords:  Dr Wenliang sacrificed his life in the pursuit of warning the world of a deadly airborne virus originating in Wuhan, China and Dr Fauci, by the Trump Administration in thwarting his public health efforts in limiting morbidity and mortality. In these unsettling times, the assault on medicine and public health is not only lethal, but tolerated by industry, public opinion and political factions. 

When capitalism and profit intersect with human health, the American experience has often been in the favor of the former. American medicine in the 19th century was profit driven, fueled by several hundred medical schools that had no legitimate science curricula, no formal training programs and no criteria for competent professors. US medical students, desiring a top flight education, would journey to Paris to get state of the art instruction. Snake oil salesmen who peddled dangerous potions for multiple ailments thrived in the 19th century. 

The 20th Century provided some sanity and sanctity in the pursuit of science and healthcare. Abraham Flexner, an American educator, at the request of the Carnegie Foundation, reported in 1910 on quack medical training that resulted in the closure of multiple schools and began the scientific basis of medical education in the U.S. The Food and Drug Administration, established in 1906,  provided an oversight of drug therapy and provided a safety net to the general public.

Greed and the pursuit of profit in healthcare today still cannot be denied.  Popular entertainment reinforces the profit motive. Mr. Wonderful, on Shark Tank, when reviewing a vitamin and herbal supplement, gleefully queried the proprietor, “I don’t care if it works, what are your yearly sales?” Gordon Gecko, in the 1980’s movie “Wall Street”, uttered “Greed is good.”  Even in the 1950’s, Jim Anderson,  the iconic principled father in “Father Knows Best” sitcom during  the Eisenhower era, readily endorsed the Springfield snake oil salesman’s request for a business license because he was good to his dog and family. 

Congress got into the act of greed and greenbacks in response to a potential flood of pharmaceutical lobbyist money, further sacrificing the principles of science and public safety. Utah Senator Orin Hatch orchestrated potential legislative medical malpractice with The Dietary Supplement and Health Education Act of 1994 (DSHEA) which decreed that over the counter supplements and herbal products did not need to prove safety data prior to their release to the public and any complications would only need to be voluntarily reported. The supplement companies could not claim to treat a “disease” but misleading euphemistic claims such as “supporting health, “wellness,” or supporting a biologic system could be used in advertising without any scientific data to confirm the claim. What was the result? The OTC industry money profits increased from $9 billion to $50 billion,  Salt Lake City, Utah became a destination for the supplement companies. Hatch’s family became lobbyists for the industry and he and other members of Congress had a reliable flow of campaign donations.  What did the consumer get? The answer is clear: A flood of products that resulted in liver injury, life threatening drug interactions and occasional cardiovascular deaths. Product labeling was often misleading or wrong. Probiotics, living bacteria that can contribute to health, were often non viable or absent when analyzed by microbiologist/scientist scrutiny (R. Knight, UC San Diego). Families put themselves into financial jeopardy by spending hundreds of dollars per month on bogus supplements hawked by salesmen and health providers. This was a legislative fiat that legally supported medical quackery.

Now the technology industry is attempting to expand their profits by tapping into our health obsession and circumventing health law. Products that evaluate sleep hygiene, pulse and heart rhythm and oxygenation are entering watches, phones and bracelets. When developing a new technology, the rational response is to compare your experimental device to a gold standard that accurately measures the outcome you are looking at. For sleep analysis this is polysomnography, a medical test that looks at EEG, respiratory rates, eye movements among other data; oxygenation gold standard is the transmission pulse oximeter. Tech companies, such as Fit Bit and Apple, for instance, bypass the gold standard test and support their device results with an opaque “secret artificial algorithm.”  In the few studies that compare products to their gold standard, they are often shown to be inaccurate. The companies, unable to get FDA approval, then take guidance from the supplement industry by using “wellness” as the reason for the biometric. With no reproducibility and no public direction on the meaning and actionable explanation for the results, we are left with tech company advertising babble to encourage their purchase. 

It has been the pandemic of 2020 that has shown the stark reality of science deniers. Trump’s effort to undermine science and mask wearing and the infiltration and destruction of our beloved NIH, CDC and FDA autonomy has been an armageddon moment in healthcare. Pushing hydroxychlorquine, megavitamins and experimental medications that have not been fully vetted in randomized controlled studies as effective cures is unacceptable to the medical community and cannot be recommended as treatments to the public at large. Furthermore,  anti-vaxers, and proponents of the deadly “Herd Immunity” strategy are further evidence of our dilemma.

I am reminded of Dr. John Snow, a British obstetrician in the mid 19th century, who observed his London patient washing her infant’s diapers in a common water pump in town that spread cholera throughout the community. Snow’s work established the water-borne source of cholera and his urging of removing water pump handles. His pleas went unheeded by the public and scientists of his time leading to the death of thousands of additional victims in the cities around the globe. Accepting well designed investigations and their conclusions are our only way to avoid a “Dark Ages” outcome of health goals.

Our hope for the future lies in the investment of science teachers, high quality training of physicians and allied health providers, debunking and removing dangerous healthcare products on our social networks and providing the public with political leaders who want to move away from the past and into the evidenced based medical world of the present. 

This moment in my medical training recurs in my mind as I watched for the past 3 ½ years at the news correspondents’ quizzical looks as they tried to respond to Donald Trump’s ever increasing disjointed communication.  While my patient in the county psych ward communicated with violent behavior, he nonetheless was unable to express a coherent on-topic conversation that mirrors reality like Donald Trump.  As the evidence mounts of Trump’s psychopathology,  supported by Ivy League and family embedded mental health specialists, the parallel becomes more realistic.

How can you account for the election and sustained authority of a man that has no appreciation for reality, no empathy and no problem solving ability? Three concepts are critical, in my opinion: 1) The firewall of falsehoods that support politics and insulate the economic, profit motive for governance; 2) the pseudo-reality of 7 decades of television watching; 3) the inability of rational people to respond to a psychotic dialogue.

The political firewall of falsehood is particularly thick in our early education. We learn that Thomas Jefferson, the author of the Declaration of Independence and the third president of the United States is a great American, however educators skim over his ownership of slaves.  Andrew Jackson, our “people’s president” and victor over the British in New Orleans during the War of 1812, was also the architect of the forced removal and slaughter of the Cherokee from Georgia despite two Supreme Court rulings against its legality.  Various wars fought in the name of preserving the American way of life were often a subterfuge for economic gain. The latter was particularly relevant for me during the Vietnam War, as my generation was drafted and conducted the war at the bequest of past presidents, including the corrupt Richard Nixon. The firewall called the war effort to “prevent the spread of communism” and contain China and Russia from world domination.  These pseudo-facts were debunked by Southeast Asian historical scholars and disseminated in political science courses during my college years and validated by the subsequent arc of history.  Profits and employment opportunities in the U.S. were the nested reasons for this conflict. Lobbyists dominate political decision making and mask the true reason for congressional and presidential decision making. When one does break the firewall of mendacity and falls on the other side, the lure of profiteering can steer you back to the wrong side. No wonder, during my one Vietnam era protest in Washington, I was warned by relatives that this could harm my future employment in Wall Street financial firms. It was hard to contest the Trump supporter’s claim that “all politicians lie.”

Television was the final coup de grace that catapulted Trump into the White House. The lack of critical thinking is pervasive in our society and television has obliterated the lines of news and entertainment. Early television could still cling to morality and group cooperation (think Father Knows Best and Gilligan’s Island). “Reality” shows that masquerade as truth created a fictional narrative that viewers accepted without reservation. Without The Apprentice, Donald wouldn’t have had the political on-ramp he enjoyed.  While all who worked with Trump in the real world of construction and media declared him a fraud, he was on television and they must be mistaken.

In summary, rational people brought up on falsehoods, ensconced in Reality TV  for a number of years combined with protective self-talk when confronted with uncomfortable behavior from elected leaders, begin to accept and adapt to irrational discourse and actions. Consequently, they excuse or ignore it.

So the narrative goes as follows: Yes, he tells lies, but don’t all politicians do the same (the firewall of falsehood) and he’s a competent businessman, it says so on television. The psychosis element is dismissed by either: 1) not dealing with it (think of how many people avoid the homeless);  2) he couldn’t be in his position with a diagnosis of mental illness.

Mental illness that erupts into violent and dangerous behavior is easy to discern and react to swiftly with isolating the perpetrator from society.  That was easy to understand in my early days of training. Like the frog slowly boiled in hot water,  we have as a society built a firewall from truth, televised abnormal behavior into entertainment and have been trained to look away and excuse or normalize statements of question or actions by leaders when confronted with uncomfortable behaviors.  My Uncle Jack use to respond to all inexplicable government driven situations with, “It’s Fixed.”  I think he is correct, but it is up to us to fix the fix.