This Measles Patient Is Merely Resting
There was a time when the Centers for Disease Control and Prevention had a straightforward job:
Disease appears. Scientists investigate it. CDC counts it. Doctors try to prevent more of it.
Admittedly, this lacked theatrical flair.
Fortunately, American public health has entered its Monty Python period.
We join the Department of Health and Human Services, where Pennsylvania has arrived at the National Public Health Pet Shop carrying two reported measles-associated deaths.
PENNSYLVANIA: I wish to register two deaths.
CDC: What sort?
PENNSYLVANIA: Measles-associated deaths.
CDC: Are you certain?
PENNSYLVANIA: We investigated them.
CDC: But are they really measles deaths?
PENNSYLVANIA: We said measles-associated. There is an important medical distinction.
CDC: Ah! A distinction. We shall need additional documentation.
PENNSYLVANIA: We have death certificates.
CDC: Excellent. We shall place them in the special federal drawer marked “Things That May Have Happened.”
One of the deceased was a newborn with measles listed as a contributing condition on the death certificate. That doesn’t necessarily establish measles as the immediate cause of death, and reviewing that distinction is perfectly legitimate.
Then Robert F. Kennedy Jr. entered the room carrying a large herring.
He suggested the deaths might have been fabricated.
And suddenly a reasonable epidemiological question—What role did measles play in these deaths?—became:
“Have we considered the possibility that Pennsylvania invented the dead people?”
Welcome to the Ministry of Silly Epidemiology.
The Federally Unconfirmed Corpse
There are actually three separate questions here.
Was measles associated with the deaths? Pennsylvania says yes.
Did measles directly cause or materially contribute to them? That’s a medical determination worthy of careful review.
Has CDC accepted them for its national measles death count? Not yet.
Perfectly reasonable distinctions.
But “the federal government hasn’t confirmed the causal classification” and “perhaps state officials fabricated the deaths” are not neighboring scientific conclusions.
They’re not even in the same ZIP code.
One is epidemiology.
The other is a conspiracy theory wearing a lab coat.
Meanwhile, measles continues its irritating habit of behaving according to virology rather than political affiliation.
The virus is extraordinarily contagious.
The MMR vaccine remains highly effective.
And viruses, displaying a shocking lack of respect for social media, continue replicating without first checking X.
NIH Enters the Sketch
NIH Director Jay Bhattacharya has acknowledged the decidedly inconvenient facts that there is no cure for measles and that two doses of MMR provide about 97 percent protection.
One imagines the staff meeting:
HHS: Jay, we’re trying to have a vaccine controversy here.
BHATTACHARYA: The vaccine works.
HHS: Could you say that in a more confusing way?
BHATTACHARYA: Two doses provide about 97 percent protection.
HHS: You’re ruining the atmosphere.
The great accomplishment of contemporary federal health policy isn’t changing the scientific evidence.
It’s making Americans wonder whether scientific evidence exists at all.
The New Scientific Method
For centuries, science worked something like this:
Observation → Hypothesis → Experiment → Data → Conclusion
Bizarro World science is considerably more efficient:
Conclusion → Social-media post → Find data → Attack inconvenient data → Demand more data → Question motives → Announce that science is finally transparent
The advantage is speed.
You can reach the wrong conclusion before breakfast.
And Then There Is Samoa
Kennedy has repeatedly maintained that his 2019 trip to Samoa had “nothing to do with vaccines.”
Unfortunately, before the trip he wrote Samoa’s prime minister proposing an assessment involving the country’s MMR vaccines.
His letter reportedly used “vaccine” or “vaccination” eight times.
Eight.
Not once, accidentally, while asking where the restroom was.
Eight times.
PARLIAMENT: Was your trip about vaccines?
KENNEDY: Absolutely not.
PARLIAMENT: Here’s your letter about vaccines.
KENNEDY: Correct.
PARLIAMENT: You mention vaccines eight times.
KENNEDY: Indeed.
PARLIAMENT: And propose studying the MMR vaccine.
KENNEDY: Precisely.
PARLIAMENT: So the trip concerned vaccines?
KENNEDY: Good heavens, no.
PARLIAMENT: What would constitute a vaccine-related trip?
KENNEDY: Nine mentions.
Nobody Expects the Advisory Committee!
For generations, Americans could reasonably assume that CDC recommendations emerged from epidemiologists, infectious-disease specialists, pediatricians, statisticians and enormous piles of painfully dull evidence.
Boring was the feature.
You don’t want your bridge engineer to be fascinating.
You want him to be extremely boring and unusually interested in load-bearing calculations.
You certainly don’t want him livestreaming from the bridge explaining that gravity may be a pharmaceutical conspiracy.
The same principle applies to the people deciding whether your grandchild should receive a vaccine.
Public health ought to be among the dullest institutions in Washington.
Instead, it has become must-see television.
The Joke Stops Being Funny
Government health agencies deserve scrutiny. CDC, NIH and FDA have made mistakes. Scientists should be challenged. Data should be examined. Experts should explain themselves.
But skepticism is not reflexive disbelief.
A state’s classification of a death can legitimately be questioned.
Federal scientists can reasonably ask for more information.
What they shouldn’t do is convert scientific uncertainty into insinuation.
“We haven’t established causation” is science.
“Maybe they fabricated the deaths” is something else entirely.
And that distinction matters because public health depends upon something no laboratory can manufacture:
credibility.
Once government health institutions spend that credibility, getting it back is considerably harder than eradicating measles was in the first place.
Perhaps CDC should simply update its dashboard:
Measles-associated death
Death under federal review
Federally confirmed measles death
Death pending interagency vibes
Mostly dead
Resting
Pining for the fjords
Nailed to the epidemiological perch
And somewhere in Atlanta, an exhausted career epidemiologist closes the office door, pours another cup of coffee and whispers:
“This is an ex-public-health agency.”
The underlying science isn’t terribly mysterious.
Measles is real.
It can be dangerous.
Vaccination dramatically reduces the risk.
Deaths deserve careful investigation.
And extraordinary accusations deserve extraordinary evidence.
None of this should be partisan.
It shouldn’t even be exciting.
Public health should be competent, transparent and almost painfully dull.
Bring back boring.