The recent incidents of Ebola virus infections in the United States have prompted something of a crisis, but not a crisis as other outbreaks before: our present crisis is of confidence, not necessarily fear of infections.
Most damaged has been the reputation of the CDC and its head, Dr. Tom Frieden;
Simply put, when a person wearing the mantle of Scientist/Physician says things like;
“Though we might wish we can seal ourselves off from the world, there are Americans who have the right of return and many other people that have the right to enter this country,” Dr. Thomas Frieden told a press conference. “We’re not going to be able to get to zero risk no matter what we do unless we control the outbreak in West Africa.”
The argument of “zero risk” is a giant red flag for anyone even passingly familiar with medicine; it’s a political term used to provide plausible cover for not taking an action, in this case, enacting a travel ban. Consider, for example, that never touching a cigarette does not reduce your risk of lung cancer to zero. If we were to apply the logic Dr. Frieden espouses, why should a physician discourage a patient from smoking? It will not reduce your risk to zero.
The answer is, of course, that not smoking or quitting smoking has a substantial and positive increase in your health. The idea that people shouldn’t quit smoking because their risk will not go to zero is silly… yet this is the logic the head of the CDC promulgates. Scientists and physicians speak in terms of risks and rewards, benefits and trade-offs: ceasing or restricting the number of people coming from West Africa would not reduce the risk to zero. But!
- Restricting ports of entry would allow concentration of personnel,
- Concentrating personnel allows for concentration of expertise,
- Reducing volume of incoming travelers increases man-hours of safety personnel per traveler,
- Increasing man-hours per traveler allows systems to perform differently: health monitoring systems that would be overwhelmed with 1000 visitors per day may perform fine with 10 or 20 per day.
Now, there may be perfectly reasonable drawbacks to any of these hypothetical benefits (then again, some of them already seem to be happening), but we’re not having that discussion. Instead we’re having a discussion that leads one to conclude that “[t]he public-health profession is more committed to social justice than to sound science“, and an administration with little approval burns through yet more of the public’s confidence.
At the same time we’ve also seen some astonishing partisan attacks to go along with the flailing of the administration. While Ebola is very unlikely to become a major health hazard in the US, that doesn’t change the basic nature of the virus. So it’s especially disturbing to see political partisans in the media tear into Senator Rand Paul (one of the few MDs in Congress) for stating basic medical facts;
Sen. Rand Paul (R-Ky) reportedly put on his scientist hat this morning, telling CNN’s Ashley Killough that Ebola is more easily spread than AIDS–a statement that is an irresponsible, flat out lie.
You’ll be shocked to discover that Mother Jones is… pretty much completely wrong, and Dr. Paul pretty much right (or, at least, he was using the CDC’s own recommendations). This can be simply and easily understood with the following practical advice;
A person that wished to engage in sexual relations with a significant other infected by HIV/AIDS needs the following,
A person that wished to engage in sexual relations with a significant other infected by Ebola needs the following,