Wednesday, December 07, 2005

Lip reading

My father was an old fashioned GP (actually a "Physician & Surgeon," the kind of doc that doesn't exist anymore--he delivered babies, treated their childhood illnesses, married them off, took out their appendix and then treated their mid life heart disease and diabetes, all the while making housecalls). I remember he used to subscribe to a monthly continuing education publication with the wonderful titile, "Disease-a-Month" and I used to look at the red binders with the DM logo on his office shelves. That was in the 1950s.

"Disease of the month" has made a comeback but not as a periodical. In Secretary Leavitt's meetings with state public health officers this week he encountered it along with a fair amount of frustration and cynicism:
Oregon's public health director, Susan Allan, worried that the heavy emphasis on flu also could affect public health officials' credibility if a pandemic doesn't occur. "People have lurched from one 'disease of the month' to another for the past five years. We did our anthrax plan, we did a SARS plan, now it's pandemic flu," Allan said.

"I'm worried about that," Leavitt responded, noting "there's a better than 50% chance" that the H5N1 virus now spreading among birds worldwide won't cause a pandemic in humans.

"But, ultimately, it's going to happen." (Daily News Central)
This is a variation on the Crying Wolf fear: that repeated false alarms will result in public indifference or skepticism. Too late. You've got the worst of both worlds: a scared public who is skeptical and distrustful. Secretary Leavitt had the right answer, but he doesn't understand its significance. If we thought government was properly prepared for foreseeable eventualities, even bad ones like a flu pandemic, the Wolf wouldn't be half as scary and we wouldn't have a Crying Wolf syndrome.

Yes, ultimately a pandemic will happen. The influenza virus is resourceful in finding new ways to reproduce itself and periodically uses the human species for that purpose because of our wonderful ability to inhabit virtually any environment on earth and the equally wondrous ability to move from one place to any other within the infectious period of the disease. "Ultimately, it's going to happen."

But we knew that five years ago, ten years ago and twenty five years ago when Reagan started to dismantle the key government agencies that protected the population's health. Reagan showed how, without the cooperation of Congress, he could effect politically conservative policy just by wrecking the agencies he didn't like because they interfered with "the free market" (like occupational health and safety, the social safety net, consumer protection, etc.).

Now with public health and public services (indeed the very notion of "public service" itself) in a shambles, Secretary Leavitt is discovering it would be good if we were prepared more generically, not just for the Disease du jour but for whatever might come along. And while he is correct to say a pandemic will happen sometime, it is equally true many other things of less drama but with as big a toll in death, disease and disability go on daily, "pandemics in slow motion." (For one example, see The Weekly Toll or consider the 150 people a day who die of occupational and environmental cancer).

So here's what I say to Secretary Leavitt. The next time you sit in a Cabinet meeting and your buddies talk about cutting taxes under the slogan that "the people" know better how to use their money than the government (meaning the very wealthy know how to use it better because they can buy whatever protection and well-being they want), tell them the average person's $300 tax cut can't buy them pandemic flu protection or police protection or fire protection or better teachers or shelter from a hurricane or security in their old age . . . . Tell them to buy those things each person has to put his or her $300 together with their neighbor's $250 and their friend's $50 and the $400 of the person in the next block . . . .

Tell them, "Read My Lips: No More Bullshit."