Comments from AAPS President Paul Kempen, MD, PhD:
Today, I was greatly dismayed to read an editorial in the New England Journal of Medicine (NEJM), apparently signed by all (over 30) members of that editorial staff. The editors have taken a unanimous political view, suggesting the upcoming election will allow Americans to force those dangerously incompetent leaders to be separated from their jobs, due to the COVID 19 crisis. Where was this unanimous medical opinion these past months, so greatly needed to stop the conflagration leading to this leadership vacuum over COVID.
The editorial political opinion now appears in the name of the journal and its medical leadership, but their political message as editors exceeds their authority as physicians or experts. As a medical journal, such political messaging seems inappropriate as it suggests the whole physician community agrees with their personal political orientation. Oddly, the medical leadership most identifiably and directly responsible for the current COVID crisis are appointed and not elected individuals (department heads and experts). They have allowed numerous errors and failures to compound the COVID medical problem more than anyone in political office. Anyone and everyone has become an expert with an agenda, and not just doctors. Some of these appointed doctors are clearly blinded from truth by power, office and financial gains, enjoying above all the media exposure as politically selected expert pundit.
The media has been inundating the public with opinions from likeminded pundits and such declared experts. Now the NEJM jumps into this fray.
But what is left unsaid by the NEJM? Facts like the FDA has approved NO medical therapy for COVID. And multiple high profile appointed leaders have vacillated on the issue of protective equipment: first don’t wear (save them for “providers”-then wear-wear anything you can even make at home and call a mask. If masks are so important, the state government should assure production, distribution and free provision of masks to all. Home-made devices are of questionable efficacy without evaluations.
The NEJM also ignores the fact that unconstitutional restrictions of citizens, in the name of social distancing, are being imposed without regard to unintended consequences. Testing recommendations, for tests of often questionable accuracy, also fluctuated weekly. And of course the very definition of “COVID death” or “case” continues without logical definition, while incentives for payment and upcoding to Covid deaths are prevalent and may effectively explain the high numbers. These should not be political decisions, but decisions of medical leaders. The NEJM board apparently does not live by the maxim, if you are pointing a finger at someone, you have three fingers pointing back at yourself.
While legislation and emergency orders have been enacted by non-medical authorities, governors and senators —not just the president, many “providers” have also, like the NEJM editors, attempted to push political agendas using which ever fall guy seems expedient to blame, while often getting in the way of frontline physicians striving for individual patients.
With no “FDA approved therapy” for COVID, I have seen hydroxychloroquine restricted from use in spite of biological evidence that it may work and the fact that our President was able to access this medication. Physicians have been threatened my medical board sanction, should they prescribe, and pharmacists have refused to issue the drug, which is FDA-approved for other conditions and has been used safely in billions of patients worldwide for many decades. It is unconscionable to restrict inexpensive available medications from patients and threaten doctors who TOGETHER choose a reasonable course of treatment, given the potential threat of death from this disease and complete lack of any other FDA approved alternative. Also consider that the President received experimental and expensive treatment at the Naval Hospital with multiple NON-approved drugs. Why should the whole US citizenry be actively forbidden to use any drug they and their doctor chose as a personal option? These are issues that should be pertinent to the NEJM editorial board, but instead they throw political haymakers.
They paint the U.S. as an outlier with worse results than third world countries. But they do not take an honest look at why. They wring their hand that the U.S. purportedly has a higher positive test rate. After a significant period with inadequate testing, we are now flooded with tests and promise that they are “the solution.” Meanwhile, respected outlets like 60 Minutes let us know that these tests were marketed without adequate validation and some individual test reported 100% of all tests as “positive.” There are also financial incentives to inflate positive rates here in the States. Hospitals are being paid to code for COVID, i.e. big money. It is little surprise that the USA has such high rates with these unique and absurd incentives to diagnose. Not to mention that other countries have different reporting structures, and may not be paying indiscriminately for COVID care “up-coding.” The Vaccine is now touted as the answer, but we know other non-novel COVID infections can reoccur even within one year in the same person. Reinfection with Covid has already been reported.
When I first heard of COVID-19, and shortly thereafter witnessed the launch of the “War on COVID,” I purchased twenty N95 masks online and advised my octogenarian parents to stay home and let us shop for them. As an anesthesiologist, I go daily into the hospital and provide care of the airway-one of the single greatest risk factors for contracting COVID. The population demands I go to work and incur my professional “acceptable risk.” What else does the NEJM conveniently neglect? The underlying fact of infectious diseases is that personal health requires personal commitment to health. I have yet to hear anywhere that personal responsibility for health is of any importance in COVID or elsewhere. Cigarettes, heroin, alcohol and above all, OBESITY, are great killers in the USA, yet have never lead to removal of constitutional rights of those abstaining from these vices. I firmly believe the excess death rates-if they are real- may well be also due to the inherent unhealthiness of US citizens vs the rest of the world. Intubation and ventilation of morbidly obese people and those with lung disease is simply poorly tolerated in healthy baseline patients with these “comorbidities”, yet alone with a COVID infection, and this is a well known truth for other non-covid lung diseases.
It is time to face the fact that government cannot protect us, only WE can protect ourselves by living healthy and using appropriate precautions. The fact is that 80% of COVID deaths occur in individuals over age 65. Let the low risk children and adults go back to work and school. Let everyone take personal responsibility. It is much cheaper to make effective and rational Personal Protective Equipment available to all who feel a need for protection. Universal precautions and self-responsibility was the message in the 1980s to address the AIDS epidemic, the resolution of which appears largely to be within sight. . Yes, every death is tragic. Yet in any war it is impossible and implausible to reduce loses to zero . It is time to promote personal responsibility, choice and FREEDOM and move forward together, sequestering only the sick and the endangered. We DO have sensible preventative measures and treatment in October, 2020. Shame on the NEJM to use the COVID crisis for a purely political agenda. While pointing fingers at others, an opportunity was missed to advance actual solutions that benefit patients.