STAT, Churnalism and A Zen Parable
There is a Zen parable in which two monks, one old and one young, are walking through a forest. They come upon a rich man by a stream. The rich man says to the older monk, “Monk, carry me across that stream so I don’t get my clothes muddy.” The young monk begins to protest but the older one quiets him and carries the rich man on his back across the stream.
The monks go their way, and the rich man goes his.
After a few hours walking in silence, the old monk says, “It is a beautiful day to walk in the forest. Days like this are ones you must cherish.”
The young monk replies, “That rich man was terribly rude to you. I can’t believe that you agreed to carry him across the stream. He was younger and stronger than you.”
The old monk says, “I put that man down hours ago, why do you keep carrying him.”
Last week STAT published an article titled How infectious disease experts are responding to Covid nearly three years in. Vinay Prasad published a hilarious screed about this article on his Observations and Thoughts Substack and cross-posted it here.[i] His take is definitely worth a read.
In the STAT article, the author admitted that “many people appear to have given up trying to avoid the SARS-CoV-2 virus. Restaurants are packed, airports are hopping. Once-ubiquitous masks are now an increasingly rare sight.” She reached out to “epidemiologists, virologists, immunologists, and related experts” with a series of “yes” or “no” questions and then published the data of the 34 who replied. These 34 people had definitely NOT given up on trying to avoid SARS-CoV-2
I should have read the article and Vinay’s take and left it behind as the old monk left the rich man, but the article has been bothering me.[ii] I hope that writing about it will allow me to forget it.
Vinay did an excellent job on why this article was churnalism. It had a lot in common with an article on intravenous vitamin infusions that we wrote about in one of churnalism intro pieces. Instead of writing about a personal experience (Hunter S. Thompson style), this just took a convenience sample and reported behaviors that reflected their fears and beliefs.
So why did this article bother me so much?
I am troubled by this story because it plays into the irrational fear of COVID that I still see in some of my patients and friends. Now, I am certainly not downplaying the risk of COVID. The virus has killed millions and the combination of the virus and our reaction to it has left most of uspoorer, less healthy and less happy.[iii] That being true and acknowledging the tripledemic that people can’t seem to write enough about, the people I am talking about are the healthy, quintuple vaxxed among us.
My approach to dealing with other’s reaction to COVID has mostly been to live and let live. If you want to wear an N-95 while you are out walking your dog, be my guest. It does not affect me. I have also tried to not let my own degree of risk tolerance affect my medical advice. I share with patients my personal risk tolerance when I counsel them on how to deal with COVID risk because I believe doctors’ recommendations on this topic have been based more on personal preference than on science.[iv]
What I remain troubled by are people whose life has been worsen by fear of COVID beyond what is reasonable. This is sometimes hard to judge. I have patients who confided in me that the pandemic provided them license to live life as they wanted: less socializing; avoiding restaurants; a ready excuse to bow out of family gatherings. I know other people who would like to do more, see more people, and travel but who are still living in fear of COVID, Long COVID and other. ill-defined COVID adjacent issues.
This is where an article like the STAT debacle comes in to play. Our job as physicians is to provide honest counsel to patients. We need to outline facts and uncertainties. We need to help people to weigh risks and benefits. Answering a survey that will be promoted without context is wrong. Publishing an article about people’s personal behavior is not helpful.
What would I have rather read? I would have welcomed an about the behavior of two hospital epidemiologists or infection control doctors who are presently behaving differently. These two physicians could have told us about their understanding of the science and their personal risk calculus. A reader would have learned what people “in the know” are doing and why. A reader could have used this information. Instead, we were given information that will not affect the behavior of the overwhelming majority of Americans who have completely abandoned an non-pharmacologic infection control behaviors.[v] On the other hand, this article probably makes it more difficult for those who want to, and can safely let down their guards but are afraid to because of what STAT and the like continue to feed us.
[i] I think he must have thought the piece a bit strident for Sensible Medicine
[ii] In my defense, Vinay published a video about the STAT article on Sunday. He might have bigger problem than me!
[iii] It is my experience on twitter that I feel I actually need to state the obvious, that COVID is bad.
[iv] I ski but I would never heli-ski. I traveled by air throughout 2020 but I wore an N-95 and goggles. On summer mornings, I swim in Lake Michigan but not if the waves are much above 3 feet. I drive a Volvo.
[v] As I write this, I am sitting in a packed gait area at Logan airport. Looking around I estimate 200 people waiting for their flights. Three of them wearing N-95s and another three are donning surgical masks.
“If you want to wear an N-95 while you are out walking your dog, be my guest. It does not affect me.”
Is this really true? While I agree everyone has the right to wear or not wear just about anything they want without being accosted (other than, say, a suicide vest or a shirt depicting child pornography), is it really true that it doesn’t affect you? Would you rather live in a society where people hide their faces, their smiles, their frowns, or one in which these fundamental outward expressions of our humanity are readily displayed? Masks make the world uglier, less friendly, more anxious, less connected, etc.
I live in Thailand, where masking remains prevalent, though thankfully no longer mandatory, and I communicate in my second language. The barrier that masks have imposed in my everyday interactions is huge. It definitely affects me. This country is known as the Land of Smiles, and for three years now those smiles have been concealed by utterly useless surgical masks, indoors and out. Is it really true that we lose nothing of value, that it doesn’t affect me or society at large, when smiles disappear, when facial expressions are no longer a part of our interactions? This affects me a great deal, and I find it hard to believe it doesn’t affect you.
Dr. Cifu, I’m grateful for this post – and while I sympathize with your longing to “let go” of the debate, I thank you for caring enough to be bothered. More doctors should be bothered!
A great deal of social harm is being done by the systematic exaggeration of Covid hazards and promotion of inappropriate and damaging “precautions.” Academic medicine at its upper levels should take a great deal of the blame. So should the self-styled “high-quality” and “progressive” media outlets like Stat, the Globe and the NY Times, which pride themselves on targeting the “educated” and “pro-science” reader. (Whew, that’s a lot of air quotes.)
Bottom line: That person out walking their dog in an N95 mask may be a statistical outlier. But they are also likely to be an Influencer with considerable social and political clout.
Deepening political polarization is probably the worst fruit of that influence. At least one academic declined to participate in Stat’s survey, and another asked Stat not to use their name, because they could not handle the vitriol attached to the debate “between the militant zero-Covid crowd and the It’s-Just-A-Cold crowd,” as one put it. The worst of this comes from experts who continue to insist that mask-wearing is a moral obligation to protect others by not transmitting the virus. Similar claims are made for fourth and fifth booster shots. In both cases the evidence is extremely meager and grows thinner by the day. Yet because these claims are felt to encourage “positive” behavior, both experts and sophisticated journalists close their eyes to the lack of evidence.
It's bad enough that the media constantly frame the maintenance of rigid Covid restrictions as science-based, while their relaxation is attributed to emotional frustration, boredom and wishful thinking by an ignorant population eager to be “over it.” What’s worse is that those who object to zero-Covid policies are denounced as selfish monsters who are willing to sacrifice society’s most vulnerable for the sake of mere convenience. This all-too-quickly becomes a political fight: Take off your mask and you’re not only reckless, you’re probably a racist “Trumper” who’s happy to throw the have-nots under the bus.
If increasing numbers of people shut out “public health messaging” of this sort, can anyone be surprised? We are breeding a level of suspicion and resentment of science, medicine and public health that will haunt us for years to come. The era of the Noble Lie – propagation of virtually evidence-free claims about Covid hazards in the interests of Positive Messaging – must end. Highly-placed, politically-connected “experts” have been a huge part of the problem. They need to call a halt and become part of the solution. Thanks again for doing your part.