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.

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[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.