Consider, for example, taking time for the New Yorker article by Siddhartha Mukherjee, a cancer doctor, biologist, and best-selling nonfiction author who delves into the question of “What the coronavirus crisis reveals about American medicine.”
His premise includes in its painful illumination a quote from Warren Buffet, the Oracle of Omaha, whose quip assumes a different poignancy when applied to the post-pandemic state of medicine: “When the tide goes out, you discover who has been swimming naked.”
As Mukherjee hypothesizes:
“What those of us in the medical profession have learned from the Covid-19 crisis has been dismaying, and on several fronts. Medicine isn’t a doctor with a black bag, after all; it’s a complex web of systems and processes. It is a health-care delivery system — providing antibiotics to a child with strep throat or a new kidney to a patient with renal failure. It is a research program, guiding discoveries from the lab bench to the bedside. It is a set of protocols for quality control — from clinical-practice guidelines to drug and device approvals. And it is a forum for exchanging information, allowing for continuous improvement in patient care. In each arena, the pandemic has revealed some strengths — including frank heroism and ingenuity — but it has also exposed hidden fractures, silent aneurysms, points of fragility. Systems that we thought were homeostatic — self-regulating, self-correcting, like a human body in good health — turned out to be exquisitely sensitive to turbulence, like the body during critical illness. Everyone now asks: When will things get back to normal? But, as a physician and researcher, I fear that the resumption of normality would signal a failure to learn. We need to think not about resumption but about revision.”
He provides tough reporting on the problems in the boom-and-bust reality not only in medical supplies and drugs but also virus research. He explains how regulators can be collegial and open, even while the processes they enforce can be maddening and glacial.
He has harsh, evidence-based criticisms for bureaucracies and bureaucrats in medicine, whether they reside in electronic health records that are built for billing and not patient care, or managerial suits maniacal about lethal efficiencies. He reported:
“For decades, consultants had taught the virtues of taut business practices. ‘Slack’ — underutilized resources, inventory waiting to be put to use — was shunned. I spoke to David Simchi-Levi, an M.I.T. professor who studies supply-chain economics and how enterprises respond to disasters. ‘Cost is easy to measure,’ he told me. ‘But resilience is much harder.’ So, we reward managers for efficiencies — and overlook any attendant fragilities. His view can be summarized simply: We’ve been overtaught to be over taut. ‘We’ve been teaching these finance guys how to squeeze,’ Willy Shih, an operations expert at Harvard Business School, told me, emphasizing the word. ‘Squeeze more efficiency, squeeze cost, squeeze more products out at the same cost, squeeze out storage costs, squeeze out inventory. We really need to educate them about the value of slack.’”
Over at Stat, the science and medical news site that has drawn praise from the New York Times for its prescient and deep coverage of the pandemic, Sharon Bagley has put up a special report that one social media commentator has said paints a picture of the Covid-19 response ala Charles Dickens and Scrooge’s Christmases past, present, and future.
Bagley interviewed experts who, by analogy, ask whether the potential futures for the disease and the nation will be “recurring small outbreaks, a monster wave, or a persistent crisis.”
As she reported, quoting specialists, including epidemiologist Michael Osterholm of the University of Minnesota:
“What all three scenarios agree on is this: There is virtually no chance Covid-19 will end when the world bids good riddance to a calamitous 2020. The reason is the same as why the disease has taken such a toll its first time through: No one had immunity to the new coronavirus. ‘This pandemic is not going to settle down until there is sufficient population immunity,’ slightly above 50%, epidemiologist Gabriel Leung of the University of Hong Kong told a New York Academy of Sciences briefing. Since the world ‘is far from that level of immunity,’ said Osterholm (he estimates that no more than 5% of the world population is immune to the new coronavirus as a result of surviving their infection), ‘this virus is going to keep finding people. It’s going to keep spreading through the population.’ And that, he said, ‘means we’re in for a long haul.’”
How individuals and societies respond to the virus, as well as how well medical scientists advance their work on a vaccine or drug treatments, will play vital roles, of course, in determining whether the various scenarios play out and how, Bagley noted.
At the Atlantic, the terrific reporter Ed Yong — who earlier put out his own thought-provoking article describing various experts theories on “How the pandemic will end”— points out the present and future may be clouded for a key reason, which he digs into and explains “Why the coronavirus is so confusing.”
As he wrote:
“[M]uch else about the pandemic is still maddeningly unclear. Why do some people get really sick, but others do not? Are the models too optimistic or too pessimistic? Exactly how transmissible and deadly is the virus? How many people have actually been infected? How long must social restrictions go on for? Why are so many questions still unanswered? The confusion partly arises from the pandemic’s scale and pace. Worldwide, at least 3.1 million people have been infected in less than four months. Economies have nose-dived. Societies have paused. In most people’s living memory, no crisis has caused so much upheaval so broadly and so quickly. ‘We’ve never faced a pandemic like this before, so we don’t know what is likely to happen or what would have happened,’ says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. ‘That makes it even more difficult in terms of the uncertainty.’ But beyond its vast scope and sui generis nature, there are other reasons the pandemic continues to be so befuddling — a slew of forces scientific and societal, epidemiological and epistemological. What follows is an analysis of those forces, and a guide to making sense of a problem that is now too big for any one person to fully comprehend.”
There’s a lot to ponder in the well put together article, which, like the others, takes advantage of the talented writers getting more time to think, research, and analyze, as well as the space to lay out their findings. To be able to take the material, especially with the time to do so, may be an unexpected outcome of the awful state we’re all in now?
In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of therapies and prescription drugs, too many of which turn out to be dangerous drugs.
With Americans expending roughly 18% of the gross national product or roughly $3.6 trillion annually on health care, our trying to get a grasp of what works and what doesn’t in medicine and why was a priority before the pandemic. Now as millions are infected and tens of thousands die from a novel coronavirus our need to know and grasp what’s going on in medicine and science has become paramount. Sometimes it means keeping up with the shorter, incremental developments but it also demands longer, more detailed inquiries. Along with health care workers, first responders, and the too often poorly paid “essential” workers keeping us in food and needed supplies, journalists are doing important work in these difficult times. They deserve a salute and support, even as their industry has been staggered by the pandemic. We’ve got a lot to read, learn, and work to do in the days ahead.