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The Physician Philosopher Podcast

TPP 54: Vaccines, Shaming, and American Individualism

Editor’s Notes: Today’s thought is this…

Larry Keller

I’ve never met a person in my life who was convinced they were wrong by being beat over the head with information.  It is time that we stop shaming people who aren’t vaccinated and start listening. 

I record my episodes in advance, which is good so that I can protect patients’ privacy.  But at the time of recording this, in the 72 hours prior to recording this episode, I’ve been involved in intubating multiple patients with COVID.  This wasn’t in an ICU. Or an intermediate care unit. It was not in the operating room.  It was in a community hospital.  On a regular hospital floor.  In rooms that aren’t equipped to have ICU ventilators hooked up.  Instead, we had to use transport ventilators.  And then we had to wait.

Why?  Because our hospital system is so ravaged by COVID that these patients cannot be transferred to an ICU.  Some of them were 20 or 30 people down the list to even make it to an ICU despite being on high levels of support.  After we intubated them, we have had trouble placing them in ICUs for multiple days sometimes.

MORAL INJURY

And we aren’t alone. There have been reports of cancer patients who are having their surgeries delayed or cancelled across the country because there are no beds in the hospital system for them after their surgery.  Can you imagine being in that family’s shoes?

“Yes sir, your wife does have cancer.  And, yes, we have the ability to take it out.  Yes, it could continue to grow… but we just can’t do the surgery right now.  Why?  Because there is no where to put patients after surgery.”

Talk about the definition of MORAL injury when you know what to do for a patient, have the ability to do it, but simply CAN’T because the system cannot accommodate it right now.  

And THIS is preventable. We know that the vaccines at this point cannot prevent all disease.  We have seen breakthrough cases of COVID in vaccinated patients.  We have even seen vaccinated patients transfer disease to non-vaccinated patients. 

BUT we also have good data that vaccines have remained extremely effective at preventing severe disease in the vast majority of patients.  In fact, these vaccines have a greater than 90% chance of preventing severe disease. The kind of disease that required me to intubate multiple patients this week in a non-ICU setting.

Back to my story

Speaking of the patients I intubated recently when I spoke with them prior to their intubation, they had fear and understanding in their eyes.  “Do whatever you have to do, doc”.  They were tired of breathing.  Of being deprived of oxygen. 

And, I’m not going to lie.  It has weighed heavily on me.  There have been other times I’ve put someone to sleep to intubate them where I knew there was a high likelihood I would be the last person that will ever speak to them.  The last person who could make them feel like they mattered.  Yet, this felt different. 

…because what is happening right now is preventable over 90% of the time.

Initially, this made me angry.  I’ll be honest.  It made me mad that people are continuing to die.  Moms and dads.  Husbands and wives. Sons and daughters.  This is all completely unnecessary. 

 And – to be clear – I’m not mad at the patient.  I’m mad at the system.  At the situation.  And at our inability as a medical community, country, and political system to communicate effectively enough to help people make a decision to get a vaccine that could save their lives.  

NOW, I am going to state unequivocally… I don’t think this is the lay-person’s fault.  While this is a disease predominantly of the unvaccinated at this point, the fault rests squarely on the shoulders of the leaders who have miscommunicated, poorly communicated, or mislead people. 

And the blame continues to rest on the shoulder’s of those who think that shaming someone into something is ever going to work.  It won’t. It never has. 

I know that you rae angry.  I know this is unecessary… but blaming people who don’t have your experience and perspective as a physician isn’t going to fix this problem. 

Shaming only causes deeper division and polarization.  That’s exactly what the news and social media echo chambers want.

So, again, let me be clear. I am NOT shaming anyone who has decided not to get vaccinated.  But – in my way of dealing with this… I’ve spent a lot of time thinking about the ethical dilemma that is mandating vaccines in a culture that prides itself on American Individualism.

Why Aren’t People Getting Vaccinated?

And that’s what I want to answer on this podcast.  Why are normal, everyday Americans failing to get a vaccine that we know can save their lives?  

There are two reasons.  

  1. Poor Communication
  2. American Individualism & Mandates

Poor Communication

The truth is that the CDC and several other governing bodies and authorities have changed their tune multiple times during this pandemic.

At first they thought one thing, then another.  And this happened multiple times on multiple issues.

Truthfully, this probably had more to do with changing evidence as we started to learn more about this novel disease.  

But think about it. If you aren’t in medicine, place yourself in the shoes of the regular American people?  What did it look like to them when leaders and large health care organizations had contradictory statements from their own bull horn?

“Wait, you said it wasn’t airborne?  Now, it is?”

“Wait, you said I didn’t need a mask at first? Why do I need one now?”

From the regular person’s vantage point, they didn’t know who or what to trust.  Why? Because when things were changed, they were not always effectively communicated. 

Most Americans don’t appreciate or understand the nuance of a changing body of literature because they aren’t in medicine and are not used to critically thinking about scientific data and studies.

When the wires started getting crossed, what did people do when they felt like they couldn’t trust the CDC or governing officials?

They turned to other sources.  They entered their echo chambers where their thoughts would be molded by those they trust – namely news and media sources that exist to make money.  News organizations and politicians who put their own self-interest first.

Those news company’s don’t care about the truth. They care about making a buck.  Polarization and divisiveness is good for them.  It breeds loyalty among their listeners, and loyalty makes money.

And – right now – as someone who spends a lot of time talking with people about their thoughts, you may already have ideas of what I am saying.  And I haven’t even named a news agency. 

Yet, I know… right now, you are listening to this and if you are on the conservative “right” you are thinking about backhanded news agencies on the left, and if you are liberal and on the “left” you are doing the opposite.

That’s how divided we are.  It is an “us” versus “them” mentality right now.  Where have the days gone that we could have a difference of opinion without hating the other side? Without shaming them?

Days like when Tip O’Neill – a democrat – and Ronald Reagan – a Republican – could disagree while debating policy and then go have lunch afterwards because  – while their opinions differed, they still respected each other?

The miscommunication around this virus and around the vaccine have devolved into an American political issues where everyone loses. 

While the shaming and politization have been a massive issue in our country, I think there is an equally damning problem.  In fact, it may be worse.

American Individualism and Mandates

And this is the idea of putting a mandate of any kind in front of someone who whole heartedly supports American Individualism and autonomy.

Like most Americans, I don’t like ANYONE telling me what to do.  I do not like governmental overreach.  And I think that every man and woman should have the right to choose what is best for them.  This might be why I tend to be Libertarian in my political beliefs and why I can relate to my friends on both the left and the right.

And we see this on both sides of the aisle right now.  There have been examples on both sides where an encroachment on individual choice was seen as a threat.

I mean, think about this… could you imagine if five years ago I told you that Republicans would be the ones to be saying “my body, my choice”?  And that democrats would disagree?

Or that democrats would back a mandate to force health choices on others, while Republicans were pro-choice?

It turns out that Americans simply do NOT like being told what to do. In fact, when people do that, we often recoil.  It’s in our blood.  It is a part of our 

DNA.

Letting someone take our autonomy is about the last thing we would ever let happen.  

Yet, this is exactly what the mandates do.  And this was compounded by the fact that it was preceded by poor communication from leaders.

The problem: This is not an individual situation anymore

While most Americans support the notion that every person should have the right to life, liberty, and the pursuit of happiness… this is an individual way of thinking. 

We are wired in this country to think about the individual.  Not what is best for the whole.  American beliefs resonate from the belief that every single life is worthy and worth saving.  We have and will expend unbelievable amount of resources to save just one life. 

From cancer patients receiving high-cost treatments despite low chances of survival to the trauma patient who has a low likelihood of survival getting pumped full of every blood product we have… we work hard to save the individual in this country.

Why? Because we have an individual view of ethics.  And – in America – you can do what you want until it crossess someone else’s ability to achieve freedom. 

In other words, your freedom stops where someone else starts.

And that’s the problem. 

We have crammed mandates down people’s throats without explaining to them that their decisions aren’t really individual decisions anymore.

To them, this is a threat on their individual rights and choices.  On their autonomy as a human being.  On their very DNA as an American.

Why can’t leaders and politicians explain eloquently the nuance of this problem… that the vaccine that we all know can save lives isn’t about the individual anymore, it is about the greater good for everyone.

I have seen it first hand when a younger healthier person gives this disease to someone else who in their family who later ends up being intubated and dying a lonely death in the hospital.

The family are absolutely devastated.  They feel like their decision to not get vaccinated  – and to encourage their family to do the same – was their fault.  That they were the cause of their loved one dying.

This decision is not just an individual choice.  People are slowly and painfully starting to understand that.

It is not about you.  It is about the…

  • Patients who are being intubated, sedated, and on drips to keep them alive in community hosptals on regular floors
  • Cancer patients who are having their surgeries being cancelled
  • Those who cannot get vaccinated due to age or medical restrictions. 
  • Health-care workers who are exhausted, burned out, and at their wit’s end trying to save the lives of countless Americans… some of whom are ending their own lives because of the trauma caused by this pandemic.  

We need to understand that – while individual choice is as much in my DNA as it is in yours – this is not an individual choice anymore.  

Utilitarian Ethics is Un-American

I recognize that this is a new way of thinking for most Americans.  New problems require new ways of thinking.  And what is needed right now is a view of ethics where we no longer focus on whether we should get a vaccine based on whether it is “what is best for me” and start to think about this in terms of “what is best for everyone”

Why? Because I know a LOT of people in my own community who are not getting vaccinated because they feel like they are otherwise healthy and that the vaccines should go to those who really need it.

Fortunately, there are more than enough to go around in this country.  But this isn’t stopping people from feeling like they are young and healthy enough to not require it. 

And, yet, they have a very different point of view when they end up on ECMO and they are otherwise healthy and less than 45 years old.

We are all on the same team here.  Let’s work together to make sure things like this don’t keep happening.

Wind Down of Show

So… if you are listening to this right now, I hope you are truly and critically examining whether you should get a vaccine or not.  If you have family members who are thinking through this problem, too… 

I hope you share this show with them. And that when you do, you…

Don’t shame them.  

PLEASE Listen.  Listen to their concerns. Try and hear what they are saying. 

As Stephen Covey would say, “Understand then be understood.”  God gave you two ears and one mouth for a reason.  Actually listen to the concerns people have.  And then share some stories of your own.

Tell them the stories of what you are seeing in medicine. Tell them about… 

  • The stories of the cancer patients who are having their surgeries canceled because we have nowhere to put these patients after the surgery they need.
  • The healthy patients that are getting intubated.  
  • Tell them about the patients who are asking for the vaccine right before they get intubated and are having to be told its too late at that point.
  • How patients are having to be sedated and paralyzed by medications just so that we can breath for them while they are face down in a hospital bed.
  • About the grief that family’s are going through when they realize that they were young and healthy and then gave the disease to their family member who later died.  The devastation this causes.

 

I’m not sure if this show was more for you or for me.  I just know that I am tired of seeing people die from a disease that is at this point largely preventable.

Please, consider getting the shot.  And, if you have questions, please talk to your doctor about it.  Hell, you can shoot me an email and I’ll be happy to help you think through this decision.

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4 Comments

  1. steveark

    I think there is also the fact that the odds of a healthy person getting significantly ill from Covid are very low. So if you are that healthy person and can do math and can determine that the data shows your risk of not getting vaccinated is extremely low then it might not be fallacious to balance that risk against something that there is no data on long term risks for. I got vaccinated because I was high risk and felt the unknown odds of bad problems later were smaller than the known odds of a bad outcome now. However if I was forty and in perfect health I might have taken the small odds that Covid could hurt me in stride and avoided the unknown vaccine risks. I just had elective surgery in Denver, and by the way the place was not at all crowded and I had no trouble in scheduling the procedure within only a couple of weeks of asking. But that’s not why I mention it. The procedure I elected to have had a 1% mortality rate, pretty scary high, much higher than Covid for a healthy person younger than 60. I only elected to go that way because the risk of mortality from not having the surgery was about 26% according to the latest data I could find. Logic says go with the lower risk, so I did. I can’t fault healthy people accepting a very low known risk (Covid)instead of going with an unknown long term risk(vaccine). And mandating that choice for people when the long term risks of the vaccine are unknown is overreaching. And sure, you can argue that past experience shows there probably aren’t any long term risks, but medical history is littered with the corpses of victims of treatments that were deemed perfectly safe at the time. There is good reason for being skeptical of the latest medical wisdom.

    Reply
    • Catherine McGinnis

      The point he is making is that the decision is not just about “you” anymore. It is about your family, neighbors, coworkers, kids at school and their teachers and parents and grandparents…! It is about a choice that unites us as a community to suppress this dreadful illness, give our healthcare workers a break and our hospitals some room for other people. The other side of rugged individualism has to be helping our neighbors.

      Reply
  2. KD

    Thank you for calling out the shaming and the bullying. It needs to stop ASAP.

    Steveark nailed it by saying it’s a risk number game for a lot of people. Some of “vaccine resistance” is due to belief in falsehoods. A whole lot of it is because people are looking at their individual risk data.

    There’s contradiction in saying that vaccinated people can spread covid (true) AND people need to get vaccinated to protect others. In the eyes of the lay person, both of these things can’t be true.

    We professionals understand the nuance of risk reduction, however we are publicly speaking in absolutes and this messaging undermines us.
    People hear this contradiction and consequently reject the message.

    Many outright reject the notion of getting a vaccine that they are not comfortable getting for the benefit of somebody they don’t know. This is human nature and fighting it may very well be a losing battle, no matter how virtuous the intent.

    If we achieve 100% vaccination rate in those with risks/comorbidities, would we consider this a success?

    Reply
  3. Gino

    In addition, to what Steve said, many that are considered “healthy” who contract COVID are not.

    The markers for inflammation for metabolic syndrome are usually present in most of these “healthy” patients but overlooked.

    What had truly made this disease bad, is the overall health of most Americans. Who eat an ultra highly processed diet laden with carbs, starches and sugars.

    We have missed a huge opportunity to tell the public that their diet and lifestyle matters!

    I see so many people wearing masks pushing around shopping carts full of bread, cookies and pop. And it’s disheartening.

    I eat an ancestrally appropriate diet. My markers for inflammation are all well below the baseline such as HbA1c, 5.0.

    Yet, I’m being pressured to take an experimental vaccine for a virus that I already had which left me feeling sluggish for one day. And now I have the antibodies.

    The government could do a lot more in this campaign but unfortunately there is no money to be made in getting people healthy.

    It’s a truly sad that we have sick care not healthcare.

    Imagine if folks began eating Whole Foods in a manner in which they would feel satiated. They would in turn eats less via intermittent fasting and our health would turn around. But there is no money to be made in getting people healthy.

    Reply

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