On SCOTUS, medicine and public health

In a well-functioning society, individuals and professional institutions work together, respect each other’s expertise and boundaries, and policy makers weigh in on the consequences of their decisions. In health matters, the SCOTUS has shown it is no longer willing to rule by these principles when they put their ideological interpretation of an 18^th century Constitution ahead of our 21^st century realities.

Does SCOTUS expect legislators to understand a woman’s reproductive biology and function better than medical providers? As “natural” as pregnancy is, practitioners never underestimate the fact that it is a biological state that imposes a heavy overload on a woman’s physiology and carries many risks, some of them with life-long consequences, especially for teenagers and those with underlying health issues. Patients and their medical providers already have clinical guidelines that are evidence-based and monitored by licensing boards to achieve the safest and best possible health outcomes. They don’t need politicians to tell them how to practice reproductive medicine.

For years, physicians have declared gun violence a public health epidemic. When SCOTUS puts individual right-to-bear-arms undisputedly above the horrible consequences of an unregulated gun culture, it endangers our communities.

Aware of the health problems associated with pollution, Congress previously decided that national environmental air standards are best set by climatologists and public health experts. By reversing the power to regulate pollution back to legislators, SCOTUS widens the door for fossil fuel lobbyists in Congress.

This regressive SCOTUS majority is a clear and present danger to the health of Americans.

(Submitted July 7, 2022 to the Gazette Times, Corvallis, OR)

On the US Constitution in our modern times

I am not a constitutional scholar, but neither are many people who quote the US Constitution to support a personal socio-political position.  If the Second Amendment right to bear arms is the ultimate legal ground to oppose any gun safety regulation, then consider this: “Arms” might include anything from a knife to a nuclear weapon; landmines around my yard and armored tanks to drive in city streets would qualify as legitimate self-defense arms. Similarly, Supreme Court originalists, asserting that all statements in the constitution must be interpreted based on the original understanding “at the time it was adopted”, are challenging the legality of Roe vs Wade, since reproductive rights were never mentioned in the original document.

Of course, nobody is currently advocating a ban on pocket-knifes, nor claiming individual rights to own atomic bombs, landmines or tanks. Scholars have also repeatedly pointed out that the Constitution was written and adopted as a compromise document written by a handful of males with wide vision but who chose to ignore the rights of half of humanity.

My point is: While respecting our Constitution, we should understand it as a historical document full of ambiguities and omissions. We have now challenging issues that aristocratic, paternalistic 18^th century men are not expected to know about, like public health safety and healthcare equity. In discussing the divisive issues of gun and abortion rights, we would be abdicating our communal responsibility to make reasonable, common-sense decisions if we use the Constitution as an obstacle to a more perfect Union.

(a slightly shorter version of this letter was published on June 22, 2022,  in the Gazetter Times, Corvallis, OR)

Reflections on the Covid pandemic, year 2

When I wrote in this column about the origin of SARS-CoV-2 (April 2, 2020), and pleaded that “we should give public health a chance” (Dec 18, 2020), I did not anticipate that, a year later, I would return to this topic. How can we, humans who count among ourselves Da Vinci, Pasteur, Einstein and Desmond Tutu, be brought to our knees by an invisible, brainless organism whose “raison d’être” is doing nothing but making more of its RNA?

What the pandemic has done is to reveal the fragility of our social fabric and the weaknesses of our institutions, here and globally. It exposes, and worsens, our socio-economic inequalities that have existed for decades: Wall Street investors and large corporations taking in large profits and benefiting from tax loopholes, while blue collar workers are earning less than livable wages under inflation; the meritocratic elite comfortably “working from home”, while “essential” front-line workers risk their lives, their children having unreliable access to online education and healthy activities;  worsening access and affordability of healthcare, resulting in higher rates of mental illnesses, and disproportionate disease morbidity and mortality for the underprivileged.

Inequality feeds anxiety, anger and despair, and invites distrust in the government and democratic institutions. We see increases in gun sales, senseless crimes, drug use and suicides, racial and class tensions; opportunities for extremists at both ends of the ideologic political spectrum to ride on righteous vitriols and mutual loathing, fabricating theories and narratives aimed at nothing less than fracturing our social fabric to its core – cracks and fractures through which Covid-19 can easily spread.

So, how can we respond? First, I would urge everyone to continue to “give public health a chance”. With Covid-19 being a fast-moving target, public health officials have to continuously adjust their recommendations based on new, albeit temporary scientific data. This gives rise to some degree of public frustration and distrust.  Medical sciences, despite their remarkable achievements (in vaccine, testing and treatment) are always embedded in some degree of uncertainty, but legitimate debates on their risks/costs/benefits to individuals and society should not be sensed as systemic incompetence, nor lead to dis-information campaigns.

All over the world, public health and medical experts are now drawing up plans on how to prevent and control the next pandemic(s), and I am sure that on paper they will do well. Some already have heralded in the “Golden Age of Medicine and Bio-tech”, giving us interventions that will quickly be claimed as “miracle drugs”, true or not. But vaccines and drugs, lockdowns and face masks will not work unless we also address the social determinants of health.

As Americans, we all cherish the same values - justice, patriotism, freedom, and the pursuit of happiness, but we now live in separate emotional matrices and mental realities, where the understanding of science, the empathy for others, the concern for our common future is filtered through the prisms of our own prejudices, fears and self-interests. Until we give up the language of degradation and violence that defines our culture wars, and the identity politics that separate “us vs them”, we cannot heal our national self-inflicted wounds. The vast majority of Americans are reasonable, caring and generous people. We cannot allow extremist fringes of our society speak for us and determine our common fate. 

Pandemics come and go, but medical and public health interventions alone will not prevent nor mitigate their damages unless we also face our social inequities, reform the faulty socio-economic structures of our nation and call an end to our tribal wars. Easier said than done, but perhaps worth a try, and it starts with you and me.

(Modified version of an essay submitted Dec 31, 2021 and published Jan 9, 2022 in the Gazette Times, Corvallis, OR)

On the wonders of capitalism

In his letter (Mailbag Aug 18) Mr. Brenan pointed out “how quickly free enterprise corporations managed to develop and produce” the Covid vaccines, and implied that the “wondrous successes under capitalism” would not have been possible if the whole program had been managed by the government. 

While we celebrate the entrepreneurs and the competitive force of the “free market”, let us not forget that it is the basic research by scientists and academicians whose salaries are bankrolled by taxpayers and whose grants are issued by government-run agencies that made those advances possible. They are the ones who took the painstaking steps to understand the molecular biology and who developed laboratory technologies that made the mRNA vaccines possible. Private companies merely scale up the technology to an industrial level, and market the products at the highest allowable profits. Even then, they benefit plenty from government subsidies and tax-breaks. Among other examples of how capitalists pick up the fruit of government-funded research include the internet, GPS, and robotics, and many clinical applications in medicine.

To simplify that government is all inertia or that capitalism is the driver of all creations is to ignore the fact that our American success stories has always been the delicate balance of public-private cooperation, with basic research coming from government agencies and funding of industrial development coming from private investors. Beyond this, the continuing role of government is proper regulations and consumer protection. It is when legislators and capitalists are cozy bed-fellows that we all lose.

(Submitted on Aug 18, and published on Aug 25,2021 in the Gazettte Times, Corvallis)

January 6, 2021

As our TV screens flashed images of the mob incited by President Trump storming and vandalizing the US Capitol, commentators stated that January 6, 2021 will be remembered as another “day of infamy” in our history. May I suggest that actually it should be remembered as a “good day” for America. Sad, shameful, terrifying, of course, all of the above, and more; but in the end - a good day, for two reasons:

First, it was a long overdue wake-up call that spoke louder than any of Trump’s previous actions his populist and political supporters had chosen to ignore. But our democratic institutions survived by the end of the day, just enough perhaps to begin more soul searching and positive changes. Mental health therapists know that sometimes patients have to “hit the bottom” before climbing up the road to recovery. Maybe we just did.

More importantly, Georgia’s election results are a tsunami against the entrenched power of “Deep South traditions”. Dr King, J Baldwin, and many legendary civic leaders would have cried with joy and pride on this day. Disfranchised people have finally flexed their muscles with their votes, and from now on, will remember and teach their children the power of civic involvement.

On Jan 6, 2021, we survived an insurrection by white supremacists and political conspiracy theorists, and we proved that people cannot be marginalized forever. It was very painful; it was not easy. But I feel that a new chapter is being written. God Bless America.

(Submitted to the GT, Jan 7, 2021)