Uttering a Sacred No in the Age of Coronavirus

Many of us are finding it frustrating to distance ourselves from other people during the Coronavirus pandemic and it's not surprising. As human animals, we are wired to be social and this includes introverts like me, at least some of the time. When restraining ourselves from going out to physically spend time with others, it feels like our lives are on hold. it feels like we are doing nothing important. We love bathing in the social froth of face-to-face meetings. It doesn’t seem like we are fully human when we actively bar others from entering our physical spaces. Living in isolation sucks. Each of us is getting an extremely tiny taste of the pain that inmates feel while in solitary confinement.

As we wander around our homes, turning down tempting invitations to visit neighbors and friends and acquaintances, it might seem that we are doing nothing to actively help with the spread of the Coronavirus. It feels disempowering. We need to reframe.

We need to keep in mind that when we say “no” to these temptations to gather with others, we are not doing nothing. We are uttering a sacred no. We are exercising power each and every time we resist this temptation to physically gather together. This sacred “no” is not merely an exercise of power. Each time we say “no,” we are employing a superpower with a logarithmic extension illustrated by this data. Uttering the word “no” with unfailing consistency flattens the curve. Scroll down to find the chart in this article showing the dramatic improvement when ¾ of the population exercises social distancing. The effect is so incredibly powerful that it almost seems magical, but these numbers are based on basic biology and basic math. When we say no, we are channeling Archimedes, who once illustrated the power of levers by stating: “Give me the place to stand, and I shall move the earth.” To the extent that we work together to achieve social distancing, we are collectively moving the earth.

It can be frustrating to physically avoid the people we love, but things could have been a lot worse. At moments like these, it’s repeatedly worthwhile to appreciate the magic of the Digital Revolution. The hard work of thousands of very smart people over many decades is allowing us to stay connected in meaningful, albeit imperfect, ways.

Those who are limiting their digital communications to texts and audio should consider video connections such as Facetime and Skype. Video offers many advantages over texts and audio. See here and here. Research has shown that video conversations are much better than audio (e.g., phone calls) for avoiding depression and nurturing social connections. Researchers examined the frequency of in-person, telephone and written social contact, including email. Then they looked at the risk of depression symptoms two years later, adjusting for potential confounding factors including health status, how close people lived from family and preexisting depression. The researchers found that having little face-to-face social contact nearly doubles your risk of having depression two years later. They also reported that having more or fewer phone conversations, or written or email contact, had no effect on depression.

So thank you Digital Revolution, for keeping us from being completely isolated in these trying times. The fact that we can stay connected should give us the social support we need to maintain physical isolation.

The world has become a shockingly small place as this pandemic progresses and each of us has unwittingly become a member of a highly integrated medical/social web. Each of us can and should embrace a phrase attributed to the Hippocratic Oath: “Do no harm.” Interestingly, that phrase does not appear in the Hippocratic Oath, but this one does: “Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption . . .” The modern version of the Hippocratic Oath provides.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

Let us work together to live by these Hippocratic principles.

Repeatedly saying no to the temptation to socialize with others might seem disorienting, nonchalant, frustrating and boring, but living these principles is extremely strong medicine during this pandemic. Your frustration and boredom are small prices to pay for saving many thousands of lives. You are being a hero to the extent that you are consistently say no.

Stay safe.

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How to Prepare for Coronavirus in the U.S.

According to this article in Scientific American, stockpiling and hoarding supplies is not a solution.

The reality is that there is little point “preparing“ for the most catastrophic scenarios some of these people envision. As a species, we live and die by our social world and our extensive infrastructure—and there is no predicting what anybody needs in the face of total catastrophe. In contrast, the real crisis scenarios we’re likely to encounter require cooperation and, crucially, “flattening the curve” of the crisis exactly so the more vulnerable can fare better, so that our infrastructure will be less stressed at any one time.

. . .

The infectiousness of a virus, for example, depends on how much we encounter one another; how well we quarantine individuals who are ill; how often we wash our hands; whether those treating the ill have proper protective equipment; how healthy we are to begin with—and such factors are all under our control. After active measures were implemented, the R0 for the 2003 SARS epidemic, for example, went from around three, meaning each person infected three others, to 0.04. It was our response to SARS in 2003 that made sure the disease died out from earth, with less than a thousand victims globally.

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Disrupting the Healthcare System

This morning I attended a conference titled “Disruption and Innovation in Healthcare 2.0“ at Washington University in St. Louis. I was humbled at how well informed and nuanced the speakers were. They included Alex Gorsky (CEO of Johnson and Johnson), I certainly learned a lot. My main concern is that the ability to understand the complexity of the health care system is well beyond the ability of most people. The simplistic positions of our politicians are a great disservice to our country. For example, it is absolutely clear that our health care system is NOT a functional market, meaning that the Ayn Rand/Free-Market conservatives are deceiving us when they claim that all we need to do is “get government off our backs” to fix healthcare. I admire that progressive politicians are calling for universal access (something that almost all developed countries have, but not the U.S.). That said, how do we square that universal access with the need to incentivize future innovations, in addition to ongoing care? Any big changes to the current system could have disasterous ramifications.

The stakes could not be higher. To the extent we are tempted to implement broad new changes, we need to keep in mind (as one of today’s speakers said), “This is not a dress rehearsal. It’s the real deal.”

[On the right] Johnson and Johnson CEO, Alex Gorsky

The speakers somberly delivered the following shocking information: There is currently no payment model for many current (and anticipated) extremely expensive curative therapies. Thus, people who can be CURED of horrific diseases will languish under the status quo because we can’t figure out how to give them more than palliative treatment, even when palliative treatment is sometimes more expensive in the long run. I dare you to read previous sentence a few times and then shrug and try to convince yourself that we, as a country cannot do better.

Here’s another fact was mentioned several times today: 75% of our health care budget is the result of bad choices made in early life by individual Americans. Preaching at people to get their act together shouldn’t offend reasonable people. For instance, urging that children should eat healthier food should be applauded, even though some conservatives ridicule Michelle Obama’s urgings in that direction. But what about more? To what extent should we, must we, put some skin in the game for people who are actively self-destructing their bodies? I think we need to seriously look at some low-hanging fruit and make some people uncomfortable for their own well being and for the greater good of the United States. The overall health of the United States is most definitely a public good. The ill-health of any of us affects all of us.

These issues are ultra-complex, highly nuanced, in addition to being critical important. Anyone pretending otherwise should be promptly yanked off the political stage.

Here’s more information about this event. It was being video-recorded and hope that it will be made available to anyone interested in these issues. “2nd Annual Olin Business School Healthcare Symposium: 'Disruption and Innovation in Healthcare 2.0'

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Read more about the article Why Flu Shots Rarely Match the Current Flu, and Why You Should Get One

Why Flu Shots Rarely Match the Current Flu, and Why You Should Get One

As any science guy recognizes, evolution is a fact of life. If an environment is inhospitable to a population, that population dwindles and another prevails. Flu shots are designed every year to prevent the premier emerging strains that are likely to become dangerous, either through virulence in the body, or…

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The cost of asthma inhalers in the United States compared to other countries

I'm traveling abroad, a trip centered on teaching law school for a week in Istanbul. On the way out of the U.S., I had an asthma attack while walking through the perfume area of a Duty Free store in Atlanta. I had an inhaler, but it was getting low (my inhaler is the red Albuterol inhaler on the left. It costs about $70 or $80 WITH the insurance price. My first stop overseas was in Beirut, Lebanon, where I entered a pharmacy without a prescription. They didn't have Albuterol but the pharmacist sold me the Lebanese equivalent called Salres. Total price was $5. When I arrived at Istanbul Turkey, I visited a pharmacy and paid less than $2 for their equivalent, "Butalin," the one in the middle Again, no prescription needed, and the pharmacist assured me that this was an equivalent prescription. I am now in Madrid. Yesterday, I visited a pharmacy here, no prescription, and they sold me the "equivalent," the inhaler on the right. Price was 2.5 Euros (about $2.85). I spoke with the pharmacist in Spanish. I told her that in the United States, my inhaler costs about $80 with the insurance rate, $300 without. Her immediate reaction was shock at the price. The she became angry, and asked "What do children do when their families cannot afford the medicine?" I told her that I don't know, and that it is a terrible situation and that there is no excuse for it.

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