Medlock

Mathew asked NPR not to use his full name because he fears repercussions from his health insurance company if it finds out he got married to obtain coverage.
Marrying for health insurance? The ACA cost crisis forces some drastic choices

Like, what, exactly? There's no indication in the story that Mathew didn't actually marry Christina, his long-time roommate, so it's not as if he could be charged with fraud. And marriages of convenience aren't a new thing. When an unemployed ex-girlfriend of mine was having mental health issues, co-workers had no compunctions about suggesting a walk down the aisle, with the express purpose of obtaining coverage for her on my insurance plan.

This is another problem that corporations have, reputation-wise, in the United States. The idea that some actuary somewhere pores over news stories like this, and when they find someone who married someone they don't plan to have children with, as a means of gaining coverage, they report it to the legal department or something. It's how people like Brian Thompson become the villains in their own murders; the idea that they're so grasping, and so petty, that nothing that gives them a reason to deny people is off the table. And so Mathew doesn't give his full name, even though there's likely enough information in the story that a sufficiently determined insurance company employee could likely figure out who he was.

But I think that this goes beyond a problem with corporate reputations. Just like with science, it's not clear that there's nothing about corporations that render them inherently untrustworthy. So this becomes yet another story about a lack of trust in people. And there's no shortage of those. The United States is a society of people who constantly fear that others are out to get them, or get over on them, because everything is zero-sum. Everything that anyone wants has to be taken from someone else, and if that person (or persons) isn't ready, willing and able to go to extraordinary lengths of protect what's theirs, they lose out. And that's all that matters.

Understanding the Assignment

The cover story for the January issue of The Atlantic is "The Most Powerful Man in Science." It's ostensibly a story about Robert F. Kennedy Jr., but it's really a story about Secretary Kennedy's worldview and his feuding with the "medical establishment." And, as such, the phrase "trust in science" came up.

It was misplaced. Many people, and I would count Secretary Kennedy among them, don't have a problem with science; they has a problem with people. What they suspect is going on is that the policy prescriptions that they're receiving are not neutral, but motivated by people who stand to benefit. Opaque, technical studies are being used as weapons against them.

And once the specter of human dishonesty enters the picture, all bets are off. Because a study, or one hundred studies, can say whatever; once someone believes that the outcomes of the studies have been manipulated, none of it matters anymore.

Social trust is a tool, not a moral imperative. People have to feel that trusting other people comes with some direct benefit to themselves. The public-health and perhaps the broader scientific communities have a problem in the sense that people feel that not trusting them is the best way to go. High profile arguments, or even future data, aren't going to solve that. A sense that trust is rewarded with a better life will. 

Doctored

"Frankly, we get asked all the time, 'So you're a junior doctor, are you going to graduate from med school soon?'" [Alisa Gifford, president of the Oregon Society of Physician Associates] said. "It's important to show them that we're associates, we are professionals."
Physician assistants' push for a rebrand gains steam

But the answer to that patient question is "no." The Physician Assistant (or "Associate") that's working with them is likely not going to graduate from medical school soon, because Physician Assistant programs are not a stop on the medical training that MDs receive. Now, it's possible that the PA in question is, in fact, in medical school, but that would be up to them as an individual; the programs are separate.

I'm not convinced that it was wise for Axios to print Ms. Gifford's statement as-is, in the way that they did. The American Medical Association says that changing the role title from "Physician Assistant" to "Physician Associate" would be confusing, presumably because it would lead patients to believe that "Physician Associates" were a junior class of actual physicians, "Associate Physicians," as it were. And, as presented, Ms. Gifford's statement appears to acknowledge that confusion and use it as a rationale for the change.

As there the ratio of doctors (especially general practitioners) to the overall population ticks down, Physician Assistants and Nurse Practitioners are starting to take over the role of primary care provider for a growing number of people. And many people, correctly or not, understand their primary care provider to be their "doctor." It strikes me that what the PAs and NPs are up against is that connotation, along with the idea, as advanced by the American Medical Association, that a "physician" is a person who holds either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. The PAs may have decided that in updating their title to "Physician Associate" may help break down that distinction in the eyes of the public, and offer them greater status. Because for an allegedly "classless" society, the United States is very status-conscious.

I suppose that the best thing for everyone involved would be for the public to have a better understanding of the training and capabilities of MDs, DOs, PAs and NPs, so that society at large comes to see medical practitioners who are not Doctors as reliable and competent and not the "unskilled labor" of the medical profession (to the degree that anyone involved in medicine can be "unskilled"). But it's likely, as the saying goes, "That sounds too much like work." And besides, I doubt that the Doctors see it in their interests (just as they don't see allowing practitioners from overseas to practice here as being in their interests).

Step one of problem-solving is understanding the problem to be solved. There's a certain strain of affluenza that leads people to conflate their interests with the problem(s) to be solved. And that's what strikes me as going on here; it's common when questions of status (which tends to have impacts on pay) are involved.

Nothing to Fear But...

Even if you're an individual with no health risks and you catch the virus, there are things to worry about: just plain feeling awful is possible even if you're not high-risk. You might have to miss work. You run a risk of long COVID. And then there's the possibility you could transmit the virus to others at risk of severe COVID and death from the virus.
Coronavirus FAQ: 'Emergency' over! Do we unmask and grin? Or adjust our worries?

All true enough. But none of this, other than "long COVID," is unique to a SARS-CoV-2 infection. But this is National Public Radio, and NPR's audience, being left of center in the United States, is primed to see constant vigilance concerning SARS-CoV-2 as a marker of conscientiousness.

The thing that I've found strange for the past three years is the idea that many people seem to have that serious respiratory viruses simply didn't exist before SARS-CoV-2 came along, despite the earlier panics over emergent diseases like, well SARS. You know, the illness caused by SARS-CoV-1. Like the various strains of SARS, any number of other illnesses spread pretty quickly in crowded conditions, like cities. So It's not clear to me why precautions like wearing a mask in public or carrying hand sanitizer wherever one goes aren't simply held out as useful things a person can do if they are worried about illnesses in general. After all, there's nothing unique about SARS-CoV-2 that renders it uncommonly susceptible to vaccines, for instance. After all, there are photos of people wearing face masks during the influenza pandemic of 1918. And, as so many people have been quick to note, SARS and influenza are not the same.

As has been made clear by Fox News, media outlets tend to be beholden to their audiences. And, as a publicly-funded entity, NPR is perhaps more beholden to it's audience than most. But even noting that, it seems mired in a need to always present the 2019 coronavirus as a singular threat, unmatched by any other possible pathogen, rather than simply one of any number of virii and/or bacteria that have potentially serious health consequences attached to them. And I'm not sure that I see the need. If someone wants to go all out to avoid catching the common cold, more power to them. Being sick is a drag, even when it's not particularly serious. Constantly hyping up the potential complications of a single illness in the name of justifying precautions seems like little more than a recipe for anxiety. But maybe that's what the audience tunes in for.

Back to Normal

According to the BBC, "The World Health Organisation (WHO) has declared that Covid-19 no longer represents a 'global health emergency'."

To which most of the rest of the world would answer "We could have told you that."

Not that the World Health Organization is beholden to public opinion when making decisions. But it's unknown how these decisions are made, and that is what I think drove (and still drives, apparently) a lot of conspiratorial thinking concerning the WHO and the SARS-CoV-2 outbreak. No-one has asked me (and with good reason), but I would advise that organizations like this have published criteria for making these sorts of determinations. It could easily lead to a really complicated formula for figuring things out, but this is why mankind invented computers.

Would it fix anything? Maybe not. The arguments and conspiracy theories might simply shift to the data, with skeptics of interventions declaring that the data was faked. But for other people, there would be some opportunity to look at the information, and predict what's going to happen next. Here in Washington State, back when the state government put a "shelter in place" order into effect and ordered many "non-essential" businesses to close, I was making the same point; measures like that should not be seen as something that an administrator, or even the governor, arbitrarily decreed into existence. Data was being tracked, and made public, and so tying decisions to that data would have allowed people to predict what was coming, and therefore be prepared.

Social trust is a more fragile thing than I think it's been given credit for. A better ability of the general public to understand how the institutions that drive world events work my be helpful in building and maintaining that trust.

What Then

Think about a person who has suffered from depression and chronic post-traumatic stress disorder (PTSD) for many years. She has received on-and-off treatment with variable results. She feels hopeless, has continuous negative thoughts about herself, and wants to die. What should this person do?

It's an interesting question, and one that, unfortunately goes unanswered as the author's intent is to hold up assisted death, whether that be assisting a person in ending their own life or ending the life of a person who is unable to carry out the deed themselves, as unethical. And okay, I can understand that viewpoint. And I can understand the idea that "there is something cynical and nihilistic" about the argument that for some people, death by something other than natural causes may be their best option. But leaning heavily into the point that "as members of a society" we have a duty to mitigate the suffering of the severely mentally ill doesn't answer of the question of what recourse the suffering person has if "we" fail.

In fact, after the first paragraph, where we are told that in Belgium, the sufferer can speak to their psychiatrist or therapist about assisted death, the hypothetical patient is never mentioned again. At all. They become a footnote in an argument that is ostensibly about what options they have when they feel they have exhausted all others. And that's unfortunate because "What should this person do?" is a very important question, especially when one is arguing that one option they might have be taken away from them. For some people, hope is a very powerful emotion, but it must be kept in mind that it's not possible to force it on someone else.

And maybe people know this. It occurs to me, that other than the seemingly obligatory anti-suicide messaging that accompanies stories of people actually attempting or committing suicide, I haven't yet come across can article that attempts to speak to someone with, say treatment-resistant depression and suicidal ideation, and convince them that there are better options out there than seeking to end their own lives. To the degree that the people suffering are part of the conversation of what they should do about it, they're props, at best, rather than active participants. Perhaps because they're seen as so broken that there's something wrong with taking them seriously. Or maybe because their disorders render them poor spokespeople for themselves. I don't know. But I am starting to find their absence conspicuous.

And Going, and Going, and Going...

WHO says Covid remains a global emergency but pandemic could near its end in 2023

That's nice. Come back when there's actually something resembling information to share.

One of the things that I was looking for when this whole mess started up was clear guidance. Not only on what governments were going to do, but what the trigger points were. This way, it would be possible to look at the situation as it unfolded, and have a workable idea of what was coming, and what preparations it made sense to take.

No such luck. And I think that this is what drives a lot of the conspiratorial thinking concerning the SARS-CoV-2 situation. (Even calling it an "outbreak" seems strange, after three years.) As much as the public health community here in the United States found its job made more difficult by a lack of public trust, I'm not sure that much has been done to repair that trust. Pushing the World Health Organization to create and publish formal guidelines for when a pandemic starts, and when it ends, might help. It's difficult to make the case to people that three years in, with many people having some level of immunity from vaccination and/or having been sick with the disease, that it's still an emergency. A problem to be dealt with, sure. But after all this time, an emergency seems to be stretching things just a bit. SARS-CoV-2 seems to have passed through its acute phase, and has now become a chronic concern. A rather more serious one than other respiratory viruses, like influenza, but still a chronic concern. The language of emergency doesn't seem to suit things at this state.

“We remain hopeful that in the coming year, the world will transition to a new phase in which we reduce hospitalizations and deaths to the lowest possible level, and health systems are able to manage Covid-19 in an integrated and sustainable way,” [WHO Director-General] Tedros [Adhanom Ghebreyesus] said in a statement.

As the saying goes, hope is not a strategy. If the World Health Organization and other public-health bodies are going to retain credibility, they're going to have to do something more than hope that something changes; especially in the face of a world that is constantly changing. If a 70% drop in the number of serious illnesses doesn't allow for the alert level to be brought down from it's highest point, maybe a more granular scale is in order. Because eventually, things are going to get to a point where no-one feels that these statements are worth listening to. And that could have serious consequences the next time around.

PSA

I was doing some reading the other day and I came across a long-form article on one man's experience with treatment-resistant depression and suicidal ideation. And it started like so many other articles that deal with suicide do: with a statement urging people who may be considering suicide not to act on their feelings, but to contact organizations that would help. Something like this:

Dial 911 in an emergency. Or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week, or use the Lifeline Chat at the Lifeline website. The Lifeline is free, confidential, and available to everyone.

In all honesty, these messages barely register with me anymore. They're like the side-effects part of pharmaceutical advertising; if I haven't checked out by the time I get to that point, I'm certainly no longer paying attention once it starts. I think the only reason why I noticed anything this time out was that it opened the article, rather than being tacked on to the end. Still, I think I would have simply blown it off were it not for the fact that I'd been reading other articles that dealt with potentially self-harmful behavior, and there had been no such message.

So why aren't articles about, say, excessive drinking or violent crime prefaced with the same sorts of public service announcements? If it's understood that it's possible to connect to a person who may be considering killing themselves (or their families/acquaintances) via a message like this, why not other people who may be considering behavior that society would like to prevent? It's not like such messaging doesn't exist. Anti-drug messages are scattered around the landscape like so many fallen leaves in the Autumn. But particular messages about how to receive help with a drug or alcohol problem aren't a ubiquitous feature of articles about people attempting to deal with such problems. Likewise, articles about people seeking to avoid, or end, entanglement in criminal activities don't always come with pointers to resources that may help.

Which lead me to wonder: Are the anti-suicide messages at the beginning or end of articles about depression for a depressed depressed person who may be reading, or for the rest of us? The downside of being unable to understand what happens in other people's minds is that it leaves us without a solid way of judging the effectiveness of such messaging on what I would think is the intended audience. Sure one can ask people who present (or are in) treatment or the like if they've seen such messages and what part they've played in those people's thinking, but for people who've killed themselves, there is no such avenue for understanding. From my limited understanding of depression, it seems that such messaging is unlikely to make a difference. Not to be snide, but were it that easy, there wouldn't be as large of a problem. Part of it, I think, is a general difficulty in relating to people suffering from mental illness, mainly because they don't always see themselves as ill. Plenty of people, however, speak to those suffering from mental illness as if they were instead suffering from a physical malady, and one they should wish to  be rid of. I've been guilty of the same. An uncle succumbed to Schizophrenia and it was intensely difficult for me to speak to him appropriately. Of course, my simply telling him that he wasn't the Messiah wasn't going to suddenly cure him and restore him to the person I remembered. But to listen to me, one would have concluded that I sincerely believed that I might somehow convince him.

Part of me suspects that such messages are legally mandated, but my Google-fu was not up to the task of tracking down any such regulation. And besides, it's not like this would be the only journalistic convention that had attained broad adoption across the industry.

Me being me, I suspect that a lot of what's happening is that I'm simply overthinking things. For all that there may be a general understanding that hopelessness and despair are overly common in American society, reactions to them are often based on a combination of the perceived outcomes and the level of sympathy towards the sufferer (two factors that may themselves be intertwined). While there are religious strictures in some faiths that hold that despair is a sin, and suicide along with it, for many people, a loss of hope leading to self-harm is basically a tragedy, and the story ends there. Despair that leads to injury to others, or to the risk thereof, tends to be brushed aside, in favor of explanations that cast the actor as morally culpable. So a young person who turns to burglary out of a sense that they have no other way to a workable standard of living is cast as lazy and/or greedy, because to see them as despairing seems to foreclose salving feelings of injury by punishing them. Likewise, despite mountains of evidence to the contrary, there is still a widespread understanding that addiction comes from a lack of willpower or other personal moral/ethical failing, rather than being a means of coping with difficulties in life.

My personal conclusion is that suicide is something that people care about. The belief that stories about suicide and suicidal ideation encourage the same (as if people would never think of such things on their own) dies hard, and journalistic outlets understand that they may be blamed if someone kills themselves and it's found that they read an article without an attendant anti-suicide message. And I don't begrudge people their caring, or their choices of what to care about, and what not to. I do wonder, however, if a greater show of caring for other matters may be effective in blunting their impacts on society.

A Gate Unkept

One of the common clichés one hears about the Internet is that it "Democratizes" things. It removes "gatekeepers" so that "anyone" can be a fill-in-the-blank. And one of the most common words to go into the blank space is "journalist." And this expansion of the ranks of "journalists" has lead to an expansion of the definition of "media" to pretty much anything that bills itself as some sort of news and/or commentary site.

Which is all fine and good, but it makes criticism of "the media" a lot like shooting fish in a barrel. One simply waits for someone to present something stupid, inaccurate or un-sourced, and the pounces. Which is my basic gripe with the NPR opinion piece: "Media coverage of monkeypox paints it as an African virus. That makes me mad". To be sure, I understand Dr. Nsofor's irritation. The stories people read about things can quickly shape opinions that then become very hard to dislodge or change, and it's common for people to seek to protect themselves from perceived threats by attaching those threats to people visibly different from themselves and avoiding (or attacking) those people. There's a reason why the World Health Organization considers naming diseases after the places where they're first identified to be a bad idea.

But I think that it's worthwhile to be at least somewhat selective in whom one anoints with the title of "the Media." Here's something that Dr. Nsofor took special exception to:

Here's how a story from the publication "Voice from Europe" described the first case of monkeypox in England in 2018: a "horrible Nigerian disease called monkeypox spreads in the United Kingdom for the first time."

I'd never heard of "Voice from Europe" before, but the construction of the headline left me with an immediate suspicion that the author was out to make a racist/nationalist point. So I decided to find the article in question. And couldn't. In fact, the only reference I could find to the article was the paper: "Lay media reporting of monkeypox in Nigeria," co-authored by Dr. Nsofor, which notes "A European headline (from the Voice of Europe) was ‘Horrible Nigerian disease called monkeypox spreads in the United Kingdom for the first time’." Aha. So now I had a more accurate rendering of the name. And that enabled me to find an article titled: "Voice of Europe closes down following Big Tech censorship and ad service ban," on a site call ReMix. Of itself ReMix says: "Remix offers news and commentary from Central Europe, the Visegrád countries of the Czech Republic, Hungary, Poland and Slovakia." And it doesn't take long to understand where it stands, politically. The headlines lay it out pretty well:

• Almost 2 gang rapes happen every single day in multicultural Germany, and cases more than doubled in just 3 years
• Turkish migrant dad chokes out teen football player and pulls knife on playing field named after George Floyd in Berlin
• Macron tries to silence non-conformist media in France, but French MSM only worries about lack of media pluralism in Hungary
• US: Google employee admits company manipulates search results in favor of Democrats in Project Veritas video
• Big Tech censorship: YouTube blocks Polish conservatives
• YouTube removes video criticizing LGBT ideology

In any event, ReMix had this to say about Voice of Europe in June of 2020.

In a farewell note posted to its website, Voice of Europe stated that it was ceasing operations due censorship on social media and a decision from ad networks to pull all ads from the site, leaving the publication unable to generate revenue to continue operations.

The publication was widely read for its reporting on Europe’s ongoing migrant crisis, but also covered topics related to the culture wars, economics, and other global news topics.

Despite having been "widely read" there is no immediate trace of the site today. It's apparently been taken down, and mostly lost to history. A direct search on the text of the headline brings up only two pages of Google search, with all of the results being either the paper or Dr. Nsofor's op-ed. Not even an archived copy of the original article pops up. Of course, that might be because I live in the United States, and Google presumes that I'm not interested in European Internet archives. (I also tried Bing, but Bing seems not to understand that placing text in quotes means "search for this string exactly as presented," and I wasn't going to sift through page after page of unrelated Monkeypox stories to maybe find what I was looking for.)

I don't disagree with Dr. Nsofor's impression that Voice of Europe's headline was designed to cast Africa in a bad light. But I do disagree with the good Doctor being willing to grant Voice of Europe a status equal to that of "BBC, the Independent, CNBC and ABC News" and labeling them all as simply "Western journalists." Sure the stock photo of a Black African covered in blisters from the disease doesn't help people understand that other people have it, and can spread it (albeit with some amount of difficulty). But a stereotypical choice of stock photo does not rise to the same level as intentionally attempting to create a link in people's minds between Nigeria and Monkeypox. It doesn't count as the "echo" that Dr. Nsofor says it is. Voice of Europe set out to create a "Blame Africa" message. As far as I'm concerned, the biggest problem with using a few stock photos of infected Africans in Europe and the United States is that it likely doesn't give an accurate expectation of what people should expect to see, should they somehow encounter someone with Monkeypox.

"Colonialism" is a convenient villain, but "thoughtlessness" is a more likely culprit in many cases. And one worth calling people out for. Not that it's likely to do any more good. The media is drawn to drama; and people who are suffering from severe, untreated cases of the pox make for more dramatic images than people whose infections are under control. A few angry op-eds is not going to change that. So rather than a passive-aggressive missive on racism in the media, I suspect that a crash course on medical media literacy would be more helpful. But anger drives more clicks. (Guilty as charged.)

Bulletproof

There's a story on National Public Radio's website that uses the young daughter of reporter Michaeleen Doucleff, PhD, as the entry point to an exploration of why some children may have managed to ward off being infected with SARS-CoV-2. The story explores the effects of being exposed to other coronaviruses, the protections that the retinoic acid-inducible gene I (RIG-I) receptors offer in children and makes passing mention of the fact that children, for all that they tend to come across to adults as self-propelled bio-warfare agents, are fairly good at dealing with diseases (otherwise, there likely wouldn't be very many of them, with predictable results for the species as a whole).

But the whole thing started from the premise that given the young Miss Doucleff had been in a room with someone who was later found to be infectious on more than one occasion, she should have contracted the virus and become ill at some point. While this is taken for granted however, it's never really backed up.

It's understood that the many variants of SARS-CoV-2 have varying levels of virulence and some of them are quite transmissible. But even the Omicron variant, which was considered highly contagious, didn't manage to infect everyone that a carrier might come into contact with. R0, which, remember, presumes no precautions and a completely naïve population, never rises to infinity. An estimated R0 for the Omicron BA.2 variant of about 12 is pretty high, but measles still beats it out at 16. And it's understood that not everyone who comes into contact with someone who has the measles will contract the disease.

So why treat a child managing to avoid becoming sick as if it were some sort of unique event? I suspect that part of the answer is that this is an NPR story, and the political dimension to the coverage of, and public reaction to, the disease outbreak has to be taken into account. NPR's audience, like most of the American Left seems to have a heightened perception of risk from the virus, and NPR's coverage both reflects and validates that risk. Who has the greater influence on whom is open to debate, but I think of it as something of a symbiotic relationship, with NPR both reacting to, and calibrating, the expectations of the audience. It's the nature of the news business, and news is, after all, a business.

The idea that people are poor at evaluating risk has become a cliché. And while the idea that "perception is reality" is also something of a cliché, it's also very (if not perhaps completely) true. And so coverage of events, including the pandemic, generally has to start somewhere that is recognizable to the audience. And to the degree that left-leaning audiences view the threat of SARS-CoV-2 as ever-present, the story needed to present it that way.

Invaluable

Because someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ.
Richard Gibson “The Heartless Matter of Organ Transplantation and COVID Vaccination”

The “right” person, huh? And how on Earth is that determined? Mr. Gibson suggests that “it is simply a matter of maximizing outcomes and minimizing risks,” and “getting the best ‘value-for-money’.” But then he goes on to suggest that some failures to minimize risk are less salient than others. Not being vaccinated against the SARS-CoV-2 virus is a legitimate reason to be denied an organ. But putting oneself at risk by engaging in extreme sports is not. But if it makes sense to say that a person who is vaccinated against the virus is a much less risky investment than an unvaccinated person, why shouldn’t the hobbies of the extreme sportsperson be taken into account?

There is, in my opinion, nothing wrong with creating some sort of risk criteria when deciding how to distribute a scarce resource, especially one that some group of people need to ensure their continued survival for a time. By the same token, there’s nothing wrong with deciding, as the person or persons in control of a scarce resource, that it will go to people whose values best align with one’s own. But using one as a cover for the other strikes me as disingenuous. I tend to be of the opinion that people are generally partisan and arbitrary; they make decisions based on what they understand their interests to be, and then attempt to slot them into a greater framework. Not out of dishonesty, but out of culture and upbringing. I don’t believe that I’ve ever encountered a person who adopted an ethical viewpoint under which the decisions that they were accustomed to making on a day-to-day basis were considered wrongful without some explicit desire to change those decisions.

While there is something of an understanding that all human lives are precious beyond measure, in the everyday world lives are worth the resources that people are willing to marshal to protect and extend them. Mr. Gibson hints at this when he notes that the people who die while waiting for organs to become available to transplant are “deemed less worthy” than those who are given organs. A bit earlier in the article, he was more direct: “Some people are more deserving of organs than others.”

But what makes one person deserving and another not, at the end of the day, are the triage decisions of the people in control of the procedure. Those they prioritize to save become more deserving. Those that must be deprioritzed become less worthy. So why not own those decisions? If not being vaccinated is automatically too risky to be allowed to receive a transplant, but endangering one’s life out of a sense of sportsmanship doesn’t upset the ‘value-for-money’ calculation, why not just own up to the idea that the final decision has more (or less) to do with factors other than a “simple” years-of-life determination?

There is no way to distribute a scarce resource in such a way that those who receive less than they feel they need (or nothing at all) will be forced to concede that the distribution was “fair.” When it comes down to it, “fair” often simply stops having any meaning to the person being told that they’re going to die due to being the 11th in line for 10 life-saving transplants.

The idea that “there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ” presupposes that there is one “right” person every time there is an organ to be received. That there is some calculus that can be done that consistently places one person on top of the heap. But people have never worked this way. It has never been possible, as near as I can tell, to boil ethics down into a form of mathematics. The difference between 2³ = 8 and prioritizing one set of patients over others is that 2³ = 8 is always free of any value judgments.

Of course, the thing that I’ve realized while writing this is that even the expression of values is driven by values. People hide their value judgments because they understand that being seen as free of them is valued. I value openness, so I prefer people to wear their values on their sleeves. I wonder how well that irony is appreciated.

And In This Corner

Last year, SSM Health, a network of 23 hospitals, began using a points system to ration access to Regeneron. The drug would be given to patients only if they netted 20 points or higher. Being “non-White or Hispanic” counted for seven points, while obesity got you only one point—even though, according to the CDC, “obesity may triple the risk of hospitalization due to a COVID-19 infection.” Based on this scoring system, a 40-year-old Hispanic male in perfect health would receive priority over an obese, diabetic 40-year-old white woman with asthma and hypertension.
Shadi Hamid "Race-Based Rationing Is Real—And Dangerous"

The article is subtitled: "The cultural left’s worldview is beginning to distort health policy." I take exception to that because it implies that health policy is not already distorted.

And when patients had long bone fractures or acute pain from other types of traumatic injuries, black people were 41% less likely to get pain medication than white people.
Nonwhite patients get less pain relief in U.S. emergency rooms

I don't know about you, but a greater willingness to withhold pain medication from people with broken bones seems pretty distorted to me.

The problem, as I see it, with SSM Health's scoring system for access to Regeneron isn't that is privileges some hypothetical "40-year-old Hispanic male in perfect health" over an equally hypothetical "obese, diabetic 40-year-old white woman with asthma and hypertension." It's the implicit assumption that such a matchup would never occur, because any given 40-year-old Hispanic male who walks through the doors of one of their hospitals is presumed to be in such poor condition that an obese, diabetic, asthmatic and hypertensive white woman is still far likely to be in better overall health than he is.

Mr. Hamid makes the point that outrage is tempting. I think part of the reason for that is that outrage tends to be inward looking. Aaron Sibarium's articles struck a chord with many White readers because they justified a feeling of being unfairly devalued in the eyes of "the cultural Left." But there's another way of looking at it, namely, "Crap... how on Earth is it true that the medical establishment has come to see simply being Black as being correlated with so many health problems, that it's like being a White person of retirement age?"

Lost in all of the "outrage" about "wokeness" and "rationing" is the understanding that the collective health of Black and Hispanic people in the United States is an utter disaster; at least as far as the health care system is concerned. Because holding up some hypothetical Black teenager "in perfect health" to an ailing, middle-aged White person makes for a better conflict, and thus, magazine headlines.

One of my recurring themes on this blog has become the degree to which Americans see themselves as impoverished, and thus, released from any obligation to share resources with one another. This is just another example. It's also an example of how the past of the United States is conveniently forgotten. The factors that led to Black people, Hispanics, Native Americas and no doubt others having such poor collective health didn't all simply dry up and blow away once the Civil Rights Acts were all passed and signed into law. Their effects lingered, and, in some cases are still active and impacting people.

But the overall understanding is that, as a nation, we are too broke to fix these things. And so it makes sense to tell people that they should be able to work hard and find good-paying jobs to lift themselves out of poverty while sending as many jobs as can be managed overseas, specifically because people there will work for less that it costs to support oneself here. And the United States condemns to make-work jobs millions of people that society has spent between 10 and 15 thousand dollars a year to educate for 13 years. Over 160 thousand dollars spent, and the consensus is that they're good for flipping burgers, bagging groceries or preparing coffee. And given the general competition for low-skilled work, precisely because it doesn't require an expensive college degree, a number of people are doomed to long-term, if not perpetual, unemployment.

Outrage is easier than solutions. And likely more satisfying, too. And certainly a lot less expensive. At least for the individual.

The ironic thing about all of this is that if, as a nation, the United States weren't so good at pitting groups against one another to fight to be valued, there wouldn't be a need to continuously fight over who is worthy of being valued. Were the United States genuinely the wealthy nation it portrays itself as, there wouldn't be this pervasive sense that there aren't enough necessities to go around. And in a further irony, the United States doesn't see itself as being poor enough that it needs all of the human capital that it has. So much human potential is wasted, allowed to wither away and die, because putting it to work would mean sharing the benefits of that work.

But maybe it's all that, all of it, that drives the outrage. I don't find much value in anger, but I know a lot of people who see it as a valuable first step to greater change. And in that, the anger feels like doing something. And when people buckle under to the anger, editing out the targets of outrage, perhaps it seem like change. Even though tomorrow, the problem remains the same.

Who's Keeping Score?

Last week, I met with a few friends for a birthday dinner. One of the attendees didn't have a mask with him; he tends to keep them in his car, and this time, he didn't drive himself. I keep a few of the blue surgical-style masks in my car, so we walked over to pick some up. It was about two blocks there, and two blocks back. When we made it back to the restaurant, he put the mask on just outside the door. We then entered, walked the maybe thirty feet to the table, and then both proceeded to take off our masks to drink from the water glasses at our seats. Appetizers were ordered, and eaten, then the main course arrived, drinks were served and refilled, and then dessert came. Then, after the bill had been settled, everyone put their masks on, and we walked the thirty feet or so back to the door, and once out in the street, everyone took their masks off again.

I want to say "while I completely understand the reasons for all of this," I'm starting to realize that I don't. And so the feeling that the current iterations of the non-pharmaceutical interventions that governments have put in place to slow (I want to say "manage" here, but it all comes across as too haphazard for that) the progress of the infection through the population comes across as theatrical, in the sense that it's designed to project that something is being done, rather than to be strictly effective.

And it's not that I believe that all of the measures that have been put in place are ineffective. I have no way of knowing how effective they are or are not. So I suspect that they're doing something. I just can't tell you what that something is. And I can't tell you that it's worthwhile. While discussions of the Reproduction Rate for SARS-CoV-2 in a given location have long gone out of fashion, what that number might reasonable be is still useful to know. It's understood that if the Reproduction Rate drops below 1, the disease will peter out at some point; not enough new people are being infected before the people already infected recover, presumably after having purged their bodies of the pathogen. So if measures can push the rate for a disease down to below 1, can keep it there for a sufficient time, they can effectively eradicate the disease in a given population. And for a disease of a given serious, the cost-benefit analysis of those measures will pencil out at some point, and a decision can be made.

On the other hand, there is a Reproduction Rate for a sufficiently serious disease such that the number of people ill enough to require some sort of high-quality care to avoid death or other serious consequences will outstrip the availability of such care, and this place serious strain on the persons tasked with providing such care, especially given that the level of training needed to provide such care makes the supply relatively inelastic. Since that number, whatever it is, doesn't have a set value, we'll just call it x. Again, it's understood that if non-pharmaceutical interventions can bring the local Reproduction Rate down below x, then the overwork of care providers can be avoided. But with this calculation, the idea is that at some point, some other factor, either time or pharmaceutical interventions will come along and push the local Reproduction Rate down even further, or at least stabilize it.

But if broadly applied non-pharmaceutical interventions aren't making the difference between being above a given threshold or below it, are they worth the costs? With the understanding that SARS-CoV-2 and influenza aren't the same thing, I'm going to enlist the flu as my example here. Once the Flu Pandemic of 1918 was a thing of the past, the annual flu season wasn't really seen as a reason to enforce interventions. Even in years where 50,000 or so people died from the disease and its complications, it was understood that the Reproduction Rate wasn't going to rise to x, and it would only be a few months before warming weather pushed it down below 1. Given that understanding, it wasn't seen as worthwhile to pay the costs of mandated interventions, even though it was understood, at least in some circles, that lives would be saved.

I don't know that anyone has ever considered a scenario like the world has at this point, where the lowering of the Reproduction Rate to 1 isn't happening anytime soon, and it's x that's worth looking at. I presume that there are people out there, likely in the public health field, who know what x is. I, for my part, have no idea.

What I also don't know are a) what the current Reproduction Rate in my local area is, b) what the circumstances that create that rate are, and c) how much the current batch of interventions, pharmaceutical or not, are doing to it. Something tells me that I'm not alone in that, because a lot of people I know have come to treat a SARS-CoV-2 infection as some sort of roaming death warrant, just looking for someone to serve itself on. This viewpoint, I think, leads to an understanding that every individual instance of illness is something of an avoidable tragedy and unacceptable outcome; another in a host of frightening trees that completely obscures the forest and give things like mask mandates and a need to show proof of vaccination to eat in a fast-food place an air of being ends in themselves.

With the understanding that a certain amount of consistency and predictability are important, does it really make sense to require people who have to be demonstrably prove they are vaccinated wear a mask for the walk from the door to the table and back again? A sick person in a relatively small area can easily exhale enough virus-laden air to reliably infect a number of people around them over the course of a moderate meal (Something I learned the hard way not long out of college.), so is really worthwhile? Or have things, at least in Blue America, where I happen to live, settled into a need to be seen doing something, and that's what's important?

Cost Sharing

I get the frustration, I really do. But punishing the unvaccinated by saddling them with potentially crippling medical debt is not right, no matter how you feel about their decision.

[...]

 Everyone deserves health care regardless of the decisions they've made in their life; it's why we admit people to hospitals when they're sick or hurt, rather than allow them to die in the streets.
Jeva Lange "Nobody should go bankrupt for COVID-19 treatment. Even anti-vaxxers."

Perverse incentives 101: Allowing people to retain the benefits of opportunities they find, while spreading the costs of the risks they take among the populace at large is a recipe for increased risk-taking. It's one thing to conclude that compassion demands that people be cared for, regardless of whatever choices they've made. But telling people that any cost they feel should be extracted from people who make poor choices is a sin is asking for resentment. And in a society that already behaves as if resentment is a virtue, I don't know how helpful that is.

One of the characteristics of societies in general is that they bring together larger groups of people than might normally decide to be a part of the same collective. And the assignment of privileges and responsibilities across large collectives is always tricky. This is part of the reason why coupling those two concepts together tends to be a good idea, even when it's a given that it's not realistic to always do this.

It's worth keeping in mind that what Ms. Lange refers to as "punishing the unvaccinated" is little more than "Most private insurers are no longer waiving cost-sharing for COVID-19 treatment." In other words, treating a SARS-CoV-2 infection pretty much like any other reason that a person may be hospitalized. There is a legitimate point to be made that health care in the United States is broken in any number of different ways, and that one of those ways is that it's not completely socially subsidized (although, I would point out that the experience of nations with socialized medicine would argue against it being a cost-free panacea). But arguing that a specific disease or disorder should receive special treatment, just because, seems weak.

And if the point here is that medical care should be universally affordable (a nebulous term that seems to lack any real definition) regardless of what a person may or may not have done to require such care, then looking to place the responsibility on other parties is a poor justification.

Doesn't the Biden administration also hold some responsibility for not effectively reaching vaccine skeptics?

This makes a pretty big assumption, namely that it's always possible to convince someone to make the "correct" choice; all that one needs to do is "effectively reach" them. This is the sort of statement that people make because nothing is impossible to the person who doesn't have to do it themselves. The thought that "There has to be a way," is not the same as being able to articulate a way. And if responsibility for payment is going to be assigned according to responsibility for the actions taken, this simply sets up a dynamic of passing the buck (as is being done above). While it's a common Liberal viewpoint that the average person on the street is more or less helpless to care for themselves without some sort of professional intervention, that viewpoint can be used to argue for compulsory vaccinations. That certainly makes more financial sense than footing the bill for people who have decided that the arguments in favor of voluntary action are not credible.

What's worse, like those who abuse the emotional support animal system, the people who take a "rules don't apply to me" approach to the COVID-19 vaccine are actively endangering the members of the community they purport to be a part of.
Jeva Lange "COVID-19 vaccine 'medical exemptions' are the new emotional support animals"

Here is where I pick on Ms. Lange a bit, in shifting to another one of her columns on the topic of the vaccines, and people's refusals to avail themselves of them. I'm going to point out that in most societies, there tends to be little in the way of sympathy for people who are portrayed as actively placing other people in danger due to their actions. Making the point that people who are engaged in actively harmful activities should have the blowback to themselves social subsidized is something of a hard sell. In nations where medical care is exclusively tax-funded, it may be par for the course, but even then, other consequences are certainly going to be exacted, and this is not commonly considered a failure of compassion.

You never know another person's medical situation, and a lack of compassion for others isn't productive. But anti-vaxxers need to take accountability for their stances and not hide behind the language of others' real medical conditions.

Isn't expecting people sharing the costs of the medical expenses brought about by such stances, in the way that others are expected to as matter of course, a measure of accountability?

In the end, this is likely one of the pitfalls of being a columnist. Not all of the things one writes will be condense into a neat, coherent, whole. I know that I try to maintain a certain level of consistency, but my views on the world have changed over time (this is part of the reason why the "Rampant Idiocy" tag has been retired). Still, I think that it's often helpful to take a broader view than the one that ideology first presents.

So Scary

The good professor is at it again.

It’s obvious what an unvaccinated person should do: get vaccinated ASAP, and stay super-safe until fully vaxxed (remember, shot #1 doesn't protect against Delta the way it used to). Particularly in a high case prevalence region, your chance of catching the virus has never been higher, and – while treatments have improved – there’s still a decent chance of a stormy course, including Long Covid, hospitalization, and (depending on your risk factors) death. I’d be afraid. Yes, I'd be very afraid.
Professor Robert M. Wachter, Chair of the Department of Medicine at UCSF.

Now, if you've read this blog for any period of time, especially since the beginning of the SARS-CoV-2 outbreak, you may recall that fearmongering gets on my nerves, and I've dunned Professor Wachter for this previously. While I understand the reasons why one might seek to use fear as a motivator, it's not always the best way to go about things. In a situation in which people trust one to advise them, there's no real need to use fear. As I've stated before, the intuition that only fear breeds an understanding of the usefulness of precautions is misplaced; people are perfectly capable of taking action to prevent outcomes that they aren't necessarily afraid of. Understanding an outcome to be undesirable is not the same as being afraid of that outcome. And for people who don't trust the person seeking to advise them, fear comes across as an attempt to manipulate.

This is not a rapidly-emerging situation where an immediate fear response is needed. While it may be conventional wisdom in some sections of society that it is literally impossible to be too careful where SARS-CoV-2 is concerned. not everyone is ready, willing or able to hand over a blank check in that fashion. And there's no need to. There isn't anything that one can do with a threat that one can't do by understanding what motivates someone and appealing to that.

But I don't think that's the point. I don't know if Professor Wachter is really attempting to spark fear in those people who haven't taken a vaccine or justify the fear (and perhaps loathing) of those who have. Because honestly, how many people is the Professor going to reach with his tweets who don't already agree with him? It more likely that his words have become a cause for the vaccine-supportive to fear for their children than the vaccine-opposed to fear for themselves. And for those who have already been vaccinated to nod along in agreement as to how stupid their "fellow Americans" are.

I am of the opinion that the United States is not, and has never been, a unified polity. The United States is too large and populous, and not wealthy enough, for people to not have interests that are direct cross purposes with someone else's interests. And that clash of interests eventually lead to people seeing one another as The Enemy. The SARS-CoV-2 outbreak is just another in a long line of things that people have used to sort themselves into Good and Bad, while their backers cheered them on. Sometimes, the media finds the cheerleading to be newsworthy.

Just Say It

Still, I'm not going to lose my running mask just yet. Not because I'm "addicted" to the pandemic, or distrust the science or advice of the CDC — on the contrary, I'll be the first to explain all the ways we know running outside without a mask is safe. But I first started wearing my mask outdoors as a courtesy, a signal to my neighbors that I cared about their health and was taking precautions to keep them protected. As we begin rolling back pandemic restrictions and resuming "normal life," I'm not quite ready yet to stop sending that message.
Jeva Lange "Why I'll keep running with my mask on"

While I certainly understood Ms. Lange's motivations, I do feel that her take on this contributed to the overall "public health theater" aspect of the way that the SARS-CoV-2 pandemic has been handled. The expectation that everyday people can't understand the nuances of the situation that they live in, and thus symbolic reassurances that don't actually improve the situation are helpful, leads to a state in which signalling takes on an outsized importance.

But that signalling also sends a message. For Ms. Lange, it's that she cares about her neighbors. However, just as with any other message, once it's out there in the world, the sender has no control over what it actually communicates. And a culture of wearing masks communicates that people should see themselves as a hidden danger to others and others as hidden danger to them. While it's true that covering one's mouth and nose can decrease the chance of direct person-to-person transmission of the virus, the reason why ubiquitous mask-wearing was mandated was that it's possible to not have any symptoms of the disease, yet still be contagious. The risk of miscommunication isn't necessarily a reason to change one's behavior, but understanding the potential for it is helpful, as it reduces the temptation to confidently state other people's understanding of the world around them.

It might also bring a certain openness to other possible messages. Running without a mask on is unlikely to communicate to everyone who sees Ms. Lang that she's uncaring and incautious. There will likely be some who would see that as a sign that the messaging on the current public health understanding was getting through to people or that being outside doesn't carry the same level of risk as other activities.

In the end, message by signalling is imprecise. Granted, imprecision is a fact of life. One can walk up to someone and speak one's mind and the other person might still not be 100% clear on the meaning of one's words. But part of public health theater is the understanding that simply giving people information is ineffective. But I don't know how accurate that understanding is. When there's no reason to treat a person jogging on the sidewalk as a significant risk of infection, then perhaps it's best to be up front about that, and start making it clear that this is a situation in which an abundance of caution, and certain precautions, are not warranted.

Reasons

I'll admit to being a touch surprised by the fact that "They assist in public health" somehow didn't make the cut. Because, as much as I think that most masks don't do much to limit the spread of airborne respiratory diseases, that was kind of the point of wearing them. I suppose that is may be assumed, but I think that I wouldn't have left is as as assumption, given how polarizing an issue it became.

Most of the face masks available these days are what are termed breath deflectors; the basic point is to stop the direct transfer of air from a potentially infected person to a presumably uninfected person. And so wearing masks, on the assumption that one was infectious, became a substitute for actually knowing whether or not one was infected.

And that created something of a paradox. Personally, if I suspected that I might be carrying a potentially fatal respiratory infection, showing people that I cared for them would entail completely staying the heck away from them. After all, breath deflectors (and all of the masks I have fall into this category) don't prevent exhaling pathogens; they simply prevent one from blowing them more or less directly into someone else's face. And so a lot of masking worked under the convoluted premise that one was infectious enough that one shouldn't breathe on another person, but not so infectious that doing one's best to remain isolated was called for.

For me, this contributed to a sense that masking was primarily a form of public health theater; the important thing was to be seen doing it, to be seen showing that one cared, rather than actually understanding the circumstances. Of course, with the public health infrastructure (or lack thereof) in the various states, ubiquitous testing was never going to happen; once things fell behind, there was no catching up. And eventually the project was simply abandoned. Maybe that's where things went wrong.

The Only Thing

Plus, who wouldn’t feel a bit more comfortable venturing into the world knowing that everyone around them isn’t a vector of disease?
Yasmeen Serhan "The Futility of Vaccine Passports"

Okay. So I have a question. Since when does a vaccine, or other immunity, against the SARS-2 coronavirus mean that a given person "isn't a vector of disease?" Did all other human communicable diseases drop dead while I was away? Because I know, for my own part, I've had some nasty respiratory bugs in my day, not to mention the random pain in the butt that is the common cold. (Although, perhaps strangely, I've never had influenza.) Have all of these pests been eradicated in the past year? This would be huge news, so I'm impressed that I haven't heard about it.

This transition of the SARS-2 coronavirus over the past fifteen or sixteen months, from being a new disease to being the only disease worth having any concern over is somewhat remarkable, and so I'm a bit surprised that more hasn't been made of it. Granted, formulations like the one I quote from Yasmeen Serhan, which imply that proof of SARS-2 immunity can be taken as a sign that a person is free of any communicable disease, are likely rare; I don't believe I've seen it put quite that way before. But broader implications that the virus is the only, rather than a different, threat to one's health are out there.

And the outbreak dominates the news. The BBC, for instance, has added a section for Coronavirus to its home page. And this article on a new Utah law aimed at making men pay for half the costs of a partner's pregnancy has a link to a video captioned "Coronavirus: 'Pregnancy during a pandemic is terrifying'," and the "You may also like:" headlines are "In pictures: The babies born into a pandemic", "From boom to bust - why lockdown hasn't led to more babies" and "'Raw and inspiring': Tales of pandemic motherhood." This, for a story where the SARS-2 coronavirus is never mentioned. And other sites that normally have some sort of paywall, like The Atlantic, have elected to allow their pandemic-related stories to be freely available.

There's nothing particularly inappropriate in all of this. The pandemic has come to dominate the news cycle for the past year, and news outlets haven't been shy in making room for it. And, being the sort to see the news media as a business, I'm of the opinion that pandemic coverage takes center stage because people are interested in it. After all, this is something that seemingly came out of nowhere to become the third leading cause of death in the United States. It's responsible for a significant majority of the increase in deaths from 2019 to 2020. But unlike heart disease and cancer, which hold the top spots, many people feel a sense of agency concerning the SARS-2 coronavirus.

But it's not the only thing that people might have to be careful of. And the implication that "safe" from the pandemic equals safe overall hides that fact. Deaths from the flu may have been completely swamped by the SARS-2 CoV pandemic, but some forty-thousand or so deaths annually is still worth taking into account.

If there were one thing that would change about the overall reaction to the pandemic, it would be to more firmly place it in a context of public health more generally. As much as vaccine hesitancy and opposition to mask mandates make headlines and offer convenient villains to boo, I suspect that it's likely that a culture that sees staying home while sick as socially-dangerous malingering is also a culprit. Back when the pandemic was just starting to ramp up in the United States, I had a couple of encounters with visibly ill people working in grocery stores. I doubt that either of them had come down with a SARS-2 CoV infection. But they were disease vectors nonetheless. Maybe keeping that in mind will help the nation make some changes that will blunt the inevitable next disease outbreak.

Gamble

Although operation warp speed was successful, at least in comparison with Europe’s efforts, part of its victory came down to luck. If the vaccines that the U.S. scooped up so many doses of, by Moderna and Pfizer, had failed clinical trials, “the U.S. would look extraordinarily stupid right now,” [Scott] Greer[, a health-policy professor at the University of Michigan,] says.
The One Area Where the U.S. COVID-19 Strategy Seems to Be Working

I suppose that it's part of how people tend to see the world, but the conflation of unlucky and stupid (especially in many modern contexts, where "stupid" is a descriptor of moral, rather than intellectual, failing) has struck me as being unfair for some time. Part of me wonders if this viewpoint is a cause of people being loss-averse or an effect of same, but the outcome is the same: the expectation that bad outcomes are always predictable. There is some irony, I think, in the fact that one of the "unfair" things about the world is that so many people believe that the world is in fact, "fair." If one inhabits a world where the difficult events that befall other people are generally of their own making, then it makes sense that the person who gambles and loses has revealed that they are of flawed character, even if the precise nature of the flaw remains unknown.

But there is something else that occurred to me when I read Professor Greer's words; that hint of mistrust that people often have for one another, especially people who work in the corporate world. Had Moderna's and Pfizer's vaccines not turned out to be effective, I suspect that a lot of people would have been prepared to claim that the companies had acted in knowing bad-faith; understanding all along that either the task before them was impossible, or, since the money was theirs either way, not worth the expense of doing well. Bad faith and ill-intent are things that many people pride themselves on being able to suss out in others, despite the fact that people generally are quite poor at it.

In any event, there is always an understanding that people need not really ever deal with uncertainty. The person who gambles and wins is credited with being able to put together all of the clues that pointed to an inevitable outcome. The person who rolls the dice and loses is faulted for not having seen the same.

It's interesting that Operation Warp Speed was deemed a success because the vaccines turned out to work. One wonders if that was actually the criteria when it was proposed. After all, the whole point behind funding research and development into anything is to try out a number of different approaches and ideas and see not only what works, but what doesn't. In that sense, even if the program hadn't directly lead to a single effective intervention, it still would have been useful, in pointing out the blind alleys quickly. It does a disservice to forget that.

Dialing It In

Companies and government inaction are standing in the way of progress. But let’s be clear: The cult of “me first”—whether it’s at the scale of nations hoarding vaccine doses; leaders ignoring the plight of the marginalized in their own backyards; or the mad, individual-level scramble to get a jab as soon as one can figure out how to—is the source of the problem.
Gregg Gonsalves "The Vaccine Line Is Illogical"

I'm not going to disagree with the good Professor in his assessment that "the cult of 'me first'" is a problem. But I will dispute that it is the source of the problem. It's been ten or eleven months since the SARS-2 coronavirus hit the United States, and in that time, most of the public has been turned into cowering paranoids and many of them have come to see the less-paranoid as dangerously irresponsible. Those people who suspect that they might not be in very much danger of dying have been constantly warned that even on the off chance that they are correct, they could give the disease to someone who could give the disease to an elderly relation or neighbor; and would this be responsible for an unnecessary death. Even now that remarkably effective vaccines are becoming available, the doomsaying continues, with talk of continued ability of the vaccinated to spread the disease to the unvaccinated (which kind of wrecks one of the primary goals of mass vaccination in the first place) and new variants that might be completely able to escape the vaccines (which kind of wrecks the point of vaccines, period) being common in the media.

It's been a highly effective machine of fear. And in the face of such, why would one expect people to calmly wait their turn in line? If you want an orderly queue for the lifeboats on a sinking ship, you first have to convince everyone that even the last person in line will be well underway before there's a chance for them to get their shoes wet. That's a difficult message to convey when one is also attempting to frighten those who refuse to leave into heading above decks.

If in fact the shelf-life for vigilance in the U.S. is only about 3 months, new surges may occur in the fall in previously hard-hit regions such as the Northeast—unless residents remember to stay afraid.
Professor Robert M. Wachter, Chair of the Department of Medicine at UCSF.

In this case, the supposed "cult of 'me first'" is not the source of the problem, but a symptom. If public health officials are telling the public that they need to "remember to stay afraid," and a vaccination is the solution to that fear, why would people not be clamoring to the first in line? I'm not particularly worried about what would happen if I contracted the novel coronavirus. I live alone, so there's no-one else in my home to infect, I've survived severe respiratory illnesses before and I'm not yet old enough to be in the high-risk population. So while it would quite likely suck out loud, I think I'd get through it. I've encountered people who consider me to be something between insane and insufferably arrogant for thinking this way, seeing my lack of outward concern as indicative of willful ignorance of the risks.

Fear may be an excellent motivator, but it's not a particularly precise too. It's difficult, if not impossible to simply turn it on or off when one thinks it should be. If the only thing that people are supposed to fear is the SARS-2 coronavirus, then it's reasonable to expect that they'll act as though they are afraid. And the whole point behind fear is to motivate people to do something to relieve it. If that means doing whatever it takes to get to the front of the line, that's what will happen. If Professor Gonsalves wants people to be willing to wait longer in the name of equity, perhaps he could have a talk with Professor Wachter.