The Best Decision For A Doctor Might Not Be Yours

Probably for the shock value, news outlets are quoting this odd doctor, Ezekiel Emanuel, who, the title promises us, says “U.S. Must Stay Locked Down For 12-18 Months Until There’s A Vaccine.

“Realistically, COVID-19 will be here for the next 18 months or more. We will not be able to return to normalcy until we find a vaccine or effective medications,” e [sic] said. “I know that’s dreadful news to hear. How are people supposed to find work if this goes on in some form for a year and a half? Is all that economic pain worth trying to stop COVID-19? The truth is we have no choice.”

EZEKIEL EMANUEL: No one is immune to the COVID-19 virus. It threatens all of us.

That last statement is not so. Those who have had it and have developed antibodies are immune—but that’s a pedantic point. There may be many more who are naturally immune, or who possess characteristics that forestall infection.

Let that pass. Let’s discuss the return to normalcy instead.

The H1N1 virus responsible for many deaths is still with us. for this year, the CDC says, “Nationally, influenza A(H1N1)pdm09 viruses are now the most commonly reported influenza viruses this season.”

Given the ease with which it spreads, it’s reasonable to suppose variants of COVID-19 will be with us in years to come, too.

Accepting its permanence, should we shut down everything forever? We’d have to, and it would be worth it if, as Governor Cuomo said early on in this crisis, it “saves at least one life.” A permanent lock down will take a lot more lives than it saves once starvation, and the other associated diseases with it, set in. This Emanuel says “we have no choice.”

No choice?

There is always a choice. We could return to normal in the same we did after Swine Flu, Asian flu, Hong Kong flu, and on and on, by realizing everybody dies and you have to die of something, and that it’s better to die standing rather than crouching under the bed hoping to avoid only one disease out of all of them.

Why can’t Emanuel see this? The same reason his colleague Anthony Fauci says “I don’t think we should ever shake hands ever again, to be honest with you. Not only would it be good to prevent coronavirus disease; it probably would decrease instances of influenza dramatically in this country.”

He’s right. Foregoing handshakes would decrease all manner of disease. Just as locking people in their homes would block transmission of sickness. Both would radically change our culture and manner of living. Yet if our only goal in life is to save lives, we should do both!

Why do doctors like Emanuel and Fauci sound as clueless as they do? Because doctors don’t think like ordinary people: their goals are largely different. Here’s a brief explanation why.

Most medical tests are imperfect. (Some tests are great. Doctors usually nail it when they say “That guy’s dead.”) The expected error means you can’t trust at face value the results of the tests. Because a test says you have a disease doesn’t mean you have it with certainty, and vice versa. You can formalize this, which we did for coronavirus. The always surprising result is that for most diseases, coronavirus included, you still do not have a large chance of having the disease even when you test positive.

Still, just because the chance of having a disease isn’t high, doesn’t mean you shouldn’t take some action regarding it. And vice versa: just because the test says you don’t have it don’t necessarily mean you wouldn’t act.

How to act depends on how you view the costs and losses associated with the possible outcomes.

Tests usually come in batteries, from simple error-prone first tests to complex, expensive, and accurate secondary tests. Suppose a first cheap test comes back positive. You might opt to go in for a more expensive test “to be sure”. Or you might notice that even thought the cheap test gives a positive, you still only have a small chance of actually having the disease. Anyway, you’d rather not take your chances in a hospital for the second test, which are full of sick people. And even if you do have the disease, you’re not too worried about overcoming it. You blow the second test off.

On the other hand, the cheap test might come back negative, implying you’re disease free. Most would celebrate and get on with things. But a few are so nervous about the possible consequences of a dread disease, that they still go for more tests.

Whatever the case is, you make your decision by weighing the probabilities and the costs and loses relevant to you. All this can be formalized, and your decisions made optimal—for you. I’ve done so in a series of papers (gory details here).

Doctors are different the ordinary people. They do not have the same cost-loss values you do. The decisions they make—decisions optimal to them—are therefore almost always different than decisions optimal for you.

You might like most people be satisfied with a negative test on a cheap metric, say a drive-in nose swab. The disease wasn’t too likely in the first place (according to background rates). And even if you get it, you likely won’t suffer much. Odds of dying from it, given your (we assume) good physical condition are tiny. A negative on a cheap test is good enough.

But a doctor might order more tests. He’d do so for all kind of reasons: he’s not paying for them, ordering second tests are mandatory protocol, he suffers no angst waiting for the tests to come in, finding something wrong with people is his job, and not finding something wrong when it really is scares the Hell out of him. He suffers professionally, his insurance rates rise. Doctors are much more concerned with quantity of life over quality of living.

And so on. You have the idea.

Magnify all this at a national scale and, even though I’ve given the barest sketch, you can see why putting doctors in charge of political decisions leads to overly cautious, even painfully frightened, decisions. Doctors become too narrowly focused on the single malady in front of them, to the exclusion of all else.

Not for the first time I leave us with these wise words from Mark Twain:

There are people who strictly deprive themselves of each and every eatable, drinkable and smokable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get for it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.

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29 Thoughts

  1. Agree. Near sighted medical analysis is what keeps doctors offices full and testing services busy.

    I am 85 years old and have been diagnosed with atrial fibrillation, congestive heart failure, and aortic stenosis but am asymptomatic in all cases. If the doctor had not told me this at a yearly physical exam I would never have known. Accordingly, I only go for my yearly physical, refuse any more tests, and carry-on as if these conditions didn’t exist—which they don’t in a manner of speaking.

    I blame a lot of this on too much “free” government medical care, but medical care that is highly profitable to practitioners.

  2. “…this odd doctor, Ezekiel Emanuel…”

    I kept waiting for the punchline that was sure to follow after that set-up in the first sentence. But it never came.

    You do know who Ezekiel Emanuel is, right?

    His father, Benjamin Emanuel, was a cold-blooded terrorist. He specialized in bombing buses in Palestine for the Irgun, the original “Middle East terrorists.” And the King David hotel bombing.

    His brother, Rahm Emanuel, was a Clinton henchman and fund-raiser, a Congressman, Obama’s chief of staff, and mayor of Chicago. Rahm volunteered to serve in the military of a hostile foreign nation, but was never in the US military.

    Ezekiel came to prominence during his brother’s Obamacare fiasco. Ezekiel, whose schtick is “bioethics” (read: how to justify killing babies and old people), was a constant presence on the PC-Prog media, droning on about “bending the cost curve” (sound familiar?) and the other Emanuel marketing points for Obamacare.

    And now the nasty Ezekiel pops up as a media shill with another way to destroy Normal America–lock-down forever.

    Lots more, but there’s the punchline on Emanuel!

    Background on their terrorist father. Their real name is not Emanuel. That was the terrorist name the killer chose to be called:

    “Benjamin Emanuel, a Jew from Russia whose real name was Ezekiel Auerbach, was arrested by British police for terrorist activities in the months prior to Israeli independence.

    “Many of the British policemen killed by Emanuel and his Irgun colleagues between 1947 and 1948 had been transferred to Palestine upon Indian and Pakistani independence in 1947. Irgun saw the increase of British policemen from the Indian subcontinent as a major threat.

    “The Jewish terrorist murders of British troops and policemen resulted in massive anti-Jewish riots in London, Liverpool, Glasgow, Manchester, and Cardiff in 1947. In 1946, Emanuel’s Irgun bombed the King David Hotel in Jerusalem, killing 91 people, including 28 British soldiers and policemen.

    “British intelligence also believed that Benjamin Emanuel may have been related to Vladimir Jabotinsky, a Russian Jew from Odessa who founded Irgun.

    “Jabotinksy, who was an admirer of Benito Mussolini and who secretly negotiated for the expatriation of Jews to Palestine with the Nazi government in Germany and Admiral Miklos Horthy’s pro-Nazi regime in Hungary, died of a heart attack in New York in 1940.

    “Wikipedia deleted Benjamin Emanuel’s entry in 2008*, shortly after Rahm Emanuel was designated as President Obama’s chief of staff. Wikipedia is a favorite device for the perception management goals of Dr. Cass Sunstein, Obama’s director of the White House Office of Regulatory Affairs.”

    http://www.salem-news.com/articles/january262011/emanuel-palestine.php

  3. Is it easy to imagine Covid 19 being seasonal? SARS the first disappeared after two years, completely. So Covid 19—SARS CoV 1—is more likely to behave like seasonal flu than the SARS virus that it very closely resembles? How and why???

    “No one is immune to the COVID-19 virus. It threatens all of us.” Didn’t they use the same lie with HIV/AIDS which is now a badge of honor????

    Emanuel is a medical ethicist—read evil creature out to destroy humanity. We learned the meaning of that term in the 1940s.

    “that it’s better to die standing rather than crouching under the bed hoping to avoid only one disease out of all of them.” Personally, I prefer to aim for outliving all the naysayers. Stupid commercial for “enamel loss” in teeth just came on TV–NEWS FLASH. EATING DESTROYS YOUR TEETH. STOP EATING. Medicine/health is no longer science.

    “Doctors usually nail it when they say “That guy’s dead.”” Usually….

    ‘Because a test says you have a disease doesn’t mean you have it with certainty, and vice versa.” Two biopsies said my tongue was fine. Both lied.

    “Doctors are different the ordinary people.” My ENT says “We’re not like other people”. At least he’s honest!!

    With doctors, their job is to find illness. It’s what they do. Take fibromyalgia. Telling women they hurt and that’s the way it is hurt the teeny, tiny feel goods of women. So, BRILLIANT move–name the pains “fibromylagia”!!! Yep, women are stupid and fell for it hook, line and sinker. Doctors did their job–found illness where their patients demanded they do so. Success.

  4. Hospitals are going broke.
    They can’t take in elective procedures, except abortions.
    There’s money to be collected by a death being attributed to Covid.

  5. Kevin, I would guess that I am not the only one to notice that Japan is left off the first link.

  6. No one is immune? BS.

    For every infectious disease, some are naturally immune due to lack of the necessary entry mechanisms. Some are naturally immune due to cross reactivity induced by exposure to similar enough infections previously. The rest are not naturally immune. Of these, some will get an asymptomatic infection; and of these, some will spread it. These are the most frightening folk. Of the rest differing fractions will get mild symptoms (mostly non-specific and related to the dose received and the personal kind of immune reaction). Others will get a more serious illness. Then some will get a fatal illness. Since everyone’s body will die at some point, cost/benefit determinations must be made and done under uncertainty.

    A good doctor will do the least harm and do the most benefit by providing the information necessary for patients to make the best decision for them. Still, everyone is human and doctors are no more immune to making bad decisions than anyone else.

    Humans are subject to manias and panics. That is a part of human nature. That medicine is best when tailored to the patient runs into the hard law of governments/bureaucracies. Top-down big government systems simply cannot perform well for everyone. It doesn’t matter if these systems are overt or covert. The same issues apply; and most of the worlds systems are either overtly top-down or covertly top-down.

  7. Great Twain quote!

    Doctors order tests for reasons given above, AND, because they own the lab doing the tests (more profit to them), they’re young (and need more bills to skim some more profit to pay for med school loans), and so on.

    Follow the money.

    Logic of exploitive selfish self interest is a factor one needs to consider. Always…when humans are involved.

  8. JohnK: I didn’t remember the Briggs article, but thanks for pointing it out. I must note that all the testing in the world and decision making aids don’t substitute for your own intuition and paying attention to your own body. Yeah, that assumes you’re not hypochondriac, of course. My tests were negative, twice. But I still knew something was wrong. In retrospect, all the signs were there that my tongue was going cancerous, but the biopsies said no. It really didn’t matter in the end–I knew something was wrong and the lump (or was it bump?) was growing and it had to go. I was right–test or no test, if you’re looking at something that looks so very wrong, you probably need to go around the test or find a way to test further. You know more than you think–most people do anyway. That being said:

    cdquarles: “Humans are subject to manias and panics.” Humans pretty much ARE manias and panics. It served the evil and dictatorial well throughout history. Why, look what a total eclipse could do!!! We spent our history trying to overcome what we have yet to master.

  9. Fauci. Not ABS’ doctor.

    Doctors without borders? OK…

    Doctors without licenses? No

    Brix is operating without a license.

    ABS has known a few doctors and has interacted with not a few in several Emergency rooms, and ABS also has doctors who are in-laws and they all share a universal trait- arrogance.

    They can not believe it when ABS disagrees with them and does not obey what they say and when ABS points out to them they do not follow the Ten Commandments they say “Well, that is different…”

    Yes, yes it is different…

  10. Kent careful around that rabbit hole you might stumble and fall in.
    Worse yet someone could come up behind and give you a nudge.
    Interesting connections none the less puts me in mind of a passage in
    John.

  11. Fredo–reality can be very scary for some.

    Note how carefully their background is ignored.

    Imagine Osama bin Laden’s son as the Chief of Staff to a President. Or the mayor of Chicago. Or a death panel doctor advising the best ways to kill the most Americans.

  12. Kent… There are many amazing connections among the political, banking,
    academic, and media class exacerbated by migration from the purges of 37.

  13. I’m looking at a moron wearing a damn mask on the local news. At this point, I hope every business dies out and everyone lives in the hell they so want. I am sick of stupid irresponsible morons and will support NO businesses, nothing after this crap. No luxury spending, no buying anything not “essential” as defined by these jerks right now. Businesses deserves death. People deserve whatever hell they end up in. This is utter insanity and I no longer care at all. Stuff it, stupid, stupid Americans. Your forefathers hate your freaking guts and think you deplorable and you are. What a horrible bunch of bleating little crybaby sheep you all are.

  14. Sheri Amor,

    I went to 3 stores today, none of them grocery stores. I wore the lovely mask my wife made me out of an old Hawaiian shirt. Very spiffy.

    The first store had about 50 people in it. I was the only one wearing a mask. The second had over 100 people in it. Three of us had masks (mine was the nicest). The third store was small, had only about 10 people in it, and none of us had masks (I left mine in the truck — don’t tell my wife).

    My conclusions: average Americans really don’t give a cr*p about what the Goobers, Quacks, and other Pointy-Headed Officials tell us to do. We aren’t rude about it; we just ignore them.

    The rural economy around here is humming along nicely. The roads are busy, log trucks are rolling, everybody is buying cheap gas, the sun is finally out, not a cloud in the sky, gardens are going in, folks are doing their usual thing. I planted peas and onions today.

    The America you see on TV is not the real one. Hope that mitigates your judgement.

    PS – the death rate so far in my state from Stupid Virus is one per 100,000 residents. That might partially explain the lack of panic or even any evident concern.

  15. ”…wise words from Mark Twain:”

    Those were wise words from Sam Clemens. Here’s more:

    It is easier to fool people than it is to convince them that they have been fooled”

  16. Just to clarify, my state is under “lockdown”. The Goober decreed it two weeks ago. But nobody seems to care. The peasants are totally ignoring it. Utterly oblivious.

    btw, one of the items I purchased today was a box of mason bee tubes. I’ll bet that nobody who reads this blog has ever bought any or even knows what they are. I live in an alternate universe.

  17. @Uncle Mike
    ” I’ll bet that nobody who reads this blog has ever bought any or even knows what they are. I live in an alternate universe.”
    Don’t bet too much on that. As long as you use them only for apiary work, you’ll be just fine 😉

  18. Dear Uncle Mike
    I live down under in Aus so I had to look up “Mason Bee Tube”
    I didn’t feel silly at all as I doubt we have those bees here, however we do have some very interesting native bees
    Cheers
    HarryG

  19. Non-PC-Prog media connects-the-dots on the terrorist’s-son-doctor-of-death Ezekiel Emanuel. The death-obsessed scumbag suggests that 75 is the right age to die–otherwise you’ll be remembered as “less vibrant.” Interestingly, Emanuel is Joe Biden’s “health advisor.” Sorta ironic, isn’t it? Biden’s 77 this year. Whatcha waiting for Joe?

    “Ezekiel Emanuel, a?k?a Dr. Death, is a bit of a crank — but he’s also frighteningly influential.

    “The older brother of President Obama’s chief of staff Rahm, Emanuel helped craft the ObamaCare law and has long been an adviser on medical issues for Joe Biden. And the de facto Democratic nominee just tapped him for his new Public Health Advisory Committee. ”

    “Biden needs to cut ties with the rationing-obsessed doctor, lest he seems as callous. Most notably, Emanuel is no fan of “wasting” resources on the elderly. In his Atlantic piece “Why I Hope to Die at 75,” he allowed as how “death is a loss” but insisted “living too long is also a loss.” People won’t remember you as “vibrant” as you once were, for example.

    “Take note, Joe: You’re 77, after all.”

    https://nypost.com/2020/04/10/joe-biden-needs-to-cut-ties-with-dr-death/

  20. We already have identified, safe, direct attack, anti virus medications. But big pharma, the democrats, the deep state, and humans with no functioning cause and effect genes are blocking their disbursal. Iodine, proven anti viral since 1918.
    https://www.potableaqua.com/products/pa-drinking-water-germicidal-tablets/
    – and Chloroquine, proven anti viral since 1947. Iodine treated water is safe to drink 24/7 for a year (Afghanistan 2011-2012). It’s also safe to inhale (nasal mister) to treat lung infections. You can laught it up through your nose, cought it up (wrong pipe), sneeze it up (nose, tear ducts), and all it does is actively hunt and kill viruses, and germs.

  21. You forgot the anti malarial, anti dengue fever, anti parasite cocktail of chloroquine, iodine, and zinc. Used as a prophylaxis by combat, and jungle pilots the world over.

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